Prostatic Abscess in a 45-Year-Old Male: Atypical Presentation and Successful Management With Open Transperineal Drainage

A prostatic abscess is a rare but serious urological emergency that requires prompt recognition and intervention due to associated risks of urosepsis, multi-organ failure, and death. This case describes a previously healthy 45-year-old male who experienced delayed diagnosis and management of a complex prostatic abscess following multiple encounters with secondary care services. Imaging revealed a prostatic abscess with atypical features, including multiloculation and extension into the ischiorectal fossa and gluteal region. Given the extensive nature of the infection and preoperative signs of sepsis, emergency drainage was performed through an unconventional transperineal open approach in a joint procedure between Urology and General Surgery. This method was selected because aspiration alone, although considered the first-line approach for prostatic abscess drainage, was unlikely to provide adequate drainage given the multiloculated and extensive nature of the abscess. As no underlying cause for abscess formation was identified during inpatient admission, the patient underwent a comprehensive outpatient evaluation following acute management. This follow-up included detailed biochemical and clinical assessments, coupled with thorough history-taking, to identify any missed risk factors. This case underscores several key considerations for clinical practice, including the importance of early imaging to guide management, guideline-directed antibiotic therapies, robust follow-up and safety-netting systems, and timely multidisciplinary collaboration. It also demonstrates that an open transperineal drainage approach serves as a safe and effective treatment for atypical abscesses when conventional transurethral, transrectal, or minimally invasive transperineal methods are likely to be inadequate.