Treatment of Chronic Bacterial and Nonbacterial Prostatitis by Local Injection of Amikacin Sulfate

Park, Jong Ho; Lee, Young Tae; Hong, Young Kwon; Shin, Jae Seop

Abstract

PURPOSE
Prostatitis causes significant morbidity and represents a major indication for diagnostic procedures and treatment with antibiotics or other medications. Chronic bacterial prostatitis is effectively controlled by local injection of antibiotics and can be diagnosed by tissue culture. Also, chronic nonbacterial prostatitis often proves to be of bacterial origin by tissue culture. We introduced intraprostatic injection of antibiotic (amikacin sulfate) for chronic bacterial and nonbacterial prostatitis
PATIENTS AND METHODS
From March 1996 to January 1998, we treated 42 patients complaining of prostatitis symptoms and showing >10 leukocytes/high-power field in expressed prostatic secretions (EPS). All patients had suffered prostatitis for more than 6 months and had histories of use of medications. Eight patients proved to have bacterial prostatitis and 34 patients nonbacterial prostatitis. We injected 500 mg of amikacin sulfate via the transperineal approach under the guidance of transrectal ultrasonography.
RESULTS
Of the 42 patients, 27 (64%) improved symptomatically and showed normal EPS finding. Twenty-two patients (65%) in the nonbacterial prostatitis group and 5 patients (63%) in the bacterial prostatitis group were cured, with 23 patients (85%) requiring only one or two intraprostatic injections to obtain the cure. Complications occurred during and after the procedure in eight patients: severe pain, hemospermia, gross hematuria, and dysuria.
CONCLUSIONS
Intraprostatic injection of amikacin sulfate is an alternative treatment for chronic bacterial and nonbacterial prostatitis. The advantage of this therapy is that it provides high concentration of the antibiotic at the infection focus without any risk of metabolic activation.