Editorial Comment to Prevention of infectious complications after prostate biopsy procedure.

Abstract

The article by Togo and Yamamoto reviewed the topic of prevention of infectious complications after a prostate biopsy procedure and the current consensus.1 They clearly showed them under classification of the approach (transperineal or transrectal) and the risks for infection (high and low) according to the risk factors, such as larger prostate volume, diabetes mellitus, steroids, severe dysuria and immunocompromised hosts. There are many Japanese studies regarding prophylaxis in prostate biopsies. As the authors showed, Yasuda et al. offered evidence of the efficacy of piperacillin/tazobactam in high-risk patients, which could be a relevant reference for IJU readers for the selection of prophylactic antibiotic administration on transrectal prostate biopsy.2 Just recently, the guideline for perioperative measures for urological surgeries and procedures, including prostate biopsies, was updated by Yamamoto et al., and the importance of the classification of high and low risks for infection was emphasized.3 We also presented other regimens using cephamycin plus fluoroquinolones for high-risk patents.4 There is a possible difference in the targeted bacteria between high- and low-risk patients. This is because the former (high-risk patients) could be infected before prostate biopsy, especially in the prostate (chronic prostatitis), but no apparent pyuria or bacteriuria findings are seen in their urine, so they may not be diagnosed as having an infection. The important issue is that we need to exclude patients with infectious disease based on the evidence of pyuria, bacteriuria or related symptoms, and they were not subjects for the purpose of this review and the guideline mentioned above; they need to be treated with antibiotics in advance, which show susceptibilities to the causative bacteria isolated by culture tests. Therefore, the evaluation on if the patients have infection or not is necessary before prostate biopsy, as well as the classification of high and low risk for post-prostate biopsy infection. One matter that we would like to raise is whether this procedure can be carried out on an outpatient basis, or if the patients need to be hospitalized. Recently, urologists have been asked by those patients with suspected prostate cancer if they would like to undergo prostate biopsy as outpatients; however, currently, we have no evidence, as far as we know, that this procedure (prostate biopsy) can be carried out safely on outpatients without inferiority compared with inpatients. Therefore, future research is required regarding this question. None declared.