Prostatic abscess is rare among presentation of all urological emergencies. Currently there are no available guidance of treatment or management. It is most commonly present among male in 50s, with risk factors of immunocompromised status.

Multiple approaches of abscess drainage have been mentioned in literature including, transrectal, transperineal or endoscopic de-roofing of abscess wall. Burkitt et.a. has suggested percutaneous drainage has advantage of less invasive nature as compared to transurethral approach although it has a lesser successful rate of 86% against 96%.

We are presenting a case of 57 year old male, presenting with clinical sepsis requiring resuscitation and had a CT proven bilateral large, multi-loculated prostatic abscess who required surgical drainage. Patient operation was complicated as he was on clopidogrel for his known background of ischaemic heart disease. Due to the nature of abscess and patient co-morbidity, transurethral approach were elected in this case.

We have demonstrated the key steps of procedure including deroofing the abscesses from 3 and 9 o’clock of prostatic urethra, manual evacuation/expressing of abscess internally using resectoscope and rectally, and extensive haemostasis using rollerball diathermy post evacuation. Patient has achieved remarkable recovery with continue of intravenous antibiotic as per culture sensitivity (pus cultured +staph aureus). Patient had a MRI scan which showed the prostatic abscess were completely resolved.

Our case study has demonstrate transurethral approach might be preferred in patient with bleeding risk factor in emergency setting as we are able to archive better haemostasis through diathermy.

B Purkait, M Kumar, AK Sokhal, A Bansal, SN Sankhwar, V. Bhaskar. Outcome analysis of transrectal ultrasonography guided aspiration versus transurethral resection of prostatic abscess: 10 years' experience from a tertiary care hospital. Arab J Urol, 15 (3) (2017), pp. 254-259