Ergani Batuhan, Çetin Taha, Yalçın Mehmet Yiğit, Özbilen Mert Hamza, Bildirici Çağdaş, Karaca Erkin, Boyacıoğlu Hayal, Koç Gökhan, İlbey Yusuf Özlem
Clinic of Urology, Muş State Hospital, Muş, Turkey.
Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey.
Turk J Urol. 2020 Jan 6;46(2):159-164. doi: 10.5152/tud.2019.19172. Print 2020 Mar.
Infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB) can range from asymptomatic bacteriuria and febrile or non-febrile urinary tract infection (UTI) to sepsis. Cleaning of rectal mucosa with topical antiseptics such as povidone iodine or chlorhexidine before the procedure are alternative prophylaxis methods. We aimed to investigate the effects of these two different topical antiseptic agents on infectious complications and their superiority to each other.
The study was conducted with 200 patients. Rectal mucosa cleansings were performed in 50 patients with povidone iodine and 49 patients with chlorhexidine. The remaining 101 patients did not receive any antiseptic treatment. The results were examined according to the hospital admissions or hospitalization for the first 30 days after the procedure due to UTI, body temperature >38.5°C, sepsis, hematuria, rectal bleeding, and urinary retention.
The mean age of study population was 63.3±7.26 years, and the mean prostate specific antigen value was 13.96±29.5 ng/mL. Acute prostatitis occurred in 14 patients (7%), 9 of whom were hospitalized due to sepsis after TRUS-PB. Statistically significant less acute prostatitis was observed in those patients who were treated with topical rectal antisepsis (topical rectal antisepsis 2% vs. no rectal antisepsis 12.1%, p=0.01). Chlorhexidine and povidone iodine were not superior to each other in terms of inhibiting the development of acute prostatitis (chlorhexidine 2% vs. povidone iodine 2%, p=1.00).
Rectal mucosal cleansing with chlorhexidine or povidone iodine before TRUS-PB prevented the development of sepsis due to acute prostatitis. We recommend that this effective method, which is easy to apply, cheap, reliable, easily tolerated should be used in all prostate biopsy practice.
经直肠超声引导下前列腺穿刺活检（TRUS-PB）后的感染并发症范围可从无症状菌尿症、发热或不发热的尿路感染（UTI）到脓毒症。术前用聚维酮碘或氯己定等局部抗菌剂清洁直肠黏膜是替代预防方法。我们旨在研究这两种不同的局部抗菌剂对感染并发症的影响以及它们相互之间的优越性。
本研究对200例患者进行。50例患者用聚维酮碘清洁直肠黏膜，49例患者用氯己定清洁直肠黏膜。其余101例患者未接受任何抗菌治疗。根据术后前30天因UTI、体温>38.5°C、脓毒症、血尿、直肠出血和尿潴留而入院或住院情况来检查结果。
研究人群的平均年龄为63.3±7.26岁，平均前列腺特异性抗原值为13.96±29.5 ng/mL。14例患者（7%）发生急性前列腺炎，其中9例在TRUS-PB后因脓毒症住院。在接受局部直肠抗菌治疗的患者中，观察到的急性前列腺炎在统计学上显著较少（局部直肠抗菌治疗2% vs. 未进行直肠抗菌治疗12.1%，p=0.01）。在抑制急性前列腺炎的发生方面，氯己定和聚维酮碘彼此之间并无优越性（2%氯己定 vs. 2%聚维酮碘，p=1.00）。
TRUS-PB术前用氯己定或聚维酮碘清洁直肠黏膜可预防因急性前列腺炎导致的脓毒症。我们建议在所有前列腺穿刺活检操作中使用这种易于应用、便宜、可靠且易于耐受的有效方法。
