Pre-biopsy Enema Research Articles

Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3.479 prostate biopsy cases.

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.

AUA Quality Improvement Summit 2014: Conference Proceedings on Infectious Complications of Transrectal Prostate Needle Biopsy

IntroductionThe AUA Quality Improvement Summit is a continuing AUA effort to provide education around issues related to quality improvement and patient safety. Due to the rapidly increasing rates of hospitalization following prostate needle biopsy, Infectious Complications of Transrectal Prostate Needle Biopsy was selected as the inaugural topic. MethodsThe information is largely unpublished data provided by the presenting physicians. Infection rates are predominantly self-reported with protocols specified by the physicians' home institutions. Beyond the identified speakers, the open forum of this summit allowed for input from a majority of the participants. ResultsCurrent hospitalization rates for transrectal prostate needle biopsy infections vary widely from 0.5% to 6%. Antibiotic resistance of coliform organisms appears to be a major risk of these infectious complications. Prophylactic protocols also vary widely among the represented institutions. Antibiotic resistance profiles showed extreme regional variation and, as such, a prophylactic antibiotic protocol should be based on the current local antibiogram in order to reduce infection rates. Opinions vary in relation to the specific antibiotics appropriate for an augmented antibiotic prophylaxis, in the use of rectal swab and prebiopsy enema, and povidone-iodine preparation of the rectal vault. Standardization of the transrectal antibiotic prophylaxis across practices has been proven to reduce the infectious complications rates. ConclusionsUrologists should monitor the prostate biopsy infection rates of the practice and consult the current local antibiogram. Physicians should query patients to assess whether they are at high risk for resistant organisms. If so, prophylactic protocols might be intensified.

MP25-19 EFFICACY OF RECTAL POVIDONE-IODINE SWABS IN DECREASING INFECTIOUS COMPLICATIONS AFTER TRANSRECTAL PROSTATE BIOPSY

biopsies (USTRPB) is a long-standing and current practice in many centers around the globe. Strong evidence supporting such recommendation is lacking. The objective of the present trial is to analyze the difference in complications among patients with and without pre-biopsy enemas. METHODS: Single center, randomized prospective study. We included patients scheduled for USTRPB in our Institution (march 2013-ongoing). One group (A) applied two glycine enemas and the other (B) did not apply any enemas. Urinalysis and urine culture were performed prior and 5 days post-biopsy. A clinical evaluation was performed 10 days after the biopsy. Clinical complications were defined as need for hospitalization, sepsis or urinary retention. A “visualization score” was done by the urologist performing the biopsy (blinded to the study). IBM SPSS Statistics Version 22 was used for data analysis. Chi square analysis was used for categorical variables and Student-T for comparing means with normal distributions. RESULTS: 139 patients were included. Mean age was 64.79 (48-93) years old. 33.9% were hypertensive and 21.4% diabetic. All patients had a pre-biopsy urine culture (96% were negative and 4% received culture guided treatment). 56.5% used enemas. PostUSTRPB complications and visualization scores are shown in table. Other complains after biopsy were hematuria (74.1%), hematospermia (29.5%), rectal bleeding (40.2%) and fever (12.5%), without group differences. 31.8% of patients had prostate cancer, without any group differences. CONCLUSIONS: Our preliminary data shows that the routine use of pre-biopsy rectal enema did not lead to a significant decrease in terms of complications, visualization or diagnostic accuracy when compared to the absence of pre-biopsy enemas. Further more, the omission of pre-biopsy enemas could result in a cost and discomfort reduction to the patient.

Complications of transrectal ultrasound-guided prostate biopsy: impact of prebiopsy enema.

PurposeTransrectal ultrasound (TRUS)-guided biopsy of the prostate is usually safe. However, some patients are hospitalized owing to complications from TRUS biopsy. We identified the risk factors for complications and effective preventive measures for treating complications after TRUS biopsy.Materials and MethodsMedical records and radiological images of 1,083 patients who underwent TRUS biopsy of the prostate over 10 years in Gyeongsang National University Hospital were examined retrospectively to investigate the correlation between complications after TRUS biopsy and preventive antibiotics, prebiopsy enema, number of biopsy cores, and pathological findings.ResultsComplications occurred in 69 patients (6.4%). The complication rates of the 1,008 patients who received antibiotics and the 75 patients who did not were 6.3% and 8.0%, respectively (p=0.469). Complication rates of the pre-biopsy enema group (n=658) and the group without prebiopsy enema (n=425) were 4.7% and 8.9%, respectively (p=0.007). Complication rates of the 6-core biopsy group (n=41) and the 12-core biopsy group (n=955) were 7.3% and 6.3%, respectively (p=0.891). Complication rates of the prostate cancer group (n=306) and the no prostate cancer group (n=713) were 6.2% and 6.6%, respectively (p=0.740).ConclusionsA prebiopsy enema was associated with a reduced risk of complications after TRUS biopsy. Preventive antibiotics, number of biopsy cores, and pathological findings did not significantly influence the complication rate.

Prevalence of ST131 Among Fluoroquinolone-resistant Escherichia coli Obtained From Rectal Swabs Before Transrectal Prostate Biopsy

To identify the prevalence and characteristics of fluoroquinolone-resistant (FQ-R) Escherichia coli ST131 isolates in men undergoing ultrasound-guided transrectal prostate biopsy (TPB). Twenty-seven FQ-R E coli isolates from rectal swabs from 136 men undergoing TPB at 3 institutions in southern California (January 2009 to March 2010), with a focus on repeat biopsy patients, were assessed for E coli phylogenetic group, sequence type ST131 status, extended virulence genotype, pulsed-field gel electrophoresis profile, and antimicrobial susceptibility profile. ST131 accounted for 70% of the 27 FQ-R pre-TPB E coli rectal isolates, including 82% of those from non-Asians vs 20% from Asians (P = .017). ST131 was associated negatively with prebiopsy enemas and positively with previous TPB. Compared with non-ST131 isolates, the ST131 isolates had a significantly higher prevalence of 4 virulence genes (sat, usp, ompT, and malX), distinctive virulence profiles, and numerically higher virulence scores (median, 12 vs 8), but similar antimicrobial resistance scores. Most rectal ST131 isolates exhibited pulsed-field gel electrophoresis profiles typical of clinical ST131 isolates. In our locale, the epidemic multidrug-resistant ST131 clonal group accounts for 70% of FQ-R rectal E coli isolates among men undergoing TPB. Such ST131 isolates have distinctive virulence profiles, are extensively antimicrobial-resistant, and are negatively associated with Asian race. Further investigation is needed regarding risk factors for and clinical consequences of colonization with such strains among men undergoing TPB.

1435 MORBIDITY OF PROSTATE BIOPSY FOLLOWING SIMPLIFIED VERSUS COMPLEX PREPARATION PROTOCOLS: ASSESSMENT OF THE RISK FACTORS

INTRODUCTION AND OBJECTIVES: Although transrectal ultrasound (TRUS) guided prostate biopsy is considered a generally safe and well tolerated procedure, it is associated with significant complications. We determined whether prostate biopsy complications were affected by two varying pre-biospy protocols implemented at our institution. METHODS: We retrospectively evaluated a total of 1438 TRUS guided prostate biopsies between January 2001 and June 2008 from our institutional review board approved database. In group (A), 931 men had only one dose of a quinolones antibiotic immediately before the procedure and no enema was performed. Group (B) was comprised of 507 men who underwent a pre-biopsy enema and were given oral antibiotics starting the day before the procedure for a total of 3 days. We analyzed demographics and biopsy complications between the 2 groups including age, prostate volume, number of biopsy cores, number of previous biopsies and recent use of anticoagulant or antiplatelets therapy. RESULTS: The overall complication rates for both groups were categorized as infection (2.2%), urine retention (0.8%), haematuria (4.4%), rectal bleeding (1.5%), vasovagal syncope (3%), sepsis (0.2%). There was no significant statistical difference in the incidence of infection or sepsis between the two groups (2.7% vs. 1.4%, p 0.157 and 0.1% vs. 0.4% p 0.285, respectively). Both the incidences of haematuria and clinically relevant haematospermia were greater in the second group (7.9% vs. 2.5%, p 0.001 and 2% vs. 0.2%, p 0.001 respectively). Prostate size was a significant risk for both haematuria (OR: 1.7 (1.2–2.44), p 0.003) and acute urinary retention (OR: 4.45 (2.01– 9.84), p 0.001). CONCLUSIONS: The current study demonstrates that a single antibiotic dose before prostate biopsy may be sufficient. Additionally, use of pre-biopsy enemas is unnecessary to decrease overall complication rates.

Morbidity Of Prostate Biopsy After Simplified Versus Complex Preparation Protocols: Assessment of Risk Factors

To determine whether prostate biopsy complications were affected by 2 varying prebiospy protocols implemented at our institution. Although transrectal ultrasound (TRUS) guided prostate biopsy is considered generally safe, it is associated with significant complications. We retrospectively evaluated a total of 1438 TRUS-guided prostate biopsies between January 2001 and June 2008. In group A, 931 men had only one dose of a quinolone antibiotic immediately before the procedure, and no enema was performed. In group B, 507 men who underwent a prebiopsy enema and were given oral antibiotics starting the day before the procedure for 3 days. We analyzed demographics and biopsy complications between the 2 groups. The overall complication rates were categorized as infection (2.2%), urine retention (0.8%), hematuria (4.4%), rectal bleeding (1.5%), sepsis (0.2%). There was no significant statistical difference in the incidence of infection or sepsis between the 2 groups (2.7% vs 1.4%, P = .157 and 0.1% vs 0.4%, P = .285 respectively, for group A vs B). Both hematuria and hematospermia were more common in group B (2.5% vs 7.9%, P < .001 and 0.2% vs 2%, P < .001 respectively, for group A vs B). Prostate size was a significant risk for both hematuria (odds ratio = 1.7, 95% confidence interval = 1.2-2.44, P = .003) and acute urinary retention (odds ratio = 4.45, 95% confidence interval = 2.01-9.84, P < .001). This study demonstrates that a single antibiotic dose before prostate biopsy may be sufficient. In addition, use of prebiopsy enemas is unnecessary to decrease overall complication rates.

Profilaxis antibiótica en la biopsia transrectal de próstata

Introduction Transrectal ultrasound-guided needle biopsy of the prostate is a safe technique, but it is not complication-free, and its most serious complications are genitourinary infections (GUI) and the conditions they cause. The purpose of antibiotic prophylaxis is to reduce this GUI incidence rate. However, no established guidelines exist and there are significant differences among centres where this procedure is performed. The objective of the present report is to review antibiotic prophylaxis protocols described in the literature. Material and methods We reviewed indexed articles published in English or Spanish and accessible through literature databases. Results Five articles comparing antibiotic prophylaxis with a placebo observe lower bacteriuria and infectious complications percentage rates in the group receiving prophylaxis. In most cases, E. coli is the microorganism responsible for infection. Oral quinolones are the most commonly prescribed prophylactic antibiotics. Three studies of oral vs. parenteral prophylaxis found no differences between the two groups. Three other articles comparing short term and single-dose prophylaxis found no differences between the two groups. Conclusions Administering prophylactic antibiotics is more advantageous than not doing so. The moment for beginning prophylaxis depends on the antibiotic's bioavailability and how it is administered. The chosen antibiotic will preferably be administered orally as a single dose or short term course, according to the sensitivities of prevalent microorganisms. More studies are needed to determine what role pre-biopsy enemas play in reducing infectious complications.

Transrectal Needle Biopsy of the Prostate: The Efficacy of a Pre-biopsy Enema

Purpose: There are numerous biopsy protocols that have been described in the clinical literature. We especially assess the role of the use of an enema before a transrectal prostate biopsy by comparing the post biopsyinfectious complications rate. Materials and Methods: From January 2007 to August 2007 we retrospectively evaluated 302 men who underwent transrectal needle biopsy of the prostate according to the inclusion criteria. Patients in group 1 (121 patients) did not receive an enema and were given oral ciprofloxacin (500 mg) for 3 days. Those in group 2 (181 patients) received an enema before the biopsy and were also administered intravenous ciprofloxacin (400mg) and an additional oral form (500mg) for five days. Only complications related to infection were evaluated, that is, fever and chills with systemic inflammatory symptoms, within two weeks after the biopsy. Results: Patients demographics, such as age and prostate size did not differ between the two groups (p>0.05), but the level of prostate-specific antigen (PSA) in group 2 was significantly higher than in group 1 (12.70ng/ml versus 28.88ng/ml, p 0.05). The infectious complications rate was 2.6% (8/302) overall and did not differ significantly between the two groups (2.5% versus 2.8%, p>0.05). Especially for group 2 patients, there were two cases of bacteremia and Escherichia coli was reported as the pathogen. Conclusions: Our findings suggest that the use of a pre-biopsy enema shows no significant benefit given the considerations of infectious complications rate, and the patient quality of life. (Korean J Urol 2008;49:248-251) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Time of administration of a single dose of oral levofloxacin and its effect in infectious complications from transrectal prostate biopsy

To evaluate the efficacy of two prophylactic schemes for prostate biopsy using a single dose of oral levofloxacin given either before, or immediately after transrectal ultrasound-guided prostate biopsy. A total of 300 men formed two groups of 150 patients each: the first group received one dose of 500 mg of levofloxacin 30 min to an hour before, and the second group the same antibiotic immediately after prostate biopsy. No pre-biopsy enema was used. Side effects after prostate biopsy were recorded, and the two groups were compared. Only one patient from the first group developed a urinary tract infection after biopsy. A mean number of more than 10 cores per patient were taken. Haematuria was the most common complaint, followed by haemospermia. Haematuria and rectal bleeding were more common in patients where more than 8 cores were taken from the prostate (P = 0.005 and P = 0.017, respectively). Prostate cancer was detected in 34.3% of patients in total. The use of a single dose of 500 mg levofloxacin given immediately after prostate biopsy proved to be quite effective for the prevention of infectious complications, even in the setting of an extensive biopsy protocol.

Patient’s Preparation in Order to Reduce Pain, Anxiety and Complications of TRUS Prostatic Biopsies

Objectives: Prostatic biopsy is a minor diagnostic procedure; despite the simplicity of execution this procedure can determine a high patients’ discomfort. Methods: We analyzed the experience reported in the literature concerning the pain and the anxiety, the role of local or intrarectal anesthesia and the complications related to prostatic biopsy. Key words used for the Medline search included: prostate cancer, biopsy, transrectal ultrasound anesthesia, complications. Results: The reduction of patients’ pre biopsy anxiety may help the physician to perform a better prostate biopsy. While the use of pre biopsy enemas seems questionable, the use of antibiotic prophylaxis is mandatory when the biopsy is transrectal and could be useful if the approach is transperineal. The use of anaesthesia (periprostatic local injection of lidocaine or intrarectal administration of lidocaine gel) seems to reduce patients’ discomfort. The higher is the number of biopsy cores, the greater is the need for anaesthesia. Conclusions: Trans-rectal ultrasound (TRUS) prostatic biopsy with a correct patient’s preparation has a limited impact on patient’s well-being.

BACTEREMIA AND BACTERIURIA AFTER TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

We determined the incidence and predisposing factors of bacteremia and bacteriuria after prostate biopsy with specific emphasis on the value of a pre-biopsy enema. We randomized 50 men undergoing ultrasound and biopsy to rule out prostate cancer to receive a preoperative (25) or no (25) enema. Preoperatively urine was obtained for culture, and questionnaires regarding urological history and voiding symptoms were completed. The initial prostate biopsy, biopsy needle, and postoperative urine and blood specimens were cultured. The following day a symptom questionnaire was completed. Bacterial growth in post-procedure cultures did not correlate with the number of biopsies, prostate specific antigen, obstructive voiding symptoms, prostate volume, cancer or post-biopsy hematuria. Bacteriuria was noted in 44% of the cases and bacteremia was present in 16% of the patients, of whom 87.5% did not receive an enema (p = 0.0003). Only 1 patient had chills and fever greater than 37.5C, requiring additional antibiotics. On the followup questionnaire 12% of patients described dysuria, including 84% with bacteriuria after biopsy. Bacteremia and bacteriuria after multiple biopsies are common but usually asymptomatic. Bacteria is apparently introduced into the urine and/or blood from the rectum via the biopsy needle, which may be minimized by a pre-biopsy enema. Dysuria or a history of urinary tract infection did not predict problems after biopsy.