One Minute Poster Pitches Archive

UK & Ireland Prostate Brachytherapy Conference 2024

Abstract number 7 

A Quality Improvement Project for prescribing for local anaesthetic trans-perineal prostate biopsies: outcomes from 944 patients.

Tomas Austin, Joshuah Hill, Sean Pellow, Sally Deverill, Matt Crockett, Dominic Hodgson Portsmouth Hospitals University NHS trust 

Purpose: Trans-perineal biopsy (TPB) for prostate cancer diagnosis is a very common local anaesthetic, outpatient procedure, but has potential significant complications of the development of urinary retention and infection. There is uncertainty as to whether the use of alpha-blocking drugs and/ or antibiotics can reduce such risks. We have routinely performed local anaesthetic trans-perineal prostate biopsies since 2019 having previously limited these to general anaesthetic day case procedures when an alpha blocker and prophylactic antibiotics were administered. We repeated this approach (using Tamsulosin 400mcg O.D. for a week, and Ciprofloxacin 500mg for two doses) until 2020 when an audit of our outcomes identified a low incidence (0.7%) of infection, and we stopped routinely prescribing anti-biotics. In 2023 we established, again through audit, a low incidence of retention in our men (0.3%), and so, similarly, ceased routinely prescribing Tamsulosin. This current study, then, compares the incidence of infection and retention within these three cohorts. 

Methods: A retrospective audit of 944 biopsies was performed, assessing the post procedure incidence of urinary retention and infection complications. 

Results: A total of 252 patients received both Tamsulosin and Ciprofloxacin with an incidence of 0.7% (2 patients) of infection and 0.7% (2 patients) of urinary retention. A total of 343 patients then received Tamsulosin only as prophylaxis with an incidence of 0.8% (3 patients) of infection and 2% (7 patients) of urinary retention. Out of these seven patients who developed urinary retention six were already taking tamsulosin at the time of their biopsy. Of the 349 patients who received no prophylaxis an incidence of 0.2% (1 patient) of infection and 0.5% (2 patients) of urinary retention.

Conclusion: Neither prophylactic antibiotics or an alpha-blocker seem to decrease the risk of developing post-procedure infections and retention following local anaesthetic trans-perineal prostate biopsy and their routine use may not be necessary.