Update on Techniques to Prevent Infections Associated With Prostate Needle Biopsy

Matteo Fontana; Luca Boeri; Emanuele Montanari


Curr Opin Urol. 2018;28(4):392-397. 

In This Article

Abstract and Introduction


Purpose of review: Postbiopsy infections (PBIs) are among the most common complications associated with transrectal ultrasound-guided prostate biopsy (TRUSPB). This article discusses the pathogenesis of TRUSPB-associated infectious complications and reviews the most recent findings on techniques to prevent PBIs.

Recent findings: Risk stratification is a powerful tool for identifying TRUSPB candidates whom warrant additional preventive measures. Bowel preparation with povidone-iodine-based enemas and needle disinfection with formalin solution are simple and attractive strategies, but their effectiveness needs to be thoroughly assessed. Antibiotic prophylaxis represents the mainstay for the prevention of PBIs: the prophylactic regimen must respect the principles of antimicrobial stewardship, and local antibiotic resistance patterns among uropathogens should always be considered. Augmented and targeted antibiotic prophylaxes are powerful options, but their role in current clinical practice has yet to be clarified. The transperineal approach has shown a near-zero rate of PBIs, and should therefore be considered for the highest-risk patients.

Summary: Several procedures have been introduced to prevent TRUSPB-related infectious complication, but their utility and applicability in the clinical practice has yet to be elucidated. More robust evidence based on randomized control trials is needed to establish the efficacy of these tools in improving patient outcomes.


Transrectal ultrasound-guided prostate needle biopsy (TRUSPB) is the mainstay for the histopathological diagnosis and preoperative local staging of prostate cancer (PCa), allowing for the collection of single or multiple tissue samples in an outpatient setting. TRUSPB is a common urological procedure, with more than 1 million biopsies performed worldwide every year.[1] It is generally considered safe despite several complications being described, including pain, hematospermia, haematuria, hematochezia, and potentially severe infectious complications, ranging from urinary tract infections (UTIs) and prostatitis to sepsis. Postbiopsy infections (PBIs) arise in 5–7% of all TRUSPBs, with evidence of an increasing trend; more severe infections requiring hospitalization occur after 1–3% of biopsies, and fatal events remain uncommon (0.1–1.3%).

Several methods to prevent PBIs are currently debated, and their clinical utility and applicability in the everyday practice have not yet been established. This article summarizes the pathogenesis of TRUSPB-associated infectious complications and reviews the most recent findings on techniques to prevent PBIs, discussing them in two separate sections: pre and intra-procedural.