Intraprostatic injections

[lupus]

I just wanted to share my experience with everybody thinking about sticking needls in their prostate.
I was diagnosed with Bacterial prostatitis 4 years ago ,and desperation took me here,I had only one intraprostatic injection and it just worsen my sympthoms ,more pain on my devastated left side.
Although over these years I have been building up tolerance to my pain level I didn't know how to get rid of sexual effects that CP gave me (weak erections,libido loss.....),some kind of nerve damage has already been done and I start to think it could harm permanently.
After the intraprostatic injection results I bought the book A HEADACHE IN THE PELVIS,and started to relax the pelvic muscles (didn't believe much on the part that talks about Paradoxical relaxation,but I focus on the possible theory about pain originated on the pelvic muscles,no matter what cause brought that contracture on pelvic muscles (infection, trauma,hormone disbalance...or whatever) it sounds logic what these doctors say in the book,in fact ,I started to check my pelvic muscles and I felt pain almost everywhere,its been a month doing dayly massage on pelvic muscles and although I still have pain on my left side I have found several places that when pressing I felt pain ,specialy one, extremely close to the prostate (curiously on the left side where the pain stays) that seems to be very hard to touch,and I first thought it could be some kind or part of bone,but its very well delimitated and who know whats that,I had a transrectal ultrasound and didn't show any calcification,PSA was ok,and my doctor told me that he only could notice some congestion on the arterie and vein (big vascular hypetrophy),a part from that the proste seemed healthy to touch and what showed on the TR ultrasound ¿?
So I keep massaging and relaxing pelvic muscles and I will be doing it for the next several months,since my prostatitis is technically BACTERIAL,this method woudnt have to have much positive impact on my sympthoms but I'm gonna try it anyway.
Bacterial prostatitis suffers,any input on how to handle sexual dysfunction?,for me its the worst part of everything,when moving through my prostate ,my left side (where most of the pain comes) feels different than the right probably due to the nerve damage.........and hypervascular and nerve congestion.....anybody,any comment?
I will keep you updated on my progression.
I have tried antibiotics (seem to improve sympthoms but after quiting them all comes back again)
Quercetin (did nothing)
Serenoa Serrulata (help a bit)
At this moment I do not take anything just practice pelvic muscle relaxation.
I have no urination problem,just left side pain and sexual disturbance commented above.

Best of luck to you,God bless all of you suffering this thing !!,I'm not the same person before and after this condition hit me,it changed my life totally !!,now I just pay attention and really care about the important things in life..........and the main is HEALTH

[scotsman]

....since my prostatitis is technically BACTERIAL,this method woudnt have to have much positive impact on my sympthoms but I'm gonna try it anyway.

Welcome to the board lupus.

What makes you say its bacterial prostatitis?

Richard.

[james-d]

I am sorry to hear about your experience.

I, on the other hand, had a wonderful experience with my interprostatic injections.

I think, like many forms of treatments, it works very well for SOME people - and not for others.

I am sorry it did not work for you.

What modality of injection did you have and with what drugs (e.g. transperenial or rectal injections, and what drug cocktail?) - just curious so that we can compare notes.

[lupus]

What makes you say its bacterial prostatitis?

Positive cultures:
They found Citrobacter,Enterococus and Staphilococus.

What modality of injection did you have and with what drugs (e.g. transperenial or rectal injections, and what drug cocktail?) - just curious so that we can compare notes.

I had transperineal injection with general anesthesia (20 min) ,my doc did a cytoscopy when I was asleep,but told me that everything was ok.
The cocktail had levofloxacin+bethametasone+gentamicine ,dont recall if metronidazol was used as well.
The biggest clue and benefict I had with my injection experience was that I noticed when I walk out of the medical center after the injection that even with that HUGE CONCENTRATION OF CORTICOID RUNNING INTO MY PROSTATE I STILL HAD PAIN on my perineum ,after a few days when I was told to ejaculate ,the pain became much stronger since all the corticoid and antibiotic was ejected due to the ejaculation (by the way ,it was terrible having to see during at least a couple of weeks bloody semen when I ejaculated) but that pain was different than the one I have been suffering for so long,that makes me think that theres something wrong apart from my prostate,How come that tremendous concentration of corticod couldnt stop the pain ?,may be that pain has other cause besides the prostate.

During this month streching and doing dayly massage on my pelvic muscles ,I still have pain but I can say that it is not that bad as it used to be,I have to say that when doing massage on pelvic muscles I use a corticoid medicine indicate to treat hemorroids and I extend the medicine through the rectum into the pelvic muscles,since I found so many trigger points.

[MastCells]

Positive cultures: They found Citrobacter,Enterococus and Staphilococus.

The idea that these three species of bacteria have been "infecting" your prostate for the last 4 years is absurd. I can't see how you'll make any progress with the Stanford/Wise-Anderson Protocol or similar methodology if you don't let go of the idea of nasty little bugs attacking your prostate. Thinking about that all the time would make anyone anxious and prone to clenching his pelvic muscles.

[scotsman]

Positive cultures: They found Citrobacter,Enterococus and Staphilococus.

The idea that these three species of bacteria have been "infecting" your prostate for the last 4 years is absurd. I can't see how you'll make any progress with the Stanford/Wise-Anderson Protocol or similar methodology if you don't let go of the idea of nasty little bugs attacking your prostate. Thinking about that all the time would make anyone anxious and prone to clenching his pelvic muscles.

Completely agree MastCells.

Lupus - have you had your pelvic floor been internaly assessed by a trained physio? If not then I'd highly recommend it.

Richard.

[alprost]

An important point here is that, whilst an documented infection may have initiated your problem, it is very unlikely to be causing your symptoms now. So, say one of the bugs did cause a prostate infection 4 years ago (the Uro I saw at Stanford mentioned that Enterococus is sometimes implicated in bacterial prostatitis) which resulted in significant pain and urinanry dysfunction. This then sets up nerve sensitisation and myofascial trigger points. The infection which caused this is treated by ABX and clears up, but the effects (i.e. trigger points and pain sensitization) remain and cause symptoms, and need also to be treated. For example, perineal pain is usually caused by trigger points in the pelvic floor of chronic prostatitis / chronic pelvic pain syndrome patients IMHO.

As stated by others, you should get your pelvic floor examined by someone experienced in this area. You might also want to read this article, and follow the links to the 4 sites at the end:
https://ucpps.men/chronic-prostatitis-is-a-psychoneuromuscular-condition

For the record, I dont think intraprostatic injections are ever appropriate in CPPS, which is caused primarily by pelvic floor dysfunction and NOT the prostate. They may have a place in the treatment of chronic bacterial prostatitis which recurs after oral ABX, but at the moment there doesn't appear to be enough research data to say for sure one way or the other, although cases such as James's are very interesting.

[alprost]

I started to check my pelvic muscles and I felt pain almost everywhere,its been a month doing dayly massage on pelvic muscles and although I still have pain on my left side I have found several places that when pressing I felt pain ,specialy one, extremely close to the prostate (curiously on the left side where the pain stays) that seems to be very hard to touch,and I first thought it could be some kind or part of bone,

I've been told that some of my trigger points were so wound up and hard they felt like bone when they were palpated - the only way to know for sure what this is is to get your pelvic floor examined by a specialist (easier said than done I know, but you need to pull out the stops and find someone who can do this for you).

[james-d]

I noted that your injections were transperenially - that is a particularly painful (and potentialy more dangerous ) way to get them.

If you or any other patient out there is considering injections - I urge you to consider the trans-rectal approach - it is the same technique used for a prostate biopsy.

And yes - it does hurt like hell - but only for a few moments - once the TRUS device and needle are gone - so is the pain from the injection.

My experience is very positive with this method - it is the same method explained by Dr. Bahn.

The transperieniel approach is much more complicated and potentially painful - and requires a higher degree of doctor competency.

[lupus]

Mastcells:

The idea that these three species of bacteria have been "infecting" your prostate for the last 4 years is absurd. I can't see how you'll make any progress with the Stanford/Wise-Anderson Protocol or similar methodology if you don't let go of the idea of nasty little bugs attacking your prostate. Thinking about that all the time would make anyone anxious and prone to clenching his pelvic muscles.

Yes,I guess that some psychological contribution plays a big roll in all this crazy illness.

Scotsman:

Completely agree MastCells.

Lupus - have you had your pelvic floor been internaly assessed by a trained physio? If not then I'd highly recommend it.

No,its been a few months ago since I started to investigate, reading this web and the book AHIP ,and considering the posibility of another cause of my sympthoms a part from bacterial .(almost 3 years wasted following the medical community point of view)


Alprost:

I've been told that some of my trigger points were so wound up and hard they felt like bone when they were palpated - the only way to know for sure what this is is to get your pelvic floor examined by a specialist (easier said than done I know, but you need to pull out the stops and find someone who can do this for you).

Yes,not an easy task to find someone who can do that,more even when the only answer I get is MORE ANTIBIOTICS !!

James-d

The transperieniel approach is much more complicated and potentially painful - and requires a higher degree of doctor competency.

My doc chose transperineal because transrectal could lead more chances to enterococus contamination,thats what he said......
My experience was totally a disaster and I wouldnt recomend it to anyone.


I realize that you all support the myofascial dysfunction theory,and you may be right,but scientifically speaking, if you find positive cultures prior to the intraprostatic injections as I did,that means that likely THERE IS AN INFECTION ,and as Dr Shokes commented somewhere time ago "if therere signals of infection DO TREAT THE INFECTION".
What makes you think that the whole bacteria even after several rounds of antibiotics and 4 years, has been eliminated from all the acinis of the prostate?,you all know how bad antibiotics penetrate into the prostate and how difficult the prostates acinis are to reach.

[MastCells]

I realize that you all support the myofascial dysfunction theory,and you may be right,but scientifically speaking, if you find positive cultures prior to the intraprostatic injections as I did,that means that likely THERE IS AN INFECTION ,and as Dr Shokes commented somewhere time ago "if therere signals of infection DO TREAT THE INFECTION".

You've already been treated for an infection though...several times. Do you think Dr. Shoskes would treat you with antibiotic after antibiotic for years even after it's obvious that they aren't working? I doubt it.

Normal, perfectly healthy men have bacteria in their prostates. Maybe the cultured bacteria *should* be in your prostate, or maybe contamination is to blame for the lab results. Have you ever had a positive urinalysis? Frequent, documented UTIs? If not, you probably don't have CBP. From the NIH definition of chronic bacterial prostatitis: "Patients with chronic bacterial prostatitis experience recurrent episodes of bacterial urinary tract infection caused by the same organism, usually E coli.."

What makes you think that the whole bacteria even after several rounds of antibiotics and 4 years, has been eliminated from all the acinis of the prostate?

If you have had an infection that can't be treated by antibiotics that has lasted 4 years now, your immune system must be severely compromised. Do you have AIDS, or are you taking large doses of immunosuppressants because you had an organ transplant?

you all know how bad antibiotics penetrate into the prostate and how difficult the prostates acinis are to reach.

That's completely false. Several common antibiotics have excellent prostate penetration, and there is research to prove it. Don't believe everything you read on the internet. I have a feeling that you've been reading some quackery. Read all of https://ucpps.men ; I consider it an anti-quack site.

[lupus]

You've already been treated for an infection though...several times. Do you think Dr. Shoskes would treat you with antibiotic after antibiotic for years even after it's obvious that they aren't working? I doubt it.

Dont know about Dr Shoskes but here I have visited many docs with the same answer " lets do a PROPHYLACTIC cycle of antibiotics"

Normal, perfectly healthy men have bacteria in their prostates. Maybe the cultured bacteria *should* be in your prostate, or maybe contamination is to blame for the lab results. Have you ever had a positive urinalysis? Frequent, documented UTIs? If not, you probably don't have CBP. From the NIH definition of chronic bacterial prostatitis: "Patients with chronic bacterial prostatitis experience recurrent episodes of bacterial urinary tract infection caused by the same organism, usually E coli.."

Thats true Mastcells,I havent had frecuent or UTIs but in the firsts epidodes of the illnes,in fact the last two years have been absolutely urinary free sympthoms.In fact this kind of pain has no relation with the pain I had during the first stages of the prostatitis,indeed the pain I have now came after a very stressfull situation on my life that last several months,might be coincidence but all the pieces of the puzzle seem to have conection each other.
As I said, since I found this web and the book AHIP my whole concept of this illnes has change dramatically ,I admit that what you (Mastcell) and many others consider about myofascial dysfunction sounds very logic to me and it could be the culprit of many peoples pain.

If you have had an infection that can't be treated by antibiotics that has lasted 4 years now, your immune system must be severely compromised. Do you have AIDS, or are you taking large doses of immunosuppressants because you had an organ transplant?

No AIDS or inmunosuppresants,transplants,etc.....apart from chronic prostatitis / chronic pelvic pain syndrome I'm a healthy man......again what you say its true,if an infection lasts that long ,something really bad is happening on the immune system.

That's completely false. Several common antibiotics have excellent prostate penetration, and there is research to prove it. Don't believe everything you read on the internet. I have a feeling that you've been reading some quackery. Read all of https://ucpps.men ; I consider it an anti-quack site.

As I told you I've been following doctors advice in order to beat this condition with poor results ,now I'm considering pelvic myosfascial dysfunction to be the core of the problem instead of keep blaming the prostate,as a matter of fact from now on ,all my effort will follow that therapy direction.
I want to thank the creators of this forum and to all of you that contribute to make this site as a reference in the treatment of CPPS,medical community is so lost (For medical community I'm still clasified as Chronic Bacterial Prostatitis) that only sufferss initiative could bring some light to darkness,folks,were alone in this !!

[CppsDad]

Just re-reading your post, I noticed that you said "left side pain" a few times. When I see someone comment on pain on a particular side, it's almost always a red flag. To me, it suggests that you have some pelvic-floor muscle issues. The prostate is in the middle. I don't know why it would hurt one side more than the other, especially if you have a uniform infection in it. This wouldn't be true in all cases, but the fact that you have soreness all over when you touch the muscles supports these theories too. As the others have pointed out, bacteria in the prostate is perfectly normal according to some studies. Perhaps your "normal" range is different than others. But after 4 years of taking anti-biotics, you might as well try some other approaches at this point. The long term effects of taking antibiotics are a lot worse than the long term effects of physical therapy, relaxation, and stretching. At the very least, try both. If you have a willing partner to help you, they can learn to do the PT with you. My wife is getting really good at it, and she's only done it 10 times. Of course, I saw a PT first just to make sure I KNEW what it should feel like. But the internal massage has been critical for me. I could NOT have progressed at all without it. I don't want to say it's the most important part of the therapy for me because the party line on this board is that all 3 components are equally important, but I'll say it anyway. I stretched. I relaxed. I did EVERYTHING I could to avoid tensing the pelvic area. But none of it mattered until I started getting those trigger points released. I'm not going to tell you all the bacterial stuff is in your head or that it isn't important, but until you've checked out all angles you'll never fully understand the cause of your pain.

[latte]

One of the participants in Dr. Wise's clinic in Sebastopol told me last fall that he had taken antibiotics for several years with no change. He was so happy to have an alternative treatment available. The real beauty of the PT method is that there are no lasting side effects, only positive ones besides the initial soreness from the massage. I hate drugs and avoid them at all costs. The PT takes time and money but at least you can try something that has a chance of alleviating your pain. I also have one sided pain(left).

[lupus]

Thanks CppsDad and Latte for your answers.....
Its been about a month and a half since I started self internal massage on the pelvic muscles and about a week since I started massaging the pelvic muscles using a corticosteroid topical medicine (indicated for haemorrhoids,although I don't have haemorrhoids I get benefit from the anti-inflammatory properties of the topical cream ).
Since I started self massage the pain was still there but seemed to lessen every week,the big change came when I massage using the anti-inflammatory topical cream ,since then, the pain has almost gone ,even though I only apply it once a day (at night) when I prepare myself to do the pelvic floor massage.

Conclusions so far :

-Doing pelvic muscle self massage every day for almost a month and 1/2, has improved my situation in terms of diminishing the pain (although I STILL had pain),after the intraprostatic injection I was on pain almost all the time.

-One week doing pelvic muscle self massage every day for one week using corticosteroid topical cream on the pelvic muscles before massage has almost cut the pain totally,although I still have the erection problem I commented above,I'm going to check my hormone levels and follow a treatment of VitB1+VitB6+Vit12 to see if I can improve pudendal nerve transmission because these years of continuous pain might have damage the nerve,or may be this erection thing its only on my head but I doubt it ,I think that this sexual thing has relation with my prostatitis and myofascial dysfunction .
The only thing that remains the same is like a 2mm square nodule very hard to the touch that seems to me like a calcium nodule rather than a muscular contracture ,I wonder if this nodule has something to do with the pudendal nerves?

Best of luck for all of you !!