Chronic Prostatitis Treatment Evolution at the Prostate Institute of America
Antibiotics are the most important and main component in my medication treatment mixture. Infection 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 antibiotics for a long period of time with variable clinical success.
It has become apparent that most of my patients have been exposed to Fluoroquinolones for extended periods of time before they come to get the treatment here. Easy access, oral formulary availability, and broad-spectrum coverage have led to widespread and improper use of Fluoroquinolones. Subsequently, resistance against Fluoroquinolones have developed worldwide.
A few years ago, I replaced Fluoroquinolone (Levofloxacin) with Cephalosporin (Ceftriaxone) in the treatment mixture. Ceftriaxone is a broad-spectrum antibiotic, and has less chance of overuse and improper use since it can only be administered only intramuscularly or intravenously. In my personal experience I have noticed slightly better results 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. Infections with ESBL-producing organisms have been associated with poor outcomes.
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 the updated information, I have revised my treatment cocktail. It now consists of a mixture of Carbapenem antibiotic, Aminoglycoside antibiotic, anti-anaerobe/anti-protozoa antibiotic, and antifungal 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.
Perform a complete transrectal ultrasound of the prostate and the seminal vesicles to identify the location and extent of the inflammation. This ultrasound unit has a comprehensive color-Doppler capability as well as tissue harmonic and elastography function for better image resolution and interpretation.
The rectum is thoroughly cleaned with surgical antiseptic solution (betadine) and lubricated with gel that contains 4% Lidocaine.
Insert an ultrasound probe with a needle guide attached into the rectum and target the area of interest.
Using 22-g fine needle, the mixture of the medications are injected and infiltrated throughout the prostate tissue. If the seminal vesicle needs treatment, there will be direct injection of the medication into the seminal vesicle lumen. Please note that seminal vesicle infection is very common in my patient population since there is no antibiotic delivery mechanism to the seminal vesicle by oral, intramuscular or even IV administration. It is a hollow organ and no tissue in the lumen meaning no blood flow to deliver the medications. The needle is re-sterilized prior to each puncture. You will watch the entire procedure via a high resolution screen in front of you.
It is well tolerated procedure, reporting only minor discomfort. You will notice some degree of blood in the urine and in the semen up to two weeks. I have not encountered any clinically significant side effect or complication.
The treatment is usually repeated several times depend on your situation. The usual plan is to have three treatments, for example, on Monday, Thursday and following Monday.
It should be clearly understood that it is a highly experimental and investigational method. There is no short or long term follow up outcome data nor complication data in peer-reviewed medical literature. There is no known effect on fertility as well.
All patients fill out 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.
The abstract presented at the American Urologic Association Annual Conference in 2018.
This data is based on Dr. Bahn’s 110 consecutive patients.