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Nationwide Population Based Study of Infections after Transrectal Ultrasound Guided Prostate Biopsy
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
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2014 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 192, no 4, 1116-1122 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: Transrectal ultrasound guided biopsy is the gold standard for detecting prostate cancer but international reports suggest that increasing risks are associated with the procedure. We estimated incidence and risk factors for infection after prostate biopsy as well as 90-day mortality using a nationwide Swedish sample. Material and Methods: We performed a population based study of 51,321 men from PCBaSe between 2006 and 2011. Primary outcome measures were dispensed prescriptions of antibiotics for urinary tract infection and hospitalization with a discharge diagnosis of urinary tract infection. Multivariable logistic regression was used to examine risk factors for infection in men who underwent prostate biopsy. Results: During the 6 months before biopsy the background incidence of urinary tract infection was approximately 2%. Within 30 days after biopsy 6% of the men had a dispensed prescription for urinary tract antibiotics and 1% were hospitalized with infection. The strongest risk factors for an antibiotic prescription were prior infection (OR 1.59, 95% CI 1.45-1.73), high Charlson comorbidity index (OR 1.25, 95% CI 1.11-1.41) and diabetes (OR 1.32, 95% CI 1.17-1.49). Risk of an antibiotic prescription after biopsy decreased from 2006 to 2011 (OR 0.79, 95% CI 0.70-0.90) but the risk of hospital admission increased (OR 2.14, 95% CI 1.58-2.94). No significant increase was observed in 90-day mortality. Conclusions: Severe infections with hospitalization after prostate biopsy are increasing in Sweden. The risk of post-biopsy infection is highest in men with a history of urinary tract infection and those with significant comorbidities.

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 192, no 4, 1116-1122 p.
Keyword [en]
prostate, biopsy, complications, urinary tract infections, anti-bacterial agents
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-94937DOI: 10.1016/j.juro.2014.04.098ISI: 000342113900032OAI: oai:DiVA.org:umu-94937DiVA: diva2:762655
Available from: 2014-11-12 Created: 2014-10-20 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Outcomes and complications in surgical and urological procedures
Open this publication in new window or tab >>Outcomes and complications in surgical and urological procedures
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background:

Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective.

Aim:

To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events.

Results:

When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days.

Conclusions:

The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 66 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1899
Keyword
Hydrocele, Spermatocele, Groin hernia, prostate biopsy, complication, infection, chronic pain
National Category
Urology and Nephrology
Research subject
Urology; Surgery
Identifiers
urn:nbn:se:umu:diva-135046 (URN)978-91-7601-717-3 (ISBN)
Public defence
2017-06-09, Hörsalen, Östersunds sjukhus, Östersund, 09:00 (English)
Opponent
Supervisors
Available from: 2017-05-19 Created: 2017-05-17 Last updated: 2017-05-24Bibliographically approved

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Lundström, Karl-JohanStattin, Pär

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