Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice

The effect of povidone-iodine rectal cleansing on post-biopsy infectious complications

OBJECTIVE

To evaluate the effect of pre-biopsy povidone-iodine rectal cleansing on post-biopsy hospitalization rates due to prostate biopsy-related infectious complications.

MATERIAL AND METHODS

In this retrospective study, we reviewed 552 patients who underwent ultrasonography-guided transrectal prostate biopsy between 2014 and 2022. Group 1, 361 patients (January 2014-October 2020) were not applied povidone-iodine rectal cleansing, and group 2, 191 patients (November 2020-January 2022) were applied povidone-iodine rectal cleansing since we changed our biopsy protocol. All patients were given the same antibiotic prophylaxis, ciprofloxacin 500 mg, and ornidazole 500 mg twice daily starting 24 h before the biopsy and lasting a total of 5 days. Sodium phosphate enema was applied to all patients in the biopsy morning. The outcome was the hospitalization rates of patients because of infectious complications a month after the biopsy.

RESULTS

No patients were hospitalized in the povidone-iodine rectal cleansing group because of biopsy related complications. The hospitalization rate of group 1 was 3% and there was a statistical difference between groups.

CONCLUSION

The povidone-iodine solution is cheap, safe and easy to apply. The povidone-iodine rectal cleansing method seems to decrease infectious complications related to prostate biopsy procedure, but we need a randomized controlled trial to confirm our study.

TRIAL REGISTRATION

We got permission for this retrospective study from the Karabuk university ethics council with the number 2021/649 on 1 October 2021.

Revisión Retrospectiva de Biopsias de Próstata Realizadas en el Hospital La California, San José, Costa Rica de Enero 2018 a Diciembre 2019

Objetivos: Valorar la indicación de las biopsias transrectales de próstata (BxTr) y correlacionar la misma con un eventual resultado positivo por cáncer de próstata (Cap). Diferenciar si la indicación de tacto rectal (TR) alterado vs antígeno prostático (APE) alterado tienen mayor valor predictivo positivo. Determinar si el protocolo de biopsias de próstata de nuestro centro es seguro  para los pacientes. Metodología y materiales: Revisión retrospectiva de expedientes médicos de pacientes sometidos a BxTr de próstata del Hospital La California desde enero 2018 a diciembre 2019.  Las muestras fueron tomadas en su totalidad por el Dr. Mario González (especialista en urología). Del total de 200 biopsias, se incluyeron los casos que tuvieran todos los datos completos en el expediente tales como APE y  tacto rectal para un total de 168 pacientes incluidos en la revisión. Las indicaciones de biopsia para efectos de esta revisión fueron APE alterado por encima de 2.5 ng/ml y tacto rectal alterado definido como cualquier endurecimiento sospechoso de neoplasia prostática. Se documentaron como complicaciones el sangrado que requiriese internamiento no mayor a 12 horas posterior a la biopsia y fiebre mayor de 38.5ºC dentro de las 24 horas posteriores al procedimiento. Resultados y conclusiones : Entre enero 2018 y diciembre de 2019 se realizaron 200 biopsias de próstata. Se incluyeron en el estudio los datos de 168 pacientes que cumplían con los criterios de inclusión. La media de edad de los pacientes fue 62.5 años (mediana 62). El tamaño promedio de las glándulas prostáticas fue de 53.9 gramos. Del total de pacientes (n=168), 41 presentaron alteración en el tacto rectal (24.4%). Por otro lado el APE se encontraba alterado (=> 2.5 ng/ml) en 162 de los casos (96.4%). El porcentaje de pacientes con TR y APE alterado fue de 22% (37/168). En cuanto a la correlación clínica con el resultado histo patológico de adenocarcinoma,  el 35.1% de los casos tuvieron resultado de adenocarcinoma de próstata (59/168). Por otro lado los casos con TR alterado con biopsia positiva fue de 18.4% (31/168) casos. Al combinar TR alterado con APE alterado de 29/168 casos (17.2%) fueron positivos. No hubo ingresos hospitalarios (0/168) y solo 4/168 presentaron una prostatitis post biopsia (0.02%),ninguno de ellos requirió hospitalización, se manejaron con antibióticos intra musculares.

Effect of rectal mucosa cleansing on acute prostatitis during prostate biopsy: A randomized prospective study

OBJECTIVE

Infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB) can range from asymptomatic bacteriuria and febrile or non-febrile urinary tract infection (UTI) to sepsis. Cleaning of rectal mucosa with topical antiseptics such as povidone iodine or chlorhexidine before the procedure are alternative prophylaxis methods. We aimed to investigate the effects of these two different topical antiseptic agents on infectious complications and their superiority to each other.

MATERIAL AND METHODS

The study was conducted with 200 patients. Rectal mucosa cleansings were performed in 50 patients with povidone iodine and 49 patients with chlorhexidine. The remaining 101 patients did not receive any antiseptic treatment. The results were examined according to the hospital admissions or hospitalization for the first 30 days after the procedure due to UTI, body temperature >38.5°C, sepsis, hematuria, rectal bleeding, and urinary retention.

RESULTS

The mean age of study population was 63.3±7.26 years, and the mean prostate specific antigen value was 13.96±29.5 ng/mL. Acute prostatitis occurred in 14 patients (7%), 9 of whom were hospitalized due to sepsis after TRUS-PB. Statistically significant less acute prostatitis was observed in those patients who were treated with topical rectal antisepsis (topical rectal antisepsis 2% vs. no rectal antisepsis 12.1%, p=0.01). Chlorhexidine and povidone iodine were not superior to each other in terms of inhibiting the development of acute prostatitis (chlorhexidine 2% vs. povidone iodine 2%, p=1.00).

CONCLUSION

Rectal mucosal cleansing with chlorhexidine or povidone iodine before TRUS-PB prevented the development of sepsis due to acute prostatitis. We recommend that this effective method, which is easy to apply, cheap, reliable, easily tolerated should be used in all prostate biopsy practice.