Surgery and Medical Treatments
Intraprostatic Injection for Prostatitis
Medically reviewed by Dr. Paul Song M.D
The intraprostatic injection for prostatitis procedure is a fairly recent treatment for chronic bacterial prostatitis. This nonconventional treatment is a last resort to be considered only after exhausting all of your other options in conventional, natural, and alternative medicine. Some experts also feel that this method can be helpful for cases of difficult-to-treat chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) as well, since it allows strong immunosuppression/modulation to be delivered to the gland and not the entire body. This avoids the usual side effects that come with full-body treatment.
The treatment was developed because sometimes men have to take several courses of antibiotics over several months, and these antibiotics are not always effective. That may be because chronic bacterial prostatitis is sometimes caused by a local autoimmune disease process and the possible presence of intraprostatic bacterial biofilms that the oral antibiotics are unable to penetrate.
In the early 2000s, the concept of injecting the prostate transperineally with a combination of steroids (betamethasone) and antibiotics (to prevent the steroid-induced local immunosuppression leading to abscess) gained currency through the efforts of European practitioners, and especially Dr Federico Guercini of Rome, Italy. Dr Guercini claims a high success rate (65% cured at 6 and 12 month follow-ups), and he presented a paper on the treatment at the American Urological Association Meeting in 2002.
The team of researchers enrolled 150 patients between 1999 and 2001 because of symptoms of chronic bacterial prostatitis. Before receiving treatment, the patients underwent: 1) a clinical urological examination; 2) transrectal ultrasound with micturitional dynamics and uroflowmetry; and 3) routine cultures tests and DNA amplification with PCR of chlamidia, mycoplasmata, gonorrhea and HPV. All the tests were performed on sperm and urine samples.
During first consultation, patients completed the NIH Prostatitis Symptoms Score (NIH-PSS) and Prostatitis Symptoms Index (PSI) questionnaires. Patients were divided into three groups based on their laboratory results, and each group received an antibiotic cocktail that was specifically designed against the bacteria/diseases that had been detected, along with betamethazone (a steroid with anti-inflammatory and immunosuppressive properties). The antibiotics were administered by prostate infiltration using the transperineal approach, guided by transrectal ultrasound. Treatment was repeated after 7 and 14 days.
Follow-up was 6 and 12 months after the last infiltration treatment with uroflowmetry, NIH-PSS, and PSI. In the final assessment of the efficacy of therapy they included the scores plus the patient’s subjective judgment expressed as a “percentage overall improvement.” The percentage judgments were divided into four classes: 0-30% no improvement; 30-50% satisfactory improvement; 50-80% good improvement; and 80-100% cured. Statistical analysis of the results showed that 65% of patients were included in the cured group and that 17% had obtained no improvement.
The researchers concluded that intraprostatic injection is one of the more valid therapeutic approaches to chronic bacterial prostatitis. The researchers felt that the results will improve once drugs such as anti-TNF alpha antibiodies are available to be injected into the prostate to inhibit the autoimmune disease process, which in this study was controlled with betametazone.
There are doctors who disagree that this method is better than intramuscular shots of antibiotic. These doctors note that there were some studies 20 to 30 years ago that show that the availability of antibiotics in the prostate following the intraprostatic protocol is identical to the amount you get when you give the patient an intramuscular shot of the same antibiotic. The doctors argue that the success rate of intraprostatic injection is low and the complication rate is higher. That is why this treatment may be considered alternative and controversial.
What Does Intraprostatic Injection for Prostatitis Involve?
The intraprostatic injection procedure is done in a hospital. It involves injecting antibiotics and steroids into the prostate through the perineum (the area between the anus and scrotum). The needle is guided by ultrasound. You may expect minor discomfort. The needles used are very fine and do not damage the prostate. You will need to talk to your doctor about how many rounds of treatment you will require, but most patients require at least three rounds of treatment.
Before performing the procedure, the doctor should perform a complete transrectal ultrasound of the prostate. This can help rule out any other possible causes of symptoms such as prostate cancer or stones in the ejaculatory duct.
What Are the Side Effects?
The side effects of intraprostatic injection for prostatitis can vary based on the drugs used. Dr. Guercini states that significant pain after infiltrations happens in 2-3% of all patients treated with clarithromycin for 10-15 minutes after infiltration. Blood in semen happens in about 70% of patients for the first two ejaculations after treatment.
Some men have their symptoms get worse after receiving intraprostatic injection. Unfortunately the majority of information on intraprostatic injection for prostatitis comes from anecdotal evidence instead of documented studies. That is why this treatment is considered a last resort.
Reference for Intraprostatic Injection for Prostatitis:
Federico Guercini*, Rome, Italy, Duke Bahn, Ventura,, CA, Cinzia Pajoncini, Rome, Italy, Luigi Mearini, Massimo Porena, Perugia, Italy.Ultrasound Guided Intraprostate Iinfiltration for Chronic Prostatitis-A multicentre study