Investigative and Clinical Urology

The Korean Urological Association (대한비뇨의학회)
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Comparison of the Efficacy of Transperineal Intraprostatic Injection and Oral Administration of Fluoroquinolone in Men with Chronic Bacterial Prostatitis-Seminal Vesiculitis

만성 세균성전립선염-정낭염 환자에서 Fluoroquinolone 제제의 경구 및 국소주사요법의 효과

Kim, Yong-Jin;Ryu, Ji-Kan;Lee, Hun-Jae;Choi, Won-Sik;Suh, Jun-Kyu
김용진;류지간;이훈재;최원식;서준규

  • Published : 20061100
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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. Four- glass 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

References

  1. Lipsky BA. Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment. Ann Intern Med 1989;110:138-50 https://doi.org/10.7326/0003-4819-110-2-138
  2. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999;292:236-7
  3. Nickel JC. Prostatitis and related conditions. In: Walsh PC, Reik AB, Vaughan ED Jr, Wein AJ, editors. Campbell's urology. 8th ed. Philadelphia: Saunders; 2002;604-30
  4. Nickel JC. Antibiotics for bacterial prostatitis. J Urol 2000; 163:1407 https://doi.org/10.1016/S0022-5347(05)67630-6
  5. Ritter SJ, Lippow C. Pathological and bacteriological processes present in prostatitis and tissue reaction to therapy. J Urol 1938;39:111-4 https://doi.org/10.1016/S0022-5347(17)71842-3
  6. Jimenez-Cruz JF, Tormo FB, Gomez JG. Treatment of chronic prostatitis: intraprostatic antibiotic injections under echography control. J Urol 1988;139:967-70 https://doi.org/10.1016/S0022-5347(17)42733-9
  7. Yamamoto M, Hibi H, Satoshi K, Miyake K. Chronic bacterial prostatitis treated with intraprostatic injection of antibiotics. Scand J Urol Nephrol 1996;30:199-202 https://doi.org/10.3109/00365599609181299
  8. Park JH, Lee YT, Hong YK, Shin JS. Treatment of chronic bacterial and nonbacterial prostatitis by local injection of Amikacin sulfate. Korean J Androl 2000;18:63-7
  9. Hu WL, Zhong SZ, He HX. Treatment of chronic bacterial prostatitis with amikacin through anal submucosal injection. Asian J Androl 2002;4:163-7
  10. Yavascaoglu I, Camlikiyi H, Oktay B, Simsek U, Ozyurt M. Percutaneous suprapubic transvesical route: a new and comfortable method of intraprostatic injection. Urol Int 1998; 60:229-34 https://doi.org/10.1159/000030261
  11. Shafik A. Anal submucosal injection: a new route for drug administration. VI. Chronic prostatitis: a new modality of treatment with report of eleven cases. Urology 1991;37:61-4 https://doi.org/10.1016/0090-4295(91)80080-Q
  12. Tillotson GS. Quinolones: structure-activity relationships and future predictions. J Med Microbiol 1996;44:320-4 https://doi.org/10.1099/00222615-44-5-320
  13. Naber KG. The role of quinolones in the treatment of chronic bacterial prostatitis. In: Weider W, Madsen PO, Schiefer HG, editors. Prostatitis. 1st ed. Berlin: Springer-Verlag; 1994;175- 90
  14. Ryu JK, Lee SM, Seong DW, Suh JK, Kim SG, Choe W, et al. Tc-99m ciprofloxacin imaging in diagnosis of chronic bacterial prostatitis. Asian J Androl 2003;5:179-83
  15. Lee SM, Ryu JK, Suh JK. Role of Tc-99m ciprofloxacin imaging in the diagnosis of bacterial prostatitis. Korean J Urol 2003;44:861-5
  16. Choe W, Chung MH, Kim WH, Kim SG, Ryu JK, Kang JK, et al. Imaging prostatitis with Tc-99m ciprofloxacin. Clin Nucl Med 2002;27:527-9 https://doi.org/10.1097/00003072-200207000-00015
  17. Choe W, Ryu JK, Kim WH, Chung MH, Suh JK. Imaging seminal vesiculitis with Tc-99m ciprofloxacin. Clin Nucl Med 2003;28:501-2 https://doi.org/10.1097/00003072-200306000-00013
  18. Solanki KK, Bomanji J, Siraj Q, Small M, Britton KE. Tc-99m Infecton: a new class of radiopharmaceutical for imaging infection. J Nucl Med 1993;34:119
  19. Choe W, Im MH, Chung JK, Jeong JM. Imaging pelvic inflammatory disease with Tc-99m ciprofloxacin. Clin Nucl Med 2000;25:842-4 https://doi.org/10.1097/00003072-200010000-00028
  20. Hall AV, Solanki KK, Vinjamuri S, Britton KE, Das SS. Evaluation of the efficacy of 99mTc-infecton: a novel agent for detecting sites of infection. J Clin Pathol 1998;51:215-9 https://doi.org/10.1136/jcp.51.3.215
  21. Vinjamuri S, Hall AV, Solanki KK, Bomanji J, Siraj Q, O'Shaughnessy E, et al. Comparison of 99mTc-infecton imaging with radiolabelled white-cell imaging in the evaluation of bacterial infection. Lancet 1996;347:233-5 https://doi.org/10.1016/S0140-6736(96)90407-9
  22. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 1968;5:492-518
  23. Schaeffer AJ, Knauss JS, Landis JR, Propert KJ, Alexander RB, Litwin MS, et al. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: National Institutes of Health Chronic Prostatitis Cohort Study. J Urol 2002;168:1048-53 https://doi.org/10.1016/S0022-5347(05)64572-7
  24. Nickel JC, Downey J, Johnston B, Clark J. Predictors of patient response to antibiotic therapy for the chronic prostatitis/ chronic pelvic pain syndrome: a prospective multicenter clinical trial. J Urol 2001;165:1539-44 https://doi.org/10.1016/S0022-5347(05)66344-6