Prostate biopsy is one of the most performed procedures in urology. As a diagnostic procedure it should be of low risk. However, morbidity following prostate biopsy is common due to infectious complications.
To describe how to reduce infectious complications following prostate biopsy. We report on antibiotic and technical interventions to reduce infectious complications.
The data presented are based on a narrative review. Search in PubMed and Medline was performed until May 2018 with a focus on randomised controlled trials and meta-analyses. Articles were reviewed for data on symptomatic infections, hospitalisation, and adverse events.
Antibiotic prophylaxis is the standard of care. However, the duration of antibiotic preemptive treatment is still under debate. The use of augmented antibiotic prophylaxis as well as targeted antibiotic prophylaxis might be of potential value, but evidence is currently limited. Moreover, no antibiotic class was shown to be clearly superior to another. The evaluation of the technical aspects during prostate biopsy reveals that rectal preparation with povidone-iodine is clearly effective to reduce infectious complications. Transperineal biopsy has a potential benefit to reduce infectious complications, but powerful randomised controlled studies are missing. Finally, the number of biopsy cores, the application of periprostatic nerve block, or the use of a cleansing enema has no impact on prostate biopsy in terms of infectious complications.
The available data only suggest that rectal preparation with povidone-iodine as well as antibiotic prophylaxis is of significant advantage to reduce infectious complications following prostate biopsy. The augmented and targeted antibiotic prophylaxis shows some potential, but need further validation.
In this review we evaluate the best management strategy to prevent infectious complications following prostate biopsy. We show that antibiotic prophylaxis is essential for prostate biopsy and that rectal preparation with povidone-iodine is mandatory.
European urology focus. 2018 Nov 29 [Epub ahead of print]
Adrian Pilatz, Rajan Veeratterapillay, Bela Köves, Tommaso Cai, Riccardo Bartoletti, Florian Wagenlehner, Franck Bruyère, Suzanne Geerlings, Gernot Bonkat, Benjamin Pradere
Department of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany., Department of Urology, Newcastle University, Newcastle, UK., South-Pest Teaching Hospital, Department of Urology, Budapest, Hungary., Santa Chiara Regional Hospital, Department of Urology, Trento, Italy., Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Academic Department of Urology, CHRU Tours, François Rabelais University, Tours, France., Division of Infectious Diseases, Amsterdam University Medical Centre, Amsterdam, The Netherlands., alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University of Basel, Basel, Switzerland., Academic Department of Urology, CHRU Tours, François Rabelais University, Tours, France. Electronic address: .