Prophylactic antibiotics and Foley catheter use in transperineal needle biopsy of the prostate

We studied retrospectively 162 patients undergoing transperineal needle biopsy of the prostate. All patients had urine cultures before biopsy. Patients were divided into 4 groups: group 1--no antibiotics (44), group 2--antibiotics before and after biopsy (69), group 3--antibiotics after biopsy only (42) and group 4--antibiotics before biopsy only (7). Groups were similar in average age (65 years) and pathologic diagnosis (prostatic cancer in 28 per cent and a benign prostate in 72 per cent). Of the 162 patients 4 (2.5 per cent) had positive urine cultures preoperatively. Post-biopsy urine cultures were obtained in 86 patients and 2 (2 per cent) were positive. Only 12 patients (11 per cent) required catheters for postoperative urinary retention. Complications occurred in 9 patients (5.5 per cent): 7 (4.3 per cent) had febrile episodes, 1(0.6 per cent) had a documented postoperative urinary tract infection and 1(0.6 per cent) sustained a large pelvic hematoma. No statistically significant difference could be found among the 4 groups in regard to complication rate. This study demonstrates no advantage to the routine use of antibiotics or Foley catheters in transperineal needle biopsy of the prostate, provided the urine is sterile before biopsy. Cost analysis of these data demonstrates a considerable savings when routine antibiotics and Foley catheters are not used.