Decrease in Infection Rate Following Use of Povidone-Iodine During Transrectal Ultrasound Guided Biopsy of the Prostate: A Double Blind Randomized Clinical Trial

Abstract

BackgroundInfection after transrectal ultrasound (TRUS) guided biopsy of the prostate is a major and potentially life-threatening problem. Using antibiotic premedication can not completely eliminate infection after biopsy.ObjectivesWe performed this study to determine the value of using povidone-iodine in prevention of post biopsy infection.Patients and MethodsTotally, 280 patients who were referred for TRUS guided biopsy of the prostate were divided randomly into two equal groups. The case group received an intrarectal mixture of povidone-iodine and lidocaine gel before performing biopsy, while the control group received only lidocaine gel. Patients were followed up for 30 days for possible signs of infection including fever, chills and dysuria.ResultsThe mean age in the case group was 68.7 ± 7 years and 68.1 ± 7 years in the control group (P = 0.78). Overall, there were signs and symptoms of infection in 78 patients (27.9%), of which 27 (19.3%) were in the case group, while 51 (36.4%) were in the control group (P = 0.001, OR = 2.4, 95% CI = 1.4-4.1).ConclusionSimple use of widely available povidone-iodine for cleaning the rectum before TRUS guided prostate biopsy can reduce the infection rate.

Effect of Shorter Antimicrobial Prophylaxis and Pre-Intervention Measures on Infections Developing After Transrectal Prostate Biopsies

“…In case of rectal cleansing, different implementations were used in some studies. Ghafoori et al [22] divided 280 patients who were scheduled to undergo TPB, randomly into two equal groups. The case group received an intrarectal mixture of povidone-iodine and lidocaine gel before the biopsy and the other group received only lidocaine gel.…”

Prostate biopsy techniques and pre-biopsy prophylactic measures: variation in current practice patterns in the Netherlands

“…Finally, the EAU guidelines recommend to use rectal cleansing with povidone-iodine prior to transrectal PB [5]. This is based on a meta-analysis of six trials including 1373 men that showed that the use of pre-biopsy rectal povidone-iodine preparation in addition to antimicrobial prophylaxis resulted in lower rates of infectious complications [0.58 (0.43 to 0.76); RR (95% CI)] [22][23][24][25][26][27]. However, not a single Dutch urologist reported to use rectal povidone-iodine cleansing prior to PB.…”

Anatomical Considerations and Procedure-Specific Aspects Important in Preventing Operative Morbidity during Transanal Total Mesorectal Excision

“…Furthermore, tumoricidal irrigants may be of added value, and it is generally recommended to irrigate before and after purse-string construction. [20][21][22][23][24] Extraction and Ischemia of the Conduit Extraction and anastomotic complications can also be observed, including stress and shear strain from (when employed) transanal extraction that could lead to conduit ischemia. 1 To avoid shear stress from transanal extraction, it is recommended to deliver a bulky mesentery via an abdominal extraction site, and not via the anus.…”