Nakamura Makoto, Matsukawa Masanori
Department of Urology, Takikawa Municipal Hospital, Takikawa, JPN.
Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, JPN.
Cureus. 2024 Dec 11;16(12):e75573. doi: 10.7759/cureus.75573. eCollection 2024 Dec.
We report here a rare case of a concurrent occurrence of abscesses caused by in the prostate, seminal vesicles, and epididymis. A 71-year-old male presented to our hospital with urinary retention, and an indwelling urethral catheter was inserted. He remained afebrile until a revisit one month later when he developed a fever and left scrotal swelling. Imaging studies revealed multiple abscesses in the left lobe of the prostate, bilateral seminal vesicles, and the left epididymis. Ceftriaxone was initiated upon admission and was administered for five days before switching to cefazolin for an additional 11 days. From the sixth day of admission, levofloxacin was added to ensure adequate prostatic tissue penetration until the 18th day. Owing to his poor response to antimicrobial chemotherapy, percutaneous prostatic needle aspiration, percutaneous cystostomy, transurethral deroofing of the abscess, and left orchiectomy were performed on the eighth day. Methicillin-susceptible was isolated from the urine and abscess fluid. The patient had no recurrence at one year postoperatively. A prostate abscess may not manifest as fever or elevated prostate-specific antigen levels, even when is the causative agent, and can lead to delayed diagnosis and subsequent involvement of the seminal vesicles and epididymis.
我们在此报告一例罕见病例，患者前列腺、精囊和附睾同时出现由[病原体未明确]引起的脓肿。一名71岁男性因尿潴留前来我院就诊，遂插入留置尿道导管。在一个月后的复诊前他一直未发热，复诊时出现发热及左侧阴囊肿胀。影像学检查显示前列腺左叶、双侧精囊及左侧附睾有多处脓肿。入院时开始使用头孢曲松，用药五天后换用头孢唑林，再用11天。自入院第六天起加用左氧氟沙星以确保药物充分渗透至前列腺组织，持续至第18天。由于其对抗菌化疗反应不佳，在第八天进行了经皮前列腺穿刺抽吸、经皮膀胱造瘘、脓肿经尿道去顶术及左侧睾丸切除术。从尿液和脓肿液中分离出对甲氧西林敏感的[病原体未明确]。患者术后一年无复发。即使[病原体未明确]为致病原，前列腺脓肿也可能不表现为发热或前列腺特异性抗原水平升高，从而导致诊断延迟及随后精囊和附睾受累。
