title: Morbidity of prostate biopsy after simplified versus complex preparation protocols: assessment of risk factors.
abstract: OBJECTIVE
  To determine whether prostate biopsy complications were affected by 2 varying prebiospy protocols implemented at our institution. Although transrectal ultrasound (TRUS) guided prostate biopsy is considered generally safe, it is associated with significant complications.
  
  
  METHODS
  We retrospectively evaluated a total of 1438 TRUS-guided prostate biopsies between January 2001 and June 2008. In group A, 931 men had only one dose of a quinolone antibiotic immediately before the procedure, and no enema was performed. In group B, 507 men who underwent a prebiopsy enema and were given oral antibiotics starting the day before the procedure for 3 days. We analyzed demographics and biopsy complications between the 2 groups.
  
  
  RESULTS
  The overall complication rates were categorized as infection (2.2%), urine retention (0.8%), hematuria (4.4%), rectal bleeding (1.5%), sepsis (0.2%). There was no significant statistical difference in the incidence of infection or sepsis between the 2 groups (2.7% vs 1.4%, P = .157 and 0.1% vs 0.4%, P = .285 respectively, for group A vs B). Both hematuria and hematospermia were more common in group B (2.5% vs 7.9%, P < .001 and 0.2% vs 2%, P < .001 respectively, for group A vs B). Prostate size was a significant risk for both hematuria (odds ratio = 1.7, 95% confidence interval = 1.2-2.44, P = .003) and acute urinary retention (odds ratio = 4.45, 95% confidence interval = 2.01-9.84, P < .001).
  
  
  CONCLUSIONS
  This study demonstrates that a single antibiotic dose before prostate biopsy may be sufficient. In addition, use of prebiopsy enemas is unnecessary to decrease overall complication rates.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Osama M
authors.initials: OM
authors.lastname: Zaytoun
authors.forename: Thomas
authors.initials: T
authors.lastname: Anil
authors.forename: Ayman S
authors.initials: AS
authors.lastname: Moussa
authors.forename: Li
authors.initials: L
authors.lastname: Jianbo
authors.forename: Khaled
authors.initials: K
authors.lastname: Fareed
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis; D001707:Biopsy, Needle / Q000009:adverse effects*; D004733:Enema; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology; D012007:Rectum / Q000000981:diagnostic imaging; D012307:Risk Factors; D018084:Ultrasonography, Interventional