BPH is a innocent bystander in later stages of male life in humans. Normally Benign Prostatic hyperplasia is curable by using the various avaliable treatments and medications like 5alpha reductase inhibitors and antiandrogenic therapies. TURP, TUIP and prostatectomy are also advised very often. But what is the indication of the progression of the problem which is not curable from the avaliable measures. Is it a cancerous situation then? Is herbal therapy the probable answer of the problem in complicated cases?
Frank pus in the prostate is pretty rare. Often you may see prostatic secretions during a TURP, typically in a benign gland. If there is frank pus beware of severe urosepsis for any manipulation including a rectal examination. Differential diagnosis is tuberculosis.
Foci of prostatitis and small abscess cavity is not rare during TURP. Infection may be precipitating cause of acute urine retention. Link to cancer formation is not reported up to my knowledge
Is there any herbal treatment in this case? Or prostatectomy is the only solution? Any other treatment options?? The age of the patient is around 55. And the situation arose all of a sudden. Is this a severe case?
Other options for prostatic abscesses (other than transurethral unroofing) are transrectal drain placement....and of course antibiotics, which should be given regardless of the exact management approach taken
The presence of pus during TURP is not so rare, but for sure it is not related with the presence of tumor. In my experience, after repeated prostate biopsies this occurrence is more frequent. Personally, I don't change my therapeutical strategy if I encounter pus during TURP (I don't add antibiotics).
Recurrent prostatitis can frequently be a result of effective obstructive BPH. The treatment can be long series of a oral quinolone followed by a Greenlight laser resection of the infected central tissue that's when seen during an office flexible cystoscopy. I usually continue antibiotics after Greenlight for an additional 3-4 weeks. With the discontinuation of alpha blockers immediately so the infection nidus will more likely drain antegrade to the tip of the penis and out versus with alpha blockers retrograde into the bladder. The latter leading to a extended infectious course. If concerned with prostate adenocarcinoma a few slices of central tissue can be sent off intraoperatively but otherwise wait 2 months prior to performing an ultrasound guided biopsy of the prostate.
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