| A 59-year-old man with a personal history of chronic alcoholism and smoking habit of years of evolution, who had presented an episode of upper gastrointestinal bleeding secondary to analgesic complications. | |
| As urological antecedents a proband syndrome two years of evolution without secondary complications. | |
| She came to the emergency department with intermittent febrile syndrome of four days duration, associated with urinary incontinence in the last 48 hours, along with dysuria and sacral pain radiating to both lower limbs and worsening with movements. | |
| Rectal tenesmus of recent onset is also associated. | |
| Upon arrival to the emergency room, fever of up to 39oC was observed, and the patient was hemodynamically stable, confused, and sweaty. | |
| On physical examination, the abdomen was glossal, blade and depressible, non-peritonitic. | |
| Painful consolidation in the bilateral lumbar area at the level of L5-S1, as well as in the hypogastric area and perineal region. | |
| She doesn't have a bladder balloon. | |
| Genital examination is normal, and the rectal examination volume I adenomatous, slightly painful. | |
| Neurological examination showed decreased strength in both lower limbs in their upper third and sensitivity was preserved. | |
| Pathogenic reflexes and aquile are present. | |
| The patient has an urgent blood count and biochemical analysis: Hemoglobin 14.2 g/dl, Haematocrit 41 mEq/5%, Leucocytes 20.300 (Neutrophils 72.9%), Creatinine 212 mg | |
| Urine analysis showed negative leukocytes, negative nitrites and normal sediment. | |
| The analysis was completed with a coagulation study that determined prothrombin activity of 83%, a cefalin time of 27.2 sg, and fibrinogen of 574 mg/dl. | |
| An emergency computed tomography (CT) scan revealed multiple simple cysts in the kidneys and left renal lithiasis. | |
| No dilation of the urinary tract. | |
| Increase in size prostate gland, hypodense lesions in both side lobes of 3.3 cm and 3 cm compatible with prostatic abscess. | |
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| Empirical antibiotic treatment was then started with ceftriaxone 1 g/12 h, ampicillin 1 g/6 h and gentamycin 240 mg/24 h. | |
| With the diagnosis of prostitute abscess controlled drainage of the collection with ECTR and urinary diversion. | |
| In the operating room, lumbar puncture was performed prior to intradural anesthesia. | |
| Turbio-amillent cerebrospinal fluid output was observed and a sample was sent to microbiology and biochemistry; 1070 leukocytes (polymorphonuclear leukocytes) were isolated. | |
| On the other hand, ECTR confirms the diagnosis of prostitute abscess, in which there is evidence of the consolidation of 30ces and 28 mm that affect the left lobe and the right lobe respectively, with the rest of the prostate being heterogeneous. | |
| After a perineal puncture-drainage, 10 cc of pus were evacuated from the described median drainage, leaving a cystostomy tube for drainage. | |
| Urine was removed by suprapubic cystostomy. | |
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| From the culture of the samples (prostatic and lumbar puncture) S. aureus oxycilin sensitive was isolated and we started treatment with Cloxacillin 2 g/24 and Rifampicin 300 mg/12 urgent lumbar symptoms. | |
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| Subsequent follow-up based on new ECTR shows a clear improvement, although it is still necessary to re-drain a hyperechogenic area in the right prosecutive lobe, evacuate 4 cc of purulent material. | |
| Subsequent follow-up did not reveal new pathologies. | |
| A transesophageal ultrasound was also performed, ruling out secondary endocarditis and a new control lumbar MRI after six weeks of antibiotic treatment, which showed complete resolution of the subdural empyema. | |