Definition of the disease. Causes of the disease

Prostate abscess is a life—threatening polyethological purulent-necrotic inflammatory disease in which purulent melting of the glandular tissues of the prostate occurs, followed by the formation of single or multiple purulent cavities. The resulting abscess in the prostate gland requires immediate, immediate inpatient treatment.

The prostate gland is normal and with an abscess
Prostatic abscess in most cases is a serious complication of acute or chronic infection of the lower urinary tract and occurs as a result of focal accumulation of pus in the prostate gland.

In the modern era of widespread use of antibacterial drugs, the incidence of prostate abscess has significantly decreased. To date, the prevalence of this pathology is about 0.5-2.5% of all prostate diseases and 0.2% of all urological diseases.[1]

The disease has become quite rare, especially in developed countries. A significant decrease in the incidence of prostate abscess was influenced by a decrease in the incidence of gonococcal urethritis, since before the advent of modern antibiotic therapy, 75% of prostate abscesses were caused by gonococcus, and the mortality rate from pathology ranged from 6 to 30%.[2] At the same time, despite the low prevalence of the disease, timely diagnosis and adequate treatment prostate abscesses remain serious problems for urologists.

Since the advent of antibiotic therapy, the bacteriology of prostate abscesses has changed. Historically, the causative agents of prostate abscess were Gonococcus, Staphylococcus aureus and Koch’s bacillus. Currently, the most common pathogens of the disease are gram-negative bacteria, such as E. coli and Staphylococcus.[3]

Predisposing factors of the disease:

various instrumental manipulations on the urethra;
use of permanent urethral catheters;
chronic renal failure (prolonged hemodialysis);
immunosuppression (HIV infection);
organ transplantation.
Most prostatic abscesses develop as a result of or against the background of acute and chronic prostatitis, as well as after a prostate biopsy. Thus, according to the literature, prostate abscess complicates the course of acute prostatitis in about 5% of cases and is the result of the progression of acute parenchymal inflammation in the prostate gland.[8]

In recent years, there have been reports that a prostate abscess is no longer considered a consequence of an untreated urinary tract infection.

In elderly patients, prostate abscess can complicate the course of benign prostatic hyperplasia. In younger men, prostate abscess may be the initial manifestation of chronic conditions such as diabetes mellitus, HIV infection and cirrhosis of the liver. Thus, more than 50% of men suffering from prostate abscess have diabetes mellitus.

In the specialized literature, cases of hematogenic bacterial spread of infection from distant foci (for example, the digestive tract and respiratory tract) have been described.[5]

If you find similar symptoms, consult a doctor. Do not self-medicate – it is dangerous for your health!
Symptoms of prostate abscess
Against the background of the widespread use of antibiotics, prostatic abscess has become quite difficult to diagnose in a timely manner, since it mimics and hides under the mask of other diseases of the lower urinary tract.[5]

The most pronounced clinical manifestations of the disease are signs of a severe septic condition:

an increase in body temperature (of a hectic nature, i.e. in the form of a debilitating fever) with chills;
intoxication;
increased sweating and palpitations;
it is possible to attach a violation of consciousness.
On the part of the organs of the urinary system , it may develop:

frequent urination;
dysuria (for example, soreness and difficulty in excreting urine);
sometimes acute urinary retention and hematuria (the presence of blood in the urine).[4][5]
Patients are concerned about pain in the lumbar region and perineum. A distinctive feature is that the pain syndrome has a unilateral localization, which corresponds to the prostate lobe affected by the inflammatory process.

By nature, the pain syndrome is intense, sharp, with pulsation, usually spreading to the rectum. In some cases, there is a violation, up to a delay in urination and defecation, sometimes the discharge of gases is difficult.

The above clinical manifestations of the disease are characteristic of the infiltration stage. After the transition of the pathological process occurring in the prostate to the stage of purulent destruction or during the separation of the abscess, some “improvement” of the patient’s condition occurs:

the intensity of the pain syndrome decreases;
the body temperature decreases.
However, such well—being is imaginary, since it is during this period that a breakthrough of the formed abscess into the fiber located around the urethra or the paravesical cellular space that is located around the bladder can occur, with the subsequent development of formidable complications (for example, phlegmon).

After there has been a spontaneous breakthrough of the abscess into the fiber located around the urethra (urethra), it is possible:

the appearance of pus in the urine;
change in the color and nature of urine (it becomes cloudy, flakes appear);
the addition of an unpleasant sharp smell.
In some cases, the opening of the prostate abscess into the lumen of the rectum occurs, followed by the formation of a rectal fistula. In this situation, patients note the appearance of an admixture of mucus and pus in the feces.

It should be noted that after the breakthrough of the abscess, complete emptying of the abscess cavity does not occur, therefore, a relapse of the disease is possible in the future.

Prostate abscess on the background of immunodeficiency (HIV infection) has its own characteristic features. Symptoms of intoxication significantly prevail in this category of patients:

weakness;
muscle pain;
prolonged increase in body temperature to subfebrile figures;
joint pain.[4][5]
At the same time, local manifestations of prostatic abscess are less pronounced. Sometimes, only with detailed questioning, it is possible to detect a slight deterioration in urination and the appearance of pulling pains in the perineum.

In HIV-infected patients, prostate abscess may occur against the background of septicopiemia (especially in heroin addicts).

Pathogenesis of prostate abscess
The prostate gland has a fairly high natural resistance to exogenous and endogenous infection. Therefore, the inflammatory process occurs only with the suppression or reduction of local (local) immunity and with very high virulence of microorganisms.

In order to understand how infection of the prostate gland occurs, it is necessary to familiarize yourself with the anatomy of the organ. It consists of two lobes, each of which includes 18-20 separate small lobes or lobules that open into a single common independent duct.

Anatomy of the prostate gland
With a prostate abscess , infectious agents enter the gland tissue in three ways:

through the outlet openings of the ducts located on the back of the urethra;
lymphogenically (with prolonged presence of a urinary catheter);
hematogenically, i.e. through the blood (with bacteremia).
Inflammation in the prostate gland is accompanied by the release of a large number of leukocytes and microorganisms. Further, as a result of treatment or mobilization of the body’s own defenses, the focus of acute or chronic inflammation is delimited.

Some authors suggest that prostate abscess is mainly a complication of bacterial prostatitis, acute or chronic, most often observed in men aged 50-60 years, but an abscess can occur at any age.[6]

Currently, Enterobacteria, especially E. coli, are the main causative agents of acute bacterial prostatitis and prostate abscess. Klebsiella sp., Proteus mirabilis, Enterococcus faecalis and Pseudomonas aeruginosa are less common.[7] Recently, there has been an increase in the number of cases of methicillin-resistant Staphylococcus aureus as a causative agent of prostate abscess in the literature.

The table shows the causative agents of acute prostatitis and prostate abscess.

Pathogens Microorganisms
THE MAIN E. coli (escherichia coli)
Klebsiella (klebsiella spp)
Proteus mirabilis
Enterococcus faecalis (enterococcus faecalis)
Pseudomonas aeruginosa (pseudomonas aeruginosa)
POSSIBLE
(value not proven) Staphylococci (staphylococcus spp.)
Streptococci (streptococcus spp.)
Corynebacterium (corynebacterium spp.)
Chlamydia trachomatis (chlamydia trachomatis)
Ureaplasma urealyticum (ureaplasma urealyticum)
Mycoplasma hominis

The inflammatory process contributes to the development of stagnation and swelling of the gland tissue, as well as the accumulation of metabolic products in the prostate, which causes its significant damage. The formation of small ulcers occurs, which later merge, forming a larger purulent cavity.

The excretory ducts of the prostate gland are clogged with purulent-necrotic detritus, and according to the tests, an imaginary improvement can be traced, although in fact the prostate abscess has already formed.

Schematic image of the prostate gland with foci of inflammation
In some cases, a prostate abscess occurs as a complication after various instrumental diagnostic or therapeutic manipulations on the bladder or prostate gland. The cause of prostate abscess may be obstruction of the excretory ducts of the organ by the stones formed.

Diffuse purulent inflammation
Classification and stages of development of prostate abscess
In some cases, a prostate abscess may be:

primary — independent pathological process;
secondary — a potential complication of other diseases (for example, acute prostatitis, which occurs against a background of weakened immunity) [8] or medical manipulations.
Since prostate abscess often develops against the background of prostatitis, it is worth getting acquainted with the classification of prostatitis syndrome developed by the National Institute of Health. It is based on clinical signs and laboratory indicators.

Category Name Description
I Acute bacterial
prostatitis is the process of inflammation of the prostate of an acute nature
II Chronic bacterial
prostatitis is the process of inflammation of the prostate
of a recurrent nature
III Chronic
Pelvic Pain Syndrome (SHTB) Absence of an obvious inflammation process
IIIA Inflammatory SHTB The cause of the disease is inflammation, the products
of which (leukocytes) can be found
in ejaculate, prostate secretions or urine taken
after prostate massage
IIIB Non-inflammatory SHTB Non-inflammatory nature of the pathology
(the products of inflammation mentioned above
are absent)
IV Asymptomatic
inflammation of the prostate Asymptomatic prostatitis of an infectious
nature, which can only be determined
based on the results of microscopic
examination
of prostate biopsy material or its secretions (usually it
is detected during examination for
other diseases)

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