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Update on techniques to prevent infections associated with prostate needle biopsy

Fontana, Matteoa,b; Boeri, Lucaa,b; Montanari, Emanuelea,b

doi: 10.1097/MOU.0000000000000507
CURRENT EVIDENCE AND BEST PRACTICE IN RENAL AND PROSTATE BIOPSY: Edited by Mesut Remzi and Jaime Landman
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Purpose of review Postbiopsy infections (PBIs) are among the most common complications associated with transrectal ultrasound-guided prostate biopsy (TRUSPB). This article discusses the pathogenesis of TRUSPB-associated infectious complications and reviews the most recent findings on techniques to prevent PBIs.

Recent findings Risk stratification is a powerful tool for identifying TRUSPB candidates whom warrant additional preventive measures. Bowel preparation with povidone-iodine-based enemas and needle disinfection with formalin solution are simple and attractive strategies, but their effectiveness needs to be thoroughly assessed. Antibiotic prophylaxis represents the mainstay for the prevention of PBIs: the prophylactic regimen must respect the principles of antimicrobial stewardship, and local antibiotic resistance patterns among uropathogens should always be considered. Augmented and targeted antibiotic prophylaxes are powerful options, but their role in current clinical practice has yet to be clarified. The transperineal approach has shown a near-zero rate of PBIs, and should therefore be considered for the highest-risk patients.

Summary Several procedures have been introduced to prevent TRUSPB-related infectious complication, but their utility and applicability in the clinical practice has yet to be elucidated. More robust evidence based on randomized control trials is needed to establish the efficacy of these tools in improving patient outcomes.

aDepartment of Urology, Ospedale Maggiore Policlinico, IRCCS Fondazione Ca’ Granda

bUniversity of Milan, Milan, Italy

Correspondence to Emanuele Montanari, MD, Department of Urology, Ospedale Maggiore Policlinico, IRCCS Fondazione Ca’ Granda, University of Milan, Via della Commenda 15, 20122 Milan, Italy. Tel: +39 02 55034501; fax: +39 02 50320584; e-mail: emanuele.montanari@unimi.it

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