Effect of needle disinfection with different antiseptic agents on infectious complications after TRUS-guided prostate biopsy: a prospective randomized study.

BACKGROUND

Transrectal ultrasound-guided prostate biopsy (TRUS-guided biopsy) remains widely used for the diagnosis of prostate cancer, but it is associated with a risk of infectious complications despite antibiotic prophylaxis.

OBJECTIVES

To evaluate the effect of disinfecting the prostate biopsy needle with different antiseptic agents after each core sampling on post-procedural infectious complications.

DESIGN

A prospective, randomized, single-center clinical study.

METHODS

Between February and May 2025, 240 patients undergoing TRUS-guided prostate biopsy were randomly assigned to four groups (n = 60 each): no needle disinfection, povidone-iodine disinfection, 10% formalin disinfection, or 70% isopropyl alcohol disinfection after each biopsy core. All patients received standardized empirical antibiotic prophylaxis based on the institutional protocol and local antibiogram data. Prophylaxis consisted of oral cefixime initiated on the day of biopsy and continued for 5-7 days. Patients were actively followed for 30 days for febrile urinary tract infection, hospitalization, sepsis, and microbiological culture results.

RESULTS

The rate of febrile urinary tract infection was highest in the non-disinfection group (11.6%). No cases of fever, hospitalization, or sepsis were observed in the formalin group. Povidone-iodine and isopropyl alcohol disinfection were associated with lower infection rates than no disinfection, but were less effective than formalin. Escherichia coli was the most frequently isolated microorganism in positive cultures.

CONCLUSION

Disinfection of the biopsy needle after each core sampling is associated with a meaningful reduction in infectious complications following TRUS-guided prostate biopsy. Among the evaluated agents, 10% formalin demonstrated the greatest protective effect; however, further multicenter studies with longer follow-up are required to confirm long-term safety and generalizability.

TRIAL REGISTRATION: This trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06836271; Local trial ID: HititUrology001).