Condom perforation during transrectal ultrasound guided (TRUS) prostate biopsies: a potential infection risk

Transrectal ultrasound (TRUS) guided prostate biopsies are amongst the most common outpatient diagnostic procedures performed in urology practice. Of concern appear to be recent reports of infectious complications following this procedure in which contamination of the biopsy equipment was the likely source. This study looks at the rate of condom perforation during prostate biopsy and we look to highlight the potential problems, which may arise as a result of inadequate cleansing of the equipment between cases during a busy prostate biopsy clinic

All patients attending for prostate biopsies over a three-month period in our institution were included in the study. All condoms (latex) used were made by the same manufacturer and were checked prior to the procedure and found to have no leaks. The biopsy gun was inserted through an externally placed needle guide, as is standard practice in many departments in the UK. After the end of each procedure the condom was removed from the rectal probe and filled once again with water to assess for perforations. Two experienced surgeons carried out all the procedures.

10 out of 107 patients were found to have at least one perforation in the condom. In some of the condoms there were multiple perforations.

We have demonstrated a significant condom perforation rate (9%) amongst patients undergoing prostate biopsies. This raises the serious issue of hygiene and cross infection, particularly with blood borne communicable diseases such as hepatitis and HIV unless strict disinfection and sterilization protocols are followed between patients. Perforation of the condoms used during TRUS guided prostate biopsy and hence faecal and blood contamination of the biopsy equipment could potentially have far-reaching implications for urologists and the infection control community. Although the risk of cross infection is probably small this serious issue needs addressing.