Prostate Abscess: Pathogenesis, Evaluation, and Management

Generally, an abscess forms after a severe inflammatory reaction to an infectious process. It is a collection of purulent material that includes cellular debris, liquefied infectious agent tissue, bacteria, leukocytes, and enzymes.

A prostatic abscess is a localized collection of purulent fluid within the prostate, which often forms as a complication of acute bacterial prostatitis. It is difficult to clinically distinguish acute bacterial prostatitis from a prostatic abscess based solely on presenting symptoms, history, and physical examination.

A prostate abscess can cause severe urosepsis and septic shock.

If appropriate measures are not taken in a timely manner, these conditions still lead to death. Acute bacterial prostatitis usually affects men aged 20 to 40 years and >60 years. Symptoms are usually acute and include frequency, perineal pain, and dysuria. The urine becomes infected and systemic symptoms such as fever, malaise, chills and muscle pain usually appear.

Many patients experience difficulty urinating or even urinary retention. Those who undergo intermittent catheterization are at higher risk, with lifetime probability as high as 33%. Any male patient presenting with a urinary tract infection (UTI) and fever should be considered at risk for acute bacterial prostatitis.

In modern medicine, the number of patients with prostate abscess has decreased considerably due to the careful use of antibiotics. However, prostate abscesses remain relatively common in developing countries and in high-risk patients such as men who have undergone urological procedures, such as prostate biopsies.

Other men at high risk include those with significant chronic medical conditions such as diabetes, patients with end-stage renal disease on hemodialysis, liver cirrhosis, cancer patients receiving chemotherapy, transplant recipients, patients with HIV/AIDS, men with benign prostate disease inadequately treated. hyperplasia and others with immunodeficiency.

Due to the lack of clear research and treatment guidelines and the fact that it is now relatively rare, a prostate abscess can be challenging to diagnose and treat in the real world, leading to significant morbidity. On the other hand, many physicians are relatively unfamiliar with prostate abscess having seen very few cases due to its infrequent presentation.

Prostatic abscess often develops as a complication of acute prostatitis, primarily due to reflux of infected urine into the prostatic ducts during urination.

They generally occur in patients with poorly controlled diabetes or a compromised immune system.

More than 50% of those affected are diabetic. Although rare in the current era of antibiotics, patients who do not receive appropriate or adequate treatment for acute prostatitis are at high risk of developing an abscess.

Men at risk for prostate abscess are those with indwelling Foley catheters or a suprapubic catheter, neurogenic bladder dysfunction, poorly controlled diabetes, liver cirrhosis, end-stage renal failure, or immunocompromised patients, including those HIV positive.

Patients who intermittently self-catheterize or have bladder outlet obstruction are also more prone to prostate abscess formation. Any significant type of voiding dysfunction, whether due to neurological diseases or severe benign prostatic hyperplasia and some forms of pelvic injury, also places patients at higher risk.

Despite the increasingly widespread use of antibiotics, recent literature shows an increased occurrence of abscesses after prostate biopsies.

In the literature of the pre-antibiotic era, sexually transmitted organisms such as Neisseria gonorrhoeae and Chlamydia were the most commonly identified pathogens in prostate abscesses. This was often complicated by spontaneous rupture into the urethra, perineum, or rectum and was associated with a 50% mortality rate. More recent data indicate that the most common causative agent in the modern era is gram-negative bacteria.

In a meta-analysis, more than 70% of prostate abscesses were attributed to Escherichia coli followed by Klebsiella, Pseudomonas, Proteus, Enterobacter, Serratia, and Enterococcus species. Staphylococcus aureus , the cause of prostatic abscesses, is also well documented, possibly through hematogenous spread of osteomyelitis, chronic gingivitis, extensive boils (furunculosis), or rheumatic fever. S. aureus also appears to be an increasingly common causative organism. These patients tend to have higher temperatures, require somewhat longer antibiotic treatment, and are more likely to have diabetes than other patients with prostate abscess. Klebsiella pneumoniae is increasingly found in cultures of prostate abscesses, as well as fungal organisms such as Blastomyces, Cryptococcus , and Nocardia .

In a case series of melioidosis , Burkholderia pseudomallei was found to be a relatively common pathogen in prostatic abscesses. Mycobacterium tuberculosis is a rare cause and is almost always associated with some degree of immunodeficiency. Although E. coli is the most common causative organism of community-acquired prostate infections, nosocomial infections are much more likely to involve Pseudomonas aeruginosa , Enterococcus or S. aureus , have a more virulent and aggressive presentation, as well as more probability of developing sepsis, more frequently showing greater resistance to antibiotics and a greater propensity to progress to a prostate abscess.

In general, older men will develop a prostate abscess as a complication of a prostate biopsy, benign prostatic hyperplasia, or inadequately treated acute bacterial prostatitis. Often, patients will have a good initial response to antibiotic treatment.

Several studies have shown that about 10% of men with prostate abscesses have recently undergone prostate biopsies.[16][17] It has also developed after prostate cryotherapy, brachytherapy, intravesical BCG therapy, and other types of urologic instrumentation.[7] Risk factors include poorly controlled diabetes and an immunocompromised state.

Patients at risk often present in a weakened state or with other signs of poor general health. In younger men, a prostate abscess may be the first sign of an underlying debilitating or chronic medical condition. For example, 17 to 25% of younger men presenting with a prostate abscess were found to have previously undiagnosed diabetes.

The global incidence of prostate abscess can reach 0.5% of all urological diseases.

The mortality rate is 1 to 16%, and almost 6% of all patients with acute bacterial prostatitis will develop a prostate abscess.

In general, patients in the older age group are more frequently affected due to a higher incidence of underlying medical risk factors and a higher likelihood of urological procedures, such as prostate biopsies.

Prostate abscesses due to sexually transmitted organisms will tend to occur in younger men. On the other hand, younger men who develop prostate abscesses are likely to have a prior undiagnosed chronic medical condition.

Typically, the pathogenesis of a prostate abscess is due to suboptimally treated acute or chronic bacterial prostatitis. Infection of the prostate tissue occurs as a result of reflux of infected urine into the prostate ducts, or there may be direct contamination through a transrectal needle during a prostate biopsy.

Inadequate antibiotic prophylaxis and systemic risk factors that promote infections lead to acute/chronic bacterial prostatitis and/or prostatic abscess.

Other localized infections that predispose to the formation of a prostatic abscess include urinary tract infections, epididymitis, gonorrhea, and pyelonephritis.

Hematogenous spread from a distant primary infected focus, such as a liver abscess, abrasion, bronchitis, otitis, perinephric abscess, appendicitis, diverticulitis, boils, or other skin and subcutaneous infections causing bacteremia, primarily due to S. aureus , could also lead to the formation of a prostate abscess. Additionally, one prostate abscess was reported after placement of hydrogel spacers prior to radiation therapy for the treatment of prostate cancer.

Rarely, an emphysematous prostate abscess may develop from a urinary tract infection with gas-forming organisms, particularly in patients with poorly controlled diabetes. Although rare, these cases of emphysematous prostate abscesses show a more rapid progression of the disease and a very high mortality rate (25%).

In general, early diagnostic imaging in suspected cases clearly demonstrates the presence of gas in the wall of the prostate or bladder. Typical gas-forming organisms include Escherichia coli , Klebsiella pneumonia , and Staphylococcus aureus .

In all cases of bacterial prostatitis, a complete history of all underlying medical illnesses and any risk factors for immune compromise should be obtained promptly. This helps evaluate the potential risks of developing a prostate abscess.

Persistence of symptoms in acute or chronic bacterial prostatitis, especially in patients with high-risk factors or inadequate prior treatment, should alert clinicians to the need to evaluate for an abscess. As this pathology commonly derives from an ascending infection of the urinary tract, patients present various urinary symptoms such as frequency, urinary urgency, dysuria, hematuria and urethral burning.

In some cases they may have difficulty urinating or even acute urinary retention. More specifically, perineal discomfort should point to a prostatic etiology. Other systemic manifestations of infectious etiology are fever, chills, myalgia, and low back pain. Terminal hematuria and expression of frank pus from the urethra are possible but uncommon presenting symptoms. Up to a third of patients may present only systemic signs of infection.

Physical examination findings that may occur in the presence of a prostatic abscess include purulent urethral discharge, painful digital rectal examination, and possible fluctuating areas in the prostate.

Unfortunately, the authors say, the mere finding of a sore, swollen, and tender prostate does not distinguish a prostate abscess from prostatitis, and fluctuation is found in only 16% of cases of prostate abscess.

Virtually all patients will have a tender, tender prostate on digital rectal examination, and more than 90% will demonstrate leukocytosis and pyuria.

In addition to being quite painful for the patient, digital rectal examination risks exacerbating infection and possible sepsis. Therefore, clinicians should be highly suspicious of the presence of a prostate abscess in any patient with acute prostatitis who is high risk due to presentation and comorbidities, or who does not respond rapidly to treatment (within 48 hours).

The diagnosis of prostate abscess based solely on history and physical findings is difficult because the symptoms are nonspecific and overlap with other lower urinary tract pathologies. A high level of clinical suspicion is necessary for early diagnosis and timely management, particularly in unresponsive patients with acute prostatitis. Patients with acute prostatitis who do not respond to treatment after 48 hours should be evaluated for possible prostatic abscess.

Due to its rare incidence and non-specific clinical characteristics, the diagnosis of prostate abscess is often delayed. Necessary investigations include a complete blood count with urinalysis, blood and urine cultures, used to evaluate underlying infectious diseases and chronic medical conditions and identify the source of infection.

If there is suspicion of a prostate abscess based on history and physical findings or basic laboratory results, imaging is indicated to confirm the diagnosis and guide treatment, as it helps with drainage procedures.

Prostate images can be obtained using transrectal prostate ultrasound, CT, or prostate magnetic resonance imaging (MRI).

Transrectal ultrasound is usually the initial diagnostic test for a prostate abscess. It can accurately identify a prostate abscess, at least in 80% of affected patients. Findings of hypoechoic areas with well-defined walls and septa suggest an abscess. They are typically found in the transitional and central zones.

Ultrasound also has the advantage of allowing immediate treatment through transrectal needle aspiration of the abscess, for therapeutic drainage and culture (aspiration requires a thick needle, at least 18 gauge.) Transrectal ultrasound is inexpensive, it avoids radiation exposure, is familiar to most urologists, and is readily available. However, it can be uncomfortable for the patient, depending greatly on the operator, does not indicate spread outside the prostate, and may involve significant manipulation of an infected organ.

CT of the abdomen and pelvis (with and without intravenous contrast) can better delineate the spread of any prostate infection to adjacent organs, and is especially useful in more severe cases or sicker patients. It is the imaging modality of choice for emphysematous prostate abscesses, since the gas and liquid mixture is clearly visualized. CT scans can also identify enlarged lymph nodes, but this is usually a nonspecific finding. It may also be difficult to differentiate small abscesses from benign cystic prostatic nodules using CT alone. If necessary, confirmation can be obtained by transrectal ultrasound.

Magnetic resonance imaging ( MRI) is also used to obtain prostate images, even in very sick patients. The abscess is evident as a hypointense area on the T1-weighted image and hyperintense on the T2-weighted image. The abscess will typically appear as a cystic lesion with thick walls. The interior can be septate or heterogeneous.

A prostatic abscess will usually appear as an area of ​​restricted diffusion, which correlates with the T2-weighted lesion. Contrast-enhanced MRI readily shows thick-walled fluid collection and is very useful in detecting local extraprostatic extensions. In general, MRI has better soft tissue resolution and diagnostic accuracy than CT images and is more sensitive than transrectal ultrasound in the very early stages of abscess formation, where ultrasound is often inconclusive.

Using MR imaging in conjunction with transrectal ultrasound fusion guidance can greatly assist transrectal aspiration by making the target abscess more visible than with ultrasound guidance alone. Although MR imaging can be improved with the help of endorectal coils, these instruments are often too large and painful for use in patients with prostate abscesses and acute prostatitis. However, an external phased array pelvic/prostatic MRI antenna is commercially available and greatly improves image quality and resolution on 1.5 and 3 Tesla resonators, without the need for an endorectal coil ( such an array is most commonly used to improve imaging and detection of prostate cancer).

In summary , patients with high-risk acute prostatitis (immunocompromised) and immunocompetent patients with acute prostatitis who do not improve within 48 hours of initial treatment should be evaluated for prostate abscess. Only a targeted imaging study (transrectal ultrasound of the prostate, CT or MRI) confirms the diagnosis, since the clinical signs of prostate abscess are indistinguishable from those caused by acute bacterial prostatitis.

Although transrectal ultrasound is usually the initial imaging study, prostate MRI should also be considered, as it avoids radiation exposure, easily identifies extraprostatic extensions, and provides clear, detailed images of the prostate without the need for prostate manipulation with a transrectal probe. Transrectal ultrasound and MRI fusion guidance is available to assist transrectal aspiration of the abscess.

Early diagnosis is important because prostate abscesses require prolonged therapeutic protocols and, sometimes, surgical drainage.

Although surgical procedures are not necessary in all cases of prostate abscesses, surgical drainage has been shown to shorten antibiotic use and hospitalizations, as well as improve voiding function. It is highlighted that there are currently no strict guidelines or algorithms for the management of prostate abscesses. The standard guideline is expert consensus.

If a prostate abscess is clinically suspected, diagnostic evaluation with transrectal ultrasound or another alternative imaging modality should be performed to determine the size, number, extent, and exact location of any abscess. Conservative management is reasonable for abscesses up to 1 cm in diameter, but may extend to 2 cm abscesses, but surgical aspiration and drainage usually speeds recovery and reduces hospital stay.

Patients treated conservatively should be monitored closely, as if significant improvement does not occur they may require surgical drainage. Patients who do not respond to initial ultrasound-guided drainage should undergo additional imaging, such as CT or MRI, to rule out extraprostatic spread of the abscess, in which case open drainage may be warranted.

According to the available literature, smaller abscesses (<2 cm in diameter) responded well to medical treatment, while larger abscesses (>2 cm in diameter) responded better to surgical unroofing, transurethral prostatic resection, or surgical procedures. similar drainage. Smaller abscesses, usually ≤2 cm, may respond to nonsurgical treatment, but without a surgical drainage procedure, complete resolution will likely take longer.

Conservative management includes broad-spectrum intravenous antibiotics requiring hospitalization. Empiric antibiotic therapy should initially target primarily gram-negative organisms. Antibiotic adjustment could be based on urine cultures and Gram stain results that show evidence that allows suspicion of another etiology, such as gram-positive bacteria, or rare causes, such as fungal organisms.

Commonly used first-line antibiotics are levofloxacin (renal dose adjusted), broad-spectrum beta-lactam penicillin, or a cephalosporin. The addition of an aminoglycoside (tobramycin 5 mg/kg/day) should be considered in the initial treatment regimen, depending on the severity of the disease. A minimum 2-week course of antibiotics is required for complete resolution, although the traditionally recommended duration is 4 weeks. Many men require a longer course of treatment, with the average patient receiving a little more than 30 days of medical treatment. Serial imaging should be used to monitor and confirm complete resolution of the abscess.

The emergence of more resistant organisms , such as extended-spectrum beta-lactamase-producing Enterobacteriaceae and methicillin-resistant S. aureus , has greatly complicated treatment, since up to 75% of the organisms that cause prostate abscesses are resistant to antibiotics. first generation. This requires the use of intravenous carbapenem, third-generation cephalosporins, aztreonam, amikacin, or various combinations while awaiting the results of blood and urine cultures, especially in patients who present with febrile UTIs or sepsis after prostate biopsies.

Oral fluoroquinolones or trimethoprim-sulfamethoxazole can be used later and in afebrile patients, provided bacterial susceptibility is confirmed. It is recommended to repeat cultures after 1 week of treatment. Traditional therapy has required 4 weeks of continuous antibiotic therapy, but some studies have shown that 2 weeks may be sufficient, at least in some cases.

There is some controversy regarding drainage with a urethral catheter vs. suprapubic cannula.

Urethral drainage with a Foley catheter or intermittent catheterization may induce more prostate manipulation, be uncomfortable or painful for the patient, and lead to infection. The standard recommendation for patients with problems emptying the bladder is to use a suprapubic tube to avoid further irritation and manipulation of an inflamed and infected prostate.

About 80% of patients will ultimately require early surgical drainage depending on their general condition or the size of the abscess. Different approaches have been described for ultrasound-guided abscess drainage, namely transrectal drainage, transurethral unroofing, resection or transperineal aspiration and evacuation. Each approach has its advantages and disadvantages. After a single aspiration, the reported recurrence rate ranges between 15% and 33%. Nearly one-third of patients will eventually require transurethral prostate resection.

In the past, transurethral drainage (resection) was the most commonly selected therapy due to the reduction in hospital stay days. It is also the procedure of choice for larger abscesses and for those in which aspiration alone has been inadequate. However, some experts are concerned about possible complications, such as postoperative voiding dysfunction. Transurethral resection may also miss small prostatic abscesses.

Transurethral drainage of a prostate abscess can be achieved using a holmium laser. This has the advantage of minimizing manipulation of infected tissue and can be used safely in anticoagulated patients, as well as those with untreated coagulopathies. Another approach that has been used successfully involves transrectal endoscopic ultrasound-guided drainage, which may be appropriate for selected individuals, especially when the abscess is larger and close to the rectum or, if for some reason, a procedure cannot be performed. transurethral or is not recommended.

Because the abscess is not always visible by cystoscopy, physicians should be prepared to perform an extensive transurethral resection. After transurethral resection of the prostate, transient bacteremia is not uncommon, but limited unroofing rarely results in septicemia. Some have recommended prostate massage after transurethral unroofing, in order to more completely clean and drain the abscess cavity, but this involves significant additional manipulation of an infected organ, with the potential to spread the infection. Therefore, it should only be done after carefully considering the potential benefits and risks.

Currently, the first-choice approach is transrectal ultrasound-guided drainage , especially for smaller abscesses (<2 cm in diameter), because it only requires local anesthesia, has a low risk of complications, and is easy to repeat if necessary. . A ≥18 gauge needle should be used, as the abscess contents may be particularly thick and thick, making aspiration with smaller instruments difficult.

A sample must be sent for culture, even if previous cultures have been performed.

Irrigation through the needle may also be necessary to reduce the viscosity of the purulent material and allow aspiration. If possible, aspiration and irrigation should be repeated and continued until clearance. While a single aspiration is usually sufficient for most cases, when the patient does not improve and imaging suggests that other treatment would be helpful, the procedure may be repeated. If no improvement after 2 aspirations, drainage, usually a transurethral resection or unroofing, is indicated.

Sometimes, an option is transcutaneous perineal aspiration, which can be done under tomographic guidance. Aspiration guided by the fusion of MRI and transrectal ultrasound is also possible using the same technology as for targeted prostate biopsies. Transurethral resection is recommended for larger abscesses and in patients in whom ultrasound-guided transrectal aspirations have failed.

If the abscess has spread to deeper tissue, such as the levator ani muscle, open surgical drainage may be necessary, but should be avoided whenever possible due to prolonged wound healing, possible fistula formation, and potential development of superinfections.

The prognosis of patients with prostate abscess depends mainly on timely diagnosis and adequate treatment, as well as the previous general health status and comorbidities.

Early recognition of this disorder with timely and appropriate treatment modalities markedly improves the prognosis.

Patients treated conservatively can avoid a surgical procedure, but will typically require longer-term antibiotic therapy. Regardless of the interventions, the period of antibiotic therapy is longer in cases of prostatic abscess than in patients with similar acute bacterial prostatitis, without such abscesses.

The prognosis also depends on the underlying medical conditions that contribute to the development of the abscess. Poor prognostic factors include: age >65 years, temperatures >38ºC, history of urinary retention or symptomatic benign prostatic hyperplasia, indwelling Foley catheter, uncontrolled or poorly controlled diabetes, HIV/AIDS, weakened general health, and renal failure. It is a potentially fatal condition if not diagnosed promptly and properly treated in a timely manner.

Any delay in diagnosis and timely treatment means that prostate abscess can cause serious complications as well as great morbidity and mortality.

The infection can spread locally to adjacent perineal areas, which could require more invasive interventions with long-term complications involving genitourinary functions. In severe cases, bacteremia and sepsis may occur, which can then lead to septic shock and multiple organ failure, increasing mortality. Emphysematous prostatitis, which manifests itself with gas within the abscess cavity, is particularly virulent and is associated with high mortality.

> Postoperative care and rehabilitation

After surgical drainage procedures, most patients improve fairly quickly. Serial imaging and repeat urine cultures should be performed to optimize therapy and ensure complete resolution of the abscess. In general, oral antibiotics such as fluoroquinolones or trimethoprim-sulfamethoxazole can be replaced by intravenous antimicrobials, depending on the urinary antibiogram. Traditional treatment requires at least 4 weeks of antibiotics, although some patients have responded well to as little as 2 weeks. One option is to treat the patient a little longer rather than risk a recurrence.

> Patient deterrence and education

In the modern era it cannot be assumed that a prostate abscess is simply a consequence of untreated prostatitis. Men with prostate abscesses often have significant medical problems and are commonly severely weakened or immunologically compromised. A prostate abscess may be the initial presentation of a previously undiagnosed immunocompromising condition in the younger population.

It is becoming more common in older men as a complication of benign prostatic hyperplasia or a prostate biopsy. Due to how difficult it can be to distinguish a prostate abscess in a patient with acute bacterial prostatitis and the importance of adherence to prolonged antibiotic treatments, it is very important to raise awareness among patients about the seriousness of this pathology, and among doctors, to that have a high index of suspicion, to make a timely diagnosis and, in turn, initiate appropriate treatment.

Patients with lower UTI and prostate infections should be counseled to monitor for warning signs and symptoms of abscess formation. In particular, those who develop febrile UTIs after a prostate biopsy are at high risk of developing prostate abscess. The emergence of more resistant bacterial strains and the relatively frequent presentation of this condition in diabetic and immunosuppressed patients, real-life scenarios that present increasing challenges in the diagnosis and management of these patients.

> Summary

Diabetes is the most prevalent risk factor for the formation of prostate abscesses and is found in more than 50% of patients who develop the disorder.

The diagnosis of a prostate abscess cannot be confirmed based on clinical history and physical findings alone because the symptoms are too nonspecific.

Prostatic abscesses are relatively rare and usually present with nonspecific symptoms, making it difficult to differentiate them from acute bacterial prostatitis and similar infections. This often results in delayed diagnosis and treatment, contributing to the morbidity and mortality of this condition.

A high level of clinical suspicion is required for early diagnosis, timely treatment, and optimal outcomes, particularly in high-risk individuals and unresponsive patients with acute prostatitis.

Younger patients with a prostate abscess should be evaluated for underlying predisposing medical conditions such as diabetes.

Patients treated for acute bacterial prostatitis who do not improve after 48 hours of treatment, especially high-risk immunocompromised individuals, should be immediately evaluated for prostatic abscess with appropriate imaging.

To confirm the diagnosis, prostate imaging with transrectal ultrasound, CT or MRI is needed. Transrectal ultrasound and MRI fusion guidance can be used to help identify prostate abscesses that require transrectal aspiration.

Thick needles (at least 18 gauge) are recommended for aspiration, as the contents of the abscess can be quite thick and viscous. While awaiting culture results, initial antibiotic therapy for any febrile male with UTI or acute bacterial prostatitis should be intravenous carbapenem, third-generation cephalosporins, aztreonam, amikacin, or various combinations, due to the high rate of bacterial resistance to the agents. first-line antimicrobials. This is especially important in patients with febrile urinary tract infections after prostate biopsies. Abscesses <2 cm in diameter can be treated conservatively with specific antibiotics based on the antibiogram, but will respond more quickly if the abscess is aspirated and drained.

A holmium laser may be used for abscess unroofing or prostatic resection in selected cases where anticoagulation cannot be stopped or untreated coagulopathy exists.

Fluoroquinolones or trimethoprim-sulfamethoxazole are the commonly recommended oral antibiotics, as appropriate by culture results, after completing initial broad-spectrum antimicrobial coverage. Antibiotic therapy usually takes at least 4 weeks, although there is evidence that 2 weeks may be sufficient in some cases.

Serial follow-up imaging and urine cultures are recommended to ensure complete resolution of the abscess.

Prostate abscesses often go undiagnosed because symptoms can overlap with other urinary tract diseases. Because of the need for subspecialty evaluation and management, primary care providers and internists must participate along with surgical and urologic services to improve outcomes.

Interdisciplinary team communication and care coordination among endocrinologists for diabetes management, infectious diseases, and ancillary services such as nutrition and wound care team play an important role in improving prognosis and reducing complications.

The treating physician may also request the assistance of an infectious disease specialist or board-certified pharmacist, who can assist in agent selection, provide the latest antibiogram data, verify dosing, and perform medication reconciliation.

The pharmacist or infectious disease specialist should educate the patient about compliance with antibiotic treatment. Furthermore, it is vital that primary care physicians adequately control blood glucose, advise the patient on safe sexual practices, and when it is necessary to request additional treatment. These educational processes can benefit from nursing staff who will not only provide training and answer questions, but also be able to follow up, evaluate the effectiveness of the treatment, and inform the doctor of any concerns.

Open communication among the team is vital to minimize morbidity and mortality. Patients with prostate abscesses should be closely monitored, as if appropriate and timely treatment is delayed they may experience a high mortality rate. All of this creates the need for interdisciplinary teamwork to achieve optimal results.