This study examines the impact of using rectal povidone-iodine (betadine) preparation on reducing infectious complications, including sepsis, after transrectal (TR) prostate biopsies. TR biopsies, commonly used to diagnose prostate cancer, have a higher risk of infection compared to transperineal biopsies, thus requiring preventive measures like antimicrobial prophylaxis. In a single-center retrospective review, data from 608 patients who underwent 629 TR biopsies between January 2019 and September 2021 was analyzed. Of these, 278 patients had TR biopsies with either ultrasound guidance combined with MRI (n=174) or MRI/ultrasound fusion (n=104). Patients were split into two groups: those who received rectal betadine preparation before biopsy (n=55) and those who did not (n=223). Both groups were comparable in demographic and clinical characteristics, including age, race, PI-RADS score, prostate volume, and PSA levels.
The study found a lower overall complication rate in the betadine group (1.82%) compared to the non-betadine group (6.28%), though this difference was not statistically significant. Notably, there were zero infectious complications, including fever, chills, or sepsis, among patients who received the betadine preparation, while the non-betadine group showed a slightly higher rate of infection (1.35%). Other complications, such as hematuria, hematochezia, urinary retention, and hematospermia, were similar across both groups. Although the results did not reach statistical significance, the finding of zero infectious complications in the betadine group suggests that rectal betadine preparation may serve as a valuable nonantibiotic measure to lower the risk of infection post-TR biopsy. As infection is a primary reason for hospital readmissions after TR biopsies, which incur substantial healthcare costs, this approach could have meaningful clinical and economic benefits. Future studies with larger sample sizes are needed to confirm the efficacy of betadine preparation as a standard preventive measure in TR prostate biopsy procedures.
