• Zhongyi Li, Jiaming Wen, and Nan Zhang.
• Department of Urology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
• Medicine (Baltimore). 2020 Feb 1; 99 (9): e19391.

RationaleThe emphysematous prostatic abscess is a rare but potentially life-threatening clinical condition. The early diagnosis is difficult due to nonspecific symptoms.Patient ConcernsA 72-year-old man with poorly controlled diabetes mellitus was admitted to hospital because of dysuria and acute urine retention. He had a refractory fever after admission.DiagnosesThe diagnosis of emphysematous prostatic abscess was confirmed by culture of catheterized urine and pelvic CT.InterventionsWe tried to give antimicrobial treatment and control of blood glucose at first, but the infection could not be controlled by antibiotic therapy and control of blood glucose. TRUS-guided aspiration was performed, but obviously not adequate for abscess drainage and the abscess progressed. TUR was then performed and the infection was gradually controlled.OutcomesPelvic CT scan 1 month after discharge showed complete resolution of the EPA.LessonsGiven the poor conservative treatment effect of emphysematous prostatic abscesses, CT or TRUS should be performed in the patients with suspected diagnosis. Early and appropriate drainage with proper antibiotic therapy is important to achieve a favorable outcome.

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