Modified bowel preparation to reduce infection after prostate biopsy

Infectious complications after ultrasound guided prostate biopsy are an important issue of concern. We found a higher infection rate with traditional bowel preparation, the phosphate enema, for prostate biopsy and so we modified our technique. In addition, we tried to assess the efficacy of this modified method for aged patients in an agricultural area who have poor compliance or inaccuracy when self-administering bowel preparations.

Between April 2002 and May 2005, all patients who received prostate biopsy were reviewed retrospectively. Exclusion criteria included patients who had an indwelling Foley catheter, symptomatic urinary tract infection or suspected prostatitis before prostate biopsy. Group I consisted of patients who self-administered a phosphate enema at home. Group II had a phosphate enema combined with povidone-iodine administered by a doctor at the hospital. All patients took oral fluoroquinolone (500 mg) twice daily for a period of one day before the procedure. Both groups received trimethoprim (160 mg) with sulfamethoxazole (800 mg) twice daily for three days after the biopsy. Postoperative infection was defined as an oral temperature higher than 37.7 centigrade or any episodes of chills with painful digital rectal examination.

There were 65 patients in Group I and 157 patients in Group II. Within Group I, six patients (9.23%) were found to have a symptomatic infection with leukocytosis or chills; none were found in Group II. Between Group I and II, different bowel preparation was the only parameter shown to have statistical significance on the infection rate.

Bowel preparation before prostate biopsy is not standardized among urologists. Phosphate enema with povidone-iodine administered at the hospital is an effective way to reduce the infection rate for agricultural people who have poor compliance or inaccuracy when self-administering bowel preparations.