Introduction
Prostate cancer is the second most common cancer worldwide. Transrectal ultrasonography-guided (TRUS-bx) and transperineal ultrasonography-guided (TPUS-bx) needle biopsies are well-established methods in diagnosing prostate cancer, with TRUS-bx the traditionally more preferred and more reliable method. However, bacterial sepsis is a severe complication of TRUS-bx, and hospital readmission increases over time due to these infective complications (1).
Effective prebiopsy preparation of the patient is essential; approximately 96% of urologists support preoperative antibiotics and more than 80% promote rectal enemas (2). In TRUS-bx, fluoroquinolones are the most preferred agent because of their excellent tolerability, broad-spectrum efficacy, and good penetration into the prostate tissue, and they can also reduce septic complications. However, in recent years, there has been an increase in fluoroquinolone resistance and infectious TRUS-bx complications as a result because of increased antibiotic use (3, 4). Rectal preparation is another essential stage of the prebiopsy procedure to decrease potential infection with enemas and povidone-iodine administration both effective in preventing infectious complications (5, 6). Most relevant studies suggest that enemas reduce bacterial load and, therefore, the rate of bacteremia (1).
However, conflicting results about the timing of enema administration exist in the literature, and it has also been shown that enemas may even increase infective complications and be ineffective (7, 8). As a result of these findings, the optimal preparation procedure to prevent infection remains unclear (9) although predicting and preventing such issues following TRUS-bx has been gaining increased attention (10). In the current study, we investigated the effect of enema timing on preventing infectious complications.