Yavaşçaoğlu I, Camlikiyi H, Oktay B, Ozyurt M
Uludag University, Department of Urology, Bursa, Turkey.
Urol Int. 1998 Aug;60(4):229-34. doi: 10.1159/000030261.
To assess the efficacy and safety of the percutaneous suprapubic transvesical route (STR) for intraprostatic antibiotic injections and compare it with the transperineal route (TPR), a total of 37 patients suffering from chronic bacterial prostatitis, resistant even to treatment with fluoroquinolones, were randomized to intraprostatic amikacin injections using either STR (n = 19) or TPR (n = 18). Follow-ups were done at weeks 4, 12, 24 and 52. Patients found to have failures at the first follow-up were given an additional injection using the initial route. At the 24th week, 15 patients from both groups were given another injection using the alternative route and were asked to report any subsequent voiding difficulties and compare the discomfort and pain experienced. At the end of 52 weeks, bacteriological cure rates did not differ significantly (44.4 vs. 47.3%). Overall improvement rates in the severity of symptoms and signs were similiar. Considerable difficulty in directing the needle to the prostate due to an excessive amount of subcutaneous fat was experienced, and more than 1 skin puncture was necessary in 5 of the STR group, whereas in the TPR group 7 patients with external hemorrhoids and 1 patient with a rectal fissure had prominent discomfort and pain during the transperineal procedures. Complications such as dysuria or hemospermia were encountered infrequently in both groups, but hematuria was observed more frequently in the STR group (85 vs. 54%). Less discomfort (p < 0.01) and pain (p < 0.01) were reported during access to the prostate by STR, but pain during the injection of the drug did not differ significantly. In conclusion, the percutaneous STR may well be used efficiently and comfortably as an alternative method to TPR when intraprostatic injections are needed in a limited number of cases such as those with a known hypersensitivity to fluoroquinolones or with a history of failure despite long-term systemic treatment with these agents.
为评估经皮耻骨上经膀胱途径（STR）进行前列腺内抗生素注射的疗效和安全性，并与经会阴途径（TPR）进行比较，我们将37例即使使用氟喹诺酮类药物治疗仍耐药的慢性细菌性前列腺炎患者随机分为两组，分别采用STR（n = 19）或TPR（n = 18）进行阿米卡星前列腺内注射。在第4、12、24和52周进行随访。在首次随访中发现治疗失败的患者，使用初始途径再进行一次注射。在第24周时，两组各15例患者使用替代途径再进行一次注射，并要求他们报告随后出现的任何排尿困难情况，并比较所经历的不适和疼痛程度。在52周结束时，细菌学治愈率无显著差异（44.4%对47.3%）。症状和体征严重程度的总体改善率相似。由于皮下脂肪过多，在将针头插入前列腺时遇到了相当大的困难，STR组中有5例患者需要进行1次以上的皮肤穿刺，而在TPR组中，7例患有外痔和1例患有肛裂的患者在经会阴操作过程中出现了明显的不适和疼痛。两组中尿痛或血精等并发症均较少见，但STR组血尿的发生率更高（85%对54%）。采用STR进入前列腺时报告的不适（p < 0.01）和疼痛（p < 0.01）较少，但药物注射期间的疼痛无显著差异。总之，当在有限数量的病例中需要进行前列腺内注射时，如对氟喹诺酮类药物已知过敏或尽管长期使用这些药物进行全身治疗仍失败的患者，经皮STR可以作为TPR的一种有效且舒适的替代方法。
