CBP - Enterococcus Faecalis

[lsedels]

Hello.

I have had bacterial prostatitis for years now, but have always been able to knock it down with antibiotics. Last year, I came down with Enterococcus Faecalis confirmed by culture, which basically is sensitive only to Amoxicillan or Levofloxacin. I was on Augmentin 1500mg/day for 6 weeks last fall. It worked but I had a recurrence about 2 weeks after I finished. After this, I brought in an infectious disease specialist who prescribed Amoxicillin 3000mg/day for 6 weeks. Again it worked great, but my symptoms recurred a couple of days after finishing. Most recently, he put me on Levofloxacin (this is the last resort because of the potential for tendon issues) 500mg/day for 28 days. Again it worked great, until 2 days after finishing when my symptoms returned.

My uro wants to do an aggressive TURP in an attempt to try to reach all of the infection. However, he readily admits that I may very well continue to have infections afterwards. AND ... there are small chances of permanent incontinence, permanent ED ... and larger chances of permanent retrograde ejaculation ... in addition to a guaranteed period of about 3 months of temporary incontinence.

I am 65 but I am single and trying to meet someone ... and I feel like I'm in between a rock and a hard place (well ... LOL ... sometimes).

I am reading of the intra prostatic injections, but it seems like I would have to pay out of pocket and from what I am reading it actually made many people worse. I live in the NYC area. Trying to decide what to do but it seems like I don't have many options. Can't stay on antibiotics forever.

Thanks for any help or insights.

Larry

[webslave]

Given your age, I would do the TURP. But I would not go for the ultra-aggressive option, just a normal TURP, no heroic efforts! You may need another uro with less invasive thinking.

A TURP can remove any BPH you may have that could be contributing to your problems, if not causing them outright.

[lsedels]

Appreciate your reply. I will get more opinions. But I fear that they will say that in order to have a higher probability of getting more of the infection removed (as well as getting more prostate tissue from BPH), I need the aggressive approach. You say "at my age", but I am only 65. If I were 75 or 80, I don't think I'd have as much of an issue with TURP.

[webslave]

Oh, it's very common to have BPH at 65. About 70% of men in their 60's (& 80% of men>70) have some degree of BPH.

If there is a locus of infection, or an abscess, or a fleshy abnormality that is conducive to infection, it's most likely not located out near the capsule. You can always cut more away with a further procedure, but you cannot add stuff back if the nerves have been cut or damaged. Note also that it's critical to preserve the external sphincter muscle for continence (the internal sphincter is removed by the TURP).

I just get nervous when surgeons get a gleam in their eyes and talk about aggressive procedures.

[lsedels]

I understand. And I'm a long way from agreeing to it. But you have to realize my issue is not the BPH. When I'm on an antibiotic that is sensitive to the bacteria, it's like night and day. I can't say that I'm able to pee the same way as I did 20 years ago because I do have a very large prostate. But when I'm on the antibiotic, I'm able to have a pretty decent stream during the day, it reduces at night but I'm not too limited, I retain little if any urine in the bladder as measured by my uro, and I get up 1 or 2 times a night instead of 5-6 times a night when I'm not on the antibiotic with the infection. I also have urgency and frequency more often during the day when I'm not on the antibiotic. So it appears that even though I have a very large prostate, my issues are due to the infection and it has been really difficult to get rid of or at least return it to dormancy.

[webslave]

But as I have explained to you, chronic bacterial prostatitis occurs because there is a reservoir of bugs inside the prostate for a variety of reasons as outlined above. Remove the flesh of the prostate and that hidey hole disappears. If you have a large prostate, you are heading for a TURP eventually anyway, so why not do it a few years early?

And let me add this caveat: unless you have had repeated cultures over time, all showing the same bug, then there is a very high likelihood that you DO NOT have CBP, but rather UCPPS, which is an entirely different entity and which will not be helped by a TURP. Your reaction to antibiotics does not mean much, since they are, inter alia, anti-inflammatories.

[lsedels]

I don't agree that antibiotics are necessarily antiinflammatory. I also can say that I have confirmed repeated culture results with the same bacteria. And just because one has a large prostate doesn't mean they are headed for a TURP. There are many with an enlarged prostate who have little or no quality of life impact. And lastly, I don't know how old YOU are but why don't YOU try getting a TURP a few years early and report back here to us and tell us how much you like it and you like the aftereffects? I don't get the dismissiveness of someone when they are 65 years old and single.

[webslave]

I don't agree that antibiotics are necessarily antiinflammatory.

https://ucpps.men/viewtopic.php?t=9339

[xavhernandez]

The antibiotics that works the best with faecalis are Septrim for 3 months, amoxicillin for 40 days, Fosfomycin with some injection of penicillin for 40 days or Linezolid for 40 days. You can always add N-Acetyl Cysteine to the treatment because it says it helps to break the bacteria barrier. Cipro also may also work in 40 days but it hurts your tendons. Sometimes it's better to consult a infectiologist instead of urologist because they know better the bacteria. One reason why bacteria arrive to the prostate is due to the fact that your pelvic muscles are inflamed, create an obstruction and some bacterias of the penis arrive to the prostate where they can increase because it is the perfect place for them. I hope this helps.