Prostatic Abscess

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Prostatic Abscess

  • Belgian Malinois

    • Belgian Malinois
    • 10yo MI
    • Presented with Dysuria, stranguria, anoexia, ADR of about 3-4 day duration
    • CBC: WBC 30.5, 25 neutrophils   U/A :  Active sediment
    • Palpated an enlarged asymmetric prostate
    • Ultrasound guided FNA of prostatic cyst with 22g needle removed ~80 cc of viscous turbid yellow green fluid. Injected baytril as described in ADAIN.
    • Aerobic/anerobic culture negative
    • Patient clinically improved with baytril and cyst drainage.
    • Scheduled recheck 7 days later revealed that the cyst refilled. FNA removed similar colored but less viscous fluid.
    • Culture again was negative.
    • Clinically Patient is back to normal! Neuter is schedule for this week. I will check to see if the fluid filled cyst has returned at that time.

    Questions: 

    1. Because this thick discolored fluid did not grow any bugs, could this be a sterile abscess? or just culture failure
    2. Can I use a larger gauge needle? 20g? 18 g?
    3. How often does interventional FNA of an abscessed prostate result in peritonitis?
    4. If often do cases like this (I have another one I am working with that 2 months after neuter the prostatic abscess returned) is omentalization of the prostate recommended. Success rate??

Comments

randyhermandvm
June 3, 2015 at 3:23 am -

Your cyst is a baby cyst

Your cyst is a baby cyst compared to the one I recently saw.

https://sonopath.com/forum/prostatic-cyst

Rigby was systemically sick. We cultured a Staph intermedius. 

I drained 120 ml using an 18 guage IV catheter. Refilled within a week. I have suggested

surgery to the owner- but so far no go.

In the meantime Rigby seems to back his normal self. Go figure.

 

 

randyhermandvm
June 3, 2015 at 3:23 am -

Your cyst is a baby cyst

Your cyst is a baby cyst compared to the one I recently saw.

https://sonopath.com/forum/prostatic-cyst

Rigby was systemically sick. We cultured a Staph intermedius. 

I drained 120 ml using an 18 guage IV catheter. Refilled within a week. I have suggested

surgery to the owner- but so far no go.

In the meantime Rigby seems to back his normal self. Go figure.

 

 

EL
June 3, 2015 at 3:37 am -

I never trust cultures on

I never trust cultures on these things… but the cysts nearly never resolve without neuter. I shoot baytril right back in after fukl drainage and neuter at the same time. ADAIN procedure. Only time it didnt work was a crypt that I didnt in the caudal pelvic canal see nor had in the history.

http://sonopath.com/resources/interventional-procedures

EL
June 3, 2015 at 3:37 am -

I never trust cultures on

I never trust cultures on these things… but the cysts nearly never resolve without neuter. I shoot baytril right back in after fukl drainage and neuter at the same time. ADAIN procedure. Only time it didnt work was a crypt that I didnt in the caudal pelvic canal see nor had in the history.

http://sonopath.com/resources/interventional-procedures

VSI7tsherrill
June 4, 2015 at 5:52 am -

Thanks Randy and

Thanks Randy and Eric…..

Can I use a larger gauge needle ? 20?  The fluid was very thick. I actually injected sterile saline to attempt to dilute. This seem to help.  Also followed your advice about injecting batyril into the deflated cyst. 

Any reports of leakage or abscess rupture and subsequent peritonitis caused by percutaneous drainage of a prostatic abscess reported in the literature?

VSI7tsherrill
June 4, 2015 at 5:52 am -

Thanks Randy and

Thanks Randy and Eric…..

Can I use a larger gauge needle ? 20?  The fluid was very thick. I actually injected sterile saline to attempt to dilute. This seem to help.  Also followed your advice about injecting batyril into the deflated cyst. 

Any reports of leakage or abscess rupture and subsequent peritonitis caused by percutaneous drainage of a prostatic abscess reported in the literature?

EL
June 4, 2015 at 9:26 am -

This procedure hasnt been

This procedure hasnt been published that I know of…I want to but just no time to do so.. I named it the ADAIN and started doing them in 2002 and sometimes these things are already leaking..I have never had complijcations to this and would say I have done nearly a hundred of them. I have  a number of them documented but not all of course. I always cover with baytril clindamycin systemically after the baytril injection into the cavity.. they are sick form the volume of pus and not any minor leakage i believe.

Regarding needlesize i often use a 16 g or even 14 g IV catheter depending on how thick the material is.

Here is a good one..a  prototype for the procedure that already had leakage befor the adain. : http://sonopath.com/members/case-studies/search?text=adain&species=All

EL
June 4, 2015 at 9:26 am -

This procedure hasnt been

This procedure hasnt been published that I know of…I want to but just no time to do so.. I named it the ADAIN and started doing them in 2002 and sometimes these things are already leaking..I have never had complijcations to this and would say I have done nearly a hundred of them. I have  a number of them documented but not all of course. I always cover with baytril clindamycin systemically after the baytril injection into the cavity.. they are sick form the volume of pus and not any minor leakage i believe.

Regarding needlesize i often use a 16 g or even 14 g IV catheter depending on how thick the material is.

Here is a good one..a  prototype for the procedure that already had leakage befor the adain. : http://sonopath.com/members/case-studies/search?text=adain&species=All

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