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Practitioner protocol · Injection
Prostate Ozone Injection Protocol
Madrid's gas volume, concentration and weekly schedule for ozone injections in bacterial prostatitis and benign prostatic hyperplasia.
Quick answer: Madrid gives 5–10 mL at 30 µg/mL for bacterial prostatitis, weekly for 10 weeks, and 10 mL at 10–20 µg/mL for benign prostatic hyperplasia (BPH). It uses a 27G needle and is a practitioner protocol. MediSkill limit: 20 mL per session.
Warning
Requires hands-on training from an experienced physician
Prostate ozone injection should only be performed by a practitioner trained in it by an experienced physician.
Practitioner-only procedure. Prostate ozone is given by injection near the prostate by trained, licensed clinicians, usually urologists. This sheet is a reference for them. It is not a self-treatment guide and not medical advice. Strict sterile technique is required every time.
What are the basics of ozone prostate injection?
- Madrid's prostate section is short. It gives one injection plan for acute or chronic bacterial prostatitis and one for benign prostatic hyperplasia (BPH, an enlarged prostate).
- Both plans use an ozone-oxygen gas mixture injected beside the prostate. Madrid does not say whether the needle goes in through the rectum or the perineum, and it publishes no home route for the prostate.
- For prostatitis, Madrid places the gas in the peripheral zone of each lobe. For BPH, it says to inject around the lobes, not into the prostate itself.
- Rectal insufflation is a separate systemic route. Madrid gives no prostate-specific dose for it. See the rectal protocol for the general method.
Source: Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 8. Paraphrased.
What dose and technique are used for ozone prostate injection?
| Acute or chronic bacterial prostatitis | Benign prostatic hyperplasia (BPH) | |
|---|---|---|
| Gas volume | 5 to 10 mL of ozone-oxygen | 10 mL of ozone-oxygen |
| Concentration | 30 µg/mL | 10 to 20 µg/mL |
| Where | The peripheral zone of each lobe | Perilobular, not into the prostate |
| Needle | 27G x 2, as Madrid prints it (what the 2 means is not clear in Madrid) | Not stated |
| Schedule | One session a week for 10 weeks | Not stated |
Madrid does not give a maximum, a patient position or an imaging method, so none is listed here. MediSkill limit: 20 mL of gas per session.
What are the best tips when using ozone prostate injection?
- Studies of this injection used ultrasound guidance. One used a transrectal probe with a needle guide and injected by hand while pulling the needle back, in a sextant or extended pattern, and stopped at the patient's tolerance.
- Studies gave local anesthetic first (lidocaine, procaine or mepivacaine) and used antibiotic cover.
- Madrid's base rules apply: first do no harm, and titrate from the low dose.
- For BPH, Madrid says to inject around the lobes, not into the prostate. The 2017 series below injected into each lateral lobe, which is not what Madrid advises, so do not copy that approach. Follow your urology team's protocol and record the approach you use.
Equipment (generic)
- Ozone generator with an ozone-resistant gas path (quartz glass, titanium, silicone)
- Medical oxygen tank and regulator (an oxygen concentrator is not for injections)
- Ozone-resistant, phthalate-free syringes and sterile needles
- Ultrasound with a transrectal probe and needle guide, if you use that approach
- Skin and rectal antisepsis supplies
What are the precautions for ozone prostate injection, and who should avoid it?
- Infection is the main risk to plan for. In one 25-man series, two men developed a prostatic abscess and one developed bacteremia after the injection. Madrid says most serious ozone events trace back to technique, asepsis and antisepsis.
- Never inject ozone gas into a vein or an artery. Madrid strongly discourages both because of the risk of air embolism.
- Place any anesthetic above the ozone in the syringe, as Madrid advises, so the ozone does not oxidize it.
- Never breathe ozone gas.
Contraindications
The Madrid Declaration lists these contraindications for systemic ozone (IV and blood). It gives no separate list for prostate injection, but many practitioners use the same screening before treating:
- Direct inhalation of ozone gas. The fluid lining the lungs has no antioxidants to buffer it, so inhaled ozone is toxic.
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency (favism, acute hemolytic anemia). Madrid lists it as a contraindication for systemic ozone, but whether it is absolute is debated. MediSkill protocols start low and go slow; see the contraindications article.
- Toxic hyperthyroidism (severe Graves' disease)
- Thrombocytopenia (platelets under 50,000) and severe coagulation disorders
- Severe cardiovascular instability
- Acute alcohol intoxication
- Recent acute myocardial infarction
- Acute massive hemorrhage
- Convulsive states
- Hemochromatosis
- Patients receiving intravenous copper or iron therapy
Pregnancy. Madrid advises avoiding ozone therapy in the first trimester (weeks 0 to 13) and reserves its use in pregnancy for specialists in gynecology and obstetrics.
More detail
What the studies used
Evidence is thin. The prostate injection reports are small single-group series, and the one comparison was not randomized. Study doses are listed as printed and are not Madrid dosing.
- In 30 men with BPH who had failed a trial without catheter, one injection of 40 mL of ozone (20 mL in each lateral lobe, 23 Fr spinal needle, by the rectal route) was followed by a small fall in prostate volume, 46.1 to 45.0 cc at day 7 (p=0.008) and 42.7 cc at 1 month. There was no comparison group. Mild injection-site pain (5 men) and a perianal rash (2) cleared within 24 hours (Hussain 2017). The concentration is printed as 30 µg/dL (unit as printed, likely an error). 40 mL is 4 times the 10 mL Madrid lists for BPH and twice MediSkill's limit of 20 mL per session, so do not copy that volume.
- In 25 men, ultrasound-guided injection at 30 µg/mL, using 20 mL per lobe and up to 100 mL for larger glands (10 to 20 times Madrid's 5 to 10 mL), gave no significant change in symptom score, PSA (prostate-specific antigen, a blood test) or prostate volume at 3 months in the 18 analyzed. The two men with chronic prostatitis went from symptom scores of 19 and 20 to 8. Complications were two prostatic abscesses and one bacteremia (bacteria in the blood) (Barbod 2013). Madrid cites this study for prostatitis.
- In 18 men with BPH, perineal injections beside the prostate (5 mL per lobe) with platelet-rich plasma, every 15 days for 6 sessions, were followed by lower residual urine (about 123 to 16 mL) and smaller prostate size on ultrasound. There was no control group (García-Villanueva 2012, Spanish-language report).
- Systemic route: in 272 men with chronic prostatitis (category IIIB), 10 sessions of major autohemotherapy (2 per week) beat no treatment at 6 weeks on symptom scores (IPSS, a prostate symptom score, 11.4 vs 24.2; NIH-CPSI, a chronic prostatitis symptom score, 15.9 vs 22.1). The groups were not randomized and differed at the start, and side effects were not reported (Turkish cohort, World J Urol 2025).
Learn more
Background on injection methods: Ozone injections, full article. The systemic blood method used in the 272-man study: IV ozone (MaH) protocol. Screening: Ozone therapy contraindications.
Related protocols: Ozonated Saline IV Drip (O3SS) Protocol, IV Ozone Protocol: Major Autohemotherapy (MaH), Minor Autohemotherapy (MiAH) Protocol.
Other protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.