Outcome of three different techniques of prostatic abscess drainage: a retrospective single-center experience

Abstract Background Despite the fact that prostate abscess (PA) is a serious condition, no standardized guidelines are available on the best methods for its drainage. The goal of the current study is to compare the outcomes of the three modalities of prostate abscess (PA) drainage: transrectal ultrasound (TRUS) guided aspiration (TRA), transperineal aspiration (TPA), and transurethral de-roofing (TUD). Methods The records of 66 patients diagnosed with PAs were collected between 2015 and 2022 and divided into 3 groups according to the technique of abscess drainage that was used. Group A included 26 patients treated by TRA; Group B included 28 patients treated by TUD; and Group C included 12 patients treated by TPA. The three groups were compared based on demographic data, drainage success, recurrence, complications, and hospital stay. Results The mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Central abscesses were detected in 35 patients (53%), peripheral in 21 patients (31.8%), and both central and peripheral in 10 patients (15.2%). The most common clinical presentation was lower urinary tract symptoms (LUTS) in 45 patients (68.18%), followed by fever in 40 patients (60.6%). The mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Recurrence of the abscess occurred in three (11.5%), one (3.6%), and one (8.3%) patients in groups A, B, and C, respectively ( p = 0.496). The mean hospital stay was 4.8 ± 1.7, 5 ± 1.8, and 4.5 ± 1.3 days in groups A, B, and C, respectively ( p = 0.763). When compared to the other two groups, the TUD group had a higher rate of complications (32.1%). Conclusion A TRUS-guided transrectal and transperineal aspiration of PA were comparable to TUD technique regarding the recurrence rate and hospitalization period; however, the safety profile was in favor of the aspiration groups.