7/24/2019 ajr bprostate.170.3.9490969-1 n
1/5
L B ar oz zi
P . P a v li c a1
I . M e n ch i2
M D e M at te is
M Canepari3
A JR :1 70 , M arc h 1998
75 3
O rig in a l R epo rt
P ros ta tic A bscess : D iagnos is and
Trea tmen t
O B J E C T I V E .
P ro s ta tic a bs ces se s a re un com mon in c lin ica l p rac tice b ecau se ea rly an tib i-
o tic th e rap y has red uced com plica tio ns of p rosta titis . P ros tatic abscess m ain ly affec ts d iabe tic
and imm unosuppressed pa tien ts . The o rgan ism s m os t freq uen tly in vo lve d a re Esche rie /z ia o h
an d
S taphylococcus,
whe r e a s
gonococcus is ra re ly encoun te red . T he resu lts in e igh t m en w ith
prosta t ic a bsc ess , five
o f w hom w ere treated w ith son ograph ica lly gu ided p ercu taneo us dra in -
age , a re r ep or te d. The d iag no s is , c lin ica lly s uspe c ted in o n ly th re e pa tien ts. w as confirm ed by
tran sre cta l sono graph y .
A ll pa tien ts exp er ien ced com ple te abscess reso lu tion .
C O N C L U S I O N .
T ra ns re c ta l so nography is the m os t re liab le im ag ing m eth od to d ia g -
n ose pro sta tic absces s . P e rcu tan eo us tra nspe rine a l o r tran sre c ta l d ra ina ge is the firs t c ho ice fo r
the rap y b ec ause of
the low er risk of com plication com pared w ith su rgery .
R ece ive d Ju ne 2 , 1 9 97 ; a cc ep te d a fte r re vis io n
A ug us t 5 , 1997 .
1 De pa rtm en t o f R ad io lo gy , H osp ita l M . M aip ig hi, V ia
A lb er to ni 1 5, 1 -4 01 38 B olo gn a, It aly . A dd re ss
co r r espondence
to P . Pav l ica .
2 ls ti tu to L e on a rd o D a V i nc i,
- 50100
F i r e n ze, I t a ly .
3Dep a r tmen t o f R ad io lo gy , G en era l H osp ita l, 2 00 79
S . A n g e lo L o di gi an o , I ta ly .
A..J R
1998 ;170 :753 -757
0361-803X198 /1703-753
A me ric an R oe ntg en R ay S oc ie ty
T he in ciden ce of p ros ta tic ab s ce s s
has decreased m arked ly because o f
th e w id es pre ad us e o f a nti bi ot ic s
and the decreased inc idence of g onococca l u re -
th r itis a nd its a sso cia ted ure th ra l ste no sis th at
fav ors chron ic in fec tion s. B efo re the ad ven t o f
m odem antib io tic th erap y , 7 5 of p rosta tic
ab -
s ce sse s w ere a ttrib u tab le to gonoco ccus , and
the m or tali ty ra te
w as be tw een 6 and 30 .
D ata in the litera tu re p rov e t ha t p ro st ati c ab -
s ces s
i s d ia gn o se d on ly in 0 .2 of
pa tien ts w ith
u ro log ic sym ptom s and in
0 . 5- 2 .5 o f p a ti e nt s
h osp ita lized fo r p ro sta tic sym ptom s [ I
2] . T he
d iffe re ntia l d ia gn os is b etw een acu te bac teria l
p ros ta ti tis an d pro sta tic ab sce ss is
d iff icu lt to
mak e
on th e ba sis o fc lin ica l ex am in atio n.
N ew im agin g m eth od s, esp ecially tra nsrec-
ta l son ograph y , a re particu la rly u se fu l fo r
e ar ly r ec og ni tio n
an d
trea tm en t o f in trag lan -
du la r flu id co llections . P ro sta tic
a bs ce ss d ra in -
age represen ts a sim ple a lte rna tive to m ore
comp l ex and dange rou s trea tm en ts th at can
cau se hem ato genous d issem ina tion 13].
M ate r ia ls an d M eth o d s
E igh t pat ien ts w ho w e re
36-78 years o ld an d
h osp ita liz ed fo r a cu te p ros ta t ic com pla in ts
and , in
som e case s . sep tic fev e r T ab le I ) w ere exam ined .
F ive p at ie nts w ere d ia be tic fb ur in su lin -d ep en de nt),
on e pa tie nt w as u nd ergo in g m ain te na nc e d ia ly sis fo r
ch ron ic ren a l fa ilu re , o ne pa tien t w a s un de rgo ing
immunosuppres s iv e
th erapy fo r
l ymphoma .
an d on e
p atie nt r eq uire d an in dw elling u re th ra l ca the te r . In
a ll p at ie n ts .
trans re cta l sonography was perfo rm ed
using b ip la ne li ne ar
a nd se cto r
5 -M H z tra ns du ce rs
(A U-4 50 : E .sa ote . G e no va , I ta ly ): tw o p at ie nt s w e re
also
exam in ed w ith C T usin g an IV con tra st m edium
t o e va lu a te th e per ig la nd ula r e xte nsion o f t he c ol le c-
tion . Th e la tte r tw o p a tien ts w e re a ls o s tud ied w ith
co lo r an d pow er D opp le r s onog ra ph y E id os : E s -
ao te ) using the sam e fre que nc y tran sd uce rs . F ive pa -
tie n ts w ere trea ted w ith p erc uta ne ou s tr an sp er in ea l
sonograph ica l ly gu ided asp iration us ing an 18-g au ge
(2 0-cm -long) C hiba n ee dle un de r loca l a nes th es ia
lyd oca in e ch lo rid ra te iX y lo ca ine 2 : A s tra F a r-
m aceu t ic i. M ilan o . Ita ly l). A l l p a t ien ts re ce ived
p are n te ra l a n tib io tics am pic iIlin -ge n tam ic in ) b e fo re
and 6-1 0 days a fte r th e p rxe du re . T he need le wa s
easily in se rted tran sperinea l u nder con tin uou s sov io -
g ra ph ic g uid an ce u sin g fre eh an d te ch niq ue .
T h e r em a in in g th re e p a tien ts re fused dra ina ge and
re ce iv ed s ys te mic a ntib io tic th era py fo r 3 )-5 ) d ay s
(az t reonam
paren te ra l ly an d
c ip ro t loxac in
oral ly ) .
Resu l t s
The m ost frequen t p red ispo sing fac to r fo r
pros ta tic ab sce ss in ou r series wa s d iabe tes ,
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B aro zz i e t a l.
754 A JR :1 7O , M arc h 1998
.
Pat ien t
C lin ica l D ata
fo r E ig ht P at ie n ts
w ith P ros ta t ic Absce s s
Age
Yea r s )
. .
Pred ispos ing
Fac to r
. .
R e ct al E x am i na ti on
. .
Find ings
.
U rin ar y T ra ct
.
In fec t ion
Sonog ra ph y
Pe r f o rmed
C olo r D op ple r
Sonography
Perfo rmed
C T P e rf or m ed
Percu taneous
.
Dra inage
Perfo rmed
1 36 Hem od ia lys is N o PA Y es
Y es N o No Ye s
2 54 D iabe te s PA Y es Y es Yes N o Yes
3 63 D iabe te s N o PA N o Y es N o N o N o
4
62 D iabe te s N o PA
N o Y es N o N o Yes
5 47 lmm unosuppre ss ion N o PA N o Y es N o No Ye s
6 78 D iabe te s PA Yes Y es
Yes Y es Yes
7 72 Ca the te r iza tio n N o PA Y es Y es N o Y es N o
8 70 D iabe te s PA Yes Y es N o N o N o
Note -PA
=
p ro s ta t ic a b s ce s s.
presen t
in five o f
th e e ig h t p a tien ts . O ne
pa -
C T was p erform ed in o nly tw o c ircum - P atien ts w ho refused surg ica l o r son o-
t ien t w ho com p la in ed o f fre quen t pro sta to - stances, m ak ing it po ss ib le to exac tly define graph ica lly gu ided dra inage requ ired a t leas t
v esic u la r in flam matio n was underg o in g the ex trag land u lar ex ten t o f the flu id co llec - 3 0 days to ach ieve g ood c lin ica l and sono-
chro n ic d ialysis. Sep tic fe ver p rec eded by tio n tow ard the isch iorecta l fo ssa and pe rire c- graph ic re su l ts.
ch ill w as the m ost comm on sym ptom , presen t
ta l tissue (F ig . 3 ). C o lor and pow er D opple r
in five o f the e igh t pa tien ts , and the rem a in ing sonography showed in both pat ients a h y-
th re e pa tie nts rep orted dysuria , p er in ea l pa in . povascu la r flu id co llec tion surround ed by peri-
Dis cuss ion
a nd re cta l an d b la dder te n esm us . le s io n a l inc reased p arenchym al flow (F ig . 4 ) . P ros ta tic ab scess is a n in freq ue n t cl in ical
In th re e
pa tien ts in itia l d ig ita l rec tal ex am i- In trag landu la r ca lcifIca tions w ere f requen tly occurren ce tha t is d ifficu lt to d iag nose because
n atio n in dica te d abscess on the ba s is o f pa in fu l ob se rve d s e v en of eigh t pa tien ts ). c lin ica l sym p tom s are often non spec ific [4 ];
p rosta tic en la rgem en t, tenderness, and fluc tua - P ercu tan eo us pun c tu re , car ried ou t in fiv e an tib io tic th e rap y , o ften used f or i nf la mm at or y
tion . In the rem ain in g five pa tien ts the
g land
pa tien ts, a llow ed u s to id en tify Escherich ia sym ptom s of th e u rin a ry tract, can d isg u ise
w a s in cr ea se d in size an d p ain fu l bu t no t sug -
coli as th e
o rg an ism re spon s ib le in th re e pa - typ ica l find in g s o f p ro s ta tic a b sce ss ; a nd d ig i-
g est ive o f pro sta tic abscess ; the clin ica l d iag - tie n ts (F ig . 5 ). In the rem ain ing tw o pa tien ts ta l re cta l ex am ina tio n and cy stou reth ro graphy
nos is
w as sim ple acu te p rosta titis . w e iso la ted m ixed bac teria . In th ree pa tien ts , m ay be in su ffic ien t to d iagnose or sugges t pu -
W ith tran srec ta l sonog raphy (Tab le 2 ), w e in whom asp ira tion w as no t perfo rm ed , the or- ru len t in trag landu la r co llec tion .
ob se rve d in a ll p a tien ts a hypo ech oic are a that gan ism respon sib le w as no t id en tif ie d . In an - P ro sta t ic ab sce sse s are fre quen tly d iag-
con tained h om ogeneo us f lu id in tw o pa tien ts o th er th ree pa tien ts, w ho h ad need le dra inage, n osed in eld erly p atie n ts w ith p reex isten t
(F ig . I )
and in hom ogeneou s m a te ria l in five
th e sam e pa th oge n wa s the cause of bo th th e chron ic ob struc tive trou b les o r u rina ry ep i-
pat ien ts; in on e pa tie n t th e les ion showed lin - u r ina ry tra c t in fec tion a nd the p ros ta t ic ab - s od ic in flam m a tio n a nd fre qu en tly requ ire
ear s trand ing su ggesting a sep ta ted cys tic m ass scess. A ll pa tien ts w ere trea ted w ith bro ad - hosp italiza tion , even if m ic roabscesses tha t
F ig . 2 ) . T he flu id c o lle c tio n genera lly h ad ill- sp ec trum an tib io tic s to redu ce risks asso cia ted occur in the course of acu te p rosta titis m ay be
defined b orders an d the d im ensions rang ed w ith bac te ria l d issem ina tio n . In a ll pa tien ts, treated w ithou t h osp ita liza tion . A bscesses due
b e tween 1 .5 an d 4 .0 cm . T h e ab sce sses we re d ra in ag e prod uce d ra p id c lin ica l im pro vem ent to m icroem bolism from sep tic foc i located in
lo ca te d e qu ally in t he c en tr al
ig . 1 )
or p er ip h- and reso lved th e pa in and fever. In five pa- o ther o rgans (endocard itis) a re less freq uen t.
eral zon e
ig . 2 ) of the g lan d . A hypoecho ic tien ts son ograph ic find ings com plete ly nor- T h is la tte r occurrence is genera lly cau sed by
h alo s ur ro un din g the flu id co llec tion w as o b- m alized afte r 1 0-15 days and no res idua l g ram -po sitiv e organ isms and is comm on in
se rved in o n ly tw o pa tien ts . cav ity (pseu docys t) w as v isib le . y oung pa tien ts [5 ].
.
Pat ien t
Sonog raph ic F ind ings In E igh t P a tien ts w ith Pros ta t ic
Abscess
Hypoechoic
Area
.
S o no gr ap hic A p pe ar an ce
.
S ize cm ) Bo rde rs
.
S id e
N eed le used fo r
.
P erc uta ne ou s D ra in ag e
.
Cu l tu r ed Organ ism
1
2
3
4
5
6
7
8
Y es
Yes
Y es
Yes
Yes
Yes
Yes
Yes
F lu id
I n h omogeneou s
In h omogeneou s
Sep ta ted
Flu id
I n h omogeneou s
In h omogeneou s
In h omogeneou s
2. 0
4. 0
1. 5
3. 2
2. 5
3. 7
3. 4
2. 5
Sharp
I r regu la r
I r regu la r
Sha rp
Sha rp
I r regu la r
I r regu la r
I r regu la r
Per iphe r a l
Per iphe ra l
Cen t r a l
Pe r iphe ra l
Cen t r a l
Cen t r a l
Pe r iphe ra l
Cen t r a l
1 8 g au ge
1 8 g a ug e
N o
1 8 g a ug e
1 8 g a ug e
1 8 g a ug e
N o
N o
Ps eudomona s
Esch erich ia co /i
No t i d en t if ie d
Esch erich ia co /i
E s ch e rich ia co /i
M ix ed b ac te ri a
N o t i de n ti fi ed
N o t i de n ti fi ed
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A B
Fig . 1 .-4 7 -y ea r-o ld m an underg o in g im m unosu pp re ss iv e th e ra py fo r lym phom a, p resen tin g w ith fe ve r a nd u n-
n a ry fre qu en cy . R ec ta l e xam in a t ion re su lts w ere u n re lia b le fo r ab sces s .
A
and B , Long itud ina l A ) a nd trans ve rse B ) son og ram s sh ow ab sces s a s hypoe ch o ic a rea in tran s itiona l z on e
of g land . N ote lack o f po s te rio r e nhancem en t B = b la dd er, R = r e c t um .
F ig . 2 .-62-year -o ld m an w ith d iab e tes , p resen ting w ith sep tic em ia an d pa in o n rec ta l exam ina tio n .
A and B , Lo ng itu d in a l A ) an d tra ns ve rse B ) son og ram s. A bsces s is in le ft la te ra l zo ne o f g lan d . T ex tu re is co rn -
p lex be ca use o f p resen ce o ff lu id co llec t ion w ith d eb r is a nd se p ta tio n . C alc ifica tio n
a r row ,
B re su lt o f p re vio us
in fec t ion , is c lea rly v is ib le . B
=
b la dd er, R = rec tum, A = abscess.
P ro s ta tic A b scess
A JR :17 O, M arch 19 98
75 5
Pred ispos ing fac to rs a re n um erous . D iabe-
t es , e sp ec ia ll y
i f n o t p rop e rly tre a te d , is
th e
fac tor
m ost fre quen tly d esc rib ed in the lite ra -
ta re [6] . C h ron ic d ialy sis pa tie n ts w ith pros-
ta tic in flamm atio n hav e freq uen t abscess
co llec tion s [7 ].
T herapeu tic p rocedures , such as p erm anen t
cathe te r
posi tion ing , c ou ld fav or the sp read of
g e rms
in to pros tatic d uc ts and subsequen t ab -
scess co llec tion caused
by
a typ ica l and
anaer-
ob ic germ s. A relativ ely ne w group o f p at ie nt s
at r isk for pro sta tic absces ses a re tho se w ith
dep ressed imm une system s (caused by A IDS ,
ch em oth erap y , tran sp lan tatio n . e tc .) [8 ] .
Sym ptom s and cl in ical f ind ing s o f
prostatic
absces s are ex trem ely variab le . Fever, dy sur ia ,
ur inary frequency , perinea l pa in . a nd b ac te ri-
u ria a re
r epo r ted
by on ly a few pa tien ts . T he se
sym p tom s are sim ila r to those of acu te p ros tati-
t is . In rece n t s tud ie s , fev e r h a s been repor ted by
o nly 6 0 o f p atie nts
an d
per inea l
p ain by on ly
20 . T he typ ica l pa lpab le find ing of a so ft
p ros tate w ith fluc tua ting co llec tions is a lso ex-
cep tio na l. D a ta in the literatu re conf irm tha t
absces s is p reope ratively d iagno sed in only
21-88 of ca se s. P ro sta tic
abscesses , if n o t
prope r l y
trea ted , c ou ld e vo lve d iffe ren tly ac -
cord ing to w hether they are lo ca ted near the
base
or
nea r
th e apex of the g land . In the
f i r st
case , they genera lly have sp on taneous b lad der
o r
p rox im a l pro sta tic ureth ra fistu liza tio n : in the
second case, th ey tend
to ex ten d tow ard the is-
ch iorecta l fossa and th ro ugh p er irec ta l tissue ,
p rodu c in g rec ta l and p er in ea l re gion fis tu la s
[91 .
In al l cases, th e in fec tio n frequen tly per-
sis ts, crea tin g chron ic fis tu lo us absces ses th at
m ay re lap se or ev o lve in to cysts . R ecen t im ag -
ing m eth od s, such as trans recta l sono graph y ,
C T an d MR im aging . have profo und ly m od i-
f led
preo pera tive d iag nos tic re liab ility and co n-
t r ibu ted to the deve lopm ent o f new therapeu tic
s tra teg ies . T he sonograph ic pa tte rn of prosta t ic
absces s is cha rac teristic and is eas ily d iffere n ti-
ated f rom o th er g lan du la r les ions [10 ]. D iffer -
en tia l d iagn osis v ersu s cancer is on ly d iff icu lt in
tho se rare c ase s of sm all abscesses a t an early
s tage . The in fec tion in th is c ase appears as a hy -
poechoic p seudo tumo ra l nodu le . T he d iffer -
ence
is based o n th e fo llow in g cr ite ria :
ab sce sses a re lo ca ted in the tra nsi tion al zo ne of
th e g land , and tum o rs a re m ore f req uen tly p e-
r iphera l ; tum o rs are sm aller an d m ore easily
d is t ingu ishab le from the su rround in g g land ; ab -
s ce s s g e ne ra ll y appears as a w ider hypo ech oic
zone and is le ss easily definab le du ring in itia l
phases; abscess som etim es has a hypo ech o ic
per i le s iona l ha lo tha t is ab sen t in tum o rs ; co lo r
and pow er D opp le r sono graphy show a h ig h
per i les iona l vascu la rity tha t is absen t in tum ors .
Th e increased perile siona l flow is a reflec -
tion of hy perem ia due to inf lam m a tion th at
occurs in all in flamm atory les ions . W hen the
e d ema
an d
ce ll in filtra tio n are particu la rly
ev id en t. th e hy poecho ic ha lo m ay be ob -
se rved on gray -sca le sono graphy .
Th e lite ratu re a lso reports the possib ility
o f la rge p ros ta tic and rec ta l tum o rs hav ing
necro tic and liq uefied zones ; d iag nos is in
these cases is possib le on ly by b iopsy and
d isco ve ry of neo pla stic ce lls I I 1. Because of
locat ion , d im ens ion s , e chogen ic ity . b o rde rs
o f lesio n , and ab sence o f a n y c lin ica l s ign .
d iffe ren tia l d ia gno sis in clud es m U lleria n duc t
cys ts, e jacu la to ry duc t cysts , an d sem ina l
ve sic le cy sts. CT is usefu l to assess the ex ten t
of suppu ra tive co llection in th e perip rosta tic
tissue and to de tec t gas
in
the flu id .
Trans rec -
ta l sono graphy usu ally underes tim ates the
rea l pe rig landu la r ex tension of the ab scess .
T he treatm en t of pro sta tic ab sce ss usua l ly
cons ists o f d ra in age w ith p ro pe r an tib io tic th e r-
apy [I I]. T he surg ica l appro ach is transure th ra l
or tran spe rin ea l. T h ese p rocedure s a re no t cu r -
re n tly used because perinea l in cis io n co u ld
cause im po ten ce du e
to
n erve d am ag e.
an d
t ransureth ral resec tion cou ld e li ci t h em a to ge ni c
sp read of g erm s as a resu lt o f the c rea tion o f
comm un ica tin g v enous dra inage. R ecen t im ag-
in g m eth ods such as sonograp hy and (1 have
no t o n ly fa c il ita te d d ia gno s is bu t a ls o ind icated
the b es t pa th fo r percu taneous d ra in ag e I I 2 ].
Th e
ai m
of
trea tm en t is th e com ple te co llapse
o f th e cav ity . and sonog raph ic gu idance is par-
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-
- -
- -w --
B a roz z i e t a l.
756
A JR :1 70 , M arch 1998
F i g . 3 - 72 - y ea r -o l d
man w ith in -
dwe l l ing ca the te r be ca use o f p ro s-
t at ic e n la rg e m en t and urina ry trac t
in fec tio n . R ec ta l e xam in a t ion wa s
no t ind ica tive of
abscess .
A an d B
L on gitu din al s on og ra m
A
a nd p elv ic C T sca n B ). T ra ns rec ta l
sono graph y al low s dep ict ion of ab -
n orm al flu id co lle ctio n a r r ows
A
insid e an d aro und g land . C T sc an
s ho ws m ultip le lo w-de ns ity a re as in
prosta te a nd i n p en ip ro st at ic t is su e.
A = ab sce ss , S =
symphys is SV
=
sem in a l ves ic le .
F ig .
4-54 -yea r -o ld
m an w ith d iabe-
te s a nd u rin ary tra ct in fe ctio n. R ec ta l
e xa m in at io n in dic ate d abscess .
A
a nd B , L on gitu din al g ra y-s ca le A )
and pow er Dopp le r (B ) son ogram s
show la rge inh om ogeneo us flu id co l-
le ct io n s urro un de d b y h yp oe ch oi c
halo a r rows
A . P o w e r Dopple r
sono gram sh ow s p er ile sion al hyper.
vascu la rity correspond in g to hy po-
echo ic
ha lo .
F ig . 5 .-36-year -o ld m a n u nd er go in g h em o dia ly sis , w h o c om p la in ed o f f ev er and urina ry in fection . R ec ta l exam ina tion resu lts w ere unre liab le fo r abscess .
A
a nd B , L o ng itu din al s on og ra ms b efo re A ) a nd d ur in g ( B) th er ap eu ti c t ra ns pe ri ne al pun ctu re . A bs ce ss ap pears a s hyp oe ch o ic a re a w ith irre gu la r bo rde rs , loc a te d in le ft lobe
o f g lan d . Sm all c alc ific atio ns ap pea r in surro un din g p arench ym a (A ) . S onograph ic gu idance w as u sed for c or re ct n ee dle p os it io nin g a nd d ra in ag e o f c o ll e ct io n . B
=
b ladder ,
A
=
abscess .
7/24/2019 ajr bprostate.170.3.9490969-1 n
5/5
P ro s ta tic A bscess
A JR :1 70 , M arch 1998
75 7
tic u la rly u sefu l fo r therapeu tic pu ncture
an d
drain position ing [7 ]. C on tin uous sonograp h ic
guidance make s th e procedure s im ple and
qu ick and does no t req u ire any spec ial ex per i-
ence.
LeSS exp er ienced opera to rs
can use a spe -
c if ic b io p sy -g u id e d attachm ent in ste ad of
th e
f reehand
approach .
Cu rren tly , pe rcu taneou s trea tm en t of pros-
ta tic abscesses is p re fe rred to su rgery because
of its low er risk of com plica tion . Surgery ca n
be pe rfo rm ed on
an
e le ctiv e ba sis an d a t a la te r
da te in p a tien ts w ith m u ltip le and
dif fuse
pros-
ta tic ab sce sse s w he n p erc utan eo us asp ira t ion
does n o t show com ple te reso lu tio n of th e flu id
co l lec t ion .
Transrecta l
sono graphy a lso m akes
it
possib le to fo l low up abscesses tha t w ere no t
t reated w ith d rain ag e or punc tu re bu t w ith an ti-
biotic
therapy
on ly .
Re fe rences
I.
Trapne l l
J,
Robe rts M .
P ro st at ic a bs ce ss .
Br J
Surg
1987:57 :565 -569
2 . M ea re s EM J r. P r os ta t it is an d r el at ed d is or de rs .
In : W als h P C, R e tik A B, S tam ey TA , e d s . C amp -
be lls um 1o gv 5 th ed . Ph ilade lph ia : S aunders ,
1986 :807 -823
3 . W e in be rge r M , P itlik S D , R ab in ov itz M , e t a l.
Per- recta l u l t rasonography fo r d iag nos is o f an d
gu id e to dra inage of prosta t ic absces s .
Lanc e t
1985 :5 :772
4 . C haabouni M N , P feife r P . F errand is P . et a l. P lac e
de Ia
ponc t ion t rans r {233}c ta le
{233}cho-gu id {233}ela ns Ic
t ra i t temen t des a bces
prosta t iques.
Ann Urn
1994 :28 :24-27
5 . Jaco bsen JD , K vis t E . P ro sta t ic absc ess : a rev iew
o f li tera tu re an d a prese nta tio n
of 5
cases.
S cand J
Urn ephrn 1993;27:281-284
6. D avidso n K C, G arlow W B ,
Brewe r
J.
Compu t e r -
i ze d t om o gr ap hy of prosta t ic an d per iu re th ra l ab -
scess :
2 case re po r t s . J U r n 1986 :135 :1257-1258
7 . K adm on D , L in g D , Lee
JK T
Percu taneous
d ra in ag e o f p ro static absces s . J
Urn 1985 :135 :
1259-1260
8 . T ra uz zi
SJ , Kay C i, K aufm an 0G .
Lowe
FC .
M a n a g e m e n t
of pros ta tic abscess in pa tien ts with
hum an im munodefic ien cy syn drom e. U rn ogy
1994 :43 :629-633
9.
Ku l igowska
E,
Ke l le r
E, Fem ic ci iT . T rea tm ent
of
pe lv ic a bs ces se s : v a lu e o f o n e- st ep s o no g ra p h-
ic ally g uid ed tr an sre cta l n ee dle a sp ira tio n a nd Ia -
v a ge . A iR 1995 :164 :201 -206
10 . Lee F J r. L ee F , So lom on M H , S tau b W H ,
McLear y RD . S o no g ra p hi c d e mo n st ra ti on o f p ro s-
ta t ic
absces s . J U llrasound M ed
1986 ;5 : l0 l -102
11 . Cytron 5, W einberg er M , P itlik SD , S ervad io C .
Va lue o f t ra n sr ec ta l u lt ra so n og ra ph y f or d ia gn o si s
an d trea tm en t o f p ros tatic ab scess . U rnlogv
1988;32 :454-458
12 . Thornh il l B A , Morehou s e H T , Co l eman P . Hoff-
m an T re tin JC . P rosta tic abscess: C T and so no-
g ra ph ic fi nd in gs . Ai R 1987:148:899-900
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