Absceso prostático. Diagnóstico y tratamiento de un proceso urológico poco frecuente en la actualidad / Prostatic abscess: diagnosis and treatmente of an infrequent urological entity

OBJETIVO: Presentar dos casos clínicos de absceso prostático de difícil manejo y revisar el diagnóstico y tratamiento de esta entidad.MÉTODOS/RESULTADOS: Descripción de dos pacientes con absceso prostático. El primer caso es un varón diabético de 73 años a quien se le instaura un manejo conservador con drenaje percutáneo transrectal y quien tras una evolución tórpida fallece de una sepsis urológica. El segundo caso es un varón de 59 años con mala evolución clínica tras tratamiento antibiótico ambulatorio realizándose una resección transuretral de próstata con resultado satisfactorio.CONCLUSIÓN: El absceso prostático es una entidad rara. Afecta principalmente a personas debilitadas lo que le confiere un carácter grave. Las medidas encaminadas a su resolución deben ser rápidas y oportunas(AU)

OBJECTIVE: To report two cases of prostatic abscess of difficult management and review the literature on diagnosis and management of this entity.METHODS /RESULTS: We describe two patients with prostatic abscess. The first one, a 73-year-old diabetic male, was treated using a more passive approach with percutaneous transrectal drainage; after a slow response, the patient passed away due to sepsis. The second case was a 59-year-old male who experienced a negative clinical response to antibiotic treatment. While under antibiotic ambulatory care the patient was treated with a transurethral resection of the prostate, which yielded a successful outcome.CONCLUSION: Prostatic abscess is a rare entity that affects individuals experiencing weakness and can be a serious condition. Measures taken to arrive at a resolution must be rapid and appropriate(AU)

Antimicrobials for the treatment of bacterial prostatitis. Historical developments and current trends.

The treatment of bacterial prostatitis has always been difficult since only few substances have proven effects in clinical practice. The reason for this was investigated by animal studies in two steps. First a model of experimental bacterial prostatitis was developed. Then pharmacological studies with determination of penetration of various antimicrobial substances into serum, interstitial fluid, urine and prostatic secretion were performed. As a result we could show, that the place of the inflammatory process is the interstitium with only little effects in the prostatic acini. Thus only substances with good concentration in the interstitium can be expected to be effective in the eradication of bacterial invasion of the prostate gland. These are the basic macrolide erythromycin for gram-positive germs, the amphoteric tetracyclines or the newest quinolones for gram-negative bacteria, mycoplasma or chlamydiae.