Control of infective complications of transrectal prostate biopsy.

BACKGROUND: To describe a preparatory protocol for prostate biopsy consisting of prophylaxis based on a third-generation cephalosporin and suppository-type povidone-iodine. METHODS: From January 2004 to May 2012 we reviewed infective complications in 1,684 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy. All of the patients received prophylactic antibiotics through a single intravenous injection of a third-generation cephalosporin and cefixime at 100 mg PO for 5 d, with this regimen begun before biopsy, and were also given gynobetadine in a dose of 200 mg just before biopsy. Infectious complications were classified as sepsis, fever (>38°C) without sepsis, and other clinical manifestations of infection. To evaluate the bactericidal effects of gynobetadine, we counted bacterial colonies prospectively in cultures of rectal swab specimens from 150 patients who underwent TRUS-guided prostate biopsy. RESULTS: Complications occurred in 46 of the patients (2.73%), including infective complications in 11 (0.65%) patients and non-infective complications in 35 (2.08%) patients. Of the patients with infective complications, two had fever without sepsis, none had clinical urinary tract infections without fever, and none had sepsis. In prospective in vitro investigations, the mean bacterial colony count before rectal preparation with an enema or rectal insertion of povidone-iodine suppository was 2.38×10(6), whereas the colony count after a povidone-iodine rectal enema and subsequent biopsy was 1.81×10(3) and the colony count after rectal preparation with povidone-iodine suppository and subsequent biopsy was 8.1×10(2) (all p<0.001). CONCLUSIONS: The administration of cephalosporin-based prophylactic antibiotics and the simple use of suppository-type povidone-iodine provided an excellent protocol for reducing infective complications of TRUS-guided prostate biopsy. The simplicity of use and cost effectiveness of gynobetadine were noteworthy.

An analysis of the efficacy, safety, and cost-effectiveness of fulguration under local anesthesia for small-sized recurrent masses: a comparative analysis to transurethral resection of bladder tumors in a matched cohort.

BACKGROUND AND PURPOSE: To investigate the efficacy, safety, and cost-effectiveness of fulguration compared with traditional transurethral resection of a bladder tumor (TURB) among patients who had recurrent lesions after an initial TURB due to bladder cancer. PATIENTS AND METHODS: For the period from March 2001 to January 2012, we reviewed the records of 42 patients who underwent a fulguration procedure for a recurrent Ta small bladder mass after excluding those with ≥1-cm sized masses at recurrence and those with masses at more than three sites. The included fulguration patients were matched with 42 TURB patients who presented with similar preoperative factors. The perioperative outcomes, including complications, recurrence-free survival rate, and total medical cost during each procedure, were compared. RESULTS: The mean tumor size was similar between the two groups (0.54 cm in the fulguration group vs. 0.61 cm in the TURB group, p=0.161). During the follow-up periods, 12 patients (28.5%) in the fulguration group and 11 patients (26.2%) in the TURB group experienced tumor recurrence. The recurrence-free survival rate was similar for both groups (p=0.880). The mean total medical cost of fulguration was much cheaper compared with the TURB group (393.3 vs. 1164.6 US dollars, p<0.001). CONCLUSIONS: Fulguration under local anesthesia for a small-sized recurrent mass is safe and efficacious in properly selected patients. In addition, it also significantly reduces the medical cost and avoids unnecessary anesthesia. Although the two treatments yielded similar oncological results, this finding should be validated in a large-scale, well-designed prospective study.

Radical prostatectomy versus high dose permanent prostate brachytherapy using iodine-125 seeds for patients with high risk prostate cancer: a matched cohort analysis.

OBJECTIVE: To compare the biochemical outcomes reported after radical prostatectomy (RP) versus high dose permanent prostate brachytherapy (HDPPB) using iodine-125 seeds in the treatment of matched high risk prostate cancer (HiPCa). METHODS: In this retrospective review, 55 HiPCa patients treated between March 2006 and August 2011, who underwent HDPPB using iodine-125 seeds combined with external beam radiation therapy (EBRT) or androgen deprivation therapy (ADT), were compared with 55 HiPCa patients who underwent RP. Patients were matched for age, prostate-specific antigen (PSA), clinical stage, and Gleason scores. The biochemical outcomes after HDPPB and RP were compared via Kaplan-Meier analysis. RESULTS: Of the 110 patients analyzed, the mean ages, PSA, and Gleason biopsy scores were similar between the two cohorts. Among patients who underwent HDPPB, 20 patients (36.4%) had received adjuvant EBRT. Of this subsample, most patients (98.2%) had received adjuvant ADT for 3 months. Among patients with RP, 20 patients (36.4%) had received adjuvant EBRT, whereas 28 patients had received adjuvant ADT. The mean implanted seed numbers were 92.8, the mean D90 was 218.7 Gy, and the mean V100 was 96.1% after HDPPB. With regard to oncological outcomes, biochemical disease-free survival rates were similar between the two cohorts (82.6 vs. 81.1%, p = 0.982). Urethrorectal fistula developed in one patient with HDPPB. CONCLUSION: RP and HDPPB, using iodine-125 seeds with combined treatment modalities, exhibited similar biochemical recurrence-free survival rates among HiPCa patients. Further prospective studies with greater sample sizes and longer follow-up periods are needed to validate these results.