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.