Abstract
Background: Transrectal ultrasound biopsy is the preferred
method for diagnosing prostate cancer, but it can cause infectious
complications as a result of fluoroquinolone resistance. We aimed to
explore the potential protective effect of a second rectal enema before
biopsy.
Methods: Between January 2015 and December 2020, 419 patients
were assessed retrospectively. Patients with a history of anticoagulant
use, uncontrolled diabetes, urological surgery, prostate biopsy, or
recent hospitalization or overseas travel, as well as those with
previous prostatitis, were excluded from the study. The patients were
subsequently divided into two groups: Group 1 (n=223) had received one
enema, on the morning of the biopsy, and Group 2 (n=196) had received
two, with the additional enema administered half an hour before the
procedure.
Results: There was no significant difference between the groups
in terms of age, BMI, diabetes, prostate-specific antigen (PSA) level,
free/total PSA (f/t PSA) ratio, and prostate size (p =0.076,p =0.489, p =0.265, p =0.193, p =0.518, andp =0.661, respectively) or in relation to cancer detection
(p =0.428). The median hospitalization date was significantly
higher in Group 1 (p =0.003) as was UTI development
(p =0.004). However, there was no significant difference in terms
of fever and sepsis (p =0.524 and p =0.548, respectively).
Additionally, subgroup analysis demonstrated that UTI was significantly
lower in patients with diabetes mellitus who had received a second enema
(p =0.004), though there was no significant difference in UTI
between the groups in those without diabetes mellitus (p =0.215).
Multivariable analysis showed that age and diabetes were significant
risk factors for the development of UTI (OR: 0.074, 95%CI: 1.027-1.130,p =0.002 and OR: 1.220, 95%CI: 0.131-0.665, p =0.003,
respectively). Furthermore, the second enema was a significant
protective factor for preventing UTI (OR: -1.794, 95%CI: 2.208-16.389,p <0.001).
Conclusion: Older age and the presence of diabetes mellitus are
independent risk factors for UTI after prostate biopsy. A second enema
procedure before biopsy may protect patients from related infectious
complications and could therefore be used as an alternative preventative
method.
Keywords: Biopsy, Prostate cancer, Infectious Complication,
Enema