The problem of infection after prostatic biopsy: the case for the transperineal approach.

The incidence of infection after needle biopsy of the prostate by different techniques was compared in 45 patients. Aerobic and anaerobic culture was made of the biopsy needle, prostate, urine and blood. In addition, endotoxin assays were determined by a new chromogenic method using Limulus lysate. All of the patients undergoing transrectal biopsy were found to have a bacteraemia; 27% were symptomatic and 87% had a post-operative urinary tract infection. A double-blind controlled trial using cefamandole with the premedication showed a significant reduction in the incidence of bacteraemia to 53% and the prevention of a urinary tract infection. Following transperineal biopsy, although the incidence of bacteraemia was 40% and urinary tract infection 27%, none of these patients was symptomatic and the organisms causing the bacteraemia were predominantly skin contaminants. The endotoxin assays showed differences between the groups with higher endotoxin values in the unprotected transrectal group.