Transrectal ultrasonography directed intraprostatic injection of gentamycin-xylocaine in the management of the benign painful prostate syndrome. A report of a 5 year clinical study of 75 patients

Abstract

There is almost a complete failure of the urological profession to study chronic prostate gland pain, which is its most common and difficult condition to manage. Variations in nomenclature for the disease include pelvic floor myalgia syndrome, chronic anxiety syndrome, prostatodynia, interstitial cystitis and abacterial prostatitis, so comparison of treatment populations is difficult. Over 50% of negative prostate biopsies being performed for PSA elevation show prostatitis lesions. Transperineal aminoglycoside injection for 'hard-core' prostatitis reported a 77% cure rate. A 5 year study of 75 patients with recalcitrant benign painful prostate syndrome treated with transrectal ultrasound guided intraprostatic injection of gentamycin and xylocaine produced a 90% cure rate. Of the patients, 74% required only a single injection of 160 mg of gentamycin in 4 cc with 2 cc of 1% xylocaine to achieve a cure. Minimal injection pain was encountered. Some patients required 5 injections over the 5 year period. Multiple injection patients were considered therapeutic failures. Fourteen tumor-negative prostate needle biopsies showed prostatitis lesions. One elevated PSA patient had 3 biopsies. Current medical therapy of prolonged one month antibiotics, anti-inflammatory agents and alpha adrenergic blocking agents had failed in all injection treated patients. Of the patients, 60% had prostatic calculi. Cystic seminal vesicle abnormalities were frequent. Complications were only minor, with hematospermia, gross hematuria and mild pain. The 90% cure rate was defined by the absence of symptoms.