SHM Converge Scientific Abstract ePoster Gallery-Beyond the Bladder: A Prostatic Abscess Presenting as Recurrent Utis

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A 50-year-old man with poorly controlled type 2 diabetes and hypertension presented with recurrent urinary urgency, frequency, dysuria, fever, and prior urinary retention after recent Foley catheter removal. He had been treated multiple times for presumed UTI/prostatitis: initial Foley placement and tamsulosin for retention, then ceftriaxone followed by a 7-day course of cefpodoxime after catheter-related pain and hematuria.<br /><br />On re-presentation, he was febrile, tachycardic, and had suprapubic tenderness. Labs showed leukocytosis and urinalysis with pyuria, hematuria, nitrites, and bacteria. Recurrent urine cultures eventually grew Staphylococcus aureus, Klebsiella pneumoniae, and pan-sensitive Pseudomonas aeruginosa; blood cultures also grew pan-sensitive Pseudomonas aeruginosa. CT abdomen and pelvis revealed a 1.7 x 1.5 x 2.4 cm peripherally enhancing fluid collection in the right lateral prostate, consistent with a prostatic abscess. Endoscopic ultrasound biopsy for possible insulinoma was negative.<br /><br />The patient was treated with IV levofloxacin, started on finasteride, and discharged on 4 weeks of oral levofloxacin with outpatient urology follow-up and repeat imaging planned.<br /><br />This case highlights that recurrent UTIs in men should prompt evaluation for structural abnormalities such as a prostatic abscess, especially in patients with risk factors like diabetes and urinary retention. Imaging should not be delayed, as missed diagnosis can lead to bacteremia, sepsis, and increased morbidity. Treatment differs from uncomplicated UTI and generally requires prolonged antibiotics, with drainage considered for larger abscesses.

Asset Subtitle

Alyssa Kramer

Meta Tag

Author List Adam Ard, Alyssa Kramer, Doris Lin, Parin Thakkar

Category Clinical Vignettes

Concept Urinary Tract Infection

Concept Prostate Abscess

Concept Structural Cause

Concept Female Sex

Concept Urinary Retention

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Alyssa Kramer

Track Adult

Keywords

prostatic abscess

recurrent urinary tract infection

type 2 diabetes

urinary retention

Pseudomonas aeruginosa

Staphylococcus aureus

Klebsiella pneumoniae

bacteremia

CT abdomen pelvis

prolonged antibiotics

Urinary Tract Infection

Prostate Abscess

Structural Cause

Female Sex

Urinary Retention