How does an abscess form?
Most often, the infection enters the prostate gland from the urethra or when infected urine is thrown into its ducts. Less commonly, bacteria come through the bloodstream from another source. In acute prostatitis, the gland tissue swells and becomes inflamed; if treatment is started late, the dose of antibiotic is insufficient or the immune system is weakened, individual lesions merge and melt. A cavity with pus is formed, surrounded by a dense capsule, into which antibiotics do not penetrate well, so this process cannot be treated with tablets alone.
- Ascending infection from the urethra
- Reflux of urine into the prostate ducts
- Catheterization and instrumental interventions
- Spread of infection through the bloodstream
- Incomplete treatment of acute prostatitis
Who's at risk
Not every man with prostatitis develops an abscess. The risk increases with conditions that weaken the body's defenses or obstruct the flow of urine. This is especially true for patients with diabetes mellitus, in whom purulent complications are more severe and erased. A significant role is played by prolonged use of a urinary catheter and chronic urinary retention in prostate adenoma.
- Diabetes mellitus
- Long-term bladder catheterization
- Benign prostatic hyperplasia with urinary retention
- Immunodeficiency conditions
- Chronic alcoholism
- Recent surgeries and prostate biopsy
Symptoms
The disease begins rapidly: the temperature rises to high levels, accompanied by chills, severe weakness and sweating. Intense pain appears in the perineum, which radiates to the rectum, sacrum, inner thigh, and intensifies when sitting and defecating. Urination becomes frequent, painful and difficult, up to acute urinary retention. Sometimes, if an abscess breaks into the urethra, the temperature drops sharply and pus is released in the urine - the relief is deceiving; examination is still necessary.
- High temperature with chills
- Severe pain in the perineum and rectum
- Frequent painful urination
- Weakening of the stream or complete urinary retention
- Pain during bowel movements
- General intoxication: weakness, nausea, sweating
Diagnostics
The doctor evaluates the complaints and conducts a careful digital rectal examination: the gland is sharply painful, enlarged, and an area of softening can be identified. Rough massage of the prostate if an abscess is suspected is contraindicated; it can contribute to the spread of infection. The main imaging method is transrectal ultrasound, which shows a cavity with liquid contents. If the picture is unclear or the spread of the process is suspected, a computer or magnetic resonance imaging scan of the pelvis is performed. Blood and urine tests and urine culture to determine sensitivity to antibiotics are required.
- Examination by a urologist and digital rectal examination
- TRUS of the prostate gland
- Complete blood count with leukocyte formula
- General urine test
- Culture of urine and, if possible, abscess contents
- CT or MRI of the pelvis according to indications
- Blood glucose monitoring
Treatment
Treatment is carried out only in a hospital. Broad-spectrum antibiotics are administered intravenously and then adjusted based on culture results. The formed abscess must be drained: the contents are evacuated by puncture under ultrasound control, or an opening and drainage is performed through the perineum or urethra. If urinary retention occurs, a catheter is installed or a suprapubic fistula is created. After discharge, the course of antibiotics is continued, and after a few weeks the ultrasound is repeated. Warming up, hot baths and prostate massage for an abscess are strictly prohibited.
- Hospitalization to the urology department
- Intravenous antibiotic therapy
- Ultrasound-guided puncture drainage
- Opening and drainage of large cavities
- Diversion of urine during retention
- Compensation for diabetes mellitus
- Control ultrasound after treatment
