Korean J Urol.  2008 Mar;49(3):248-251. 10.4111/kju.2008.49.3.248.

Transrectal Needle Biopsy of the Prostate: The Efficacy of a Pre-biopsy Enema

• Kang MY
• Park JH
• Kwak C
• Paick JS
• Kim HH

• KMID: 1204627
• DOI: http://doi.org/10.4111/kju.2008.49.3.248

Abstract

PUROSE: There are numerous biopsy protocols that have been described in the clinical literature. We especially assess the role of the use of an enema before a transrectal prostate biopsy by comparing the post biopsy- infectious complications rate.
MATERIALS AND METHODS
From January 2007 to August 2007 we retrospectively evaluated 302 men who underwent transrectal needle biopsy of the prostate according to the inclusion criteria. Patients in group 1(121 patients) did not receive an enema and were given oral ciprofloxacin(500 mg) for 3 days. Those in group 2(181 patients) received an enema before the biopsy and were also administered intravenous ciprofloxacin(400mg) and an additional oral form(500mg) for five days. Only complications related to infection were evaluated, that is, fever and chills with systemic inflammatory symptoms, within two weeks after the biopsy.
RESULTS
Patients demographics, such as age and prostate size did not differ between the two groups(p>0.05), but the level of prostate-specific antigen (PSA) in group 2 was significantly higher than in group 1 (12.70ng/ml versus 28.88ng/ml, p<0.05). The cancer detection rate was 36.1%(109/ 302) overall and there was no significant difference between the two groups(32.2% versus 38.7%, p>0.05). The infectious complications rate was 2.6%(8/302) overall and did not differ significantly between the two groups(2.5% versus 2.8%, p>0.05). Especially for group 2 patients, there were two cases of bacteremia and Escherichia coli was reported as the pathogen.
CONCLUSIONS
Our findings suggest that the use of a pre-biopsy enema shows no significant benefit given the considerations of infectious complications rate, and the patient quality of life.

Keyword

Prostate; Complications; Infection; Enema

MeSH Terms

Male
Humans
Biopsy

Reference

1. Carter HB, Allaf ME, Partin AW. Diagnosis and staging of prostate cancer. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 9th ed.Philadelphia: Saunders;2007. 2912-31.

2. Kim TB, Lee SE, Jeong H. The effectiveness of 12 core biopsy protocol according to prostate-specific antigen (PSA) level and prostate volume. Koean J Urol. 2006; 47:1166–71.

3. Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol. 1998; 160:2115–20.

4. Desmond PM, Clark J, Thompson IM, Zeidman EJ, Mueller EJ. Morbidity with contemporary prostate biopsy. J Urol. 1993; 150:1425–6.

5. Rietbergen JB, Kruger AE, Kranse R, Schroder FH. Complications of transrectal ultrasound guided systematic sextant biopsies of the prostate: evaluation of complication rates and risk factors within a population-based screening program. Urology. 1997; 49:875–80.

6. Djavan B, Waldert M, Zlotta A, Dobronski P, Seitz C, Remzi M, et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol. 2001; 166:856–60.

7. Tal R, Livne PM, Lask DM, Baniel J. Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol. 2003; 169:1762–5.

8. Byun SS, Lee HJ, Ku JH, Park KJ, Lim DJ, Lee SE, et al. Effect of periprostatic nerve blockade for transrectal ultrasound guided biopsy of the prostate. Korean J Urol. 2004; 45:663–6.

9. Carey JM, Korman HJ. Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? J Urol. 2001; 166:82–5.

10. Ramey JR, Halpern EJ, Gomella LG. Ultrasonography and biopsy of the prostate. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 9th ed.Philadelphia: Saunders;2007. 2883-95.

11. Sieber PR, Rommel FM, Agusta VE, Breslin JA, Huffnagle HW, Harpster LE. Antibiotic prophylaxis in ultrasound guided transrectal prostate biopsy. J Urol. 1997; 157:2199–200.

12. Griffith BC, Morev AF, Ali-Khan MM, Canby-Hagino E, Foley JP, Rozanski TA. Single dose levofloxacin prophylaxis for prostate biopsy in patients at low risk. J Urol. 2002; 168:1021–3.

13. Aron M, Rajeev TP, Gupta NP. Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study. BJU Int. 2000; 85:682–5.

14. Hwang KH, Lee SD, Chung MK. Complications and success rate of transrectal systematic sextant biopsy of the prostate under the finger guidance. Korean J Urol. 1995; 36:1231–7.

15. Cormio L, Berardi B, Callea A, Fiorentino N, Sblendorio D, Zizzi V, et al. Antimicrobial prophylaxis for transrectal prostatic biosy: a prospective study of ciprofloxacin vs pipera-cillin/tazobactam. BJU Int. 2002; 90:700–2.

16. Lindert KA, Kabalin JN, Terris MK. Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy. J Urol. 2000; 164:76–80.

17. Brown RW, Warner JJ, Turner BI, Harris LF, Alford RH. Bacteremia and bacteriuria after transrectal prostatic biopsy. Urology. 1981; 18:145–8.

18. Vallancien G, Prapotnich D, Veillon B, Brisset JM, Andre-Bougaran J. Systematic prostatic biopsies in 100 men with no suspicion of cancer on digital rectal examination. J Urol. 1991; 146:1308–12.

19. Raaijamakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology. 2002; 60:826–30.