AUA 2019: Investigation of Infectious Outcomes inIntrarectal Povidone-iodine Cleansing Plus Formalin Disinfection of Needle Tip During Transrectal Ultrasound Guided Prostate Biopsy

Chicago, IL ( The ultrasound or MRI-guided prostate biopsy is most commonly performed through the transrectal route. However, infectious complications are a growing concern, because the rate of resistance to commonly used antibiotics is increasing. Therefore, alternative strategies, in an attempt to decrease infection rates following biopsies, are currently being examined. The goal of this study was to compare the infectious complications of intrarectal povidone-iodine cleansing associated with formalin disinfection of the biopsy needle tip used for prostate biopsy.

This was a prospective randomized controlled study that enrolled a total of 802 consecutive patients undergoing prostate biopsies with a 1: 1 randomization ratio for two distinct groups. Group A included rectal cleansing and disinfection of the needle tip vs. Group B, which were controls with standard prebiopsy preparation. All patients obtained a urine culture 48 hours following the prostate biopsy and completed a telephone interview seven days after undergoing the procedure. The primary endpoint of this study was the rate of infectious complications, defined as 1 or more of the following events: Urinary tract infection (UTI), and fever or sepsis (standardized definition). The authors also attempted to evaluate the factors associated with infectious complications.

Infectious complications were observed in 33 (4%) patients, of whom, 8 (1%) had a fever, 14 (1.7%) had UTI, and 11 (1.4%) endured sepsis. The rate of infectious complications was lower in group A (2.8% versus 5.3%, OR=0.52, 95% CI 0.25-1.08, p= 0.07). The overall rate of positive urine culture was also lower in group A: 17 (4.9%) vs. 28 (9.4%), p=0.026. On multivariable analysis, prior use of urinary indwelling catheters was associated with asymptomatic bacteriuria (p=0.026). Additionally, previous use of antibiotics in the last three months before the prostate biopsy was marginally correlated to a higher risk of infectious complications.

In conclusion, rectal cleansing with povidone-iodine plus disinfection of the biopsy needle tip at transrectal ultrasound guided prostate biopsy was marginally associated with the reduction of infectious complications following a prostate biopsy.

Presented by: Felipe Costa, MD, Departamento de Anatomia Patológica, A.C. Camargo Cancer Center, São Paulo, Brazil

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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