Proximal Bulbar Periurethral Abscess

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, B, C). 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 D). Transrectal ultrasound-guided needle aspiration was performed with return of 30 milliliters of frank pus and visible resolution of the abscess (Figure-1, Panel E). The patient had subsequent rapid clinical improvement. Although the abscess fluid culture was negative, he completed a two-week antibiotic course per infectious disease recommendations. Recommended periurethral abscess antibiotic coverage is culture-specific or treatment with an aminoglycoside and cephalosporin (¹). 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.

Figure 1
Panel A) Axial CT-scan of the pelvis demonstrating a rim-enhancing fluid collection (black arrow) at the level of the proximal bulbar urethra; Panel B) Coronal CT-scan showing the periurethral abscess (black arrow) adjacent to the prostate, which is distinct from the abscess; Panel C) Sagittal CT-scan showing the periurethral abscess (black arrow) adjacent to the prostate, which is distinct from the abscess; Panel D) Transrectal ultrasound demonstrating the proximal bulbar urethra (white arrow) within the abscess cavity prior to abscess drainage; Panel E) Transrectal ultrasound demonstrating the proximal bulbar urethra (white arrow) with resolution of the surrounding abscess cavity at the completion of needle aspiration.

REFERENCES

• ¹
  Walther MM, Mann BB, Finnerty DP: Periurethral abscess. J Urol. 1987; 138: 1167-70.
• ²
  Kraus S, Luedecke G, Ludwig M, Weidner W: Periurethral abscess formation due to Neisseria gonorrhoeae. Urol Int. 2004; 73: 358-60.
• ³
  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.

Publication Dates

• Publication in this collection
  Jan-Feb 2013

History

• Received
  27 July 2012
• Accepted
  23 Jan 2013