Patient B. C. Seun Akinola MD PGY-4 HPI: 52 y.o. diabetic M who p/w urinary retention. ◦ ◦ ◦ ◦ 3 week hx of persistent hesitancy, slow stream, straining and intermittency. No baseline LUTS . Preceded by myalgia, chills/subjective fever. Initially seen in the VA ER 10/8/12 with same symptoms and a tender prostate without fluctuance and was discharged on Ciprofloxacin 500mg BID x 2 weeks and Flomax with presumed diagnosis of prostatitis. ◦ UA + and Ucx-MSSA. ◦ Switched to Bactrim by PCP 5 days prior to presentation. ◦ No Fevers since starting Abx. ROS: + perineal pain. No dysuria, hematuria. PMHx: Diabetes, HTN, Hyperlipidemia, MRSA colonization PSHx: None ALLERGIES: NKDA Meds: Aspirirn, Simvastatin, Insulin Soc Hx: Smoking- Denies Alcohol- Occasional Drugs- Denies P/E: Afeb. VSS NAD. S1S2. CTAB/L Abd soft ND. 16F foley. Urine clear. Penis uncircumcised DRE deffered. LABS: WC- 12.9 (mild left shift) HCT- 31 Cr- 1.3 CT PELVIS OBTAINED CT RMP: CT RMP: CT RMP: CT RMP: CT RMP: TO OR 10/23/12 for unroofing and SP tube TO OR 10/23/12 for unroofing and SP tube       Hospital Course Broad spectrum Abx coverage- Vanco + Gentamicin Spiked fevers intermittently post op (Tm 102.9) Intraop urine and Bcx post op grew MSSA Oxacillin + Levaquin 750mg Echo to rule out valve vegetation: Negative PLAN: Discharged with PICC line and IV antibiotics X 2 weeks    Literature review: Incidence lower in antibiotic era DM and Immuno-compromised patients Non specific presentation ◦ ◦ ◦ ◦  Irritative symptoms most common (96%) Fever in 30-70% Retention -30% Perineal pain-20% P/E◦ Most common finding on DRE: flucuance but only seen 16-18%  Imaging ◦ TRUS or CT pelvis with contrast  Treatment ◦ Transurethral unroofing vs. transrectal/transperineal drainage ◦ No recommendations re: length of antibiotic treatment Arch Esp Urol. 2011 Jan-Feb;64(1):62-6. Prostatic abscess: diagnosis and treatment of an infrequent urological entity