Prostatitis Treatment Clinic
at the MacLeod Laboratory
65 E. 79th Street
New York, NY 10021
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Attila Toth, MD
We at the MacLeod laboratory examine and treat patients with chronic prostate infection. Patients visit us either for treatment of symptomatic chronic prostatitis or as husbands of infertile couples who exhibit documented bacteriospermia The evaluation begins with a detailed history taking and objective evaluation of the patient’s symptom index. We adopted the NIH standard prostatitis questionnaire as seen here.
Following the completion of the questionnaire semen and urine analysis with culture studies follow. Cultured organisms include: Chlamydia trachomatis (from the urethral swab), Mycoplasma group, complete screening for aerobic and anaerobic bacteria and yeast. Both urine and semen are examined for the parasite Trichomonas. Next a physical examination of the genitals follows and the prostate gland is evaluated first with digital rectal examination and then rectal sonography is performed. Pictures taken during sonographic examination are stored in the chart for documentation and for future reference.
An EPS sample is examined under the microscope
for epithelial cells, bacteria and white blood cells. Similarly urine
sediment is examined to rule out a cystitis component.
The cardinal part of the therapy includes direct transperineal injections of antibiotics into the prostate. In a four week session eight injections are given. The antibiotics are chosen on the basis of the microbiological findings and sensitivity reports. The most frequently used antibiotics are: Gentamicin, Levaquin, Flagyl, Zithromax, and Diflucan. Xylocaine is added to the cocktail to control local discomfort. As routine, we do not add steroids to the antibiotic mixture. Adding EDTA is optional, though the benefit of EDTA is not proven completely. In acute prostatitis cases the prostate injections are complimented with intravenously given Clindamycin, using an ambulatory pump system or less frequently orally given antibiotics.
Advantages of the therapy
One month following the therapy the symptom evaluation, cultures, and sonography examinations are repeated.
Change in symptom index: All of our patients reported improvement in symptom scores, a minimum of 60%. The majority however was experiencing 80 to 90% improvements. A gradual improvement in the symptoms was further appreciated at the two to three month post therapy evaluation.
Change in post therapy bacteria count: There is consistently a precipitous drop in the bacteria colony count in the post therapy semen samples.
Following the initial therapy, we recommend two booster injections each at three, six and nine months later or sooner if symptoms start coming back.
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