A novel enema method can prevent infectious complications of transrectal ultrasound‐guided prostate biopsy: A single‐centre experience

Abstract

Background TRUS biopsy is the preferred method for diagnosing prostate cancer, but it can cause infectious complications that arise with the contribution of fluoroquinolone resistance. We aimed to explore the potential protective effect of a second rectal enema before biopsy. Methods From January 2015 to December 2020, 419 patients were assessed retrospectively. Patients with a history of anticoagulant use, uncontrolled diabetes, urological surgery, prostate biopsy or recent hospitalisation or overseas travel, as well as those with the previous prostatitis, were excluded from the study. The patients were subsequently divided into two groups: Group 1 (n = 223) had received one enema, on the morning of the biopsy and Group 2 (n = 196) had received two, with the additional enema administered half an hour before the procedure. Results There was no significant difference between the groups in terms of age(P = .076), BMI (P = .489), diabetes (P = .265), prostate‐specific antigen (PSA) level (P = .193), free/total PSA (f/t PSA) ratio (P = .518) and prostate size (P = .661) or in relation to cancer detection (P = .428). The median hospitalisation date was significantly higher in Group 1 (P = .003) as was urinary tract infection (UTI) development (P = .004). However, there was no significant difference in terms of fever and sepsis (P = .524 and P = .548, respectively). Additionally, subgroup analysis demonstrated that UTI was significantly lower in patients with diabetes mellitus who had received a second enema (P = .004), though there was no significant difference in UTI between the groups in those without diabetes mellitus (P = .215). Multivariable analysis showed that age and diabetes were significant risk factors for the development of UTI (OR: 1.074, 95% CI: 1.027‐1.130, P = .002 and OR: 1.220, 95% CI: 0.131‐0.665, P = .003, respectively). Furthermore, the second enema was a significant protective factor for preventing UTI (OR: −1.794, 95% CI: 2.208‐16.389, P < .001). Conclusion Older age and the presence of diabetes mellitus are independent risk factors for UTI after prostate biopsy. A second enema procedure before biopsy may protect patients from related infectious complications and could therefore be used as an alternative preventative method.

Transperineal vs. transrectal biopsy to reduce postinterventional sepsis

“…Sepsis, defined with a SOFA score greater than 2 [11], and positive urine culture were observed in 0.7% of all men. However, no statistically significant difference in the rate of sepsis after transrectal ultrasound-guided prostate biopsy was detected between the two cohorts (0.7 versus 0.5%, P ¼ 0.54) [16]. Of note, in two studies [15,16], men at high risk for infection (e.g.…”

“…However, no statistically significant difference in the rate of sepsis after transrectal ultrasound-guided prostate biopsy was detected between the two cohorts (0.7 versus 0.5%, P ¼ 0.54) [16]. Of note, in two studies [15,16], men at high risk for infection (e.g. those with immunodeficiency or other selected comorbidities) were excluded from the final analysis.…”

“…Others evaluated the efficacy of rectal laxative enemas to decrease the bacterial load in the rectum. A novel method using an enhanced enema strategy was explored by Gokalp et al [16] in men who underwent transrectal ultrasound-guided prostate biopsy while under antibiotic prophylaxis. One cohort of men received one rectal enema on the morning of their biopsy, and the other cohort received an additional enema half an hour before the procedure.…”

Analysis of risk factors for infection after transrectal ultrasound-guided prostate biopsy and analysis of the value of preoperative prophylactic antimicrobial use

“…People with combined diabetes have poor body resistance, and some studies have shown that diabetes can promote the growth of Escherichia coli and induce pyelonephritis [25]. Moreover, diabetic patients often develop insulin resistance, which may also promote the release of various inflammatory factors, resulting in hypoxia, fibrosis, centrocyte infiltration, and other changes in the prostate tissue, and with the prolongation of diabetes, the body's immune-regulatory function may decrease even under glycemic control, which may increase the chance of infection after TRUSPB [26].…”