Patient B. C. Seun Akinola MD PGY-4

Patient B. C.
Seun Akinola MD
PGY-4
HPI:
52 y.o. diabetic M who p/w urinary retention.
◦
◦
◦
◦
3 week hx of persistent hesitancy, slow stream, straining and intermittency.
No baseline LUTS .
Preceded by myalgia, chills/subjective fever.
Initially seen in the VA ER 10/8/12 with same symptoms and a tender prostate
without fluctuance and was discharged on Ciprofloxacin 500mg BID x 2 weeks
and Flomax with presumed diagnosis of prostatitis.
◦ UA + and Ucx-MSSA.
◦ Switched to Bactrim by PCP 5 days prior to presentation.
◦ No Fevers since starting Abx.
ROS: + perineal pain. No dysuria, hematuria.
PMHx:
Diabetes, HTN,
Hyperlipidemia, MRSA
colonization
PSHx:
None
ALLERGIES:
NKDA
Meds:
Aspirirn,
Simvastatin,
Insulin
Soc Hx:
Smoking- Denies
Alcohol- Occasional
Drugs- Denies
P/E:
Afeb. VSS
NAD.
S1S2. CTAB/L
Abd soft ND. 16F foley.
Urine clear.
Penis uncircumcised
DRE deffered.
LABS:
WC- 12.9 (mild left shift)
HCT- 31
Cr- 1.3
CT PELVIS OBTAINED
CT RMP:
CT RMP:
CT RMP:
CT RMP:
CT RMP:
TO OR 10/23/12 for unroofing and SP tube
TO OR 10/23/12 for unroofing and SP tube






Hospital Course
Broad spectrum Abx coverage- Vanco + Gentamicin
Spiked fevers intermittently post op (Tm 102.9)
Intraop urine and Bcx post op grew MSSA
Oxacillin + Levaquin 750mg
Echo to rule out valve vegetation: Negative
PLAN: Discharged with PICC line and IV antibiotics X 2 weeks



Literature review:
Incidence lower in antibiotic era
DM and Immuno-compromised patients
Non specific presentation
◦
◦
◦
◦

Irritative symptoms most common (96%)
Fever in 30-70%
Retention -30%
Perineal pain-20%
P/E◦ Most common finding on DRE: flucuance but only seen 16-18%

Imaging
◦ TRUS or CT pelvis with contrast

Treatment
◦ Transurethral unroofing vs. transrectal/transperineal drainage
◦ No recommendations re: length of antibiotic treatment
Arch Esp Urol. 2011 Jan-Feb;64(1):62-6. Prostatic abscess:
diagnosis and treatment of an infrequent urological entity
`