Proximal Bulbar Periurethral Abscess
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doi: 10.1590/S1677-5538.IBJU.2013.01.17
Sarah D. Blaschko, Dana A. Weiss, Anobel Y. Odisho, Kirsten L. Greene, Matthew R. Cooperberg
Department of Urology, University of California San Francisco, USA
Radiology Page
Vol. 39 (1): 137-138, January - February, 2013
A 67 year-old male with poorly controlled diabetes and persistent leukocytosis despite appropriate antibiotic treatment for pneumonia underwent computer-tomography (CT) scanning to evaluate for additional sources of infection. He was noted to have a 3.5 centimeter rim enhancing fluid collection at the level of his bulbar urethra (Figure-1, Panel A and B). Upon questioning, the patient recalled an aching testicular pain that had resolved one week prior. He denied any difficulty voiding, and post-void residual measurements were zero. Digital rectal exam, penile, scrotal, and perineal examination were normal. Transrectal ultrasound demonstrated an abscess surrounding the bulbar urethra (Figure-1, Panel C). Transrectal ultrasound-guided needle aspiration was performed with return of 30 milliliters of frank pus and visible resolution of the abscess (Figure-1, Panel D). The patient had subsequent rapid clinical improvement. The abscess fluid culture was negative, and he completed a two-week antibiotic course per infectious disease recommendations. Periurethral abscesses have been associated with gonococcal urethritis infections, urethral strictures, periurethral bulking agent injections, and urethral diverticulum (1-3). Periurethral abscesses are treated with antibiotic coverage and surgical or needle-aspiration drainage depending on abscess location. Evaluation for and treatment of underlying causes of periurethral abscesses is warranted.
References
- Walther MM, Mann BB, Finnerty DP: Periurethral abscess. J Urol. 1987; 138: 1167-70.
- Kraus S, Luedecke G, Ludwig M, Weidner W: Periurethral abscess formation due to Neisseria gonorrhoeae. Urol Int. 2004; 73: 358-60.
- Kenfak-Foguena A, Zarkik Y, Wisard M, Praz V, Darling KE, Jaton-Ogay K, et al.: Periurethral abscess complicating gonococcal urethritis: case report and literature review. Infection. 2010; 38: 497-500.
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Submitted for publication:
July 27, 2012
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Accepted after revision:
January 23, 2013
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Correspondence address:
Dr. Sarah D. Blaschko
Department of Urology
University of California, San Francisco
400 Parnassus Ave, A633
San Francisco, CA 94143
Fax: + 1 415 476-8849
E-mail: blaschkosd@urology.ucsf.edu