JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 88 June 1 995 Acute bacterial prostatitis with osteomyelitis V H Nargund FRCS P A Hamilton Stewart FRCS FRCSEd J R Soc Med 1995;88:355P-356P CASE PRESENTED TO SECTION OF UROLOGY, 24 FEBRUARY 1994 Keywords: acute; bacterial; prostatitis; osteomyelitis This short case presentation concerns the simultaneous occurrence of acute bacterial prostatitis and osteo- myelitis due to staphylococcal bacteraemia hitherto unrecorded in the literature. CASE REPORT A 67-year-old non-insulin dependent diabetic Asian male was admitted as an emergency with perineal and suprapubic pain associated with painful micturition. He gave no history of urinary symptoms. On examination he was pyrexial and in acute urinary retention. Rectal examination revealed a tender swollen prostate and an enlarged, firm right seminal vesicle. A clinical diagnosis was made of acute bacterial prostatitis causing acute urinary retention. Following catheterization 600 ml of sterile urine containing many white cells was drained. Blood culture grew Staphylococcus aureus. A computerized tomography (CT) scan of the pelvis showed several hypodense areas in both lateral lobes of the prostate characteristic of multiple small abscesses (Figure 1). Ultrasound of upper tracts was normal. A few days later with improvement of his symptoms on ciprofloxacin he complained of a painful swelling in the right leg. X-ray showed cortical bone destruction of midtibia. When he was asymptomatic and apyrexial catheter removal resulted in spontaneous micturition. Repeat scan of the pelvis 8 weeks later showed that the prostate had returned to normal (Figure 2). Biopsy of the left tibia revealed osteomyelitis but no positive culture was obtained. An isotope bone scan showed no other lesion. Two years later the patient remains asymptomatic. Figure 1 A computerized tomography scan of pelvis showing hypodense areas in prostate Figure 2 A computerized tomography scan of the pelvis 8 weeks later showing normal prostate DISCUSSION The most common causative organism is Gram-negative enterobacteria, mainly strains of Escherichia coli2. In this case the organism was Staphylococcus aureus grown on blood culture but not in the urine. Urinary organisms are often present after the drainage of the abscess has been performed3. Presence of Staphylococcus aureus suggests haematogeneous infection. The clinical features in this case are typical of acute bacterial prostatitis. Patients particularly susceptible are diabetics, those who have had urethral instrumentation and patients who are on dialysis for chronic renal failure. A fluctuant area may be palpable on digital rectal examination which can be drained under local anaesthesia through the perineal route and a pigtail catheter inserted4. It is also possible to incise the prostatic abscess transurethrally using Collings knife. Transurethral resection of the prostate is unwise because of dissemination of infection and Department of Urology, Bradford Royal Infirmary, Bradford, UK Correspondence to: Mr V H Nargund, Department of Urology, Churchill Hospital, Headington, Oxford OX3 7U, UK 355P