Reducing complications by antibiotic prophylaxis in transrectal prostate biopsy: Any additional benefit of bowel enema?

Background/Objective: This study is aimed at determining if bowel enema further reduces complication rate in Nigerian men undergoing transrectal prostate biopsy. Methods and Materials: A prospective case controlled study conducted in a hospital setting involving patients who met indications for prostate biopsy. Forty patients were equally assigned into two groups of bowel enema and no bowel enema for transrectal prostate biopsy and were discharged home on antibiotics after the procedure. The patients visited the clinic on the 2nd, 7th and 30th day after the procedure where a purpose designed questionaire was administered to measure the complication rate of fever, haemospermia, rectal bleeding, urethral bleeding,acute urinary retention associated with the procedure. Results: There appeared to be no statistically significant difference between bowel enema and no bowel enema in the development of fever (p=0.22), haemospermia (p=1.0), rectal bleeding (p=0.22), prostatic abscess (p=1.0), urethral bleeding (p=0.22), blood transfusion (p=1.0) and acute urinary retention (p=1.0). Conclusion: An overnight fast with antibiotic prophylaxis remains a relatively safe procedure and gives similar outcome as a combination of bowel enema, rectal washout and antibiotic prophylaxis before biopsy. As such, bowel enema and rectal washout before biopsy provides no clinicallysignificant outcome advantage, and potentially increases patient cost and discomfort.