Safety profile of chlorhexidine and povidone-iodine in rectal mucosa cleansing during prostate biopsy.

OBJECTIVE

To evaluate the use of rectal mucosal cleansings before transrectal ultrasound-guided prostate biopsy with a transrectal approach, comparing the safety profile of chlorhexidine and povidone-iodine.

METHODS

We conducted a retrospective analysis of our prospectively maintained database between August 2019 to September 2020 in a high-volume hospital in Cali, Colombia. 428 consecutive patients who underwent TRUS-PB with a transrectal approach were included in this study. 117 patients received povidone-iodine and 311 patients received chlorhexidine for rectal mucosa cleansings. After the procedure, we conducted telephone follow-ups at 48 hours, 7 days, and 30 days. The complications were registered in our database. Analysis was performed using STATA 15.

RESULTS

There was a statistically significant increased risk of hematuria, urinary retention, and rectal bleeding in those patients exposed to Chlorhexidine (p <0.001, <0.001, and 0.01 respectively). We did not find any differences in sepsis ( 0.18) or urinary tract infection ( 0.77) rates between the groups. Rectal antisepsis with chlorhexidine significantly increased the risk of non-infectious complications.

CONCLUSIONS

In terms of infectious complications, there were no differences between the use of povidone-iodine and chlorhexidine for rectal mucosal cleansing prior to TRUS-PB. Povidone iodine appeared to be a safer option, as it is associated with fewer risks of hematuria, rectal bleeding, and urine retention.