Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.
So, after a full calendar year of trying to manage my symptoms with antibiotics and natural supplements, and constantly reaching a wall with various tests and not finding much, I took some drastic measures this year.
After 6 months of speculation I finally managed to get a transrectal ultrasound. I’ve had chronic prostatitis for almost 5 years, and I’m surprised to say that this is the first time I’ve ever gotten a transrectal ultrasound.
*THIS SHOULD BE A PRIORITY*. Urine tests and even bladder ultrasounds aren't very useful most of the time. Only the most OBVIOUS of prostatitis sufferers (those over 40 suffering from BPH enlarged prostate) will notice anything. Those of us who are younger and inherited some or all of our issues from a sexual episode, this will not help you at all. Your likely problem is the vesicles, and you can only see that via transrectal!!
And thankfully, they finally found my issue. Seminal vesicle inflammation. So with that information I decided I needed to finally do what I’d been considering doing all year long and get antibiotic injections directly into the prostate/seminal vesicles.
I’ had actually gone to see Dr Toth in New York but he didn’t treat me. he time I was on numerous antibiotics and the swelling went down to a level where he could not actively see a problem. Therefore he didn’t subject me to the treatment and even warned me of drawbacks. — I’ll be honest, this was a very honest move on his part, he didn’t take my money so I’m thankful for that.
So, upon meeting Dr Bahn, he was very nice, mild mannered, kinda straight to the point. He doesn’t spend a lot of time speculating on issues in relation to lab work and bacterial findings. He is there to eradicate whatever it is that may be residing in your prostate and vesicles.
He said it was a very difficult condition to treat, in my case.
Ultrasounds very thorough . your able to see so much detail in the ultrasound. this is a key reason for going. you’re not going to get a better diagnostic on this side of the world as far as what is going on with your seminal vesicles and prostate.
BAHN: BOTH right and left seminal vesicle is all infected. The reason is that yeah, the seminal vesicle is a little distended about twice the size. This all white stuff is all infected material within the LUMEN of the seminal vesicle.
THE PROCEDURE: ( see attached for full report)
He cleaned out the rectum with bentadine swabs, and then injected the antibiotics.
His medications have changed over the past 12 months. As of this writing (January 23rd 2014) he currently injects patients with:
Gentamicin, Morapenem (a carbapenem antibiotic which is used to destroy beta-lactamace biofilm in very resistant bugs) Flagyl, and a few painkillers. Overall this is a pretty wide-spectrum antibiotic treatment as far as covering anaerobes, gram positives and negatives.
Overall I would say it wasn't too uncomofrtable. You obviously do feel a slight pinch when he injects (and he doesn't inject softly - this was more startling than painful anyway to be honest so just be prepared).
Pain afterwards on the first injection was a bit intense at first, but easily managed by 2 extra strength NSAIDs (Advil/Ibuprofen, Tylenol/Acetaminophen, both work well). If I could describe it , its that the pelvic floor kind of goes into a shock because you have a needle basically pushed up in your body. So to me, it was more of a systemic and somewhat natural response, than anything I would describe to be attributed to "needle trauma" proper.
Now, of course he does advise his patients to ejaculate about 48 hours after the procedure. Semen at that point is almost 100 percent blood. iv'e heard patients say that it goes away after a few months. Ejaculation itself isn't any more or less painful, but in my case the vesicles were changing shape and expanding from the injections, so swelling after the fact is a little painful.
But again overall it was easily managed by over the counter NSAIDs. I would advise also for those doing this procedure eating a high amount of bran / fiber cereal before and after the ultrasound to help clear out the colon.
I continued to get injections every 3 days. Each time I saw him, he noticed a marked improvement on the size of the vesicles, and the apperance of them. I dont currently have an ultrasound scan of the later images.
Each injection became easier to tolerate. I was bedridden the first day from the pelvic floor tension, but by the 3rd one I was driving around and shopping later in the evening.
My symptom score went from a 28 to 17 over the course of that week and a half. The most noted improvement was urinary frequency. I dont have excessive urinary frequency -- usually once an hour to two hours at the most. (During a proper "flare up", usually from coffee or alcohol, I will have to pee every 10-20 minutes) but i find lately i'm able to go about 3 hours without having to urinate.
As far as teh vesicles are concerned, I'll only really know how well its worked when the side effects like the blood and swelling subside. Only time will tell. I have also decided to take it upon myself to get a prescription for Doxycycline to kind of manage whatever bacteria that could be leftover in my genitourinary tract.
Just from a diagnostic perspective, this is exciting stuff. I can only hope that doctors and urologists will continue to explore and expand the treatment of prostatitis/seminal vesiculitis. Were still in the stone age as far as I'm concerned.