The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies

Abstract

Introduction Transrectal ultrasonography (TRUS) guided prostate needle biopsy has been performed to diagnose and stage prostate cancer for many years. There are many different bowel preparation protocols to diminish the infectious complications, but there is no standardized consensus among urologists. Therefore, we aimed to assess two different bowel preparation methods on the rate of infectious complications in patients who underwent TRUS-guided prostate biopsy. Material and methods A total of 387 cases of TRUS-guided prostate biopsy were included in this retrospective study. All patients received antibiotic prophylaxis with ciprofloxacin (500 mg) twice a day orally for 7 days starting on the day before the biopsy. The patients were divided into two groups according to the bowel preparation method used. Patients (Group 1, n = 164) only received self-administrated phosphate enema) on the morning of the prostate biopsy. Other patients (Group 2, n = 223) received sennasoid a-b laxatives the night before the prostate biopsy. Infectious complications were classified as sepsis, fever (greater than 38°C) without sepsis, and other clinical infections. Results Major complications developed in 14 cases (3.8%), including 3 cases (0.8%) of urinary retention, and 11 (3%) infectious complications, all of which were sepsis. There were 3 and 8 cases of urosepsis in Group 1 and Group 2, respectively. There were no statistically significant differences between both Groups regarding to the rates of urosepsis (p = 0.358). Conclusions Despite both methods of bowel preparation, sodium phosphate enema or sennasoid a-b calcium laxatives, before TRUS-guided prostate biopsy have similar effect on the rate of urosepsis, so both methods of bowel preparation can be safely used.

A prospective randomized trial of povidone-iodine suppository before transrectal ultrasonography-guided prostate biopsy

“…[12,26] However, the point at which to begin rectal preparations is still unremarkable. [30] Some institutions perform enema 1 day prior to TRUS-Bx and restrict oral intake on the day of biopsy. In this study, we performed glycerin enema 4 hours prior to biopsy and restricted oral intake after the morning meal on the day of biopsy.…”

Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound - guided prostate biopsy

“…Similar to an inadequate bowel preparation reportedly occurring in up to 25% of colonoscopies in the USA (16), we also found that an inadequate rectal preparation occurs frequently (gross stool was often found on DRE or TRUS before TRUS - Bx), especially in those with chronic constipation or those noncompliant to the rectal preparation regimen. Therefore, unlike previous studies (5-7, 13), we aimed to document the quality of rectal preparations, and our results revealed that an adequate rectal preparation could significantly decrease the post - TRUS - Bx infection rate. Moreover, because of different responses in patients even under the same rectal preparation regimen, the quality of rectal preparation should be evaluated before TRUS - Bx, and an intensified rectal preparation regimen could be considered in patients with a history of an inadequate rectal preparation.…”

“…A Cochrane review found that enemas with antibiotics were associated with fewer instances of bacteremia (a reduction from 28% to 4%), but there was no difference in the occurrence of bacteriuria or fever (13). Some reports have suggested that rectal preparations, such as enemas or bisacodyl administration, decrease the rate of infectious complications (5, 7), whereas other studies have suggested otherwise (14). Because of the lack of evidence, rectal preparation has remained controversial in the 2011 European Association of Urology Nurses guidelines and the updated 2016 American Urological Association white paper (2, 4), although almost all patients (79 – 81%) undergo rectal preparation before biopsy in daily practice (15).…”

“…The effect of rectal preparation on reducing post - TRUS - Bx infections has been debated in previous studies and remains controversial in the American Urological Association and European Association of Urology Nurses guidelines (2, 4). Although previous studies have reported on whether rectal preparation was conducted (5, 6) and whether different rectal preparation regimens influenced the post - biopsy infectious complication rates (7), they failed to confirm the quality of rectal preparation, which may have led to confounding results. In fact, an inadequate rectal preparation occurs frequently despite using cleansing enema.…”

Current Concepts and Evaluation of Uro-Rectal Diseases by Transrectal Ultrasound: A Review

“…Urosepsis [68] Renal Failure [69] Discitis [69] Rectal Bleeding [70,71] Hematoma [72][73][74] Hematochesia [75,76] Urinary Retention [77] Disseminated Intravascular Coagulation [78] Fournier's Gangrene [79] Blindness [80] Prostatic Abscess [81] Seminal vesicle abscess [82] Bacterial meningitis [83,84] Prostatitis [85] Metastasis to Colon [86] Local Recurrence [87] Epidural Abscess [88] Symphysitis [89] Hematospermia [90] Ischio-rectal abscess [91] Ureteral Injury [92] Malakoplakia [93] Table 9: Complications of transrectal biopsy of prostate [66,67].…”