Prostatic Abscess: Literature Review

Introduction and objectives: Prostatic abscess is defined as the presence of one or more collections of purulent accumulations in the prostate. Its diagnosis and management have been controversial, given the absence of clinical practice guidelines that allow a standardized approach. Objective: The purpose of this article is to suggest a diagnostic and therapeutic algorithm based on the review of non-systematic literature on physiopathology, etiology, risk factors, diagnosis and treatment of prostate abscesses. Materials and methods: We reviewed Medline with MeSH terms: "prostate", "abscess", and free terms: "prostatic abscess", obtaining 71 review articles. From these, we selected the 19 articles written in English that best correlated with the search topic. We did a critical review of these, to finally suggest a diagnostic and therapeutic algorithm. Results: Of the 19 selected articles, we found only 1 randomised clinical trial, 7 observational retrospective cohort studies, 3 non-systematic review articles, 6 case reports, 2 case series and no clinical practice guidelines. Conclusions: Standardized clinical practice guidelines for the management of prostate abscesses do not yet exist. The diagnostic method of choice is transrectal ultrasonography (USTR) of the prostate. Treatment depends on the size and location of the abscess. For abscesses < 1 cm or < 0.5 cm(3) cc, conservative treatment is suggested. For abscesses larger than this, USTR-guided aspiration is suggested if located in the peripheral zone, and transurethral resection (TUR) of the abscess if located in the central, transitional, or anterior zone.