Treatment Of Chronic Bacterial Prostatis By Local Injection Of Antibiotics Via Transurethral Route:

Khaled Adel Hamid Gamal

The material of the present study comprised 31 patients with resistantchronic bacterial prostatitis presented to the outpatient clinic of Urologydepartment of Benha University Hospital in the period from June to December1990The age incidence was between 20 and 65 years with the greatest percentageof patients (45.1%) lied in the age group 30-40 years.19 patients of the initially selected 31 patients were married (61%) and thisreflects the high incidence of chronic bacterial prostatitis among married men.All patients were interviewed, clinically, laboratory and cystoscopicallyexamined.4 patients were excluded after priliminary cystourethroscopic examinationprior to injection:• One patient with bladder neck obstruction.• Two patients with bilharzial ulcers.• One patient with a radiolucent stone bladder.The remaining 27 patients were divided into two groups according to thetype of injected antibiotic:• Group I: including 14 patients and they were injected by thimphenicol only.• Group II: including 13 patients. And they were injected-according to cultureand sensitivity test ofE.P.S. by gentamycin, amikacin and cefazolin.The 27 patients were injected transurethraly by a special long needleintroduced through the sheath of a diagnostic cystoscope. All patients reviewed at 2-3 weeks after injection and then every month forat least 3-4 months after injection.The average cure rate was 50% in group I and 61.5% in group II after firstinjection.11 patients (40.7%) of the injected 27 patients required second injection asfollow up of these cases indicated either relapse or non improvement after firstinjection.The average cure rate was significantly increased after the second injectionreaching 57% in group I and 75% in group II. This reflects the effectiveness ofmultiple injections in treatment of chronic bacterial prostatitis.The results obtained by group II was better than that obtained by group Iwhether after first injection or after second injection.The results were classified into good, fair and poor according to thefollowing criteria:1. Improvement of symptoms.2. Negative bacterial culture of E.P.S.3. Acidic PH ofE.P.S.4. Colony count less than lOO,OOO/C.mm.5. Pus cells less than lO/H.P.E. in E.P.S.6. Maintenance of subjective and objective improvement for at least 3 monthsafter injection. The results were as follow:Group I: (14 patients)Good: 6 patients after first injection (42.8%), 5 patients after second injection(71.5%).Fair: 5 patients after first injection (35.7%), 2 patients after second injection(28.5%).Poor: 3 patients after first injection (21.4%), no poor results after secondinjection.Group II: (13patients)Good: 6 patients after first injection (46.1%), 3 patients after second injection(75%).Fair: 4 patients after first injection (30.7%), 1 patient after second injection(25%).Poor: 3 patients after first injection (23%), no poor results after secondinjection.In the present study, a trial has been made to overcome the problem ofchronic bacterial prostatitis after all previous attempts show unsatisfactory results.We introduced a new technique of local injection of antibiotics depends onthe diagnostic cystoscope for proper visualization of the prostate and prostaticsinus.The antibiotics were injected in the suspected proper sites under vision usinga special long fine needle.The results obtained in this study was so encouraging that it places this newtechnique in the proper way for treatment of the most confusing disease in urology:chronic bacterial prostatitis.We recommend:1. Recommend the technique by itself and it should be retained when otherantibiotic treatment scheme have failed.2. Proper serial estimation of prostatic and serum concentration of antibioticsafter injection to detect the ideal concentration and consequently the dosesrequired for complete eradication of the causetive organisms, that was notavailable in the present study.3. The patients must reviewed at regular intervals after injection as long termremission can be expected in most patients, and once the relapse established,injection of antibiotics should be repeated because multiple injections enhancepermenant cure.