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 .

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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