CUA guidelines on prostate biopsy methodology

El-Hakim, Assaad; Moussa, Sabri

doi:10.5489/cuaj.10021

Cited by 58 publications

(37 citation statements)

References 75 publications

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“…33,34 The Canadian guidelines recommend the addition of intravenous aminoglycosides to FQ in centeres with a high post-biopsy UTI incidence. 10 Earlier studies demonstrated the benefit of adding aminoglycosides to ciprofloxacin prophylaxis in centres with high FQ resistance. 33,34 More recently, Adibi and colleagues conducted a randomized controlled trial demonstrating a decline in post-biopsy hospitalizations due to infections from 3.8% to 0.6% when intra-muscular (IM) gentamicin was added to the FQ regimen.…”

Section: Discussionmentioning

confidence: 99%

“…8 The current American and Canadian Urological Association Guidelines recommend FQ antibiotics as firstline agents prior to TRUS-PB. 9,10 Randomized clinical control trials have demonstrated efficacy of FQ in reducing the incidence of post-TRUS-PB sepsis. 11,12 However, despite the reported effectiveness of FQ, we are currently observing a global rise in bacterial resistance to these agents.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Rudzinski

Kawakami²

2014

CUAJ

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Introduction:We have seen an increased risk of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS-PB). Fluoroquinolone (FQ) antibiotics are common for prophylaxis prior to TRUS-PB. We evaluate whether increasing FQ resistance correlates with increased incidence of post-biopsy infectious complications at our institution. Methods: We conducted a retrospective chart and electronic health record review on 927 patients who underwent TRUS-PB between January and July of 2012 in Calgary, Alberta, Canada. We prospectively collected the following variables: age, pre-biopsy prostatespecific antigen, and date of biopsy. We documented presentation to an emergency department within 30 days of TRUS-PB for infectious and non-infectious complications. Results: Of the 927 patients, 58 patients (6.3%) were admitted to the emergency department due to post-TRUS-PB complications within 30 days post-biopsy. The most common infectious complications were sepsis in 21 patients (2.2%), followed by urinary tract infection (UTI) in 9 (0.9%), and prostatitis in 4 (0.4%). We found that 83% of the septic episodes and 66.6% of the UTIs were attributed to ciprofloxacin resistant Escherichia coli (E. coli). The incidence of non-infectious complications was as follows: urinary retention in 12 (1.2%), hematuria in 9 (0.9%), and rectal bleeding in 8 (0.8%). Conclusion: Our results suggest an increased incidence of infectious complications caused by FQ resistant organisms following TRUS-PB. This finding could be attributed to increasing community resistance to ciprofloxacin. The current antimicrobial prophylactic regimen needs to be re-evaluated, and a novel approach may need to be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Rudzinski

Kawakami²

2014

CUAJ

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“…As a definitive recommendation regarding the management of antithrombotic agents before TRUS biopsy is yet to be established, the benefits and adverse effects of heparin bridging therapy are debatable. Clinicians have traditionally discontinued antithrombotic agents and started heparin bridging therapy, depending on the risk of thrombotic events (Douketis et al 2008; El-Hakim and Moussa 2010). The guidelines for the management of antithrombotic agents for endoscopic procedures suggest heparin bridging therapy for higher-risk procedures (e.g., polypectomy) in high-risk patients (e.g., those with atrial fibrillation with mechanical valves, valvular heart disease, and/or a history of cerebrovascular accidents, and those who experience transient ischemic attacks) (Murasaki 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Second, they can be discontinued for several days prior to the procedure and restarted thereafter. Third, they can be discontinued with bridging anticoagulation using heparin (heparin bridging therapy), administered during the sub-therapeutic window, in patients at high risk of thromboembolic events (Douketis et al 2008; El-Hakim and Moussa 2010). However, there are few prospective studies regarding the relationship between TRUS biopsy and continuation of antithrombotic agents.…”

Section: Introductionmentioning

confidence: 99%

Safety of heparin bridging therapy for transrectal ultrasound-guided prostate biopsy in patients requiring temporary discontinuation of antithrombotic agents

et al. 2016

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BackgroundSafety of heparin bridging therapy for transrectal ultrasound-guided prostate (TRUS) biopsy in patients requiring temporary discontinuation of antithrombotic therapy is unknown. This study aimed to assess the relationship between heparin bridging therapy and the incidence of complications after TRUS biopsy.MethodsFrom January 2005 to November 2015, we performed 1307 consecutive TRUS biopsies on 1134 patients in our hospital. The patients were assigned to two groups: those without heparin bridging (the control group) and those with temporary discontinuation of antithrombotic agents with heparin bridging therapy (the bridging group). A 10–12-core TRUS biopsy was performed; the patients were evaluated for bleeding-related complications.ResultsOf 1134 patients, 1109 (1281 biopsies) and 25 (26 biopsies) were assigned to the control and bridging group, respectively. Patient background did not significantly differ between the control and bridging groups, except for age, history of diabetes, cardiovascular diseases, and CHADS2 scores. Compared with the control group, the bridging group showed a significantly higher rate of complication for any complication (35 vs. 8.3%, P < 0.001), bleeding-related complications (27 vs. 4.4%), and urinary tract infection (7.7 vs. 1.2%). No thromboembolic event was observed in the present study. Multivariate logistic analysis showed that heparin bridging therapy was a significant risk factor for the incidence of any complication and bleeding-related complications.ConclusionsHeparin bridging therapy with temporal discontinuation of antithrombotic agents may increase the risk of complications after TRUS biopsy. Further, large-scale studies are required to clarify the safety of heparin bridging therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-3610-6) contains supplementary material, which is available to authorized users.

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“…73,74 A large RCT of 537 patients receiving oral ciprofloxacin or placebo before prostate biopsy revealed the incidence of bacteriuria to be significantly lower in the antimicrobial group. 75 Subsequently, guidance was published by the Canadian Urological Association in 2010 76 and the American Urological Association in 2012 74 recommending that broad-spectrum Gram-negative antibiotics, such as fluoroquinolones, should be administered prior to biopsy. The American Urological Society also recommend first/second/thirdgeneration cephalosporins.…”

Section: Percutaneous Biopsymentioning

confidence: 99%