Prostate biopsy sepsis prevention: external validation of an alcohol needle washing protocol.

PURPOSE: Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is associated with a 1-8% risk of post-biopsy sepsis (PBS). A recent study described an isopropyl alcohol needle washing protocol that significantly decreased PBS rates. The current study examined the efficacy of this technique in our clinic population. MATERIALS AND METHODS: Data were reviewed for 1250 consecutive patients undergoing TRUS-Bx at the Charlie Norwood VA Medical Center from January 2017 to January 2023. Needle washing was adopted in February 2021. Complications occurring within 30 days after TRUS-Bx were recorded. RESULTS: There were 912 patients in group 1 (without needle washing) and 338 in group 2 (with needle washing). Groups had equivalent demographic features, and men of African descent comprised 70% of patients. Standard 12 core biopsies were done in 83% and 82% in groups 1 and 2, respectively (p = 0.788). Total complication rates were 4% and 2% in groups 1 and 2, respectively (p = 0.077). There were 13 sepsis events in group 1 (1.4%) and none in group 2 (p = 0.027). Clavien-Dindo Grade I-III complications occurred in 25 (2.7%) and 7 (2.1%) patients in groups 1 and 2, respectively (p = 0.505). Standard antibiotic prophylaxis (PO fluoroquinolone and IM gentamicin) was given in 80% and 86% of patients in groups 1 and 2, respectively (p = 0.030). Subset analysis limited to patients who received standard prophylaxis showed a significant difference in sepsis rates (1.5% vs 0%; p = 0.036). CONCLUSIONS: Adoption of isopropyl alcohol needle washing was associated with a significant decrease in PBS events.

Effect of body position on renal parenchyma perfusion as measured by nuclear scintigraphy.

OBJECTIVES: To compare differential renal perfusion in various body positions in healthy volunteers, to help postulate factors responsible for recurrent unilateral stone formation. METHODS: Ten volunteers with normal renal function and no history of urinary disease were evaluated with diuretic renography using mercaptoacetyl-triglycine. Scintigraphy was performed 1 week apart in each of three typical sleep positions (supine, left lateral decubitus, right lateral decubitus), and renal perfusion was measured. RESULTS: Symmetric renal perfusion was noted in all volunteers in the supine position. Subjects positioned in the left lateral decubitus position had a mean renal perfusion of 61.3% in the dependent (left) kidney, compared with 38.7% in the nondependent (right) kidney (P <0.05). In the right lateral decubitus position, the mean renal perfusion in the right kidney was 63.3%, whereas that in the left kidney measured 36.7% (P <0.05). Renal perfusion in the dependent kidney was increased when compared with the same kidney in the supine position in both the left and right kidneys. CONCLUSIONS: Body position had a significant effect on renal perfusion as measured by nuclear renal scintigraphy. If altered renal blood flow contributes to urinary calculogenesis, these data suggest that the urinary and vascular milieu in the decubitus position may contribute to risk factors for stone formation.

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography.

OBJECTIVES: To determine the impact on differential renal function of percutaneous nephrolithotomy for complex renal calculi. METHODS: From July 1999 to December 2000, 45 patients underwent percutaneous nephrolithotomy. Of these, 19 agreed to participate in the study. All patients completed a quantitative assessment of differential renal function preoperatively and postoperatively with technetium 99m mercaptoacetyl triglycine nuclear renography and serum creatinine measurements. RESULTS: The mean patient age was 49 years (range 11 to 75) for the 13 female and 6 male patients. The mean stone burden was 1432 mm(2) (range 156 to 5220). The mean surgical time was 2.57 hours (range 1.17 to 5.08). The median hospital stay was 2.0 days (range 1 to 19). Of the 19 patients, 13 (68%) were stone free after one procedure. Four patients underwent ureteroscopy with stone extraction for residual fragments. One patient underwent secondary extracorporeal shock wave lithotripsy. One patient underwent nephrectomy for poor renal function. Renal function, for the entire group, increased from 36.8% preoperatively to 38.5% postoperatively. Renal function was preserved in 16 (84%) of 19 patients, including improvement of function in 7 (37%) of 19 patients. Serum creatinine was unchanged in the two groups. CONCLUSIONS: Percutaneous nephrolithotomy does not result in loss of renal function when treating complex renal calculi as measured by nuclear scintigraphy. Operative and hospitalization times were decreased compared with historical open nephrolithotomy and stone clearance was similar.