Comparison of Prophylactic Methods to Prevent Clinical Infection After Trans-Rectal Prostate Needle Biopsy

INTRODUCTION: Studies have shown that infectious complications after trans-rectal prostate biopsy (TRUS-Bx) are increasing and various prophylactic methods have been developed to reduce these complications. This study aimed to compare the effectiveness of oral antibiotic and rectal Povidone-iodine usage for infection prophylaxis before TRUS-Bx.
METHODS: Data of 280 patients who underwent prostate biopsy between July 2016 and October 2019 were reviewed retrospectively. Prophylaxis was achieved with 3 days of oral antibiotic therapy before biopsy in 147 patients and with 10% Povidone-iodine rectal application during biopsy in 133 patients. The groups were compared in terms of demographic data, PSA levels, prostate volumes, cancer detection rates, number of biopsy cores, and infectious complications such as urinary tract infection and fever within 1–2 weeks after TRUS-Bx.
RESULTS: The mean age of patients receiving antibiotic prophylaxis was 62.2±8.8, while the mean age of patients receiving prophylaxis with rectal Povidone-iodine was 63.2±9.1 years (p=0.38). There was no significant difference in terms of prostate specific antigen level, cancer detection rates and age in both groups. About 15.6% had diabetes in the antibiotic prophylaxis group and 16.5% had diabetes in the Povidone-iodine group. In the group receiving antibiotic prophylaxis, acute prostatitis was seen in 7 (4.8%) patients, 2 of whom were sepsis and in the group receiving rectal Povidone–iodine prophylaxis, acute prostatitis was seen in 4 (3%) patients, 1 of whom was sepsis. The groups were not statistically different in terms of infective complications (p=0.45).
DISCUSSION AND CONCLUSION: The groups were not statistically different in terms of infective complications after prostate biopsy. Therefore, prophylaxis which was achieved with rectal Povidone-iodine application may be more appropriate in terms of both antibiotic resistance and cost.