Control of infective complications of transrectal prostate biopsy. Optimizing prophylactic antibiotic regimen in patients admitted for transrectal ultrasound-guided prostate biopsies: A prospective randomized study Prophylactic antibiotics reduce sepsis after biopsy of the prostate. Randomized controlled trial of antibiotic prophylaxis regimens for transrectal ultrasound-guided prostate biopsy. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy A prospective randomized trial of 1-day versus 3-day antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy. MRI-guided core needle biopsy of the prostate: acceptance and side effects. Prospective assessment of the efficacy of single dose versus traditional 3-day antimicrobial prophylaxis in 12-core transrectal prostate biopsy. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy--should we reassess our practices for antibiotic prophylaxis? A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. Cephalosporins periprostatic injection: are really effective on infections following prostate biopsy? The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance. The effect of antibiotherapy on prostate-specific antigen levels and prostate biopsy results in patients with levels 2.5 to 10 ng/mL. Efficiency of short and long term antimicrobial therapy in transrectal ultrasound-guided prostate biopsies. Single-dose antibiotic prophylaxis in core prostate biopsy: Impact of timing and identification of risk factors. Prospective evaluation of the safety of transrectal ultrasound-guided transperineal prostate biopsy based on adverse events Transrectal periprostatic lidocaine injection anesthesia for transrectal prostate biopsy: a prospective study Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study. Computerized transrectal ultrasound (C-TRUS) of the prostate: detection of cancer in patients with multiple negative systematic random biopsies The detection and upgrade rates of prostate adenocarcinoma following transperineal template-guided prostate biopsy – a tertiary referral centre experience Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?
BACKGROUND To describe a preparatory protocol for prostate biopsy consisting of prophylaxis based on a third-generation cephalosporin and suppository-type povidone-iodine . METHODS From January 2004 to May 2012 we review ed infective complications in 1,684 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy . All of the patients received prophylactic antibiotics through a single intravenous injection of a third-generation cephalosporin and cefixime at 100 mg PO for 5 d , with this regimen begun before biopsy , and were also given gynobetadine in a dose of 200 mg just before biopsy . Infectious complications were classified as sepsis , fever ( > 38 ° C ) without sepsis , and other clinical manifestations of infection . To evaluate the bactericidal effects of gynobetadine , we counted bacterial colonies prospect ively in cultures of rectal swab specimens from 150 patients who underwent TRUS-guided prostate biopsy . RESULTS Complications occurred in 46 of the patients ( 2.73 % ) , including infective complications in 11 ( 0.65 % ) patients and non-infective complications in 35 ( 2.08 % ) patients . Of the patients with infective complications , two had fever without sepsis , none had clinical urinary tract infections without fever , and none had sepsis . In prospect i ve in vitro investigations , the mean bacterial colony count before rectal preparation with an enema or rectal insertion of povidone-iodine suppository was 2.38 × 10(6 ) , whereas the colony count after a povidone-iodine rectal enema and subsequent biopsy was 1.81 × 10(3 ) and the colony count after rectal preparation with povidone-iodine suppository and subsequent biopsy was 8.1 × 10(2 ) ( all p<0.001 ) . CONCLUSIONS The administration of cephalosporin-based prophylactic antibiotics and the simple use of suppository-type povidone-iodine provided an excellent protocol for reducing infective complications of TRUS-guided prostate biopsy . The simplicity of use and cost effectiveness of gynobetadine were noteworthy Background Transrectal ultrasound-guided prostate biopsies ( TRUSBx ) , in spite of being one of the most frequently performed urological office procedures , are associated with a spectrum of complications , most significantly including infection . The aim of the study is to evaluate the prevalence of fluoroquinolone-resistant bacteria in rectal swabs from our local population prior to TRUSBx and to identify risk factors among a patient population harboring fluoroquinolone-resistant organisms . Methods We prospect ively included 541 men who were su bmi tted for TRUSBx in our center from March 2011 to June 2015 . The indications for TRUSBx were an elevated prostate-specific antigen level and /or abnormal digital rectal exam . All patients were r and omly divided into two groups : Group 1 ( n = 279 cases ) who received st and ard empirical prophylactic antibiotics and Group 2 who received targeted prophylaxis based on a rectal swab culture and susceptibility result . Differences in risk factors between quinolone-resistant and nonresistant patients were compared . Univariate and multivariate analyses were performed to identify independent potential risk factors associated with fluoroquinolone-resistant rectal flora . Results Sixteen out of 271 men developed infectious complications after TRUSBx in the group receiving st and ard empirical prophylaxis ( 5.7 % ) . No men in the group who received targeted prophylactic antibiotic guided by rectal swab developed infectious complications . Among the 262 patients who underwent prebiopsy rectal swab cultures , 76 men ( 29 % ) displayed fluoroquinolone-resistant rectal flora ( 29 % ) . In the multivariate analysis , a history of antibiotic exposure before prostate biopsy was the only independent factor associated with an increased risk of fluoroquinolone resistance . Conclusion Determining the prevalence of fluoroquinolone resistance in rectal flora has important implication s in the selection of targeted prophylactic antibiotic regimens . Antimicrobial profiles guided by rectal swabs may prove useful to optimize prophylaxis prior to TRUSBx ; this strategy is effective at reducing the rates of infectious complications , including sepsis , especially in men at higher risk of infectious complications INTRODUCTION Prostate cancer is the most common form of cancer in Danish men , and the incidence is rising . The diag-nosis is made by transrectal prostate biopsy guided by ultrasound . This procedure has several complications , the most severe being sepsis . In our department , this is sought prevented by administering the prophylactic antibiotics metronidazol and ciprofloxacin . This study examined the rate of sepsis in patients who had the procedure performed at our department . METHODS The electronic patient records of all patients who had transrectal ultrasound of the prostate with biopsies performed at the Department of Urology at Naestved Hospital in the period from 1 May 2009 to 31 May 2011 were examined , and all admissions to our department ( or any department in the same region ) due to sepsis within two weeks of the procedure were registered . RESULTS A total of 438 patients had the procedure performed , some multiple times , which result ed in a total of 511 procedures . In all , four patients were later admitted due to sepsis , corresponding to 0.91 % . Three of the patients had positive blood and urine cultures in which Escherichia coli resistant to ciprofloxacin were found , the last had been prescribed antibiotics by a general practitioner the previous day , and no bacteria could be cultured . CONCLUSION The frequency of sepsis after transrectal needle biopsies from the prostate at our department was found to be below 1 % in this study , which is comparable to international findings . Most of the cases of sepsis were related to ciprofloxacin-resistant bacteria . Further r and omised studies are needed to investigate the ideal prophylactic regime . FUNDING not relevant . TRIAL REGISTRATION not relevant BACKGROUND A prior study showed significant antibiotic resistance to quinolone in our population . In this study we aim ed to evaluate and compare the efficacy of a single versus a combined prophylactic antibiotic regimen  before transrectal ultrasound-guided prostate biopsy ( TRUGPB ) . METHODS A prospect i ve r and omized study was conducted at a university hospital . Patients undergoing TRUGPB were r and omized into an amoxicillin-clavulanate alone ( 1 mg ; one dose before and two doses after biopsy ) or an amoxicillin-clavulanate + ciprofloxacin group ( 250 mg ; one dose before and two doses after biopsy ) . Patients were surveyed for infection symptoms by phone on days 3 and 30 after TRUGPB . We defined an infective complication as the occurrence of symptoms including fever , chills or rigor within 30 days after prostate biopsy , requiring medical treatment or hospitalization , aided by a territory-wide electronic medical record system . RESULTS Between November 2007 and July 2009 , 367 patients were r and omized to either amoxicillin-clavulanate alone or amoxicillin-clavulanate + ciprofloxacin group . The infection rates after TRUGPB were 3.91 % in the former group ( 7 out of 179 patients ) versus 0.53 % ( 1 out of 188 patients ) in the latter . Sixty-three percent ( 5/8 ) of patients with infective complications needed hospitalization . There was no intensive care unit admission or mortality during the study period . CONCLUSIONS Combining prophylactic antibiotics with amoxicillin-clavulanate + ciprofloxacin significantly reduced the incidence of infective complications after TRUGPB . We recommended a combination regimen , especially in centre with high incidence of post-TRUGPB infection OBJECTIVES To evaluate the complication rates and possible risk factors of biopsy of the prostate , with the aim of improving patient counseling and the safety of the procedure . Biopsy of the prostate has to be a relatively safe procedure and the participants have to be well informed about the possible complications . METHODS Within the biopsy protocol of the Rotterdam section of the European R and omized Study of Screening for Prostate Cancer , we evaluated  5802 transrectal ultrasound-guided systematic sextant biopsies . All participants received prophylactic antibiotic therapy .  RESULTS We performed 5802 biopsies .  Hematuria lasting longer than 3 days and hematospermia were present after 22.6 % and 50.4 % of the procedures , respectively . More severe complications were far less frequent . Two hundred participants ( 3.5 % ) developed fever after biopsy . Urinary retention was seen 20 times ( 0.4 % ) , and hospitalization was needed in 27 cases ( 0.5 % ) . Twenty-five of these men were admitted because of signs of prostatitis and /or urosepsis . Risk factor analyses revealed that an earlier episode of prostatitis was significantly associated with hospital admission and pain after biopsy . Characteristics of prostatic hyperplasia , such as prostate volume , transition zone volume/total prostate volume ratio , and a higher International Prostate Symptom Score , were all predictors of urinary retention . CONCLUSIONS Minor complications are frequently seen but major complications are rare after prostate biopsy . Assessment of the risk factors before biopsy can help to improve the adequacy of counseling , and pre caution ary measures can be taken to minimize the risk of complications after the procedure . Transrectal ultrasound-guided sextant biopsy remains a safe procedure for the diagnosis of prostate cancer within the general population Transrectal  ultrasound guided prostate biopsies ( TRUSBx ) are associated with a spectrum of complications , including most significantly infection , which affects up to 5 % of patients . In the most severe cases , infection leads to sepsis , a life‐threatening complication . Escherichia coli is the primary responsible pathogen . Although antibiotic prophylaxis with fluoroquinolones is routinely used , there is evidence that the infection rate after TRUSBx is increasing , and this appears to be due to an increasing prevalence of ciprofloxacin‐resistant rectal flora . This is the largest prospect i ve clinical trial to date analysing the rectal flora of men undergoing prostate biopsies . We determined the microbial and antibiotic sensitivity profiles from 849 patients .  Ciprofloxacin‐resistant Gram‐negative organisms were identified in the rectal flora of 19.0 % of men . Furthermore , fluoroquinolone use within 6 months preceding a TRUSBx and the presence of a prosthetic heart valve were significant predictors of ciprofloxacin resistance on rectal swab . Determining the prevalence of rectal fluoroquinolone resistance has important implication s in evaluation of the suitability of prophylactic regimens . Antimicrobial profiles derived from rectal swabs pre‐biopsy may prove useful in guiding targeted antibiotic prophylaxis PURPOSE To compare the incidence of infection between a 1 day and a 3 day antibiotic prophylaxis regimen for transrectal ultrasound ( TRUS ) guided prostate biopsy in a prospect i ve , r and omized open-label trial . MATERIAL S AND METHODS TRUS examination was performed in the left lateral decubitus position using a Brüel and Kjaer 7 MHz rectal probe . Biopsies were carried out with an 18 gauge Tru-cut needle fired by the h and -held Biopsy gun . An average of eight core biopsies ( range 6 to 12 ) was taken . From May 15 , 2000 to May 16 , 2001 , 363 patients were enrolled in this study . Patients were r and omized to receive either 1 day or 3 days of fluroquinolone antibiotic prophylaxis , consisting of either ciprofloxacin or levofloxacin orally . Antibiotics were begun at least 1 hour prior to biopsy . Seven days later , telephone follow-up was obtained . RESULTS Two ( 0.55 % ) of the 363 patients , one in each group , had an episode of sepsis . No urinary tract infection was reported . Traumatic complications were only minor and no significant difference was observed between both groups : hematospermia ( p > 0.4 ) , hematuria ( p>0.1 ) and rectorragia ( p>0.2 ) being reported most frequently . CONCLUSION There is no clinical ly nor statistically significant difference between a 1 day and 3 day antibiotic prophylaxis regimen for patients undergoing TRUS guided biopsies PURPOSE We aim ed to study side effects , complications , and patient acceptance of magnetic resonance imaging-guided real-time biopsy ( MRI-GB ) of the prostate . METHODS Fifty-four men ( 49 - 78 years ) with elevated prostate-specific antigen after at least one negative systematic transrectal ultrasound-guided biopsy ( TRUS-GB ) were included in a prospect i ve clinical study . Suspicious areas on images were selectively sample d by obtaining a median of four specimens ( range , 1 - 9 specimens ) using MRI-GB . In TRUS-GB , a median of 10 specimens ( range , 6 - 14 specimens ) were obtained . Telephone interviews were conducted one week after outpatient MRI-GB , asking patients about pain and side effects ( hematuria , hemospermia , rectal bleeding , fever , and chills ) of the two biopsy procedures and which of the two procedures they preferred . Multinomial regression analysis and Fisher 's exact test was used to test for differences . RESULTS MRI-GB was preferred by 65 % ( 35/54 ) , and 82 % ( 44/54 ) would undergo MRI-GB again . Pain intensity ( P = 0.005 ) and bleeding duration ( P = 0.004 ) were significantly lower for MRI-GB compared with TRUS-GB . Hematuria was less common after MRI-GB compared with TRUS-GB ( P = 0.006 ) . A high correlation was given between bleeding intensity and bleeding duration for TRUS-GB ( r=0.77 ) and pain intensity and pain duration for MRI-GB ( r=0.65 ) . Although hemospermia , rectal hemorrhage , fever , and chills were less common in MRI , they showed no statistically significant difference . CONCLUSION MRI-GB of the prostate seems to have fewer side effects and less pain intensity than TRUS-GB and was preferred by the majority of patients OBJECTIVES To prospect ively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography ( TRUS ) guided prostate biopsy . METHODS A total of 400 patients who underwent prostate biopsy with TRUS guidance were included . The patients were prospect ively r and omized in three groups regarding antibiotic prophylaxis . The first group ( 139 patients ) received a single gram of intramuscular ceftriaxone , while the second group ( 131 patients ) had a 3-day course of oral ciprofloxacin . The third group ( 130 patients ) had single oral 500 mg of ciprofloxacin . All patients had urine cultures prior to biopsy and on the second day after biopsy . RESULTS The study groups were compared in terms of the results of urine cultures and clinical parameters . Overall , only seven patients ( 1.8 % of the cases ) had positive urine cultures with no difference between these three groups . Additionally , no significant difference was observed regarding morbidity rates in all groups . Only eight patients ( 2 % ) developed major complications requiring hospitalization . There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12 . CONCLUSIONS The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling Although the estimate of the incidence of sepsis following  transrectal ultrasound-guided prostate biopsy ( TRUSPB ) is low , fluoroquinolone-resistant infections after prostate biopsy are being increasingly noted . This study was aim ed at determining the prevalence of faecal carriage of fluoroquinolone-resistant Escherichia coli strains before TRUSPB and at evaluating potential predisposing risk factors . The incidence of sepsis after prostate biopsy was determined , and our routine practice for antibiotic prophylaxis for TRUSPB was evaluated . A prospect i ve study was conducted in 342 consecutive patients undergoing prostate biopsy between December 2009 and July 2010 . Before TRUSPB , a rectal swab was cultured . The correlation between the presence of fluoroquinolone-resistant strains and plausible risk factors was investigated by the use of a question naire . Of the 236 patients included , 22.0 % ( 52/236 ) harboured ciprofloxacin-resistant E. coli strains . The use of fluoroquinolones in the 6 months before biopsy was associated with an increased risk of faecal carriage of fluoroquinolone-resistant E. coli strains ( p < 0.01 ) . Faecal carriage of fluoroquinolone-resistant E. coli strains was an important risk factor for infectious complications after TRUSPB ( p < 0.01 ) . In conclusion , a significant number of patients have faecal carriage of fluoroquinolone-resistant E. coli strains ( 22.0 % ) before TRUSPB . The use of fluoroquinolones in the previous 6 months before biopsy is a risk factor for faecal carriage of fluoroquinolone-resistant E. coli strains and for infectious complications after TRUSPB . Hence , the universal administration of fluoroquinolones should be reconsidered PURPOSE Transrectal ultrasound guided prostate biopsy can lead to urinary tract infections in 3 % to 11 % and sepsis in 0.1 % to 5 % of patients . We investigated the efficacy of rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy to reduce infectious complications . MATERIAL S AND METHODS Between 2009 and 2011 , 865 men were prospect ively r and omized to rectal cleansing ( 421 ) or no cleansing ( 444 ) before transrectal ultrasound guided prostate biopsy .  Patients received ciprofloxacin prophylaxis and rectal swab cultures were obtained before transrectal ultrasound guided prostate biopsy . Patients completed a telephone interview 7 days after undergoing the biopsy . The primary end point was the rate of infectious complications , a composite end point of 1 or more of 1 ) fever greater than 38.0C , 2 ) urinary tract infection or 3 ) sepsis ( st and ardized definition ) . Chi-square significance testing was performed for differences between groups and a multivariate analysis was performed to assess risk factors for infectious complications . RESULTS Infectious complications were observed in 31 ( 3.5 % ) patients , including 11 ( 2.6 % ) treated and 20 ( 4.5 % ) control patients ( p = 0.15 ) . Sepsis was observed in 4 ( 1.0 % ) treated and 7 ( 1.6 % ) control patients ( p = 0.55 ) . On multivariate analysis resistance to ciprofloxacin in the rectal swab culture ( p = 0.002 ) and a history of taking ciprofloxacin in the 3 months preceding transrectal ultrasound guided prostate biopsy ( p = 0.009 ) predicted infectious complications . CONCLUSIONS Rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy was safe , but the 42 % relative risk reduction of infectious complications was not statistically significant . Patients who have received ciprofloxacin within 3 months of transrectal ultrasound guided prostate biopsy should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months Purpose To compare the antibiotic prophylaxis based on quinolone administered orally with a combination of cephalosporin administered periprostatically and a fluoroquinolone orally , in terms of post-prostate bioptic infectious complication rates in those men undergoing transrectal ultrasound-guided prostate biopsy ( TRUS gpb ) . Methods In a prospect i ve , r and omized , double-blind study , 150 consecutive patients were r and omized to receive 10 ml lidocaine 1 % in Group A and ceftriaxone 1 g diluted in a solution of 10 ml of lidocaine 1 % in Group B , before TRUS gpb . All signed the informed consent . The men were asked to grade the pain using a ten points visual analogue scale close after TRUS gpb . In a telephone interview at 3 and 6 days , they were asked about early and late complications , assessing rectal bleeding , urinary retection , fewer , haematuria , urethral bleeding and hematospermia . Results Of the 150 men enrolled , 135 , 70 in Groups A and 65 in Group B , completed the study . Four men ( 5.7 % ) in Group A developed sepsis after TRUS gpb requiring hospital admission and intravenous antibiotic treatment , while none in Group B. Escherichia coli was the only organism isolated . The mean pain score was 2.76 ± 1.69 and 1.73 ± 1.26 for Group A and B , respectively ( p = 0.08 ) . Complications , evaluated at 3 and 6 days after the procedure through a telephone interview , were similar in both Groups . Conclusions The antibiotic prophylaxis based on the combination of ceftriaxone administered periprostatically and ciprofloxacin orally is able to offer a best control on infections caused by fluoroquinolone-resistant E. coli PURPOSE Prostate biopsy related infectious complications are associated with significant morbidity . The risk of infectious complications in patients with prostate cancer on active surveillance remains under studied . MATERIAL S AND METHODS A total of 591 consecutive men who underwent prostate biopsy were prospect ively enrolled in a study evaluating prostate biopsy related complications between January 2011 and January 2012 . Of these men 403 were previously diagnosed with prostate cancer and were included in this study . They underwent a 14-core transrectal ultrasound guided prostate biopsy as part of an active surveillance regimen . A nurse contacted all men within 14 days of biopsy , and information was collected on potential complications , antibiotics received and bacterial culture results . RESULTS Fourteen patients ( 3.5 % ) had infectious complications including 13 requiring hospitalization . Five patients had positive urine cultures , and fluoroquinolone resistant isolates were identified in 4 patients , including 2 with extended spectrum beta-lactamase producing isolates . We evaluated the impact of risk factors including diabetes , benign prostatic hyperplasia and antibiotic regimen . However , only the number of previous prostate biopsies was significantly associated with an increased risk of infectious complications ( p = 0.041 ) . For every previous biopsy the odds of an infection increased 1.3 times ( OR 1.33 , 95 % CI 1.01 - 1.74 ) . CONCLUSIONS In men with prostate cancer on active surveillance the number of previous prostate biopsies is associated with a significant risk of infectious complications and every previous biopsy increases the risk of infectious complication . Fluoroquinolone resistant and extended spectrum beta-lactamase producing isolates represent the most commonly identified organisms . Men with prostate cancer on active surveillance should be informed of the risks associated with serial repeat prostate biopsies PURPOSE This controlled prospect i ve study aims to investigate the possible effects of antibiotic treatment on prostate-specific antigen ( PSA ) and its derivatives , and consequently on the transrectal biopsy rates , in the diagnosis of prostate cancer . PATIENTS AND METHODS One hundred and forty patients aged 45 to 70 years old , with a PSA level between 2.5 and 10 ng/mL and normal digital rectal examinations ( DRE ) , were included in this study between June 2009 and November 2010 . The patients were r and omly assigned into two groups . The first group received oral levofloxacin 500 mg 1 * 1 for 21 days ; the second , the control group , was given no treatment . Initially , total PSA , free PSA , a DRE , urinary ultrasonography ( including prostate volume , postvoiding residual urine ) , uroflowmetry , International Prostate Symptom Score , National Institutes of Health Chronic Prostatitis Symptom Index , and International Index of Erectile Function tests were performed . All of these were repeated at the end of 3 weeks of antibiotic treatment . An additional PSA measurement was also performed at day 10 of the treatment . All patients underwent transrectal ultrasonography ( TRUS ) guided prostate biopsy at day 21 , just the day after the final ( third ) PSA sampling . RESULTS The mean age of the patients was 59.6 years . Overall , in 23 patients ,  prostate cancer was detected , including those found in the rebiopsies . Statistically , there were significant changes in values of PSA and its derivatives in the treatment group ( from 5.31 to 4.69 and 4.58 ng/mL , consecutively ) . Focusing on prostate cancer patients in both the treatment and control groups , however , we did not detect any significant change in the same parameters . CONCLUSION Antibiotic treatment given to the patients with a PSA level between 2.5 and 10 ng/mL can be beneficial , before a decision for TRUS guided prostate biopsy , just in a limited subgroup , by reducing the PSA levels below the threshold value . Considering the large population of patients in the gray zone , however , it still does not provide clear solid evidence for avoiding unnecessary prostate biopsies OBJECTIVE Prostate biopsy is a frequent diagnostic measure to detect prostatic conditions , including primarily prostate cancer . Its performance does not follow a pattern , mainly regarding preparation for the examination through antimicrobial prophylaxis . The aim of this study is to compare the efficiency of short and long term antimicrobial prophylaxis in transrectal ultrasound-guided prostate biopsies . MATERIAL S AND METHODS A clinical study was conducted with a total of 140 patients su bmi tted to prostate biopsy with transrectal ultrasonographic control . Patients were r and omly separated in two groups : Group 1 receiving norfloxacin 400 mg single dose before the procedure and Group 2 receiving norfloxacin 400 mg initiating before the procedure and then bid up to 6 doses . Efficiency control was determined by the incidence of urinary tract infection ( UTI ) and complications in both groups after statistical analysis . RESULTS The incidence of minor complications in our study was 75 % , consistent with data found in the literature . Among the patients with diagnosis of simple UTI , 23 % belonged to Group 1 and 8 % to Group 2 ( p=0.08 ) . Among the patients with complicated UTI , 37 % belonged to Group 1 and none belonged to Group 2 ( p=0.44 ) . CONCLUSIONS Several advances made transrectal ultrasound-guided prostate biopsies a useful and safe diagnostic tool in the workup of urologic patients . There is no optimal prophylactic preparation to the performance of this procedure . Long term antimicrobial prophylaxis presents a trend toward lower incidence of infectious complications OBJECTIVES To assess the level of infectious complications and the impact of timing of a single , prophylactic , oral dose of ciprofloxacin 750 mg given either 2 hours before or in conjunction with ultrasound-guided core biopsy of the prostate in men without recognised risk factors and to analyse potential risk factors . METHODS All men undergoing prostate biopsy for elevated prostate specific antigen or clinical suspected prostate cancer were enrolled in an open , comparative prospect i ve study . Excluded were men with recognised risk factors for infective complications . Two end points were chosen : febrile genitourinary infection and the results of postbiopsy urine culture . RESULTS A total of 1322 prostate biopsy occasions were made in 1157 men . Twelve ( 0.9 % ) cases of febrile genitourinary infections were recorded , two of which had proven sepsis . Administrating the drug 2 hours before or at the time of biopsy ( p > 0.5 ) showed no statistical difference . Eight of 12 patients were shown to have prebiopsy undisclosed risk factors . Four percent developed postbiopsy , asymptomatic , significant bacteriuria . In addition , three ( 27 % ) men with prebiopsy unrecognised bacteriuria , who were accidentally enrolled , developed febrile genitourinary infection ; one had proven sepsis . CONCLUSIONS A single high-dose of oral ciprofloxacin 750 mg can be administered in direct conjunction with prostate biopsy to men without recognised risk factors , keeping the infection rate at approximately 1 % . Bacteriuria before biopsy is a major risk factor for infective complications . Attention given to recognising individual risk factors would reduce the risk of infection further Background Although transperineal ( TP ) prostate biopsy is growing in popularity , its safety has not been evaluated based on extensive studies . We prospect ively assessed the adverse events associated with transrectal ultrasound (TRUS)-guided TP 16-core prostate biopsy at a single institution . Patients and methods We enrolled 2,086 males who underwent first-time TRUS-guided TP prostate biopsy under lumbar spinal anesthesia at Chiba Cancer Center between 2009 and 2013 . Eight adverse events were assessed prospect ively using a purpose - design ed question naire . The prevalence and duration of all adverse events were evaluated . We performed subgroup analyses for hematuria and urinary retention in relation to clinical factors . Results Question naires were collected from 1,663 cases ( 79.7 % ) . The cancer detection rate was 53.5 % in all patients . The prevalence and duration of complications were as follows : hematuria , 73.4 % and 4.51 ± 2.88 days ; perineal bleeding , 7.1 % and 2.20 ± 2.24 days ; hematospermia 14.4 % ; dysuria , 15.7 % and 3.12 ± 2.71 days ; urinary tract pain , 49.5 % and 2.43 ± 2.08 days ; perineal pain , 35.5 % and 3.53 ± 2.59 days ; fever ≥37 ° C , 1.7 % and 1.79 ± 1.72 days ; and headache , 22.1 % and 3.40 ± 2.10 days . Seventeen patients ( 1.1 % ) required indwelling urethral catheterization for grade 2 urinary retention . Pre-biopsy International Prostate Symptom Score ( p = 0.014 ) was an independent related factor for hematuria . Prostate volume ( p = 0.001 ) was an independent related factor for grade 2 urinary retention . Conclusions TRUS-guided TP prostate biopsy under lumbar spinal anesthesia can be performed safely with only minor adverse events Transrectal ultrasound (TRUS)-guided biopsy remains the mainstay of the diagnosis of prostate cancer . Although this diagnostic method is a safe procedure and well tolerated by most patients a significant number of patients report discomfort and pain during prostate biopsy . In order to define the best method of anesthesia , many studies , in which different methods were compared , have been performed . To determine the effectiveness of local injection anesthesia in TRUS-guided prostate biopsy , we design ed and performed this prospect i ve study in order to evaluate the utility of periprostatic nerve block for pain management . A total of 100 patients who had elevated total prostate-specific antigen ( tPSA ) and /or abnormal digital rectal examination ( DRE ) were included in this study . Half of the patients received periprostatic injection anesthesia ( group I ) and the remaining half received placebo ( group II ) . Patients received 10 cm3 ( 5 cm3 each side ) 1 % lidocaine injected into the periprostatic nerve plexus under transrectal ultrasonic guidance . Pain during biopsy was assessed using a 10-point modified visual analog scale ( VAS ) . In groups I and II , mean patient age was 66.8 + 2.5 and 65.6 + 11.5 y , mean tPSA was 7.87±3.6 and 11.3±1.7 ng/ml , mean biopsy duration was 6.5±2.5 and 6.6±2.2 min and mean pain score during TRUS-guided biopsy was 1.46±2.2 and 4.5±2.1 , respectively . No statistically significant difference was observed with respect to age , tPSA and mean biopsy duration between these groups . Mean pain VAS score was statistically or significantly better ( P=0.0001 ) in the lidocaine injection group ( group I ) , and furthermore no patient had a VAS pain score ≥5 in this group . Only minor and transient complications occurred in both groups . This study reinforces the usage of periprostatic nerve block as a st and ard method of pain management during TRUS-guided prostate biopsy , because it is simple , safe , uncostly and significantly effective without requiring additional time Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy ( TRUS-PB ) . The true incidence of hemospermia , its duration and implication s are not well established . We performed a prospect i ve observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution . Sixty-three eligible men were included in the study . Most men ( 84 % ) undergoing TRUS-PB , who were able to ejaculate , experienced hemospermia , which was associated with some degree of anxiety . The mean duration of hemospermia was 3.5 ( ±1.7 ) weeks . The number of ejaculations before the complete resolution of hemospermia was 8 ( ±6.7 ) . None of the clinical and pathological factors was a significant predictor of the duration of hemospermia . Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity OBJECTIVES To evaluate the incidence , and clinical and bacterial features of iatrogenic prostatitis within 1 month after  transrectal ultrasound-guided biopsy  for detection of prostate cancer . METHODS From January 2006 to December 2009 , 3000 patients underwent a 21-core transrectal ultrasound-guided prostate biopsy at Henri Mondor Hospital ( Créteil , France ) and were prospect ively followed . All patients had a fluoroquinolone antimicrobial prophylaxis for 7 days . The primary study end-point was to evaluate the incidence of iatrogenic acute prostatitis within 1 month after the biopsy . The secondary end-point was to analyze the clinical and the bacterial features of the prostatitis . RESULTS Overall , 20 patients of the entire study population ( 0.67 % ) had an acute bacterial prostatitis within 2.90 ± 1.77 days ( range 1 - 7 days ) after the transrectal ultrasound-guided biopsy . The groups of patients with ( n = 20 ) and without ( n = 2980 ) infection were similar in terms of age , prostate-specific antigen level and prostate volume . Escherichia coli was the only isolated bacteria . The subsequent tests for antibiotic susceptibility showed a 95 % resistance for fluroquinolone and amoxicillin . Resistance to amoxiclav , trimethoprim-sulfamethoxazole , third generation cephalosporin and amikacin was 70 % , 70 % , 25 % and 5 % respectively . No resistance to imipenem was reported . They were all admitted for treatment without the need of intensive care unit referral . Complete recovery was achieved after 21.4 ± 7 days of antibiotic treatment . CONCLUSIONS A fluroquinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of acute prostatitis secondary to prostate biopsy . Patients should be provided the appropriate care soon after the onset of the symptoms . An intravenous third generation cephalosporin or imipenem-based therapy seem to provide satisfying results Abstract This study was design ed to compare the diagnostic yield of computerized transrectal ultrasound ( C-TRUS ) guided biopsies in the detection of prostate cancer in a group of men with a history of multiple systematic r and om biopsies with no prior evidence of prostate cancer . The question was asked : Can we detect cancer by C-TRUS that has been overlooked by multiple systematic biopsies ? The entrance criteria for this study were prior negative systematic r and om biopsies regardless of number of biopsy sessions or number of individual biopsy cores . Serial static TRUS images were evaluated by C-TRUS , which assessed signal information independent of visual gray scale . Five C-TRUS algorithms were utilized to evaluate the information of the ultrasound signal . Interpretation of the results were documented and the most suspicious regions marked by C-TRUS were biopsied by guiding the needle to the marked location . Five hundred and forty men were biopsied because of an elevated PSA or abnormal digital rectal exam . 132 had a history of prior negative systematic r and om biopsies ( 1–7 sessions , median : 2 and between 6 and 72 individual prostate biopsies , median : 12 cores ) . Additionally , a diagnostic TUR-P of the prostate with benign result was performed in four patients . The PSA ranged from 3.1–36 ng/ml with a median of 9.01 ng/ml . The prostate volume ranged from 6–203 ml with a median of 42 ml . Of the 132 patients with prior negative systematic r and om biopsies , cancer was found in 66 ( 50 % ) by C-TRUS targeted biopsies . In this group the median number of negative biopsy sessions was two and a median of 12 biopsy cores were performed . From literature we would expect a cancer detection rate in this group with systematic biopsies of approximately 7 % . We only found five carcinomas with a Gleason Score ( GS ) of 5 , 25 with GS 6 , 22 with GS 7 , 8 with GS 8 and even 7 with GS 9 . The results of this prospect i ve clinical trail indicates that the additional use of the C-TRUS identifies clinical significant cancerous lesions that could not been visualized or detected by systematic r and om biopsies in a very high percentage . In addition , the results of the study support the efforts to search for strategies that utilize expertise and refinement of imaging modalities rather than elevating the number of r and om biopsies ( f.e . 141 cores in one session ) in the detection of prostate cancer Introduction We aim to present transperineal template-guided prostate biopsy ( template biopsy ) outcomes at a tertiary referral centre . Furthermore , to identify the detection rate of prostate cancer in those with a previous negative transrectal ultrasound guided prostate biopsy and the up grade rate of those on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma . Material and methods We conducted a prospect i ve study of 200 consecutive men who underwent template biopsy over a 22-month period in a tertiary referral centre , using a st and ard 24 region template prostate biopsy technique .  Indications and histology results , as well as complications , were recorded . Results Median age was 67 years and median PSA was 10 ng/mL.  Overall detection rate was 47 % . 39.5 % of cases with previous negative transrectal biopsies were found to have prostate adenocarcinoma . 47.5 % of cases on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma were up grade d. The most frequent complication was acute urinary retention at a rate of 12.5 % , however , the use of a single prophylactic dose of tamsulosin was found to be beneficial , with 13 cases needed to treat to prevent one episode . Conclusions Template biopsies are safe and efficacious with an overall detection rate of 47 % in the present series . Due to the high detection rate , one must consider template biopsy following one negative transrectal biopsy where there is persistent clinical suspicion . Furthermore , those considering active surveillance for Gleason 3 + 3 = 6 disease should be offered template biopsy to confirm the grade of their disease BACKGROUND An increasing risk of infectious complications following  transrectal ultrasound-guided prostate needle biopsy ( PNB )  has been observed recently in some centers . OBJECTIVE To delineate the risk factors associated with post-PNB bacteremia and /or urinary tract infection ( UTI ) and determine why this risk has risen over time . DESIGN , SETTING , AND PARTICIPANTS A case-control study in a Canadian tertiary-care center . Cases were all patients who developed bacteremia and /or UTIs after PNB between 2002 and 2011 ; controls were r and omly selected among patients who underwent a PNB without such complications . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Crude and adjusted odds ratios and their 95 % confidence intervals were calculated using logistic regression . RESULTS AND LIMITATIONS A total of 5798 PNBs were performed during the study period , following which there were 48 cases of urinary sepsis ( 42 % with bacteremia ) . The incidence increased from 0.52 infections per 100 biopsies in 2002 - 2009 to 2.15 infections per 100 biopsies in 2010 - 2011 ( p<0.001 ) . Escherichia coli was the predominant pathogen ( 75 % of cases ) . Among 42 patients whose post-PNB infection was caused by aerobic or facultative Gram-negative rods , 22 patients ( 52 % ) were infected by pathogens resistant to ciprofloxacin . Independent risk factors for post-PNB infection were diabetes , hospitalization during the preceding month , chronic obstructive pulmonary disease , and performance of the biopsy in 2010 - 2011 . In 2010 - 2011 , the minimal inhibitory concentrations for ciprofloxacin increased compared with 2002 - 2009 ( p<0.03 ) . The major limitation of the study was its retrospective hospital-based nature , which hampered data collection on outpatient antibiotic prescriptions . CONCLUSIONS In the past 2 yr , ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center . Novel antibacterial prophylaxis approaches need to be evaluated
Widespread use of fluoroquinolone prophylaxis may be associated with an increase in resistant Escherichia coli strains , posing a potentially major health issue in the future .
INTRODUCTION Transrectal ultrasound-guided biopsies ( TRUS-gb ) are associated with both mild and serious complications .
Prophylactic antibiotics reduce the risk of septicaemia and mortality ; however , no international consensus exists on the timing and duration of antibiotics , including the optimal drug strategy .
We review ed the current evidence supporting use of prophylactic antibiotics and the risk of complications following prostate biopsies .