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

Intraprocedural Strategies for the Prevention of Post Transrectal Ultrasound-guided Prostate Biopsy Infections

Technique of Prostate Biopsy

While the transperineal approach has been progressively neglected, since it is more painful and typically performed in the operating room with general anesthesia, TRUSPB represents the most common bioptic technique. Shen et al.[26] compared the TR and the transperineal approaches in terms of PCa detection and complications and found no difference in PBIs based on the biopsy technique. Conversely, Garcia et al.,[27] demonstrated in a systematic review and meta-analysis a statistically significant increase in infectious complications with the TR approach. Recent series have also reported a zero or near-zero sepsis and infection-related hospitalization rate with the transperineal procedure,[28,29] thus suggesting the importance of this approach for the prevention of PBIs, especially in high-risk patients.

Targeted biopsies with mpMRI can reduce unnecessary biopsies, as well as the need for repeat biopsy in patients on active surveillance. However, the availability and appropriateness of MRI-guided biopsy remain limited, and systematic cores remain necessary.[30]

Previous studies have found no significant correlation between the number of cores[31,32] or thickness of the needle[33] and the occurrence of a PBIs. On the contrary, a recent study found a higher risk of PBIs in patients in whom more biopsy cores where taken.[34] Further research is needed, but these results may argue for targeted biopsies and fewer cores with the aid of MRI-fusion technologies.

Needle Disinfection

Disinfection of the biopsy needle with 10% formalin between each sampling is inexpensive and easily performed. Although experimental data found no growth of fluoroquinolone-resistant E. coli following formalin disinfection, the reduction in PBIs (0.8–0.3%) was not statistically significant.[35] In a recent observational study, Auffenberg et al.,[36] reported that hospitalization due to PBIs were less common when TRUSPB were associated with needle cleaning with a 10% formalin or 70% isopropyl alcohol solution; however, the positive effect of needle disinfection lost statistical significance after adjustment for potential confounders. Similarly, Singla et al.[37] reported a reduction in PBIs by more than 50% using 10% formalin disinfection of the biopsy needle between cores, with a trend toward statistical significance; the multivariable analysis revealed that formalin use trends toward a protective role in preventing infectious complications. Needle disinfection with formalin solution is an attractive technique to reduce PBIs based on its simplicity, effectiveness, cost neutrality, and safety.