Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy?

Grummet, Jeremy; Weerakoon, Mahesha; Huang, Sean; Lawrentschuk, Nathan; Frydenberg, Mark; O’Reilly, Mary; Murphy, Declan

doi:10.1111/bju.12536

Cited by 166 publications

(196 citation statements)

References 35 publications

(51 reference statements)

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“…Namekawa et al, recently reported on 2.086 men undergoing an initial PB under lumbar spinal anesthesia: PSA , IPSS score, prostate volume, abnormal DRE and history of α-blocker use were independent predictors of LUTS and urinary retention 13 . When compared to TRUS-guided PB, the occurrence of acute urinary retention after transperineal approach is slightly higher, ranging from 1.7% to 11.1% [8][9][10]25,26 . Pepe et al reported 11.1%, which was significantly correlated with the number of cores taken 10,27 .…”

Section: Lower Urinary Symptoms and Acute Urinary Retentionmentioning

confidence: 86%

“…However, in a biopsy-based multivariable analysis, the repeat biopsy procedure itself was not associated with a greater risk of serious complications requiring hospital admission compared to the initial biopsy session 59 . In patients undergoing transperineal PB, the reported incidence of infections and sepsis is close to zero (0-0.2%), given the avoidance of bacterial contamination (which is common during transrectal access), as well as the limited number of cores taken when performing transperineal MRI-guided in bore biopsy [8][9][10]13,[25][26][27]29,[63][64][65][66][67] . Although data are currently limited, it is uncertain whether the lower incidence of infectious complications after MRI-targeted PB could be related to the sampling route (i.e.…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

“…A recent statewide study from the Michigan Urological Surgery Improvement Collaborative (MUSIC) group, reported a reduction in hospitalization rates for infectious complications from 1.19% to 0.56%, when adopting a specific protocol for antibiotic prophylaxis (by shifting from a monotherapy to a multi-drug prophylaxis or performing culture-directed prophylaxis) 51 . Although transperineal approach for PB is infrequently used in many parts of the world largely due to logistical reasons, the incidence of re-admissions for urinary infection or sepsis is lower, ranging from 0% to 0.7% in published reports 9,10,25,26 (Table 2).Despite the currently limited available body of literature, the lower incidence of infections and hospitalizations among patients undergoing MRI-targeted PB appears mostly related to the transperineal access, rather than the number of cores taken 29,64 . In summary, the occurrence of serious major complications after transrectal PB requiring hospital admission, ranges from 0.5% to 6.9%, and has increased over time.…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

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Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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Evidence Synthesis: The most frequent complication after PB is minor and self-limiting bleeding (hematuria and hematospermia), irrespective of the biopsy approach. Occurrence of rectal bleeding was comparable among traditional TRUS-guided and image-guided PB. Almost 25% of patients experience lower urinary tract symptoms, but only a few have urinary retention, with higher rates after transperineal approach. Temporary erectile dysfunction is not negligible, with a return to baseline after 1-6 months. The incidence of infective complications is being increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, irrespective of biopsy technique. Conclusions:Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. Still, a careful appraisal of 3 patient's general health status, risk factors and likelihood of antimicrobial resistance should be done before scheduling a PB. Patient Summary:In this paper we reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, seldom represent a problem for the patient. The most troublesome complications are infections. In order to minimize this risk, a careful evaluation of patient's medical condition must be done before biopsy.4

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Section: Lower Urinary Symptoms and Acute Urinary Retentionmentioning

confidence: 86%

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

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Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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“…Recent studies have demonstrated increasing rates of antibiotic-resistant infection following TR intraprostatic procedures, suggesting TP techniques may become more frequent in the future. 32,34 Assuming the use of antibiotics is standard, there is no evidence to recommend one technique over the other. Based on the evidence presented, both approaches are safe and well tolerated.…”

Section: Fiducial Marker Implantationmentioning

confidence: 99%

Fiducial marker guided prostate radiotherapy: a review

O’Neill¹,

Jain²,

Hounsell³

et al. 2016

The British Journal of Radiology

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Image-guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogeneous whole-pelvic radiotherapy dose, but these surrogates are not reliable when using reduced margins, dose escalation or hypofractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990s. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aimed to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied, which resulted in 50 articles being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft-tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardization of all techniques and procedures in relation to the use of prostate FMs is required. Finally, a clinical trial investigating a non-surgical alternative to prostate FMs is introduced.

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“…However there are a number of negative aspects of AS such as the anxiety associated with a diagnosis of PC, the need for regular PSA testing and the complications associated with rebiopsy also place a significant burden on the healthcare system (Crawford, Black et al 2010) While small scale studies have shown no increase in reported anxiety and good satisfaction rates amongst patients on AS (Burnet, Parker et al 2007, Davison andGoldenberg 2011), as well as reduced sepsis rates owing to the transition to transperineal biopsy (Grummet, Weerakoon et al 2014), the decision for AS is largely made on an individual basis.…”

Section: Active Surveillancementioning

confidence: 99%

The decision-making role of the patient in localised prostate cancer treatment

Wang

Ranasinghe

2017

AJIS

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Our objective was to review the current literature on patient participation and decision-making in the treatment selection process for localised prostate cancer, and to evaluate capacity for improvement. Methods: 42 articles from our literature search were deemed eligible and relevant for review. We reviewed studies on all facets of the treatment decision-making process with most number of articles (16) on treatment preferences. Results: The majority of the patients prefer an active or collaborative role in decision-making. Patients are seeking information from a myriad of sources but the recommendation from their treating physician is often the most influential on the final decision. Radical prostatectomy is more likely to be selected in patients who view a cure for cancer as being of the utmost importance and radiation therapy is preferred in patients who are concerned about treatment side effects. Conclusion: Currently no ideal tool exists to assist patients in making informed treatment decisions that also takes into account patients' values and preferences. We encourage collaborative partnership in a multidisciplinary setting to optimise this process and individualised riskbased decision-making tools may provide a better pathway to assist patients reach decisions.

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Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy?

Cited by 166 publications

References 35 publications

Complications After Systematic, Random, and Image-guided Prostate Biopsy

Complications After Systematic, Random, and Image-guided Prostate Biopsy

Fiducial marker guided prostate radiotherapy: a review

The decision-making role of the patient in localised prostate cancer treatment

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