V5-09: Holmium Laser Enucleation of a Prostatic Abscess
A prostatic abscess is a commonly encountered localized genitourinary infection, best treated with surgical resection. Traditional transurethral resection places the urinary sphincter in jeopardy of thermal injury in the event of an apically located abscess.
We present a 69 year old male with a several week history of dysuria and back pain. He presented to his local physician for evaluation and after CT imaging was diagnosed with a psoas abscess, diskitis/osteomyelitis and a prostatic abscess. The prostatic abscess was noted to be in an extremely apical location posing a significant risk of thermal injury with a standard resection. Therefore, a holmium laser enucleation of the prostatic abscess was performed.
After initial inspection of the bladder demonstrated asymptomatic ureteroceles, an incision was made at the bladder neck and carried to the depth of the surgical capsule distally to the verumontanum. The lateral dissection expresses purulence almost immediately and a large abscess pocket is encountered during the anterior dissection. The remainder of the enucleation is performed without complication. The patient was spontaneously voiding by POD 2 and discharged with IV antibiotics for 6 weeks to treat his osteomyelitis.
Holmium laser enucleation of a prostatic abscess can be performed safely and effectively to both maximally reduce the abscess cavity and risk of excessive thermal injury when treating an apically located abscess.