الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
SUMMARY & CONCLUSION
50 patients out of 55 patient patients with symptoms of chronic bacterial prostatitis in the form of recurrent urinary tract infections, resistant prostatitis to systemic antibiotics for more than 6 months. The diagnosis of chronic bacterial prostatitis was confirmed by EPS with the presence of more than 10 pus cell/HPF.
Five patients were excluded 4 escape ”Not follow up”, and 1 after cystoscope examination bladder pathology ”ulcer”. The age of the patients ranged from 28-48 years with peak incidence between 30-40 years. Twenty patients of 50 patients (60%) were married.
The patients were divided into 2 groups according route of injection:
Group I: Injection via transrectal route (30 patients).
Group II: Injection via transurethral route (20 patients).
The aim of this study is to compare the out come of intraprostatic injection of antibiotics via transrectal ultrasonography guided route with transurethral route in treatment of chronic bacterial prostatitis, as an alternative to other modalities in management of this challenging problem.
There was statistical analysis between group I and group II.
- As regard the NIH/CPSI there were significant improvement between both group at 3 and 6 months were group I more improvement cause mean NIH in group I and 3 months was 6.4. But 13.2 in group II and at 6 month group I was 6.6 and group II was 14.2.
- As regard mean number of pus cells in EPS was at 3 month in group I 27.7 and in group II 10.7. But at 6 month was in group I .8 and in group II 11.8 so these was significant improvement between 2 groups at 3 and 6 month which group I has more improvement.
- According culture and sensitivity there was insignificant difference between studied groups at 3 and 6 month but there was obviously improvement in group I at 3 month, –ve culture and sensitivity 24 patients (80% ), 11patients (55%) in group II.
- But at 6 month was 22 patients (73.3%) in group I and 10 (50%) in group II so the result obtained in group I was better than them obtained in group II.
There was statistically highly significant difference between 2 studied group regard mean operative time which 14.4 in group I and 36.3 in group II and mean hospital stay (hours) which was 3.2 in group I and 12.1 in group II and mean hematuria after injection (days) which was 1.7 in group I and 5.1 in group II.
In our study was highly significant different between the 2 groups regarding type anesthesia. where the 30 patients in group I had only IV sedation (100%), while in group II spinal anesthesia needed in 95% of cases and general anesthesia in 5% of cases of group II.
In conclusion we have this important points:
1- The improvement in INH/CPS (post injection that obtained by TRUS route is better than that obtained by the transurethral route.
2- Decrease in number of pus cell in EPS was more significant by TRUS route than by transurethral.
3- There was obviously increase of percentage of –ve culture and sensitivity in EPS in group I more than group II.
4- The TRUS route has low post operative complication in comparison with transurethral route.
5- Operative time is very show in TRUS route.
6- TRUS guided route need only IV sedation but transurethral route need spinal or general anesthesia.
Finally, we can say that:-
- The transrectal route of injection is much better than transurethral route according to previous results.
- The procedure can be done in the out patient department and the technique is quick, easy and inexpensive.
- Direct transrectal injection of antibiotics into the prostate proved successful and seems to provide a new hopeful prospect for treatment chronic bacterial prostatitis.
We recommended:
• Proper serial estimation of prostatic and serum concentration of antibiotics after injection to detect the ideal concentration and consequently the doses required for complete eradication of the causative organisms, that was not available in the present study.
• The patients must reviewed at regular intervals after injection as long term remission can be expected in most patients, and once the relapse established, injection of antibiotics should be repeated because multiple injections enhance permanent cure.