A prospective randomized trial of 1-day versus 3-day antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy. Optimizing prophylactic antibiotic regimen in patients admitted for transrectal ultrasound-guided prostate biopsies: A prospective randomized study A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy Efficiency of short and long term antimicrobial therapy in transrectal ultrasound-guided prostate biopsies. Prospective assessment of the efficacy of single dose versus traditional 3-day antimicrobial prophylaxis in 12-core transrectal prostate biopsy. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy--should we reassess our practices for antibiotic prophylaxis? Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study. Local anaesthetic for transrectal ultrasound-guided prostate biopsy: a prospective, randomized, double blind, placebo-controlled study. Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis? A Prospective Comparison of Selective Multiparametric Magnetic Resonance Imaging Fusion-Targeted and Systematic Transrectal Ultrasound-Guided Biopsies for Detecting Prostate Cancer in Men Undergoing Repeated Biopsies Prophylactic antibiotics reduce sepsis after biopsy of the prostate. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Outcomes of fecal carriage of extended-spectrum β-lactamase after transrectal ultrasound-guided biopsy of the prostate. Prostate cancer detection on transrectal ultrasonography‐guided random biopsy despite negative real‐time magnetic resonance imaging/ultrasonography fusion‐guided targeted biopsy: reasons for targeted biopsy failure Transrectal ultrasound (TRUS) guided prostate biopsy: Three different types of local anesthesia.
PURPOSE To compare the incidence of infection between a 1 day and a 3 day antibiotic prophylaxis regimen for transrectal ultrasound ( TRUS ) guided prostate biopsy in a prospect i ve , r and omized open-label trial . MATERIAL S AND METHODS TRUS examination was performed in the left lateral decubitus position using a Brüel and Kjaer 7 MHz rectal probe . Biopsies were carried out with an 18 gauge Tru-cut needle fired by the h and -held Biopsy gun . An average of eight core biopsies ( range 6 to 12 ) was taken . From May 15 , 2000 to May 16 , 2001 , 363 patients were enrolled in this study . Patients were r and omized to receive either 1 day or 3 days of fluroquinolone antibiotic prophylaxis , consisting of either ciprofloxacin or levofloxacin orally . Antibiotics were begun at least 1 hour prior to biopsy . Seven days later , telephone follow-up was obtained . RESULTS Two ( 0.55 % ) of the 363 patients , one in each group , had an episode of sepsis . No urinary tract infection was reported . Traumatic complications were only minor and no significant difference was observed between both groups : hematospermia ( p > 0.4 ) , hematuria ( p>0.1 ) and rectorragia ( p>0.2 ) being reported most frequently . CONCLUSION There is no clinical ly nor statistically significant difference between a 1 day and 3 day antibiotic prophylaxis regimen for patients undergoing TRUS guided biopsies Background Transrectal ultrasound-guided prostate biopsies ( TRUSBx ) , in spite of being one of the most frequently performed urological office procedures , are associated with a spectrum of complications , most significantly including infection . The aim of the study is to evaluate the prevalence of fluoroquinolone-resistant bacteria in rectal swabs from our local population prior to TRUSBx and to identify risk factors among a patient population harboring fluoroquinolone-resistant organisms . Methods We prospect ively included 541 men who were su bmi tted for TRUSBx in our center from March 2011 to June 2015 . The indications for TRUSBx were an elevated prostate-specific antigen level and /or abnormal digital rectal exam . All patients were r and omly divided into two groups : Group 1 ( n = 279 cases ) who received st and ard empirical prophylactic antibiotics and Group 2 who received targeted prophylaxis based on a rectal swab culture and susceptibility result . Differences in risk factors between quinolone-resistant and nonresistant patients were compared . Univariate and multivariate analyses were performed to identify independent potential risk factors associated with fluoroquinolone-resistant rectal flora . Results Sixteen out of 271 men developed infectious complications after TRUSBx in the group receiving st and ard empirical prophylaxis ( 5.7 % ) . No men in the group who received targeted prophylactic antibiotic guided by rectal swab developed infectious complications . Among the 262 patients who underwent prebiopsy rectal swab cultures , 76 men ( 29 % ) displayed fluoroquinolone-resistant rectal flora ( 29 % ) . In the multivariate analysis , a history of antibiotic exposure before prostate biopsy was the only independent factor associated with an increased risk of fluoroquinolone resistance . Conclusion Determining the prevalence of fluoroquinolone resistance in rectal flora has important implication s in the selection of targeted prophylactic antibiotic regimens . Antimicrobial profiles guided by rectal swabs may prove useful to optimize prophylaxis prior to TRUSBx ; this strategy is effective at reducing the rates of infectious complications , including sepsis , especially in men at higher risk of infectious complications PURPOSE Transrectal ultrasound guided prostate biopsy can lead to urinary tract infections in 3 % to 11 % and sepsis in 0.1 % to 5 % of patients . We investigated the efficacy of rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy to reduce infectious complications . MATERIAL S AND METHODS Between 2009 and 2011 , 865 men were prospect ively r and omized to rectal cleansing ( 421 ) or no cleansing ( 444 ) before transrectal ultrasound guided prostate biopsy .  Patients received ciprofloxacin prophylaxis and rectal swab cultures were obtained before transrectal ultrasound guided prostate biopsy . Patients completed a telephone interview 7 days after undergoing the biopsy . The primary end point was the rate of infectious complications , a composite end point of 1 or more of 1 ) fever greater than 38.0C , 2 ) urinary tract infection or 3 ) sepsis ( st and ardized definition ) . Chi-square significance testing was performed for differences between groups and a multivariate analysis was performed to assess risk factors for infectious complications . RESULTS Infectious complications were observed in 31 ( 3.5 % ) patients , including 11 ( 2.6 % ) treated and 20 ( 4.5 % ) control patients ( p = 0.15 ) . Sepsis was observed in 4 ( 1.0 % ) treated and 7 ( 1.6 % ) control patients ( p = 0.55 ) . On multivariate analysis resistance to ciprofloxacin in the rectal swab culture ( p = 0.002 ) and a history of taking ciprofloxacin in the 3 months preceding transrectal ultrasound guided prostate biopsy ( p = 0.009 ) predicted infectious complications . CONCLUSIONS Rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy was safe , but the 42 % relative risk reduction of infectious complications was not statistically significant . Patients who have received ciprofloxacin within 3 months of transrectal ultrasound guided prostate biopsy should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months Transrectal  ultrasound guided prostate biopsies ( TRUSBx ) are associated with a spectrum of complications , including most significantly infection , which affects up to 5 % of patients . In the most severe cases , infection leads to sepsis , a life‐threatening complication . Escherichia coli is the primary responsible pathogen . Although antibiotic prophylaxis with fluoroquinolones is routinely used , there is evidence that the infection rate after TRUSBx is increasing , and this appears to be due to an increasing prevalence of ciprofloxacin‐resistant rectal flora . This is the largest prospect i ve clinical trial to date analysing the rectal flora of men undergoing prostate biopsies . We determined the microbial and antibiotic sensitivity profiles from 849 patients .  Ciprofloxacin‐resistant Gram‐negative organisms were identified in the rectal flora of 19.0 % of men . Furthermore , fluoroquinolone use within 6 months preceding a TRUSBx and the presence of a prosthetic heart valve were significant predictors of ciprofloxacin resistance on rectal swab . Determining the prevalence of rectal fluoroquinolone resistance has important implication s in evaluation of the suitability of prophylactic regimens . Antimicrobial profiles derived from rectal swabs pre‐biopsy may prove useful in guiding targeted antibiotic prophylaxis OBJECTIVE Prostate biopsy is a frequent diagnostic measure to detect prostatic conditions , including primarily prostate cancer . Its performance does not follow a pattern , mainly regarding preparation for the examination through antimicrobial prophylaxis . The aim of this study is to compare the efficiency of short and long term antimicrobial prophylaxis in transrectal ultrasound-guided prostate biopsies . MATERIAL S AND METHODS A clinical study was conducted with a total of 140 patients su bmi tted to prostate biopsy with transrectal ultrasonographic control . Patients were r and omly separated in two groups : Group 1 receiving norfloxacin 400 mg single dose before the procedure and Group 2 receiving norfloxacin 400 mg initiating before the procedure and then bid up to 6 doses . Efficiency control was determined by the incidence of urinary tract infection ( UTI ) and complications in both groups after statistical analysis . RESULTS The incidence of minor complications in our study was 75 % , consistent with data found in the literature . Among the patients with diagnosis of simple UTI , 23 % belonged to Group 1 and 8 % to Group 2 ( p=0.08 ) . Among the patients with complicated UTI , 37 % belonged to Group 1 and none belonged to Group 2 ( p=0.44 ) . CONCLUSIONS Several advances made transrectal ultrasound-guided prostate biopsies a useful and safe diagnostic tool in the workup of urologic patients . There is no optimal prophylactic preparation to the performance of this procedure . Long term antimicrobial prophylaxis presents a trend toward lower incidence of infectious complications OBJECTIVES To prospect ively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography ( TRUS ) guided prostate biopsy . METHODS A total of 400 patients who underwent prostate biopsy with TRUS guidance were included . The patients were prospect ively r and omized in three groups regarding antibiotic prophylaxis . The first group ( 139 patients ) received a single gram of intramuscular ceftriaxone , while the second group ( 131 patients ) had a 3-day course of oral ciprofloxacin . The third group ( 130 patients ) had single oral 500 mg of ciprofloxacin . All patients had urine cultures prior to biopsy and on the second day after biopsy . RESULTS The study groups were compared in terms of the results of urine cultures and clinical parameters . Overall , only seven patients ( 1.8 % of the cases ) had positive urine cultures with no difference between these three groups . Additionally , no significant difference was observed regarding morbidity rates in all groups . Only eight patients ( 2 % ) developed major complications requiring hospitalization . There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12 . CONCLUSIONS The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling Although the estimate of the incidence of sepsis following  transrectal ultrasound-guided prostate biopsy ( TRUSPB ) is low , fluoroquinolone-resistant infections after prostate biopsy are being increasingly noted . This study was aim ed at determining the prevalence of faecal carriage of fluoroquinolone-resistant Escherichia coli strains before TRUSPB and at evaluating potential predisposing risk factors . The incidence of sepsis after prostate biopsy was determined , and our routine practice for antibiotic prophylaxis for TRUSPB was evaluated . A prospect i ve study was conducted in 342 consecutive patients undergoing prostate biopsy between December 2009 and July 2010 . Before TRUSPB , a rectal swab was cultured . The correlation between the presence of fluoroquinolone-resistant strains and plausible risk factors was investigated by the use of a question naire . Of the 236 patients included , 22.0 % ( 52/236 ) harboured ciprofloxacin-resistant E. coli strains . The use of fluoroquinolones in the 6 months before biopsy was associated with an increased risk of faecal carriage of fluoroquinolone-resistant E. coli strains ( p < 0.01 ) . Faecal carriage of fluoroquinolone-resistant E. coli strains was an important risk factor for infectious complications after TRUSPB ( p < 0.01 ) . In conclusion , a significant number of patients have faecal carriage of fluoroquinolone-resistant E. coli strains ( 22.0 % ) before TRUSPB . The use of fluoroquinolones in the previous 6 months before biopsy is a risk factor for faecal carriage of fluoroquinolone-resistant E. coli strains and for infectious complications after TRUSPB . Hence , the universal administration of fluoroquinolones should be reconsidered OBJECTIVES To evaluate the incidence , and clinical and bacterial features of iatrogenic prostatitis within 1 month after  transrectal ultrasound-guided biopsy  for detection of prostate cancer . METHODS From January 2006 to December 2009 , 3000 patients underwent a 21-core transrectal ultrasound-guided prostate biopsy at Henri Mondor Hospital ( Créteil , France ) and were prospect ively followed . All patients had a fluoroquinolone antimicrobial prophylaxis for 7 days . The primary study end-point was to evaluate the incidence of iatrogenic acute prostatitis within 1 month after the biopsy . The secondary end-point was to analyze the clinical and the bacterial features of the prostatitis . RESULTS Overall , 20 patients of the entire study population ( 0.67 % ) had an acute bacterial prostatitis within 2.90 ± 1.77 days ( range 1 - 7 days ) after the transrectal ultrasound-guided biopsy . The groups of patients with ( n = 20 ) and without ( n = 2980 ) infection were similar in terms of age , prostate-specific antigen level and prostate volume . Escherichia coli was the only isolated bacteria . The subsequent tests for antibiotic susceptibility showed a 95 % resistance for fluroquinolone and amoxicillin . Resistance to amoxiclav , trimethoprim-sulfamethoxazole , third generation cephalosporin and amikacin was 70 % , 70 % , 25 % and 5 % respectively . No resistance to imipenem was reported . They were all admitted for treatment without the need of intensive care unit referral . Complete recovery was achieved after 21.4 ± 7 days of antibiotic treatment . CONCLUSIONS A fluroquinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of acute prostatitis secondary to prostate biopsy . Patients should be provided the appropriate care soon after the onset of the symptoms . An intravenous third generation cephalosporin or imipenem-based therapy seem to provide satisfying results OBJECTIVE To evaluate the efficacy of local anaesthetic ( LA ) infiltration in decreasing the discomfort experienced by patients undergoing transrectal ultrasound (TRUS)-guided biopsy of prostate . PATIENTS AND METHODS 98 patients were r and omized to receive 3x3ml of 1 % lidocaine ( n=55 ) or saline ( n=43 ) . The injection sites were basolaterally on each side to infiltrate the neuro-vascular bundle and one at the apex . Generally 12 systematic r and om biopsies were performed after which patients were asked to grade the pain of the whole procedure using a visual analogue scale ranging from 0 to 10 . RESULTS The LA group had a significantly lower pain score compared with placebo . The mean pain scores were 3.0 and 4.3 ( p<0.001 ) , respectively . Using an unpaired t-test , the difference between means was -1.96 to -0.51 with 95 % confidence interval . There were no significant problems associated with the infiltration of either saline or LA . CONCLUSION Local anaesthesia for TRUS biopsy is simple and well tolerated . It significantly reduces the pain associated with the procedure . We recommend its usage as a part of st and ard TRUS biopsy of the prostate BACKGROUND An increasing risk of infectious complications following  transrectal ultrasound-guided prostate needle biopsy ( PNB )  has been observed recently in some centers . OBJECTIVE To delineate the risk factors associated with post-PNB bacteremia and /or urinary tract infection ( UTI ) and determine why this risk has risen over time . DESIGN , SETTING , AND PARTICIPANTS A case-control study in a Canadian tertiary-care center . Cases were all patients who developed bacteremia and /or UTIs after PNB between 2002 and 2011 ; controls were r and omly selected among patients who underwent a PNB without such complications . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Crude and adjusted odds ratios and their 95 % confidence intervals were calculated using logistic regression . RESULTS AND LIMITATIONS A total of 5798 PNBs were performed during the study period , following which there were 48 cases of urinary sepsis ( 42 % with bacteremia ) . The incidence increased from 0.52 infections per 100 biopsies in 2002 - 2009 to 2.15 infections per 100 biopsies in 2010 - 2011 ( p<0.001 ) . Escherichia coli was the predominant pathogen ( 75 % of cases ) . Among 42 patients whose post-PNB infection was caused by aerobic or facultative Gram-negative rods , 22 patients ( 52 % ) were infected by pathogens resistant to ciprofloxacin . Independent risk factors for post-PNB infection were diabetes , hospitalization during the preceding month , chronic obstructive pulmonary disease , and performance of the biopsy in 2010 - 2011 . In 2010 - 2011 , the minimal inhibitory concentrations for ciprofloxacin increased compared with 2002 - 2009 ( p<0.03 ) . The major limitation of the study was its retrospective hospital-based nature , which hampered data collection on outpatient antibiotic prescriptions . CONCLUSIONS In the past 2 yr , ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center . Novel antibacterial prophylaxis approaches need to be evaluated Introduction : The aim of the study was to compare the prostate cancer ( PCa ) detection rate of systematic transrectal ultrasound-guided biopsies ( TRUS-bx ) and multiparametric-MRI targeted biopsies ( mp-MRI-bx ) in a repeat biopsy setting and evaluate the clinical significance following an “ MRI-targeted-only ” approach . Material s and Methods : Patients with prior negative biopsies underwent prostatic multiparametric-MRI  that was scored using the Prostate Imaging Reporting and Data System ( PI-RADS ) classification . All underwent both repeated TRUS-bx and mp-MRI-bx using image fusion of any PI-RADS ≥3 lesion . Biopsy results from TRUS-bx , mp-MRI-bx , and the combination were compared . Results : PCa was detected in 89 out of 206 ( 43 % ) patients . Of these , 64 ( 31 % ) and 74 ( 36 % ) patients were detected using mp-MRI-bx and TRUS-bx , respectively . Overall , mp-MRI-bx detected fewer patients with low- grade ( Gleason score [ GS ] 3 + 3 ) cancers ( 14/64 vs. 41/74 ) and more patients with intermediate/high- grade cancers ( GS ≥3 + 4 ) ( 50/64 vs. 33/74 ) using fewer biopsy cores compared with TRUS-bx ( p < 0.001 ) . Using an “ MRI-targeted-only ” approach in men with PI-RADS ≥3 lesions reduced the number of men requiring repeated biopsies by 50 % , decreased low- grade cancer diagnoses by 66 % , and increased intermediate/high- grade cancer diagnoses by 52 % . Conclusions : MRI-targeted biopsies have a high detection rate for significant PCa in patients with prior negative transrectal ultrasound-guided biopsies and preferentially detect intermediate/high- grade compared with low- grade tumors INTRODUCTION Prostate cancer is the most common form of cancer in Danish men , and the incidence is rising . The diag-nosis is made by transrectal prostate biopsy guided by ultrasound . This procedure has several complications , the most severe being sepsis . In our department , this is sought prevented by administering the prophylactic antibiotics metronidazol and ciprofloxacin . This study examined the rate of sepsis in patients who had the procedure performed at our department . METHODS The electronic patient records of all patients who had transrectal ultrasound of the prostate with biopsies performed at the Department of Urology at Naestved Hospital in the period from 1 May 2009 to 31 May 2011 were examined , and all admissions to our department ( or any department in the same region ) due to sepsis within two weeks of the procedure were registered . RESULTS A total of 438 patients had the procedure performed , some multiple times , which result ed in a total of 511 procedures . In all , four patients were later admitted due to sepsis , corresponding to 0.91 % . Three of the patients had positive blood and urine cultures in which Escherichia coli resistant to ciprofloxacin were found , the last had been prescribed antibiotics by a general practitioner the previous day , and no bacteria could be cultured . CONCLUSION The frequency of sepsis after transrectal needle biopsies from the prostate at our department was found to be below 1 % in this study , which is comparable to international findings . Most of the cases of sepsis were related to ciprofloxacin-resistant bacteria . Further r and omised studies are needed to investigate the ideal prophylactic regime . FUNDING not relevant . TRIAL REGISTRATION not relevant Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy ( TRUS-PB ) . The true incidence of hemospermia , its duration and implication s are not well established . We performed a prospect i ve observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution . Sixty-three eligible men were included in the study . Most men ( 84 % ) undergoing TRUS-PB , who were able to ejaculate , experienced hemospermia , which was associated with some degree of anxiety . The mean duration of hemospermia was 3.5 ( ±1.7 ) weeks . The number of ejaculations before the complete resolution of hemospermia was 8 ( ±6.7 ) . None of the clinical and pathological factors was a significant predictor of the duration of hemospermia . Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity OBJECTIVES To evaluate the complication rates and possible risk factors of biopsy of the prostate , with the aim of improving patient counseling and the safety of the procedure . Biopsy of the prostate has to be a relatively safe procedure and the participants have to be well informed about the possible complications . METHODS Within the biopsy protocol of the Rotterdam section of the European R and omized Study of Screening for Prostate Cancer , we evaluated  5802 transrectal ultrasound-guided systematic sextant biopsies . All participants received prophylactic antibiotic therapy .  RESULTS We performed 5802 biopsies .  Hematuria lasting longer than 3 days and hematospermia were present after 22.6 % and 50.4 % of the procedures , respectively . More severe complications were far less frequent . Two hundred participants ( 3.5 % ) developed fever after biopsy . Urinary retention was seen 20 times ( 0.4 % ) , and hospitalization was needed in 27 cases ( 0.5 % ) . Twenty-five of these men were admitted because of signs of prostatitis and /or urosepsis . Risk factor analyses revealed that an earlier episode of prostatitis was significantly associated with hospital admission and pain after biopsy . Characteristics of prostatic hyperplasia , such as prostate volume , transition zone volume/total prostate volume ratio , and a higher International Prostate Symptom Score , were all predictors of urinary retention . CONCLUSIONS Minor complications are frequently seen but major complications are rare after prostate biopsy . Assessment of the risk factors before biopsy can help to improve the adequacy of counseling , and pre caution ary measures can be taken to minimize the risk of complications after the procedure . Transrectal ultrasound-guided sextant biopsy remains a safe procedure for the diagnosis of prostate cancer within the general population OBJECTIVE To determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae ( PE ) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy ( TRUSbx )  and its relationship with post-biopsy infections . METHODS A prospect i ve clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted . Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy .  Rectal swab culture specimens were acquired immediately before the procedure . Demographic data , prophylaxis choice ,  quinolone or any  other antibiotic consumption within the past 2 months , history of prostatitis , repeat biopsy , intensive care unit admission , hospitalization , urethral catheterization , diabetes mellitus ( DM ) , and steroid usage were recorded . RESULTS ESBL carriage was detected in 19 % of patients and quinolone use within the last 2 months ; other antibiotic use within the last 2 months and DM were found to be significantly associated ( P < .05 ) . Symptomatic urinary tract infection ( UTI ) on the third day after biopsy was seen in 9 % of patients and was associated with fluoroquinolone ( FQ ) consumption before biopsy . Although ESBL-PE carriage was associated with post-biopsy UTI symptoms , it was not found to be associated with post-biopsy symptomatic UTI . Urosepsis was seen in 2 patients ( 0.5 % ) after biopsy , and both the patients were ESBL-PE carriers . CONCLUSION The presence of ESBL-PE was associated with DM and FQ consumption before biopsy . ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation ; however , it was not associated with microbiologically proven infections . FQ consumption before TRUSbx was also associated with post-biopsy infections To examine the value of additional transrectal ultrasonography (TRUS)‐guided r and om biopsy ( RB ) in patients with negative magnetic resonance imaging (MRI)/ultrasonography ( US ) fusion‐guided targeted biopsy ( TB ) and to identify possible reasons for TB failure Transrectal Ultrasound ( TRUS ) guided prostate biopsy is regarded as the gold st and ard for prostate cancer diagnosis . The majority of patients perceive TRUS-guided prostate biopsy as a physically and psychologically traumatic experience . We aim ed to compare in this paper the efficacy of three different anesthesia techniques to control the pain during the procedure . MATERIAL S AND METHODS 150 patients who underwent transrectal ultrasound ( TRUS ) guided prostate biopsy  were r and omly divided into three groups . Group A included 50 patients who received one hour before the procedure a mixture of 2.5 % lidocaine and 2.5 % prilocaine , Group B : 50 patients who received intrarectal local anesthetic administration ( lidocaine 5 ml 10 % ) and lidocaine local spray 15 % and Group C included 50 patients who received periprostatic block anesthesia ( lidocaine 10 ml 10 % ) .  Visual analogue scale ( VAS ) of patients in different groups was evaluated at the end of the biopsy and 30 minutes after the procedure . RESULTS The VAS of patients in Group A was 1.32 ± 0.65 ( VAS I ) and 2.47 ± 0.80 ( VAS II ) . In group B the VAS of patients was 1.09 ± 0.47 ( VAS I ) and 1.65 ± 0.61 ( VAS II ) . In group C the VAS of patients was 2.63 ± 0.78 ( VAS I ) and 1.70 ± 0.85 ( VAS II ) . There was no statistically significant difference in term of VAS I between group A and B. A statistically significant difference was determined in terms of VAS II between group A and B. There was no statistically significant difference in term of VAS between group B and C. CONCLUSIONS The most effective of the three methods for pain control we used was intrarectal local anesthetic administration and lidocaine local spray 15 % that enables an ideal patient comfort
Widespread use of fluoroquinolone prophylaxis may be associated with an increase in resistant Escherichia coli strains , posing a potentially major health issue in the future .
INTRODUCTION Transrectal ultrasound-guided biopsies ( TRUS-gb ) are associated with both mild and serious complications .
Prophylactic antibiotics reduce the risk of septicaemia and mortality ; however , no international consensus exists on the timing and duration of antibiotics , including the optimal drug strategy .
We review ed the current evidence supporting use of prophylactic antibiotics and the risk of complications following prostate biopsies .