Abstract
ABSTRACTObjectives:To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors.Materials and Methods:We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated.Results:Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively).Conclusions:Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.
Highlights
Transrectal ultrasound-guided needle biopsy (TRUS-Bx) is generally accepted as a standard procedure for the diagnosis of prostate cancer [1]
We investigated the incidence of acute prostatitis under two different prophylactic regimens with bacteriologic characteristics of blood and urine cultures
Fluoroquinolones are one of the most effective antibiotics for the genitourinary system and show excellent penetration into the prostate tissue, and because the vast majority of uropathogens and enteric species have proper susceptibility to these agents, most of the trials have focused on fluoroquinolones [10,11,12]
Summary
Transrectal ultrasound-guided needle biopsy (TRUS-Bx) is generally accepted as a standard procedure for the diagnosis of prostate cancer [1]. Despite various studies in the literature demonstrating low rates of complications and good tolerance to the procedure, it is still considered invasive and not entirely free of complications [2, 3]. Prophylactic antibiotic therapy and pre-biopsy enema are recommended for preventing infectious complications [6,7,8]. Either alone or in combination with other antibiotherapeutic agents, are the most common prophylactic practices. In the last few years, increased resistance to quinolones has been reported in association with a rise in severe infectious complications after biopsy [9]. We aimed to compare the incidence of prostatitis after prostate biopsy using two different prophylactic antibiotic protocols and provide an overview of the bacteriologic characteristics of urine and blood cultures, as well as antimicrobial resistance in NIH category I acute bacterial prostatitis
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