Korean J Urol.  2006 Nov;47(11):1185-1190. 10.4111/kju.2006.47.11.1185.

Comparison of the Efficacy of Transperineal Intraprostatic Injection and Oral Administration of Fluoroquinolone in Men with Chronic Bacterial Prostatitis-Seminal Vesiculitis

• Kim YJ
• Ryu JK
• Lee HJ
• Choi WS
• Suh JK

• KMID: 2294277
• DOI: http://doi.org/10.4111/kju.2006.47.11.1185

Abstract

Purpose
Although oral antibiotic therapy remains the most common treatment modality for chronic bacterial prostatitis (CBP), it is known to have problems, such as potential adverse effects and the development of bacterial resistance. We compared the effects of oral and local injection therapies, with fluoroquinolones, in patients diagnosed as having chronic bacterial prostatitis/seminal vesiculitis, from Tc-99m ciprofloxacin imaging.
Materials and Methods
The study randomly included 79 patients with symptom of prostatitis, who also showed hot uptake in the prostate or seminal vesicle on Tc-99m ciprofloxacin imaging. A total of 53 patients received oral antibiotics for 3 months. In 26 patients, a local injection of ciprofloxacin into the prostate and/or seminal vesicle was performed via the transperineal route, with transrectal ultrasonography guidance. Four- glass tests and Tc-99m ciprofloxacin imaging were performed, and the patients were asked to complete National institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaires at the baseline and 3 months after the initiation of therapy.
Results
The total score or subscores from the NIH-CPSI and bacteriological study after treatment was significantly decreased in both groups compared to that before treatment. The complete cure rate, based on the Tc-99m ciprofloxacin imaging findings, was significantly higher in the local injection (23.1%) than the oral therapy group (16.9%, p<0.024). In the local injection group, 15 men (57.7%) showed transient hematuria and/or bloody ejaculation, but without any serious side effects.
Conclusions
A transperineal lesional injection of fluoroquinolone will be a valuable therapeutic alternative in men with chronic bacterial prostatitis/ seminal vesiculitis; although a long term outcome study will be required.

Keyword

Prostatitis; Antibiotics; Radioisotopes

MeSH Terms

Administration, Oral*
Anti-Bacterial Agents
Ciprofloxacin
Ejaculation
Fluoroquinolones
Glass
Hematuria
Humans
Male
Outcome Assessment (Health Care)
Prostate
Prostatitis
Surveys and Questionnaires
Radioisotopes
Seminal Vesicles
Ultrasonography
Anti-Bacterial Agents
Ciprofloxacin
Fluoroquinolones
Radioisotopes

Figure

• 

  Fig. 1 (A) Transperineal injection of antibiotics using a 20gauge Westcott biopsy needle under transrectal ultrasonography guidance. (B) Ultrasonographic images demonstrating seminal vesicles. Injection of antibiotics fluid shows an echogenic area in the right seminal vesicle.

• 

  Fig. 2 Area of hot uptake in the prostate before an injection of antibiotics (A), which is not visible after treatment (B).

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