Proximal Bulbar Periurethral Abscess
Sarah D. Blaschko, Dana A. Weiss, Anobel Y. Odisho, Kirsten L. Greene, Matthew R. Cooperberg
Department of Urology, University of California San Francisco, USA
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.