Treatment of Prostatic Abscess: Value of Transrectal Ultrasonographically Guided Needle Aspiration

Treatment of Prostatic Abscess:
Value of Transrectal Ultrasonographically Guided
Needle Aspiration
Joo Won Lim, MD, Young Tae Ko, MD, Dong Ho Lee, MD, Seong Jin Park, MD,
Joo Hyeong Oh, MD, Yup Yoon, MD, Sung-Goo Chang, MD
The purpose of this study was to assess the effectiveness of transrectal ultrasonographically guided
needle aspiration in the treatment of prostatic
abscess. Fourteen patients with prostatic abscess
were evaluated with this technique and treated
with sonographically guided needle aspiration.
Using this technique, all cases (100%) had one or
more hypoechoic areas within the prostate that contained inhomogeneous materials; in 10 patients
(71.0%), the lesion showed internal septa or solid
portion. The margins of the hypoechoic area were
well defined and thick in 11 patients (79.0%) and
poorly defined in 3 patients (21.0%). The estimated
volume of the prostatic abscess ranged between 2
and 28 ml (mean, 12.0 ml). The presence of a pus
collection within the prostate was confirmed by
transrectal ultrasonographically guided aspiration
in all patients. However, successful treatment of
prostatic abscess with transrectal needle aspiration
was done in 12 (86.0%) of 14 patients; the treatment
failed in 2 (14.0%) of 14 patients. One patient was
treated with perineal incision and drainage and the
other with transurethral resection. The amount of
pus drained ranged between 1 and 39 ml (mean,
12.0 ml). On follow-up transrectal ultrasonographic
examination, no remaining abscess pocket was
found within the prostate in any of the cases. One
year later, the prostatic abscess recurred in one case.
In conclusion, transrectal ultrasonographic guidance is useful in the diagnosis of prostatic abscess as
well as in the guidance for aspiration and the
drainage of such abscesses. Transrectal ultrasonographically guided needle aspiration could be an
effective method for treating prostatic abscess. KEY
WORDS: Prostate, abscess; Abscess, prostatic;
Abscess, percutaneous drainage.
P
ABBREVIATIONS
TRUS, Transrectal ultrasonography; PA, Prostatic abscess; CT,
Computed tomography; MR, Magnetic resonance; ICT,
Intracavitary transducer
Received January 3, 2000, from the Departments of Diagnostic
Radiology (J.W.L., Y.T.K., D.H.L., S.J.P., J.H.O., Y.Y.) and Urology (S.G.C.), Kyung Hee Medical Center, Kyung Hee University, School of
Medicine, Seoul, Korea. Revised manuscript accepted for publication
May 28, 2000.
Address correspondence and reprint requests to Joo Won Lim, MD,
Department of Diagnostic Radiology, Kyung Hee Medical Center,
1 Hoe Ki Dong, Dong Dae Mun Ku, Seoul, 130-702, Korea.
rostatic abscess occurs infrequently. Its signs
and symptoms are not only highly variable
but also similar to those of acute bacterial
prostatitis without abscess. Because the diagnosis of
PA is often difficult to confirm by history and physical examination, prostatic imaging (TRUS, CT, and
MR imaging) can be important in the diagnosis and
management.1–11 Among these, TRUS is the most
widely used technique in the diagnosis and management of PA.
Perineal incision and drainage, transurethral
unroofing and resection into the abscess cavity, and
percutaneous transperineal drainage have been used
to treat PA.1–7 Although surgical drainage is the most
important step in the treatment of PA, the best
method of drainage remains somewhat controversial.4,5 Many investigators have used percutaneous
 2000 by the American Institute of Ultrasound in Medicine • J Ultrasound Med 19:609–617, 2000 • 0278-4297/00/$3.50
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TREATMENT OF PROSTATIC ABSCESS
drainage as a treating method of intraabdominal
abscess. The safety and efficacy of these methods are
well established.3,5,6,12–16 However, few studies in the
literature have indicated that needle aspiration and
adjuvant antibiotic therapy could produce a
cure.2,17,18 We report 14 cases of prostatic abscesses
that were diagnosed by TRUS and treated successfully (12 of the 14 cases) with TRUS-guided needle
aspiration and adjuvant antibiotic therapy.
MATERIALS AND METHODS
Over the course of 5 years, 14 patients with PA were
evaluated by TRUS and treated with TRUS-guided
needle aspiration. The clinical findings, including
symptoms, history, and laboratory findings, for each
patient were reviewed using the patients’ medical
records. The patients ranged in age from 43 to 75
years (mean, 65.0 years). Clinical presentation for
each patient is summarized in Table 1. Diagnostic
modalities and results of treatment with needle aspiration in patients with PA are summarized in Table 2.
Predisposing factors for PA were diabetes in five
patients, instrumentation in two patients, indwelling
urethral catheter in one patient, and immunosuppressive therapy after renal transplantation in
one patient. Digital rectal examination was performed in eight patients.
TRUS was performed with an Ultramark 9-HDI or
HDI 3000 system (Advanced Technology Laboratories, Bothell, WA) using a 9-5 MHz ICT probe and
an SSA 250A (Toshiba, Tokyo, Japan) using a 5 MHz
convex and linear transrectal probe. All patients had
a cleansing enema prior to the procedure to eliminate
as much fecal material as possible. We detected
abnormal foci within the prostate by TRUS in all
patients. The volume of pus collection was estimated
by the formula: v = 0.5 × D1 × D2 × D3 (D1, the transverse; D2, the anteroposterior; D3, the cephalocaudal
dimension of PA) or by use of software provided by
the manufacturer with the prolate ellipse formula.
Nine patients were examined with color and power
Doppler sonography using 9-5 MHz ICT probes
(HDI 3000). CT was performed in one patient, and
one other patient was evaluated with MR imaging.
TRUS-guided aspiration was performed with an
18 gauge (20 cm long) Chiba needle (Cook,
Bloomington, IN) in five patients and an 18 gauge
(20 cm long) Tru-Cut needle (Medical Device
Technology, Gainesville, FL) in nine patients.
Patients were placed in the left lateral decubitus
position with a knee-chest position. A 9-5 MHz ICT
probe (Advanced Technology Laboratories) or a 5 MHz
J Ultrasound Med 19:609–617, 2000
convex and linear transrectal probe (Toshiba) was
covered with a condom, and a biopsy guide attachment was used for needle aspiration. The needle was
inserted under TRUS guidance through the rectal
wall into the abscess cavity (Fig. 1A, B). Before TRUSguided needle aspiration, we started tentative antibiotic treatment with quinolone. After the needle
aspiration, parenteral antibiotic therapy was initiated
in all patients. Reaccumulation of pus was monitored
by TRUS. Criteria for successful treatment were clinical improvement and decrease of more than one half
of the estimated volume of pus collection on followup TRUS examination (Fig. 1C). Criteria for failure
included continued clinical symptoms with or without persistent or recurring fluid collection.
RESULTS
Clinical presentations most often included dysuria
and urinary frequency (10 patients, 71%). Six
patients (43%) had acute urinary retention. Four
patients (29%) had fever. Other clinical presentations
included hematuria in three patients (21%), low back
pain in two patients (14%), and perineal pain in two
patients (14%) (Table 1).
We tested for leukocytes in midstream urine in all
patients; eight had more than 10 leukocytes per high
power field, three had from 5 to 9, and three had
fewer than 4. Urine culture obtained in these patients
yielded a negative result in eight (57%) and a positive result in six (43%). Pseudomonas aeruginosa was
isolated in three patients, Escherichia coli in two, and
Staphylococcus aureus in one (Table 2). Elevated white
blood cell counts were present in seven patients.
Digital rectal examination was performed in eight
patients, and five cases revealed tenderness. Because
the classic finding on rectal examination of a tender,
fluctuant mass was absent in all cases, no case of PA
was diagnosed by digital rectal examination.
Table 1: Clinical Presentations in Patients with
Prostatic Abscesses (n = 14)
Signs or Symptoms
Dysuria
Urinary frequency
Acute urinary retention
Fever
Hematuria
Pain in low back
Perineal pain
Number of Patients
Percentage (%)
10
10
6
4
3
2
2
71.0
71.0
43.0
29.0
21.0
14.0
14.0
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LIM ET AL
611
Table 2: Diagnostic Modalities and Results of Treatment with Needle Aspiration in Patients with Prostatic
Abscesses (n = 14)
DRE
Method of
Diagnosis
Other
Diagnostic
Modalities
1
Not performed
TRUS
CT
23
39
Success after
third procedure
Not
identified
E. coli
2
Prostate smooth
and nontender
TRUS
None
28
20
Success after
first procedure
Not
identified
Pseudomonas
aeruginosa
3
Prostate smooth
and nontender
TRUS
None
20
18
Success after
first procedure
Not
identified
Staphylococcus
aureus
4
Prostate mildly
tender
TRUS
MRI
5
3
Success after
first procedure
Not
identified
Not
identified
5
Prostate mildly
tender
TRUS
None
5.5
3
Success after
first procedure
Pseudomonas
aeruginosa
Not
identified
6
Not performed
TRUS
CDI
2
1
Success after
first procedure
Pseudomonas
aeruginosa
Pseudomonas
aeruginosa
7
Not performed
TRUS
CDI
5
3.5
Failure*
E. coli
E. coli
8
Prostate tender
TRUS
CDI
10
3.5
Failure†
Not
identified
Staphylococcus
aureus
9
Not performed
TRUS
CDI
2
1
Success after
first procedure
Pseudomonas
aeruginosa
Not
identified
10
Prostate tender
TRUS
CDI
19
16
Success after
first procedure
Staphylococcus Staphylococcus
aureus
aureus
11
Prostate smooth
and nontender
TRUS
CDI
27
23
Success after
second procedure
Not
indentified
Klebsiella
pneumoniae
12
Not performed
TRUS
CDI
7
5
Success after
first procedure
E. coli
E. coli
13
Prostate mildly
tender
TRUS
CDI
9
12
Success after
second procedure
Not
identified
Not
identified
14
Not performed
TRUS
CDI
14
16
Success after
second procedure
Not
identified
Staphylococcus
aureus
Patient
Estimated
Volume
Volume of
of Pus (ml) Aspirate (ml)
Result of
Treatment with
Needle Aspiration
Cultured Organism
Urine
Aspirate
DRE, Digital rectal examination; CDI, color and power Doppler imaging.
*Developed periprostatic abscess after transrectal needle aspiration, which was treated with perineal incision and drainage.
†Because of small aspirate volume, prostatic abscess was treated with transurethral resection.
The TRUS findings in 14 patients with PA are summarized in Table 3. TRUS revealed one or more
hypoechoic areas within the prostate that contained
inhomogeneous material in all patients (100%); in 10
patients (71.0%), the lesion showed internal septa or
solid portions. The outer margin of the hypoechoic
area was well defined and thick in 11 patients
(79.0%) (Fig. 1A) and poorly defined in three patients
(21.0%) (Fig. 2). The prostate showed a perilesional
hypoechoic area, indicating inflammatory change, in
10 patients (71.0%) (Fig. 2A). The abnormal fluid collection was extended into a periprostatic space in six
patients (43.0%) (Fig. 2B). The estimated volume of
the abnormal fluid collection ranged between 2 and
28 ml (mean, 12.0 ml). The number of fluid collections within the prostate was one in seven patients
(50%), two in six patients (43.0%), and three in one
patient (7.0%). The location of the fluid collection
within the prostate was in the outer and inner glands
in six patients, in the outer gland in five patients, and
in the inner gland in three patients.
Color and power Doppler sonography were performed in nine patients. A diffusely increased blood
flow was observed at the margin of the hypoechoic
area as well as in the remaining portion of the
prostate in all patients (100%). No blood flow was
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TREATMENT OF PROSTATIC ABSCESS
A
Figure 1 68 year old man with diabetes who had urinary frequency and dysuria. A, Transverse sonogram shows abscess
as inhomogeneous hypoechoic area with well-defined margin and wall in both inner and outer parts of the gland
(arrows). Estimated volume of pus is 19 ml. B, Under TRUS
guidance, an 18 gauge needle (arrowheads) was inserted
through the rectal wall into the abscess cavity, and 16 ml of
pus was aspirated. C, Postaspiration follow-up sonogram
1 week later shows obliteration of abscess cavity (arrows).
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B
C
noted within the hypoechoic area (Fig. 3). CT was
done in one patient and MR imaging was performed
in another patient. Both CT and MR imaging make it
possible to define the exact extents of both intraglandular and extraglandular fluid collections (Fig. 4).
The presence of pus within the prostate was confirmed by TRUS-guided needle aspiration in all
patients, and successful treatment with needle aspiration was done in 12 (86.0%) of 14 patients.
Treatment with needle aspiration failed in two
patients (14.0%), with the development of perirectal
abscess after transrectal needle aspiration in one
patient (patient 7) (Fig. 5) and a small aspirate volume in another patient (patient 8). The former
patient was treated with perineal incision and
drainage, and the latter with transurethral resection.
Treatment with needle aspiration via transrectal
approach was completed in a procedure in eight
(67.0%) of 12 patients. The remaining four patients
(33.0%) needed a repeat procedure, these treatments
being a second procedure in three patients (patient
11, 13, and 14) and a third procedure in one patient
(patient 1). The amount of drained pus ranged from
1 to 39 ml (mean, 12.0 ml). After the TRUS-guided
needle aspiration, antibiotics therapy was initiated
in all patients, intravenously in 14 patients
(cephalosporin, third-generation cephalosporin, and
third-generation quinolone) and intramuscularly in
10 patients (aminoglycoside). TRUS-guided aspiration allowed us to identify Escherichia coli in three
patients, Staphylococcus aureus in four patients,
Pseudomonas aeruginosa in two patients, and
Klebsiella pneumoniae in one patient. In four patients,
the same pathogen was the cause of both urinary
tract infection and PA. In the remaining four
patients, the organism responsible was not confirmed (Table 2). Complication associated with needle aspiration via transrectal route, which consisted
of perirectal abscess formation (Fig. 5), developed in
one patient (patient 7). Hospital stays ranged
between 8 and 21 days (mean, 13.6 days). On followup TRUS, no remaining abscess pockets were found
within the prostate in any of the cases. After 1 year,
PA recurred in one case (patient 3).
J Ultrasound Med 19:609–617, 2000
LIM ET AL
DISCUSSION
PA is an unusual condition. Such abscesses usually
are complications of acute bacterial prostatitis that
either has not been treated or has been inappropriately treated.2,9,10 Delay in diagnosis can
have grave sequelae, including a rupture of the
abscess into the ischiorectal fossa or into the
perivesical space with associated morbidity and
613
death.1,8,9,11 Since the advent of antibiotic therapy,
the prevalence of PA has decreased, and the type of
organisms responsible for the development of PA
has changed.2–4,7 The prevalence of PA is about 0.5%
of all prostatic disease.2 In the preantibiotic era,
Neisseria gonorrheae was the primary organism,
responsible in 75% of the cases. In the antibiotic era,
gram-negative bacilli (chiefly E. coli) have caused
about 60 to 80% of cases. Other significant
Table 3: TRUS Findings in Patients with Prostatic Abscesses (n = 14)
TRUS Appearance of Lesion
Patient
Number of
Lesions
Mean
Diameter (cm)
Location
Echogenicity
Septum or
Solid Portion
Margin
Perilesional
Change
1
2
2.6, 3
Both sides inner
and outer gland
Inhomogeneous
hypoechoic
+
Well-defined,
thick wall
Periprostatic
extension
2
2
3.4, 2.7
Both sides inner
and outer gland
Inhomogeneous
hypoechoic
+
Poorly
defined
3
2
2.3, 3.2
Both sides inner gland
Inhomogeneous
hypoechoic
–
Well-defined,
thick wall
Perilesional
hypoechoic area
4
2
1.9, 1.7
Both sides outer
gland
Inhomogeneous
hypoechoic
+
Poorly
defined
Perilesional
hypoechoic
area, periprostatic extension
5
1
2.2
Left inner gland
Inhomogeneous
hypoechoic
+
Well-defined,
thick wall
Perilesional
hypoechoic area
6
1
1.5
Right outer gland
Inhomogeneous
hypoechoic
–
Well-defined,
thick wall
Perilesional
hypoechoic area
7
1
2.2
Left outer gland
Inhomogeneous
hypoechoic
+
Well-defined,
thick wall
Perilesional
hypoechoic area
8
2
2.6, 1.7
Both sides inner
and outer gland
Inhomogeneous
hypoechoic
+
Well-defined,
thick wall
Perilesional
hypoechoic
area, periprostatic extension
9
2
1.3, 1.2
Both sides outer gland
Inhomogeneous
hypoechoic
–
Well-defined,
thick wall
Perilesional
hypoechoic area
10
1
3.4
Inner and outer gland
Inhomogeneous
hypoechoic
–
Well-defined,
thick wall
11
3
1.8, 3.5, 1.8
Both sides inner
and outer gland
Inhomogeneous
hypoechoic
+
Poorly
defined
Perilesional
hypoechoic area
12
1
2.4
Left outer gland
Inhomogeneous
hypoechoic
+
Well-defined,
thick wall
Perilesional
hypoechoic
area, periprostatic extension
13
1
2.7
Right inner and outer
gland
Inhomogeneous
hypoechoic
+
Well-defined,
thick wall
Perilesional
hypoechoic
area, periprostatic extension
14
1
3.0
Left inner gland
Inhomogeneous
hypoechoic
+
Well-defined,
thick wall
Periprostatic
extension
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TREATMENT OF PROSTATIC ABSCESS
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A
B
Figure 2 62 year old man with acute urinary retention. Transverse (A) and left longitudinal (B) sonograms show abscesses as
hypoechic areas with poorly defined margin in both the inner and outer portions of the gland (arrows, asterisks). Left longitudinal sonogram shows periprostatic extension of prostatic abscess (arrowheads).
pathogens include Pseudomonas species, staphylococci,
and occasionally obligate anaerobic bacteria.2–4,6,7
The pathogenesis of a PA has been thought to
involve two distinct mechanisms. The first mechanism is infected urine reflux, which occurs in older
persons with preexisting bladder outlet obstruction.
This is the most common mechanism, and the most
frequent microorganisms responsible are Escherichia
coli or other coliform bacteria. The second mechanism is hematogenous dissemination from a primary
focus. This mechanism involved a much smaller
group of patients, and the most common microorganism is Staphylococcus aureus.2,3,5,9 In view of the
mechanisms involved, predisposing factors for a PA
include bladder outlet obstruction, urethral instrumentation, and carcinoma of the prostate; further
predisposing factors include systemic diseases, such
as diabetes, liver disease, chronic renal failure,
acquired immunodeficiency syndrome, and
immunosuppressive therapy.2,3,5,6,9
The signs and symptoms of PA included, in order
of frequency, acute urinary retention, fever, dysuria,
urinary frequency, perineal pain, hematuria, urethral
discharge, and pain in the lower back. The classic
finding on a digital rectal examination of a tender,
fluctuant mass often is exceptional and not the
Figure 3 70 year old man with hematuria and perineal pain. A, Transverse sonogram shows the abscess as an inhomogeneous
hypoechoic area with well-defined margin in the inner part of the gland (asterisk). Note perilesional hypoechoic area (arrows).
B, Color Doppler sonogram shows no blood flow within the hypoechoic area (asterisk). Note diffusely increased blood flow at
the perilesional hypoechoic area, indicating inflammatory change.
A
B
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LIM ET AL
615
A
B
Figure 4 59 year old man with diabetes who had urinary frequency and dysuria. A, Longitudinal sonogram shows abscess as
hypoechoic area. Texture is complex because of presence of fluid collection with debris and septation. B, CT scan shows multiple areas of low attenuation in the prostate with periprostatic extension (arrowheads).
rule.1–4,6 Because signs, symptoms, and physical
findings of PA are similar to those of acute bacterial
prostatitis, the diagnosis of PA often is difficult on
clinical basis alone.2,5,6,8,10 However, it is very important to distinguish between acute prostatitis and
PA, since the therapeutic approach for each is different. From this point of view, prostatic imaging
(TRUS, CT, MR imaging) is important in the diagnosis and management of PA. Of these types of prostatic imaging, TRUS is the most widely used
technique in the diagnosis of PA and in the guide
for percutaneous aspiration and drainage. It also is
useful in evaluation of response to treatment.1,2,6,8,9
The most common TRUS finding of PA was one or
more hypoechoic areas with well-defined and thick
walls, seen in 79.0% of all patients. A hypoechic area
with poorly defined walls was seen less frequently.
Other conditions that may have a similar appearance
to that of PA on TRUS are neoplastic processes, cystic lesions, and granulomas.1,2,7,10,19 However, the
TRUS appearance of PA was quite characteristic and
could be differentiated from that of other conditions.
Reported criteria discriminating PA from prostate
cancer include the following: (1) prostate carcinoma
usually appears small and is more easily distinguishable from the surrounding gland, whereas PA
Figure 5 75 year old man with indwelling catheter because of neurogenic bladder. A perirectal abscess developed after needle aspiration of PA. A, Transverse sonogram shows abscess as an inhomogeneous hypoechoic area with periprostatic extension in the apex
portion of the left outer gland (asterisk). B, After treatment of the PA with TRUS-guided needle aspiration, the patient complained
of fever and perineal pain. Transverse sonogram shows perirectal abscess as a complication of needle aspiration (arrows).
A
B
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TREATMENT OF PROSTATIC ABSCESS
occupies a large area of one or both glands; (2) carcinoma is found more frequently in the peripheral
zone of the prostate, whereas PA is usually located in
the central gland; (3) PA generally appears as a wider
hypoechoic area and is less easily definable during
its initial phase; (4) color and power Doppler sonographic examinations show a high perilesional vascularity that is absent within the tumor.1,7,19 Of these
criteria, the location of the lesion may not be helpful
in differentiating PA from prostate cancer, because
PA can occur in both inner and outer gland. In our
study, the PA was located in both the outer and inner
gland in six patients, in the outer gland in five
patients, and in the inner gland in three patients. In
addition to high perilesional vascularity, our study
showed a diffusely increased blood flow at the
remaining portion of the prostate on color and power
Doppler sonography. This was thought to represent
an inflammatory reaction.
After the diagnosis of PA is made, therapy consists
of adequate drainage of the abscess and administration of pathogen-specific antimicrobial agents.6
Surgical drainage is accepted as the most important
step in the treatment of a PA. However, the exact
method of drainage remains somewhat controversial.
Drainage techniques for PA included perineal incision and drainage, transurethral unroofing and resection into the abscess cavity, blind aspiration, and
percutaneous transperineal drainage.1,3–7 Because perineal incision could cause impotence due to nerve
damage, perineal incision and drainage is now seldom used.1,6 Although transurethral resection not
only has the potential of causing the hematogenous
spread of infectious organisms but also could have
potential complications, such as retrograde ejaculation, urethral stenosis, or urinary incontinence,1,2 it is
frequently used in the treatment of a PA in many
institution.3,4,6 Some investigators reported the placement of a transperineal drainage catheter under
TRUS-guidance as the treatment method for a PA.1,3,7
Percutaneous catheter drainage under radiologic
guidance is an accepted method for draining abdominal abscesses and other fluid collections. The safety
and efficacy of this procedure are well established. In
percutaneous drainage, the principle is that, in addition to the aspiration of all drainable pus, a catheter
should be left in the abscess cavity until all drainage
cease and the space becomes obliterated.3,5,6,12–16
Initially, a transperineal route is preferred for the percutaneous drainage of PA, because this approach
could avoid rectourethral fistula formation and fecal
contamination of the abscess cavity.18,20 In contrast to
percutaneous catheter drainage of abdominal
abscesses, transperineal drainage of a PA may result in
a painful and prolonged catheter drainage procedure.
J Ultrasound Med 19:609–617, 2000
Few reports have been published showing that
TRUS-guided needle aspiration via transrectal
route could produce a cure in the treatment of
PA.2,7,18 The rationale for this regimen is that emptying the collection is likely to a pressure reduction
within the PA, thereby resulting in easy intracavitary antibiotic inflow.2 Collado and coworkers2
reported on results in the largest series, 24 patients
treated with transrectal needle aspiration and adjuvant antibiotic therapy. Results of PA needle aspiration in these 24 patients were successful in 20
patients (83.3%); only two patients required second
procedures.2 In our experience, 12 (85.7%) of 14
cases were successfully treated with needle aspiration; four cases needed a repeat procedure.
In our study, we did not place a catheter for transrectal drainage. Although catheters provide continuous drainage of pus, thereby resulting in complete
evacuation of pus,21 there are several problems in
transrectal drainage: (1) the catheter may be uncomfortable, (2) prevention of dislodgment may be a
problem in management, and (3) restriction in ambulation may be advisable.22 The advantages of transrectal needle aspiration using TRUS-guidance
include (1) the trajectory of the needle is shorter
because of close contact between the prostate and the
probe; (2) direct access through the rectal wall minimizes bleeding, injury to adjacent organs, and spread
of infection; (3) this approach is more comfortable for
the patient than the transperineal approach, which is
more painful.2,17 In our study, seven patients had
multiple abscesses. With a repositioning of the needle, it is possible to aspirate multiple abscesses in different locations. We performed more than one
procedure in four patients (two procedures in three
patients and three procedures in one patient).
Because of thick viscous pus, initial aspirate volumes
in these four patients were small in amount.
However, in these four patients, repeat aspiration
after an interval of 3 to 7 days successfully removed
the predicted volume of pus. Thus, we considered
that the treatment in these subjects was successful
treatment. Although some investigators have used
saline solution irrigation or intraprostatic infiltration
of antibiotic to improve outcome,2,5,17,23 we did not
use it in our study. Without saline solution irrigation
or antibiotic intraprostatic infiltration, we obtained
good results in our study; therefore, we do not think
either of these is indicated.
In conclusion, TRUS is important in the diagnosis
of PA, in guidance for aspiration, and in drainage of
the PA. TRUS-guided transrectal needle aspiration
could be an effective method for treating PA that
does not require catheter placement or prolonged
drainage.
J Ultrasound Med 19:609–617, 2000
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