Relatively long symptom duration and voiding disturbances in men suspected of having acute prostatitis predicts an increased likelihood that a prostatic abscess is present and should prompt clinicians to consider performing imaging studies, according to researchers.

“Early diagnosis is beneficial because prostatic abscesses require prolonged treatment protocols, or even require surgical drainage,” Dong Sup Lee, MD, of The Catholic University of Korea in Suwon, South Korea, and colleagues wrote in BMC Urology (2016;16:38).

The investigators retrospectively reviewed 31 prostate abscesses that developed in 142 patients with acute prostatitis. All patients underwent computed tomography (CT) or transrectal ultrasonography (TRUS) to discriminate acute prostatic abscesses from acute prostatitis without abscess formation.

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Multivariate analysis showed that symptom duration and voiding disturbances were associated with significantly increased odds of abscess formation. Diabetes mellitus was associated with increased odds of abscess formation on univariate but not multivariate analysis.

The antibiotic treatment period in general was longer in cases of prostatic abscess than in those without abscess, regardless of surgical intervention, according to the investigators.

Patients with abscesses smaller than 20 mm did not undergo surgery and were cured without any complications. Patients with abscesses larger than 20 mm who underwent transurethral resection had a shorter duration of antibiotic therapy compared with men who did not have surgery. The incidence of septic shock did not differ significantly between the abscess and no abscess groups.

The vast majority of the acute prostatitis cases were caused by gram negative bacteria, the researchers stated. A wide range of microorganisms may be detected in prostatitis with abscess formation. “Therefore, physicians should perform urine culture prior to administering empirical antibiotics,” they wrote. These cultures should be repeated, if possible, during treatment. With appropriate treatment, the prognosis of acute prostatitis with and without abscess would not differ.”

The investigators noted that prostatic abscesses often are found in patients who do not improve with initial therapy. “Therefore, without [a] routine imaging study, a prostate abscess present initially may be missed rather than developing from acute prostatitis during the follow-up period.”

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In their 111 cases of confirmed acute prostatitis without abscess, abscess formation was not identified during the treatment period, the authors noted. “Routine imaging studies such as CT or TRUS should be considered in cases of acute prostatitis for this reason, especially in patients with long-term symptom duration and voiding disturbances,” they wrote. “Such imaging will allow physicians to anticipate a treatment method for an abscess, since these abscesses may require drainage.”

Dr Lee and colleagues acknowledged the study’s retrospective design was a limitation.