The effect of povidone-iodine-enhanced rectal enema on procedure-related infectious complications before transrectal ultrasound-guided prostate biopsy: A prospective randomized study

BACKGROUND: To prospectively evaluate the effects of rectal cleansing using a povidone-iodine (PI) and PI enhanced rectal enema on procedure-related infectious complications in patients undergoing transrectal prostate biopsy. METHODS: Between September 2023 and March 2024, patients scheduled for their first transrectal ultrasound-guided prostate biopsy due to elevated prostate-specific antigen levels, suspicious multiparametric prostate magnetic resonance imaging findings, or abnormal digital rectal examination were prospectively randomized into 2 groups (n = 60 each). All patients received standard prophylactic measures, including antibiotic prophylaxis starting 1 day prior to the procedure and rectal mucosal cleansing with PI immediately before biopsy. Both groups additionally underwent rectal enema administration. In the intervention group, a PI enhanced rectal enema was administered by adding PI to the sodium phosphate enema solution, whereas the control group received a sodium phosphate enema alone. Post-procedural complications, including hematuria, hematospermia, rectal bleeding, fever, acute urinary retention, hospitalization, sepsis, and urine and blood culture results, were recorded and compared using chi-square tests. RESULTS: In total of 120 patients were enrolled. The mean age in both groups was 66.6 years (± 7.20). Hospitalization due to febrile urinary tract infection occurred in 6 patients (10%) in the control group versus 2 patients (3.3%) in the study group. Positive urine cultures were found in 6 patients (10%) in the control group, while no positive cultures were detected in the study group, a statistically significant difference (P = .046). No significant differences were observed between the groups in terms of hematuria, hematospermia, rectal bleeding or acute urinary retention. CONCLUSION: Rectal cleansing with a PI and PI enhanced rectal enema prior to transrectal prostate biopsy significantly reduced the rate of positive urine cultures. Although the reductions in febrile urinary tract infections and sepsis-related hospitalizations were not statistically significant, the overall trend suggests a potential benefit. Given that infectious complications are the most common adverse events associated with transrectal biopsy, this simple and low-cost intervention may improve patient safety.