Tariq Arsalan, Stewart Adam G, Desai Devang J, Britton Sumudu, Dunglison Nigel, Esler Rachel, Roberts Matthew J
Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Curr Urol. 2023 Jun;17(2):100-108. doi: 10.1097/CU9.0000000000000159. Epub 2022 Oct 12.
This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework.
After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods.
Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years.
Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.
本研究旨在使用系统评价框架描述尿道周围脓肿的临床表现模式、病因、危险因素、管理及治疗结果。
在PROSPERO数据库（CRD42020193063）进行前瞻性注册后，对Web of Science、Embase、PubMed和Cochrane科学数据库进行了系统评价。纳入1900年至2021年发表的文章。提取的数据包括症状、病因、病史、检查、治疗及结果。使用单变量方法分析整理后的数据。
60篇文章符合纳入标准，报道了270例尿道周围脓肿患者（男性211例，女性59例）。最常见的临床特征为疼痛（41.5%）、脓尿（41.5%）、排尿困难（38.5%）、尿频（32.3%）、发热（25%）及可触及肿块（23%）。易感危险因素包括存在性传播感染或尿路感染（55.0%）、尿道狭窄（39.6%）及近期尿道器械操作（18.7%）。管理方法包括切开引流（64.3%）、抗生素保守治疗（29.8%）及微创技术（针吸、内镜引流）。病因的时间趋势分析显示，近年来感染（性传播感染/尿路感染、人类免疫缺陷病毒）发病率下降，糖尿病及尿道周围填充注射发病率上升。
尿道周围脓肿可能表现出广泛的临床特征。临床表现、危险因素及潜在病因因性别而异。最佳管理技术取决于脓肿大小。切开引流联合抗生素仍然是主要的管理方法。然而，微创技术越来越受到青睐。据作者所知，这是首个针对尿道周围脓肿的系统评估及管理算法。
