Echoguided drug infiltration in chronic prostatitis: results of a multi-centre study.
OBJECTIVE
In chronic prostatitis there are many causes that may provoke a therapeutical failure of a systemic antibiotic treatment. At the moment a consensus has not been reached on the efficacy of the many therapeutical options that are available with not one of these approaches being efficacious in all patients. In our view the main causes of treatment failure are the well-known hurdle to antibiotic diffusion inside the glandular parenchyma associated with the so-called intraprostatic bacterial biofilms and the possible presence of local auto-immune reactions. Given this background, we tested ultrasound guided intraprostate infiltration of a cocktail of antibiotics and betamethasone, for a therapeutical options.


METHODS
320 patients, referred to us because of symptoms indicative of chronic prostatitis, were enrolled in this study. The inclusion criteria were the severity of the symptoms and the failure of repeated cycles of antibiotics in the previous 12 months. At the initial consultation patients completed the NIH Prostatitis Symptoms Index (NIH-CPSI). All underwent: a) digital rectal examination (DRE), b) transrectal prostatic ultrasound scan (TRUS), c) uroflowmetry, d) cultures of first voiding and after prostatic massage urine and cultures of sperm for saprophytic and pathogen germs, yeasts and protozoa, e) DNA amplification with polymerase chain reaction (PCR) on urine and sperm, for Chlamydia trachomatis, Mycoplasmas (Ureaplasma urealyticum and Mycoplasma hominis), Gonococcus, HPV and HCV Patients on the basis of laboratory results received a cocktail of antibiotics associated with betamethasone. The cocktail was administered as prostate infiltration. Administration was repeated after 7 and 14 days. Final assessment of the efficacy of therapy included not only the NIH-CPSI scores but also the patient's subjective judgement expressed as a "percentage overall improvement". The percentage judgements were arbitrarily divided into 4 classes: 0-30% no improvement (Class I); 30-50% satisfactory improvement (Class II); 50-80% good improvement (Class III; 80-100% cured (Class IV).


RESULTS
Statistical analysis of the results showed 68% of patients were included in the Class IV and 13% were no responders (Class I).


CONCLUSIONS
In our opinion this is one of the more valid therapeutical approaches to chronic bacterial or abacterial prostatitis also if it requires more studies.
Guercini
Federico
F
Urologic Department, Perugia University, Italy. ME3403@mclink.it
Pajoncini
Cinzia
C
Bard
Robert
R
Fiorentino
Francesco
F
Bini
Vittorio
V
Costantini
Elisabetta
E
Porena
Massimo
M
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011472:Prostatitis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013094:Spermatozoa / Q000382:microbiology; D014463:Ultrasonography; D014556:Urine / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000904:Antibiotics, Antitubercular