ABP or Acute Bacterial Prostatitis if often indicated by the presence of a prostatic abscess – an uncommon complication of ABP that may require potential surgery.
Medical treatment of a prostatic abscess is usually unsuccessful, therefore surgical drainage through perineal or trans-rectal aspiration may be considered.
Other procedures include trans-rectal resection, or ultrasound guided trans-rectal placement of a drainage tube.
Perineal or trans-rectal aspiration is a preferred method and is often indicated for patients with symptoms that do not improve within one week of medical treatment.
Considerations of Prostatitis Drainage
Because medical management of prostatic abscess is often unsuccessful, trans-rectal or perineal aspiration, or, less preferable trans-urethral resection and cavity drainage are possible surgical considerations.
TURP (Transurethral Resection of Prostate) and drainage is an alternative approach for ABP and effective in the treatment of recurrent abscesses, but less desirable due to the risk of potential hemotogenous bacterial proliferation.
TURP should be undertaken with extreme caution and it is not advised unless attempts at other methods of drainage have failed.
Perineal surgery carries the risk of nerve damage with potential impotence. Because of the risk of bacteremia and systemic infection, urethral surgery should be avoided, particularly if the patient is showing signs of sepsis already, or is clinically unstable.
Pre-treatment with antibiotics before any surgery is mandatory procedure. Transurethral resection in patients with sepsis, however, may be lifesaving and a definite consideration when there is no response to conservative therapy.
The use of a Foley catheter may be considered as a first attempt for severe obstruction in patients who have acute urinary retention; however, this procedure causes extreme discomfort.
Sometimes a transurethral catheter may cause obstruction to drainage of an acutely inflamed prostate with the risk of prostatic abscess or bacteremia. A suprapubic punch is indicated in cases where the catheter is difficult to pass into the urethra.
Antibiotics for Prostatitis
Intense inflammation present in patients with ABP causes the prostate gland to be highly responsive to antibiotics which normally penetrate the prostate poorly.
The choice of antibiotic treatment for ABP is based on results obtained of the initial culture. Initial therapy should, however, be concentrated on gram-negative enteric bacteria which include agents such as tremethorpim-sullfamethoxazole, fluoroquinolones, and ampicillin with gentamicin. (Make sure you understand the risks it taking antibiotics).
If a satisfactory response is obtained treatment is continued for a period of 30 days in order to prevent chronic abscess formation and chronic bacterial prostatitis. The rapid rise in resistance to antibiotics must be considered especially in trans-rectal ultra-sound guided biopsy procedures (TRUS) where Gram-negative uro-pathogens are of particular concern. Some highly resistant strains may require prolonged IV therapy.
Hospitalization will be required for patients who require antimicrobial intravenous therapy or in the event of acute urinary retention. Supportive therapy includes antipyretics, bed rest, analgesics, increased fluid intake, and stool softeners.
Alpha-blocker therapy for ABP is another approach that should be considered. The prostate and bladder neck are rich in alpha receptors and an alpha blocker may be effective where there is obstruction of outflow as well as diminishing possible intra-prostatic urinary reflux.
Although scientifically unproven, it appears that gentle massage performed by an urologist of the prostate gland may be of benefit to help drain sequestered secretions that have formed in in an inflamed prostate or in the seminal vesicles.
Massage may help to release tension around the nerve endings of the lavator-ani muscles located behind the prostate representing a type of myofascial release.