The cardinal part of the therapy includes direct transperineal injections of antibiotics into the prostate. In a four week session eight injections are given. The antibiotics are chosen on the basis of the microbiological findings and sensitivity reports. The most frequently used antibiotics are: Gentamicin, Levaquin, Flagyl, Zithromax, and Diflucan. Xylocaine is added to the cocktail to control local discomfort. As routine, we do not add steroids to the antibiotic mixture. Adding EDTA is optional, though the benefit of EDTA is not proven completely. In acute prostatitis cases the prostate injections are complimented with intravenously given Clindamycin, using an ambulatory pump system or less frequently orally given antibiotics.
- Concentration of antibiotics in the prostate can reach several hundred folds that of the level achieved through orally or even intravenously given antibiotics.
- The sonographic guidance allows injecting the antibiotics into the most effected areas.
- The side effects of the antibiotics are not a concern.
- The procedure is extremely well tolerated.
- Local discomfort during the procedure (By far less then the discomfort associated with transrectal injections).
- Mild hematuria and hemospermia.
- Mild transient bleeding from hemorrhoids
One month following the therapy the symptom evaluation, cultures, and sonography examinations are repeated.
Change in symptom index: All of our patients reported improvement in symptom scores, a minimum of 60%. The majority however was experiencing 80 to 90% improvements.
A gradual improvement in the symptoms was further appreciated at the two to three month post therapy evaluation.
Change in post therapy bacteria count: There is consistently a precipitous drop in the bacteria colony count in the post therapy semen samples.