Prostate abscess in tropical northern Australia: drainage strategies and outcomes

Abstract

Prostate abscess is an uncommon but potentially life-threatening condition. In tropical Australia, melioidosis caused by Burkholderia pseudomallei represents a unique and under-recognized etiology. We aimed to evaluate drainage strategies and clinical outcomes of prostate abscess in a tropical referral center. A retrospective cohort study was conducted of all patients undergoing procedural drainage for radiologically confirmed prostate abscess at Cairns Hospital between August 2016 and October 2025. Demographic, clinical, microbiological, radiologic, and operative data were collected. Patients were stratified into melioid and non-melioid cohorts. Outcomes were analyzed descriptively by drainage modality and microbiological profile. 84 drainage procedures were performed. The mean age was 60 years (range 17-95). Burkholderia pseudomallei accounted for 50% of cases. Transurethral deroofing (TUD) was the most common drainage modality (n = 69; 82%), followed by transrectal ultrasound-guided aspiration (n = 9), transperineal aspiration (n = 3), and transrectal incision and drainage (n = 3). Secondary intervention was required in 33% of patients undergoing primary aspiration compared with 1% following TUD. ICU admission occurred in 19 patients overall and was more frequent in those with melioid disease. Long-term urinary and sexual symptoms were more frequently documented following TUD, although interpretation is limited by the retrospective design and lack of validated outcome measures. Prostate abscess in tropical northern Australia is strongly associated with melioidosis and systemic infection. Transurethral deroofing is commonly utilized for multifocal and complex disease, while minimally invasive approaches may be appropriate in selected cases. Observed differences in outcomes likely reflect disease severity and selection bias. Early recognition and tailored drainage strategies are essential to optimize outcomes.