Abstract
Purpose
Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is associated with a 1–8% risk of post-biopsy sepsis (PBS). A recent study described an isopropyl alcohol needle washing protocol that significantly decreased PBS rates. The current study examined the efficacy of this technique in our clinic population.
Materials and methods
Data were reviewed for 1250 consecutive patients undergoing TRUS-Bx at the Charlie Norwood VA Medical Center from January 2017 to January 2023. Needle washing was adopted in February 2021. Complications occurring within 30 days after TRUS-Bx were recorded.
Results
There were 912 patients in group 1 (without needle washing) and 338 in group 2 (with needle washing). Groups had equivalent demographic features, and men of African descent comprised 70% of patients. Standard 12 core biopsies were done in 83% and 82% in groups 1 and 2, respectively (p = 0.788). Total complication rates were 4% and 2% in groups 1 and 2, respectively (p = 0.077). There were 13 sepsis events in group 1 (1.4%) and none in group 2 (p = 0.027). Clavien–Dindo Grade I–III complications occurred in 25 (2.7%) and 7 (2.1%) patients in groups 1 and 2, respectively (p = 0.505). Standard antibiotic prophylaxis (PO fluoroquinolone and IM gentamicin) was given in 80% and 86% of patients in groups 1 and 2, respectively (p = 0.030). Subset analysis limited to patients who received standard prophylaxis showed a significant difference in sepsis rates (1.5% vs 0%; p = 0.036).
Conclusions
Adoption of isopropyl alcohol needle washing was associated with a significant decrease in PBS events.
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References
Loeb S et al (2013) Systematic review of complications of prostate biopsy. Eur Urol 64:876–892. https://doi.org/10.1016/j.eururo.2013.05.049
Mian BM et al (2024) Complications following transrectal and transperineal prostate biopsy: results of the ProBE-PC randomized clinical trial. J Urol 211:205–213. https://doi.org/10.1097/JU.0000000000003788
Simmons MN, Neeb AD, Johnson-Mitchell M (2018) Reduced risk of sepsis after prostate biopsy using a cephalosporin-fluoroquinolone antibiotic regimen and isopropyl alcohol needle washing. Urology 115:102–106. https://doi.org/10.1016/j.urology.2018.02.012
Clavien PA et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
Pradere B et al (2021) Nonantibiotic strategies for the prevention of infectious complications following prostate biopsy: a systematic review and meta-analysis. J Urol 205:653–663. https://doi.org/10.1097/JU.0000000000001399
Auffenberg GB et al (2018) Evaluation of a needle disinfectant technique to reduce infection-related hospitalisation after transrectal prostate biopsy. BJU Int 121:232–238. https://doi.org/10.1111/bju.13982
Issa MM et al (2013) Formalin disinfection of biopsy needle minimizes the risk of sepsis following prostate biopsy. J Urol 190:1769–1775. https://doi.org/10.1016/j.juro.2013.04.134
Junior JP et al (2022) Effectiveness of intrarectal povidone-iodine cleansing plus formalin disinfection of the needle tip in decreasing infectious complications after transrectal prostate biopsy: a randomized controlled trial. J Urol. https://doi.org/10.1097/JU.0000000000002910
Ding XF et al (2021) Risk factors for infection complications after transrectal ultrasound-guided transperineal prostate biopsy. World J Urol 39:2463–2467. https://doi.org/10.1007/s00345-020-03454-y
Simsir A, Kismali E, Mammadov R, Gunaydin G, Cal C (2010) Is it possible to predict sepsis, the most serious complication in prostate biopsy? Urol Int 84:395–399. https://doi.org/10.1159/000296290
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Anthony Hiffa—protocol/project development, data collection or management, data analysis, manuscript writing/editing. Merry Chen—data collection or management. Faizan Boghani—data collection or management. Michael D. Oberle—data collection or management. W. Carter Reed—data collection or management. Sherita A. King—data collection or management. John De Caro—data collection or management. Martha K. Terris—data collection or management, data analysis. Matthew N. Simmons—protocol/project development, data collection or management, data analysis, manuscript writing/editing. Thomas E. Dykes—protocol/project development, data collection or management, data analysis, manuscript writing/editing.
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All research was conducted in accordance with VA and IRB protocols. Given that the study was a review analysis, neither IRB approval nor informed consent was required. All data were collected and stored in secure databases and in accordance with institutional and federal requirements.
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Hiffa, A., Chen, M., Boghani, F. et al. Prostate biopsy sepsis prevention: external validation of an alcohol needle washing protocol. World J Urol 42, 279 (2024). https://doi.org/10.1007/s00345-024-04955-w
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DOI: https://doi.org/10.1007/s00345-024-04955-w