Is there any effect of long term alpha-adrenergic blocker and a single dose antibiotic usage in reducing febrile urinary tract infections after prostate biopsy?
Abstract
Aim: To investigate whether the using long term alpha-adrenergic blockers before biopsy has an effect on preventing febrile urinary tract infections (FUI) secondary to biopsy in patients undergoing prostate biopsy due to elevated prostate specific antigen (PSA) .
Material and Method: The data of 2558 patients who underwent transrectal ultrasonography-guided prostate biopsy (TRUS+BX) due to elevated PSA in our clinic between January 2008 and July 2021 were analyzed retrospectively. The patients were divided into two groups as those who used alpha-blockers for a minimum of three months or longer before biopsy (Group 1) and those who did not use alpha-blockers before applying to the outpatient clinic (Group 2) . Demographic data of the groups and post-biopsy FUI development rates were compared.
Results: It was observed that 1340 (52.4%) of the patients were using alpha-blockers (Group 1) and 1218 (47.6%) did not (Group 2) . The median age of the patients in the pre-biopsy groups was similar [Group 1=68 (IQR=9) years and Group 2=68 (IQR=9) years, p=0.887]. There was no significant difference between the groups in terms of median prostate volume [Group1=57 (31) ml and Group 2=58 (34) ml, p=0.199]. The median PSA value was found to be significantly higher in Group 1 than in Group 2 [10.50 (5.40) ng/dl vs 10.35 (6.80) ng/dl, p=0.026]. Postvoid residual urine volume (PVR) was found to be significantly higher in Group 2 [Group 1=40 (30) ml and Group2=60 (90) ml, p<0.001]. Similarly, the frequency of FUI development after biopsy was found to be significantly higher in Group 2 [Group 1=17 (1.3%) and Group 2=65 (5.3%) , p<0.001].
Conclusion: The use of alpha-adrenergic blockers for a minimum of three months or longer before prostate biopsy significantly reduces the incidence of FUI that may develop secondary to biopsy.
References
- Center MM, Jemal A, Lortet-Tieulent J, et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61: 1079–92.
- Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989; 142: 71–4.
- Chun FK, Epstein JI, Ficarra V, et al. Optimizing performance and interpretation of prostate biopsy: a critical analysis of the literature. Eur Urol 2010; 58: 851–64.
- Borghesi M, Ahmed H, Nam R, et al. Complications After Systematic, Random, and Image-guided Prostate Biopsy. Eur Urol 2017; 71: 353-65.
- Wagenlehner FM, van Oostrum E, Tenke P, et al. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol 2013; 63: 521–7.
- Bruyère F, Malavaud S, Bertrand P, et al. Prosbiotate: a multicenter, prospective analysis of infectious complications after prostate biopsy. J Urol 2015; 193: 145–50.
- Shandera KC, Thibault GP, Deshon GE. Variability in patient preparation for prostate biopsy among American urologists. Urology 1998; 52: 644–6.
- Masumori N, Tsukamoto T, Horita H, et al. α1-blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5-year outcome analysis of a prospective multicenter study. Int J Urol 2013; 20: 421-8.
- Nickel JC. Role of alpha1-blockers in chronic prostatitis syndromes. BJU Int 2008; 101 : 11-6.
- Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2017; 71: 618–29.
- Puig J, Darnell A, Bermúdez P, et al. Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Eur Radiol 2006; 16: 939-43.
- Ruebush TK, McConville JH, Calia FM. A double-blind study of trimethoprim-sulfamethoxazole prophylaxis in patients having transrectal needle biopsy of the prostate. J Urol 1979; 122: 492–4.
- Thomson PM, Talbot RW, Packhamand DA, Dulake C. Transrectal biopsy of the prostate and bacteraemia. Br J Surg 1980; 67: 127–8.
- Hwang EC, Jung SI, Seo YH, et al. Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study. Int Urol Nephrol 2015; 47: 595-601.
- Kalkanlı A, Gezmiş CT, Özkan A, et al. Comparison of single and prolonged fluoroquinolone prophylaxis and risk factors for infectious complications after transrectal prostate biopsy. Balkan Med J 2018; 35: 373-7.
- Choi JW, Kim TH, Chang IH, et al. Febrile urinary tract infection after prostate biopsy and quinolone resistance. Korean J Urol 2014; 55: 660–4.
- Wu X, Yu C, Li T, et al. Obesity was an independent risk factor for febrile infection after prostate biopsy: A 10-year single center study in South China. Medicine (Baltimore) 2018; 97: 9549.
- Eri LM, Tveter KJ. Treatment of benign prostatic hyperplasia. A pharmacoeconomic perspective. Drugs Aging 1997; 10: 107-18.
- Kim EH, Larson JA, Andriole GL. Management of benign prostatic hyperplasia. Annu Rev Med 2016; 67: 137-51.
- Moon HW, Yang JH, Choi JB, et al. Prescription pattern of alpha-blockers for management of lower urinary tract symptoms/benign prostatic hyperplasia. Sci Rep 2018; 8: 13223.
- Schwinn DA, Roehrborn CG. Alpha1-adrenoceptor subtypes and lower urinary tract symptoms. Int J Urol 2008; 15: 193–9.
- Masumori N, Tsukamoto T, Horita H, et al. α1-blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5-year outcome analysis of a prospective multicenter study. Int J Urol 2013; 20: 421-8.
- Nickel JC, Narayan P, McKay J, Doyle C. Treatment of chronic prostatitis/chronic pelvic pain syndrome with tamsulosin: a randomized double blind trial. J Urol 2004; 171: 1594-7.
- Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol 1998; 159: 883–7.
- Management of non-neurogenic male LUTS. European Association of Urology (EAU) Guidelines 2022; pp 4.8.
- Schulman CC. Long-term aspects of medical treatment of BPH. Eur Urol 2001; 40: 8-12.
- Roehrborn CG, Bruskewitz R, Nickel GC, et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Characterization of patients and ultimate outcomes. The PLESS Study Group. Eur Urol 2000; 37: 528-36.
- Alrabadi A, Al Demour S, Mansi H, AlHamss S, Al Omari L. Evaluation of voiding position on uroflowmetry parameters and post void residual urine in patients with benign prostatic hyperplasia and healthy men. Am J Mens Health 2020; 14: 1557988320938969.
Abstract
References
- Center MM, Jemal A, Lortet-Tieulent J, et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61: 1079–92.
- Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989; 142: 71–4.
- Chun FK, Epstein JI, Ficarra V, et al. Optimizing performance and interpretation of prostate biopsy: a critical analysis of the literature. Eur Urol 2010; 58: 851–64.
- Borghesi M, Ahmed H, Nam R, et al. Complications After Systematic, Random, and Image-guided Prostate Biopsy. Eur Urol 2017; 71: 353-65.
- Wagenlehner FM, van Oostrum E, Tenke P, et al. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol 2013; 63: 521–7.
- Bruyère F, Malavaud S, Bertrand P, et al. Prosbiotate: a multicenter, prospective analysis of infectious complications after prostate biopsy. J Urol 2015; 193: 145–50.
- Shandera KC, Thibault GP, Deshon GE. Variability in patient preparation for prostate biopsy among American urologists. Urology 1998; 52: 644–6.
- Masumori N, Tsukamoto T, Horita H, et al. α1-blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5-year outcome analysis of a prospective multicenter study. Int J Urol 2013; 20: 421-8.
- Nickel JC. Role of alpha1-blockers in chronic prostatitis syndromes. BJU Int 2008; 101 : 11-6.
- Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2017; 71: 618–29.
- Puig J, Darnell A, Bermúdez P, et al. Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Eur Radiol 2006; 16: 939-43.
- Ruebush TK, McConville JH, Calia FM. A double-blind study of trimethoprim-sulfamethoxazole prophylaxis in patients having transrectal needle biopsy of the prostate. J Urol 1979; 122: 492–4.
- Thomson PM, Talbot RW, Packhamand DA, Dulake C. Transrectal biopsy of the prostate and bacteraemia. Br J Surg 1980; 67: 127–8.
- Hwang EC, Jung SI, Seo YH, et al. Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study. Int Urol Nephrol 2015; 47: 595-601.
- Kalkanlı A, Gezmiş CT, Özkan A, et al. Comparison of single and prolonged fluoroquinolone prophylaxis and risk factors for infectious complications after transrectal prostate biopsy. Balkan Med J 2018; 35: 373-7.
- Choi JW, Kim TH, Chang IH, et al. Febrile urinary tract infection after prostate biopsy and quinolone resistance. Korean J Urol 2014; 55: 660–4.
- Wu X, Yu C, Li T, et al. Obesity was an independent risk factor for febrile infection after prostate biopsy: A 10-year single center study in South China. Medicine (Baltimore) 2018; 97: 9549.
- Eri LM, Tveter KJ. Treatment of benign prostatic hyperplasia. A pharmacoeconomic perspective. Drugs Aging 1997; 10: 107-18.
- Kim EH, Larson JA, Andriole GL. Management of benign prostatic hyperplasia. Annu Rev Med 2016; 67: 137-51.
- Moon HW, Yang JH, Choi JB, et al. Prescription pattern of alpha-blockers for management of lower urinary tract symptoms/benign prostatic hyperplasia. Sci Rep 2018; 8: 13223.
- Schwinn DA, Roehrborn CG. Alpha1-adrenoceptor subtypes and lower urinary tract symptoms. Int J Urol 2008; 15: 193–9.
- Masumori N, Tsukamoto T, Horita H, et al. α1-blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5-year outcome analysis of a prospective multicenter study. Int J Urol 2013; 20: 421-8.
- Nickel JC, Narayan P, McKay J, Doyle C. Treatment of chronic prostatitis/chronic pelvic pain syndrome with tamsulosin: a randomized double blind trial. J Urol 2004; 171: 1594-7.
- Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol 1998; 159: 883–7.
- Management of non-neurogenic male LUTS. European Association of Urology (EAU) Guidelines 2022; pp 4.8.
- Schulman CC. Long-term aspects of medical treatment of BPH. Eur Urol 2001; 40: 8-12.
- Roehrborn CG, Bruskewitz R, Nickel GC, et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Characterization of patients and ultimate outcomes. The PLESS Study Group. Eur Urol 2000; 37: 528-36.
- Alrabadi A, Al Demour S, Mansi H, AlHamss S, Al Omari L. Evaluation of voiding position on uroflowmetry parameters and post void residual urine in patients with benign prostatic hyperplasia and healthy men. Am J Mens Health 2020; 14: 1557988320938969.
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| Primary Language | English |
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| Subjects | Health Care Administration |
| Journal Section | Original Article |
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| Early Pub Date | January 9, 2023 |
| Publication Date | January 12, 2023 |
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