Dr. Bahn’s Prostatitis Treatment
The procedure I utilize is as follows: First of all, I perform a complete transrectal ultrasound of the prostate to rule out any other possible causes, such as prostate cancer or stones in the ejaculatory duct. I use the Hitachi 6500 model, which has a comprehensive color-Doppler capability, as well as tissue harmonic function for better resolution. I use trans-rectal approach utilizing 22-g fine needle. The mixture is a combination of Aminoglucoside, Fluoroquinolone, Antifungal, and Antiprotozoal. Corticosteroid and analgesics are also added. The hospital pharmacist prepares this mixture within 30 minutes of the actual injection to avoid any precipitation or chemical reaction. All together, it is 20 cc’s. I infiltrate 6-7 cc’s into each lobe of the prostate including the peripheral zone and transitional zone. I also inject 3-4 cc into each seminal vesicle. Since it is transrectal infiltration, the rectum is properly cleaned with Betadine swabs. The needle is also sterilize before each puncture. I like to repeat the treatment two more times, in one to two week intervals. I have not encountered any significant complications or side effects so far, even though they may not be known yet. It should be clearly understood that it is a highly experimental and investigatory method. There are no short or long term efficacy data nor complication data in the published literature. There is no known effect on fertility. Young patients who are in child bearing age should be aware about this fact. Self limiting hematuria and hematospermia are common. Most of my patients tolerate this procedure extremely well with only minor discomfort. All patients fill out the NIH chronic prostatitis symptom score questionnaire on each visit to objectify the effects of the treatment and this information will be used for statistical analysis for future studies.
You should not pursue this method of treatment unless all of your other options are exhausted and your situation becomes desperate.
Chronic Prostatitis Treatment Evolution at Prostate Institute of America
Antibiotics are the most important and main component in my medication treatment mixture. Infections caused by gram negative bacteria is the most common cause of bacterial prostatitis/urinary tract infection. As a result, I have used Fluoroquinolone and Gentamicin as the main antibiotic modalities for a long period of time with variable clinical success.
It became apparent that most of my patients have been exposed to Fluoroquinolones for extended period of time before they came to get treatment here. Easy access, oral formulary, and broad-spectrum coverage have led to widespread and improper use of Fluoroquinolones. Subsequently, resistance against Fluoroquinolones have developed worldwide.
About a year ago, I replaced Fluoroquinolone (Levofloxacin) with Cephalosporin (Ceftriaxone) in my treatment mixutre. Ceftriaxone is a broad-spectrum antibiotic, and has less chance of overuse and improper use since it can be administered only intramuscularly or intravenously. It is my personal experience to notice slightly better response clinically.
However, recent publications have reported increased prevalence of bacteria that contain enzymes known as extended-spectrum beta-lactamase (ESBL) that confer resistance to most antibiotics, particularly antibiotics from the penicillin, cephalosporin, and monobactam families. Furthermore, ESBL organisms often exhibit concurrent resistance against Fluoroquinolones and Cotrimoxazoles (Bactrim). Infections with ESBL-producing organisms have been associated with poor outcome.
ESBLs have been found exclusively in gram-negative organisms, particularly Escherichia coli and Klebsiella, but also in Acinetobacter, Enterobacter, Proteus, Pseudomonas, Salmonella, and Shigella.
Community and hospital-acquired ESBL-producing gram negative bacteria are prevalent worldwide. Antibiotics from the Carbapenem family are the best anti-microbial agents to treat infections caused by such organisms.
Based on these updated information and my experience, I have revised my treatment cocktail. It is now consisted of a mixture of Carbapenem antibiotic, Aminoglycoside antibiotic, anti-anaerobe/anti-protozoa antibiotic, and anti-fungal agents. Corticosteroid is also added to the mixture in case the underlying etiology is an auto-immune reaction. The treatment mixture also contains Lidocaine and Ketorolac for pain control.
This medication treatment mixture is directly infiltrated into the prostate and seminal vesicles under precise transrectal ultrasound guidance.
Revised November, 2013
– Duke Bahn, M. D.