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Kim, Ryu, Lee, Choi, and Suh: Comparison of the Efficacy of Transperineal Intraprostatic Injection and Oral Administration of Fluoroquinolone in Men with Chronic Bacterial Prostatitis-Seminal Vesiculitis
Original Article
Korean Journal of Urology

Korean Journal of Urology 2006; 47(11): 1185-1190.

Published online: 30 November 2006

DOI: https://doi.org/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

Yong-Jin Kim, Ji-Kan Ryu, Hun-Jae Lee1, Won-Sik Choi2, Jun-Kyu Suh

Department of Urology, Inha University College of Medicine, Korea.

1Department of Social and Preventive Medicine, Inha University College of Medicine, Korea.

2Department of Nuclear Medicine, Gachon University Gil Medical Center, Incheon, Korea.

Corresponding author (jksuh@inha.ac.kr)

Received 26 May 2006       Accepted 15 August 2006

Copyright © 2006 The Korean Urological Association

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. Fourglass 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.

Keywords: Prostatitis, Antibiotics, Radioisotopes

Figures and Tables

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.
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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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Table 1
Patient demographics and baseline characteristics
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NIH-CPSI: National Institute Health Chronic Prostatitis Symptom Index, QoL: quality of life, SV: seminal vesicle, EPS: expressed prostate secretion

Table 2
Symptom changes after treatment
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Sx: symptom, Tx: treatment, QoL: quality of life, NIH-CPSI: National Institute Health Chronic Prostatitis Symptom Index

Table 3
Bacteriologic data before and after treatment
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EPS: expressed prostate secretion, *tested by McNemar test, †tested by chi-square

Table 4
Therapeutic effect assessed 3 months after treatment
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p value=0.024. CR: complete responder, PR: partial responder, NR: non-responder, AR: aggravated responder

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