Needle-tip disinfection with povidone-iodine plus formalin reduces infections after prostate biopsy

Intrarectal povidone-iodine cleansing along with formalin disinfection of the biopsy needle tip helps reduce infectious complications following transrectal prostate biopsy, a study has shown.

A prospective, single-centre, phase III trial was conducted in patients undergoing transrectal ultrasound-guided prostate biopsy. Participants were randomized to rectal mucosa cleansing with gauze soaked in 10% povidone-iodine solution wrapped around the glove index finger and needle tip disinfection by immersion in a 10% formalin solution before each puncture (n=633) or to a control group (n=623).

The rate of infectious complications, defined as having fever, urinary tract infection (UTI), and/or sepsis, was 3.9 percent in the intervention group and 6.4 percent in the control group (risk ratio [RR], 0.61, 95 percent confidence interval [CI], 0.36‒0.99; p=0.049).

The rates of sepsis, UTI, and fever in the two groups were 0.3 percent vs 0.5 percent (p=0.646), 2.3 percent vs 4.1 percent (p=0.071), and 1.3 percent vs 1.9 percent (p=0.443), respectively. The rate of positive urine culture was 5.2 percent in the intervention group and 9 percent in the control group (RR, 0.57; p=0.015).

Of note, no statistically significant between-group difference was observed in the occurrence of noninfectious adverse events.

“Prostate biopsy is mostly performed through the transrectal route worldwide, and infectious complications may occur in up to 7 percent of cases,” the authors said. “Therefore, alternative strategies to decrease infectious complications are needed.”