Document 6431547

Transcription

Document 6431547

Article ID: WMC002433
2046-1690
Prostatic Abscess: Case Report and Review of
Literature
Corresponding Author:
Dr. Anthony Kodzo - Grey Venyo,
Urologist, Urology Department. North Manchester General Hospital, North Manchester General Hospital,
Department of Urology, ManchesternM8 5RB, United Kingdom, M8 5RB - United Kingdom
Submitting Author:
Dr. Anthony Kodzo - Grey Venyo,
Urologist, Urology Department. North Manchester General Hospital, North Manchester General Hospital,
Department of Urology, ManchesternM8 5RB, United Kingdom, M8 5RB - United Kingdom
Article ID: WMC002433
Article Type: Case Report
Submitted on:06-Nov-2011, 10:13:03 PM GMT
Published on: 07-Nov-2011, 04:06:58 PM GMT
Article URL: http://www.webmedcentral.com/article_view/2433
Subject Categories:UROLOGY
Keywords:Prostatic; abscess; Trans-rectal-ultrasound; aspiration; E Coli; TURP; de-roofing; Meropenem;
Tamsulosin; recurrence.
How to cite the article:Venyo A . Prostatic Abscess: Case Report and Review of Literature . WebmedCentral
UROLOGY 2011;2(11):WMC002433
Source(s) of Funding:
None
Competing Interests:
None
Webmedcentral > Case Report
Page 1 of 10
WMC002433
Downloaded from http://www.webmedcentral.com on 30-Dec-2011, 05:00:01 PM
Prostatic Abscess: Case Report and Review of
Literature
Author(s): Venyo A
Abstract
Background: Prostatic abscess is rare and quite often
its diagnosis is delayed in view of the fact that it
mimics symptoms of a number of lower urinary tract
diseases hence a high index of suspicion is required in
its diagnosis.
Aims: To report a case of prostatic abscess
To review the literature on prostatic abscess
Case Report: A 45-years-old man was admitted as
emergency in view of his worsening lower urinary tract
symptoms. He had been taking antibiotics for 3
months with a presumed diagnosis of persistent /
recurrent urinary tract infection. He was diagnosed on
admission as having insipient retention of urine due to
prostatitis. He was catheterised and received
Gentamycin injection as well as oral antibiotics and
analgesia but despite this his symptoms worsened. He
had trans-rectal ultrasound scan of prostate which
confirmed prostatic abscess and 10 mls of pus
aspirated through the guidance of trans-rectal
ultrasound scan and entonox to control pain. His
prostatic abscess recurred and he underwent further
aspiration of his recurrent abscess under general
anaesthesia and trans-rectal ultrasound scan
guidance. He also subsequently underwent
trans-urethral resection of prostate to de-roof the
abscess cavity in order to avoid subsequent
recurrence of abscess and to allow any residual pus to
drain into the urethra to be voided out within the urine
or
as
urethral
discharge.
Repeat
trans-rectal-ultrasound scan revealed complete
resolution of the abscess. His urine and pus from the
abscess grew E coli and he was also treated by
means of appropriate antibiotics based upon the
sensitivity pattern. He also took tamsulosin medication
to improve the flow of his urine.
Conclusions: The experience gained in the
management of this patient and from reviewing the
literature would point to the following concluding
statements.
* Prostatic abscess usually presents with non specific
symptoms that mimic other lower urinary tract
diseases.
* If a patient despite being on antibiotics for some time
continues to be symptomatic then prostatic abscess
should be suspected.
* In some cases digital rectal examination may reveal
fluctuation in the prostate but quite often there is only
tenderness over the prostate in that case imaging by
means of (a) trans-rectal ultrasound scan, (b) CT scan
or (c) MRI scan would confirm the diagnosis
* Differential diagnoses of prostatic abscess include:
prostatic cysts; neoplasm
* Treatment of prostatic abscess should include: (a)
appropriate antibiotic treatment which should
ultimately be based upon the sensitivity pattern of the
causative organism and (b) drainage of the abscess
* Some of the approaches to drainage of prostatic
abscesses that have been used include (a)
trans-rectal ultrasound guided aspiration; (b)
digital-guided puncture / drainage by perineal route; (c)
Trans urethral resection of prostate (TURP) to lay
open the abscess cavity; (d) open perineal drainage.
* Recurrence of prostatic abscess could occur
pursuant to the initial treatment therefore follow-up
trans-rectal ultrasound scan or CT scan or MRI scan is
required to confirm complete resolution of the abscess.
Increasingly trans-rectal ultrasound is being used for
this purpose.
Introduction
Prostatic abscess is a rare infection which can be
treated by antibiotic administration and drainage [1].
The mortality rate of prostatic abscess is reported to
be between 3% and 16% [1], [2]. Because of its rarity
and because of the fact that the symptoms of prostatic
abscess are non specific quite often the diagnosis is
delayed. A case of prostatic abscess is reported in this
paper with a review of the literature.
Case Report
A 45-years-old man was admitted as emergency with
a history of dysuria, supra-pubic pain, urinary
frequency and poor flow of his urine associated with a
stinging sensation and pain in his back passage. For
about three months prior to his admission he had been
taking antibiotics prescribed by his general practitioner
for a presumed diagnosis of recurrent urinary tract
infection.
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WMC002433
He was seen in the urology outpatient’s clinic a week
prior to his admission with similar symptoms and his
prostate gland was found on digital rectal examination
to be tender and a diagnosis of prostatitis was made.
He was put on ciprofloxacin 500 mg orally twice a day
for four weeks in addition to Tamsulosin 400
micrograms orally daily to help improve the flow of his
urine. Despite taking his medications his symptoms
persisted.
About 3 months prior to his admission he was treated
for a presumed right sided pyelonephritis and he had
had ultrasound scan of renal tract which revealed no
abnormality apart from a simple cyst in his right kidney.
He had been treated in the past for chronic
pancreatitis.
His medications included: Oxycontin, pregabalin,
omeprazole, amitryptiline, creon, tamsulosin and
ciprofoxacin.
His general examination was unremarkable; there was
evidence of suprapubic tenderness on abdominal
examination but the rest of his abdomen was soft, non
tender and he had good bowel sounds. On rectal
examination he was noted to have a slightly enlarged
smooth benign feeling tender prostate.
A clinical diagnosis of worsening lower urinary tract
symptoms (prostatism) due to prostatitis was made.
He was catheterised and clear urine was drained. He
started on Trimethoprim intitially but upon the advice
of the microbiologist he was given a start dose of
Gentamycin 480 mg intravenously as well as
ciprofloxacin 500 mg orally twice a day and his further
daily Gentamycin injections were based upon his
serum Gentamycin levels. The trimethoprim was
stopped. In view of the fact that he had earlier on been
on ciprofloxacin without improvement the ciprofloxacin
was stopped and he was put on ofloxacin 200 mg
orally twice a day.
His initial investigations included:
Full blood count, serum urea and electrolytes, liver
function test, and serum amylase which were all
normal. There was no growth in his urine culture; and
his urine cell count determined by flow cytometry
revealed: white blood cells 4 / uL (normal range 0-40),
Red blood cells 219 u/L (normal range 0-35), epithelial
cells normal.
He continued to have supra-pubic pain after being on
antibiotics for 3 days therefore trans-rectal ultrasound
scan of prostate was done which revealed a large
prostatic abscess (see illustration 1). Trans rectal
ultrasound guided aspiration of the prostatic abscess
was done with the use of entonox to control pain /
discomfort. Aspiration of 10 mls of thick pus was done
at the end of which there was ultrasound scan
evidence of minimal pus left (see illustration 2),
however, the patient found the aspiration of pus a bit
uncomfortable and did not want to undergo further
aspiration of the tiny residual abscess (see illustrations
2). The pus was sent for culture and sensitivity which
yielded a heavy growth of mixed organisms therefore
sensitivity tests were not done.
On the first day pursuant to aspiration of the prostatic
abscess he was feeling better and was happy. He was
discharged home on oral ofloxacin for four weeks with
the promise that the antibiotics may be changed
depending upon the sensitivity results from the
microbiology department.
Nine days after his discharge from hospital he was
readmitted with recrudescence of his dysuria and
rectal pain. He also noticed some blood in his urine.
On examination his prostate again was noted to be
tender. He was given the options of (a) another
trans-rectal ultrasound scan of prostate and aspiration
of any re-accumulated prostatic abscess or (b)
cystoscopy and deroofing of prostatic abscess (both
procedures under general anaesthesia). During this
admission his urine culture grew Escherichia Coli
sensitive to Nitrofurantoin and Meropenem. He was
therefore put on Nitrofurantoin. He opted for
trans-rectal ultrasound guided aspiration of any
recurrent/residual abscess under general anaesthesia.
Trans-rectal ultrasound scan done under general
anaesthesia revealed re-accumulation of large amount
of pus in the transition zone area of the prostate and 8
mls of thick pus was aspirated and sent for culture and
sentitivity.
His symptoms improved and he was discharged home
on Nitrofurantoin. After his discharge from hospital,
the microbiologists reported that the aspirated pus
from the prostatic abscess had grown Escherichia Coli
which was sensitive only to Meropenem and resistant
to Nitrofurantoin, Gentamicin, Amoxycillin,
ciprofloxacin, co-amoxiclav, and trimethoprim. He was
therefore re-admitted immediately and given a week’s
course of intravenous Meropenem. He also underwent
cystoscopy which revealed no abnormality within the
urinary bladder; trans-urethral resection of the middle
lobe of the prostate (TURP) was done which de-roofed
the abscess cavity allowing the abscess cavity to be
seen and this contained minimal residual pus.
His recovery was unremarkable and he was
discharged home and advised to continue taking
tamsulosin.
He had another trans-rectal ultrasound scan two
weeks after his discharge from hospital which revealed
that the abscess had resolved with no evidence of
residual or recurrent abscess. At follow-up 2 months
later he reported that his lower urinary tract symptoms
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WMC002433
had improved and he was voiding reasonably well; his
pain had also subsided. He was advised to continue
taking tamsulosin until his next follow-up appointment
in a few weeks with the hope that when the
inflammation in the prostate is fully settled he would
then be able to stop taking tamsulosin.
Discussion
Prostatic abscess is an uncommon disease which has
been reported to have an incidence rate as low as
0.5% [3]. The most common symptoms of the disease
include: dysuria, frequency, perineal pain, fever, chills,
and low back pain [4],[5].
Prostatic abscess is reported to occur mostly in the 5th
and 6th decades of life and the most common
organism found in some earlier reports was
staphylococcus [1],[2],[6].
The availability of trans-rectal ultrasonography in the
developed world has made it possible for trans-rectal
ultrasound scan to become the most common method
of diagnosing prostatic abscess and it is a good guide
for aspiration, per-cutaneous drainage and
assessment of response to treatment [4],[7],[8],[9].
The diagnosis of prostatic abscess is difficult in view of
the fact that at the onset of symptoms, it may mimic
several other diseases of the lower urinary tract. It is
uncommon, is rarely diagnosed, a great shift in its
mortality lately has been experienced, and since the
discovery and use of penicillin changes in its aetiologic
agents have been experienced [10].
In the nineteen forties, mortality from prostatic abscess
ranged from 6% to 30%, Neisseria gonorrhoea was
the major microorganism. Subsequent data reported a
mortality rate ranging from 3% to 16% [2], and
enterobacter as the most common causative agent.
Among these, Escherichia Coli has been reported to
have the highest prevalence, in about 70% of cases
[6].
Prostatic abscess may progress to sepsis and death if
it is not adequately treated. Most of the previously
published data on prostatic abscess are case reports
which lack standardization of the diagnostic and
therapeutic routine. A variety of factors have
influenced the shift of epidemiological profile of
prostatic abscess, such as routine and widespread
use of broad-spectrum antibiotics to patients with
lower urinary tract symptoms, without the required
investigations [11]; better control of chronic diseases
which allow an increase in population longevity,
therapeutic advances such as hemodialysis, organ
transplants, chemotherapy, and immunosuppressive
drugs, promoting longer survival, but also exposure to
risks of immunosuppression [3],[9],[11],[12].
The finding of peritonitis [13] and spontaneous
perforation of the abscess to the urethra [11],[13] is
sporadic these days.
A number of postulates exist regarding the causation
of prostatic abscess and some these include:
1. The retrograde flow of contaminated urine within the
prostate during micturition is the most prevalent
pathogenic factor [14].
2. Prostatic abscess is a complication of bacterial
prostatitis, acute or chronic, but the actual incidence
and frequency is not known [15].
3. Bacterial haematogenous spread from distant foci
(was also described) such as from respiratory tract
(bronchitis, otitis), gastro-intestinal tract (appendicitis,
diverticulitis, peri-anal abscess), urinary tract, and skin
(furuncles, abrasions). In these cases germs like
Staphylococcus Aureus, Mycobacterium Tuberculosis,
Escherichia Coli, and Candida Sp may be found [16].
With regard to presentation, the disease manifests as
dysuria, urinary urgency and frequency in 96% of
cases [10], fever in 30% to 72% [2], [3], [10]and
urinary retention in a third of patients [2], [3]. There are
reports of prostatic abscess in children at necropsy
and 2 cases that did not present with any symptoms in
a series of 69 cases [2].
The most common typical sign of prostatic abscess is
fluctuant areas in the prostate by digital examination,
although the results vary between 16% [2] and 88%
[10]. The patient had tenderness over the prostate on
digital rectal examination without any evidence of
fluctuation over the prostate.
A number of techniques have been used to diagnose
prostatic abscess which include: CT scan, MRI scan,
and trans-rectal ultrasound scan. However, it has been
suggested that the diagnostic study of choice to assist
the treatment and follow-up of patients with prostatic
abscess is trans-rectal ultrasonography of the prostate.
The most common finding of prostatic abscess on
trans-rectal ultrasound scan of prostate is presence of
one or more hypo-echoic areas, of several sizes,
containing thick liquid, primarily in the transition zone
and in the central zone of the prostate, permeated by
hyper-echogenic areas and distortion of the anatomy
of the gland [3].
The differential diagnosis of prostatic abscess based
upon trans-rectal ultrasound scan include: prostatic
cysts and neoplasia [15],[17].
It has been stated that computed tomography adds
few benefits to trans-rectal ultrasonography for the
diagnosis of prostatic abscess, especially when there
are extraprostatic collections [18],[19].
The treatment of prostatic abscess includes: antibiotic
administration and drainage of the abscess. This may
Page 4 of 10
WMC002433
be carried out by trans-rectal puncture [20] or
trans-perineal ultrasound guided, digital-guided
puncture / drainage by perineal route, trans-urethral
incision of the prostate, trans-urethral resection of
prostate (TURP) or open perineal drainage [5],[21],
[22],[23],[24].
All the aforementioned modalities of prostatic abscess
drainage have safety and efficiency reports
[5],[6],[9],[10],[14],[21],[22],[23]. However, there is a
preference for minimally invasive procedures that may
be performed under local anaesthesia or sedation and
repeated if necessary [16]. In order to identify the
causative agent of the prostatic abscess, it has been
stated that it is important to send material for culture
and sensitivity (pus, urine, blood and / or prostatic
fragment) taking into consideration that they usually
present uncommon pathogens/germs [24],[25].
It has been observed that there is a lack of uniformity
in antibiotic prescription in the management of
prostatic abscess due to the rarity of the disease [16].
It has also been suggested that the diagnosis of
prostatic abscess should be considered in patients
presenting with fever, persistent irritative voiding
symptoms despite antimicrobial use, for diabetics with
protracted symptoms, for those with lower urinary tract
symptoms and fever progressing to urinary retention,
and after the performance of prostate biopsy [16].
Trans abdominal ultrasonography of the prostate may
show a hypoechoic mass with debris in a prostate in a
case of prostatic abscess and a CT scan may reveal a
homogenous mass with a low density in the prostate
[26].
It has been stated that prostatic abscess is uncommon
with an incidence of 0.5% [3]. Some authors have
stated that prostatic abscess occurs in the 5th and 6th
decades of life and the most common organism they
observed was staphylococcus aureus [1], [2],[6].
A number of authors are of the opinion that
trans-rectal ultrasonography is the most common
diagnostic method for prostatic abscess and is a good
guide for the aspiration, percutaneous drainage, and
assessment of the response to treatment [1],[7], [8],[9].
Granados and associates [2] reported a study on 9
patients with prostatic abscess who had undergone
perineal drainage and catheter insertion to remove the
discharge without irrigation, two out of the 9 patients
developed recurrence of the abscess in 1 month
follow-up and underwent antibiotic therapy and
drainage again.
Collado and associates [7] reported a study of 6
patients with prostatic abscess who underwent
perineal aspiration using trans-rectal ultrasound
(TRUSS); one out of the six patients developed
recurrence of the abscess, and underwent
trans-urethral resection of prostate.
Basiri and associates [26] reported a patient with
prostatic abscess who underwent drainage of the
abscess trans-perineally under local anaesthesia with
the guide of trans-rectal ultrasound scan (TRUS) using
a stent for 5 days and washing with normal saline and
antibiotics. They also reported that in a 3-year
follow-up with CT scan and TRUS, no recurrence was
observed. They recommended that this method for the
treatment should be proposed as a less invasive and
less morbid method for the treatment of prostatic
abscess however, further studies are required in this
regard.
Conclusions
Prostatic abscess usually presents with non specific
symptoms that mimic other lower urinary tract
diseases.
If a patient despite being on antibiotics for some time
continues to be symptomatic then prostatic abscess
should be suspected.
In some cases digital rectal examination may reveal
fluctuation in the prostate but quite often there is only
tenderness over the prostate in that case imaging by
means of (a) trans-rectal ultrasound scan, (b) CT scan
or (c) MRI scan would confirm the diagnosis
Differential diagnoses of prostatic abscess include:
prostatic cysts; neoplasm
Treatment of prostatic abscess should include: (a)
appropriate antibiotic treatment which should
ultimately be based upon the sensitivity pattern of the
causative organism and (b) drainage of the abscess
Some of the approaches to drainage of prostatic
abscesses that have been used include (a)
trans-rectal ultrasound guided aspiration; (b)
digital-guided puncture / drainage by perineal route; (c)
Trans urethral resection of prostate (TURP) to lay
open the abscess cavity; (d) open perineal drainage.
Recurrence of prostatic abscess could occur pursuant
to the initial treatment therefore follow-up trans-rectal
ultrasound scan or CT scan or MRI scan is required to
confirm complete resolution of the abscess.
Increasingly trans-rectal ultrasound scan is being used
for this purpose.
References
1. Ludwig M, Schroeder-Printzen I, Schiefer H G,
Weidner W. Diagnosis and therapeutic management
of 18 patients with prostatic abscess. Urology 1999;
53:340-345.
Page 5 of 10
WMC002433
2. Granados E A, Caffaretti J, Farina L, Hocsman H.
Prostatic abscess drainage: Clinical-sonography
correlation. Urol Int.1992; 48:358-361.
3. Granados E A, Riley G, Salvados J, Vicente J.
Prostatic abscess: diagnosis and treatment. J. Urol.
1992; 148:80-82.
4. Savarirayan S, Shenylan Y, Gerard P, Wise G J.
Staphylococcus periprostatic abscess: an unusual
cause of acute urinary retention. Urology1995; 4:
573-574.
5. Bachor R, Gollfried H W, Haulmann R. Minimal
invasive therapy of prostatic abscess by transrectal
ultrasound guided perineal drainage. Eur Urol.1995;
28: 320 – 324.
6. Meares E M, Jr. Prostatic abscess. J. Urol. 1986
Dec; 136 (6): 1281 – 1282.
7. Collado A, Palou J, Garcia-Penit J, de la Torre P,
Vicente J. Ultrasound-guided needle aspiration in
prostatic abscess. Urology1999; 53: 548 – 552.
8. Lim J W, Ko Y T, Lee D H, et al. Treatment of
prostatic abscess: Value of transrectal
ultrasonographically guided needle aspiration. J.
Ultrasound Med. 2000; 19: 609 – 617.
9. Barozzi L, Pavlica P, Monchi I, De Metteis M,
Canepari M. Prostatic abscess: diagnosis and
treatment. A J R Am J Roentgenol 1998; 170: 753 –
757.
10. Weinberger M, Cytron S, Servadio C, Block C,
Rosenfeld J B, Putik S D. Prostatic abscess in the
antibiotic era. Rev Infect Dis. 1988; 10: 239-249.
11. Gill S K, Gilson R J C, Richards D. Multiple
prostatic abscesses presenting with urethral discharge.
Genitourol. Med.1991; 67: 411 – 412.
12. Cytron S, Weinberger M, Pitlik S, Servadio C.
Value of transrectal ultrasonography for diagnosis and
treatment of prostatic abscess. Urology1988;
32:454-458.
13. Mitchell R J, Blake R J S. Spontaneous perforation
of prostatic abscess with peritonitis. J. Urol. 1972;
107:622-623.
14. Trauzzi S J, Kay C J, Kaufman D G, Lowe F C.
Management of prostatic abscess in patients with
human immunodeficience syndrome. Urology1994; 93:
629-633.
15. Jameson R M. Prostatic abscess and carcinoma of
the prostate. Br J Urol1968; 40: 288-292.
16. Oliveira P, Andrade J A, Porto H C, Pereira Filho J
E, Vinhaes A F J. Diagnosis and Treatment of
Prostatic abscess. Clinical Urology International Braz J
Urol. Jan-Feb 2003; 29(1): 30-34.
17. Rifkin M J: Ultrasonography of the lower
genitourinary tract. Urol. Clin. North Am.1985;
12:645-656.
18. Vaccaro J A, Bellville W D, Kiesling Jr V J, Davis R.
Computerized tomographyscanning as an aid to
diagnosis and treatment. J Urol1986; 136:1318-1319.
19. Thornill B A, Morehouse H T, Coleman P, Tretin J
C H: Prostatic abscess: CT and sonographic findings.
A J R. 1987; 148: 899-900.
20. Chaabouni M N, Pfeifer P, Ferrandis P, Chokairi P,
D’Andalhon T, Dumas J P. et al. Place de pontion
transrectale écho-guidée dans le traitement des abcès
prostatiques. Ann Urol.1994; 28: 24 - 27.
21. Lopez V M, Castro V F, Pallas M P, Garcia J A,
Gonzalez P C. Drenaje transperineal de un absceso
prostático. Arch Esp de Urol. 1994; 47: 290 – 291.
22. Kinahan T J, Goldenberg S L, Ajzen A S,
Cooperberg P L, English R A. Transurethral resection
of prostatic abscess under sonographic guidance.
Urology1991; 37: 475 - 477.
23. Llanes J V, Carbonell C L, Toro A O A, Mas A G.
Abscesus prostáticos: tratamiento percutáneo. Arch
Esp de Urol 1991; 44: 67 – 72.
24. Sanjuan F G, Cidre M J, Rodriguez R R, Elios M J
P, Santos V G, Escudero J A R. Abscesso prostatico
tuberculoso en syndrome de immunodeficiencia
adquirida. Arch Esp de Urol. 1997; 50: 393 – 395.
25. Learmonth D J, Philp N H. Salmonella prostatic
abscess. Br J Urol. 1988; 61: 163
26. Basiri A, Javaherforooshzadeh A. Percutaneous
Drainage for Treatment of Prostatic Abscess: Case
Report. Urol J.2010; 7: 276 – 280.
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Illustrations
Illustration 1
Trans-rectal ultra-sound-scan showing prostatic abscess just before its aspiration
Illustration 2
Trans-rectal ultra-sound-scan showing minimal residual prostatic abscess at the point patient
could not tolerate further aspiration (at the end of the aspiration)
Page 7 of 10
WMC002433
Reviews
Review 1
Review Title: post
on prostatic abscess
Posted by Dr. Daniele Porru on 30 Dec 2011 04:15:43 PM GMT
1
Is the subject of the article within the scope of the subject category?
Yes
2
Are the interpretations / conclusions sound and justified by the data?
Yes
3
Is this a new and original contribution?
Yes
4
Does this paper exemplify an awareness of other research on the topic?
Yes
5
Are structure and length satisfactory?
Yes
6
Can you suggest brief additions or amendments or an introductory statement that will increase
the value of this paper for an international audience?
No
7
Can you suggest any reductions in the paper, or deletions of parts?
No
8
Is the quality of the diction satisfactory?
Yes
9
Are the illustrations and tables necessary and acceptable?
Yes
10
Are the references adequate and are they all necessary?
Yes
11
Are the keywords and abstract or summary informative?
Yes
Rating: 6
Comment:
This paper describes an uncommon, although not really rare, condition; the discussion of the literature on similar
cases is well conducted and described in detail.
A prostatic abscess is a potential indication for surgery. Medical management of prostatic abscess is often
unsuccessful. Thus, surgical drainage via either transrectal or perineal aspiration, transurethral resection, or
transrectal ultrasound–guided placement of a transrectal drainage tube may be considered, as reported by
authors.
Transrectal or perineal aspiration of the abscess is preferred and is often effective, especially if the patient's
symptoms do not improve after 1 week of medical therapy. TURP and drainage of the cavity is another approach;
this approach is less desirable because of the potential hematogenic spread of bacteria, particularly if an
appropriate and specific antibiotic treatment is not initiated in advance.
The abscess should be allowed to drain, or some type of drainage should be performed if the abscess is larger
than 1 cm. It is advisable to monitor the abscess closely if a spontaneous rupture occurs into the urethra.
Competing interests: no competing interests
Invited by the author to make a review on this article? : No
Experience and credentials in the specific area of science:
some recent clinical experience
Publications in the same or a related area of science: No
How to cite: Porru D.post on prostatic abscess[Review of the article 'Prostatic Abscess: Case Report and
Review of Literature ' by ].WebmedCentral 1970;2(12):WMCRW001315
Page 8 of 10
WMC002433
Review 2
Review Title: Review
of prostatic abscess paper
Posted by Prof. Akanimo Essiet on 09 Nov 2011 05:45:55 AM GMT
1
Is the subject of the article within the scope of the subject category?
Yes
2
Are the interpretations / conclusions sound and justified by the data?
Yes
3
Is this a new and original contribution?
No
4
Does this paper exemplify an awareness of other research on the topic?
Yes
5
Are structure and length satisfactory?
No
6
Can you suggest brief additions or amendments or an introductory statement that will increase
the value of this paper for an international audience?
No
7
Can you suggest any reductions in the paper, or deletions of parts?
Yes
8
Is the quality of the diction satisfactory?
Yes
9
Are the illustrations and tables necessary and acceptable?
Yes
10
Are the references adequate and are they all necessary?
Yes
11
Are the keywords and abstract or summary informative?
Yes
Rating: 5
Comment: 5. The abstract is rather lengthy. Should be abridged. 7. The 'Case report' section of the abstract
should be shortened.
Competing interests: None
Invited by the author to make a review on this article? : No
Experience and credentials in the specific area of science: A practicing urologist in a tropical, resource
limited environment.
Publications in the same or a related area of science: No
How to cite: Essiet A.Review of prostatic abscess paper[Review of the article 'Prostatic Abscess: Case Report
and Review of Literature ' by ].WebmedCentral 1970;2(11):WMCRW001113
Page 9 of 10
WMC002433
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Document 6431547

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Case Reports

D IMEN SIONS

Our Experience in the Management of Prostatic Abscess Original Article K M

Prostatic malacoplakia: report of two cases and review of the... Alan C, Irkilata C, Ors O, Zor M, Peker AF

A case of cerebral abscess due to Cladophialophora

Klebsiella pneumoniae Emphysematous Prostatic Abscess Due to

How to Manage Intra-Abdominal Abscesses in Crohn`s Disease

Document 6429915

Abscess Formation of the Round Ligament of the Liver: Report of a