Prostatic infiltrations
For patients belonging to the second category, i.e. those with documented chronic bacterial prostatitis and the presence of intraprostatic fibrocalcific areas, it makes a lot of sense to bring a cocktail of antibiotics and cortisone directly into these areas. In these situations it is very likely that the continuation of the infection depends on the persistence of unresolved and unsolvable bacterial foci with conventional antibiotic therapy.
In fact, let's consider that when we infiltrate an antibiotic directly into the prostatic capsule, in addition to overcoming the obstacle due to the defense reactions of the prostatic parenchyma and any defenses put in place by the bacterium itself, this is equivalent to an administration of over 2,000-2500 (two thousand-two thousand five hundred) times higher than if it were absorbed systemically!
This maneuver, although requiring considerable experience, is actually very simple and painless. The overall duration is approximately 2-3 minutes and at the end the patient can immediately return home.
In our experience (thousands of infiltrations performed in over 20 years) it is useful to repeat, 7-10 days later, a second and then a third infiltration.
A brief description of the technique is as follows:
1)After careful disinfection of the skin surface, a 15 cm styled needle is introduced transperineally under ultrasound guidance. from 23 G until reaching the prostate.
2) In the path of the needle between the skin of the perineum and the prostate, the muscles of the pelvic floor and the urogenital diaphragm are encountered and must be infiltrated with approximately 15 cc. of 2% carbocaine.
3)After a few seconds of waiting, to allow the anesthetic to carry out its effects, the urogenital diaphragm is passed and the needle is placed inside the prostatitis lesion(s) which are infiltrated (see film) with a suitable antibiotic cocktail associated with cortisone (dexamethazone) and EDTA.
4) At the end of the infiltration, after having removed the needle and the ultrasound probe from the rectum, a prostate massage is performed to allow the infiltrated drugs to spread evenly.
Possible side effects to prostatic infiltrations:
- a) Presence, for a short period, in a more or less accentuated manner, of blood in the sperm (frequent),
b) Presence, for a short period, of perineal tenderness at the needle entry point (frequent),
c) Presence, for a short period in a more or less accentuated manner, of blood in the urine (uncommon),
d) Presence in the first hours following treatment of a decrease in the strength of the urinary stream (rare),
e) Presence, for a short period, of a decrease in the force of sperm emission (rare),
f) Presence, for a short period, of decreased erection strength and sensitivity at the tip of the penis (very rare).