Urology Department, La Rabta Hospital, Tunis, Tunisia.
Urology Department, La Rabta Hospital, Tunis, Tunisia.
Prog Urol. 2022 Oct;32(12):830-835. doi: 10.1016/j.purol.2022.06.003. Epub 2022 Jul 1.
Prostate cancer is one of the most common cancers worldwide. Its histological diagnosis is based on prostate biopsy. The transrectal procedure is one of the most common procedures performed by urologists. Although it is considered safe, post-biopsy infectious complications are frequently observed in practice. The aim of this study is to investigate the value of urine culture before the transrectal biopsy. Secondly, we assessed potential risk factors for infectious complications following TR-PB.
We performed a retrospective analysis of all patients who underwent urine culture tests before transrectal prostate biopsy between January 2019 and July 2020. The inclusion criteria for the study were all indications for prostate biopsy (PSA>4ng/mL or abnormal digital rectal examination). Baseline characteristics and the incidence of post-biopsy urinary tract infection were compared between patients showing positive pre-biopsy culture results and those showing negative findings. Multivariate logistic regression analyses were used to determine risk factors for infectious complications following TR-PB.
Out of 163 patients included in our study, 19 patients (11.65%) had positive urine culture results before the biopsy. Age (P=0.068); history of hospitalization (P>0.999), history previous of quinolone use (P=0.75), history of UTI (P=0.64); median PSA level at diagnosis (P=0.267); prostate volume (P=0.78); post-void residual volume (P=0.374); percentage of patients testing positive for cancer on biopsy (P=0.81); and percentages of patients with a history of biopsy (P=0.889), diabetes mellitus (P=0.524), hypertension (P=0.714) and immunosuppressive medication use (P>0.999) were similar between the two groups. One patient in the positive urine culture group had post-biopsy prostatitis. However, 3.24% (five patients) of the negative urine culture group had the disease (P=0.789) (four patients with prostatitis and one with epididymitis). Among them, four patients were diagnosed by urine culture at the time of post-biopsy urinary tract infection. Multivariate logistic regression analysis demonstrated that history of hospitalization and history of previous quinolone use were risk factors for infection after transrectal prostate biopsy.
Our study suggests that systematically performing urine cultures before transrectal prostate biopsy does not reduce the rate of infectious complications after biopsy. Positive pre-biopsy cultures were not associated with the development of post-biopsy infectious complications.
前列腺癌是全球最常见的癌症之一。其组织学诊断基于前列腺活检。经直肠程序是泌尿科医生最常进行的程序之一。尽管它被认为是安全的，但在实践中经常观察到活检后感染性并发症。本研究的目的是研究在经直肠活检前进行尿液培养的价值。其次，我们评估了经直肠前列腺活检后感染性并发症的潜在危险因素。
我们对 2019 年 1 月至 2020 年 7 月期间所有接受经直肠前列腺活检前进行尿液培养试验的患者进行了回顾性分析。研究的纳入标准为所有前列腺活检指征（PSA>4ng/mL 或异常直肠指检）。比较显示活检前培养阳性结果和阴性结果的患者之间的基线特征和活检后尿路感染发生率。使用多变量逻辑回归分析确定经直肠前列腺活检后感染性并发症的危险因素。
在我们的研究中，163 名患者中，19 名患者（11.65%）在活检前尿液培养阳性。年龄（P=0.068）；住院史（P>0.999），既往喹诺酮类药物使用史（P=0.75），尿路感染史（P=0.64）；诊断时中位 PSA 水平（P=0.267）；前列腺体积（P=0.78）；剩余尿量（P=0.374）；活检阳性患者百分比（P=0.81）；以及活检史患者百分比（P=0.889）、糖尿病（P=0.524）、高血压（P=0.714）和免疫抑制药物使用史（P>0.999）在两组之间相似。阳性尿液培养组中有 1 例患者发生活检后前列腺炎。然而，阴性尿液培养组中有 3.24%（5 例）患者患有该疾病（P=0.789）（4 例前列腺炎和 1 例附睾炎）。其中，4 例患者在活检后尿路感染时通过尿液培养诊断。多变量逻辑回归分析表明，住院史和既往喹诺酮类药物使用史是经直肠前列腺活检后感染的危险因素。
我们的研究表明，系统地在经直肠前列腺活检前进行尿液培养并不能降低活检后感染性并发症的发生率。活检前的阳性培养结果与活检后感染性并发症的发生无关。
