The Efficacy of Transperineal Drainage for Treating Prostatic Abscess: A Comparative Analysis Against Conservative Management

Background: Prostatic abscess (PA) is an uncommon but serious urological condition requiring immediate intervention. Both drainage and conservative treatment are feasible because there are currently no well-established treatment guidelines. This study aimed to compare the clinical outcomes and mortality rates between patients who underwent transperineal prostatic abscess drainage (TPAD) and those who underwent conservative management. Methods: We analyzed 41 patients diagnosed with PA using computed tomography, magnetic resonance imaging, and transrectal ultrasonography between December 2021 and July 2024. The patients underwent either TPAD or conservative management. Conservative management consisted of intravenous antibiotics as the mainstay of therapy, whereas the intervention group received TPAD in addition to antibiotic therapy. TPAD was performed under local anesthesia with the patient in the lithotomy position. All patients were discharged after the normalization of inflammatory markers and body temperature. Results: Of the initial total of 41 patients, 6 were excluded based on the exclusion criteria. Among the remaining 35 enrolled patients, 18 underwent TPAD and 17 received conservative management. There were no significant differences in age, number of comorbidities, or prostate-specific antigen levels between the two groups; however, the TPAD group exhibited a significantly larger abscess size (p = 0.000), shorter hospital stay (p = 0.041), and lower mortality (p = 0.045). Conclusions: In the absence of standardized treatment guidelines, TPAD which can be easily implemented, is considered a favorable treatment method that can reduce the length of hospital stay, recurrence rates, and mortality rates compared with conservative treatment.