Formalin disinfection of prostate biopsy needles may reduce post-biopsy infectious complications

BACKGROUND: We sought to determine whether formalin disinfection of prostate biopsy needles between cores reduces postbiopsy urinary tract infections (UTIs). METHODS: We reviewed a single-surgeon experience of transrectal prostate biopsies from 2010 to 2014. Biopsies were performed in either an operative suite, where 10% formalin was used to disinfect the needle tip between each biopsy core, or an outpatient clinic, where formalin was not used. Our primary outcome was post-biopsy UTI rates, defined as a positive urine culture within 30 days of biopsy. Infection severity was characterized by the need for admission. Patient demographics, prostate size, prior biopsies, prior UTIs, pre-biopsy antibiotics and cultures and post-biopsy cultures were analyzed. Logistic regression was used to assess predictors of post-biopsy UTIs. Statistical significance was defined as Po0.05. RESULTS: A total of 756 patients were included for analysis, including 253 who received formalin disinfection and 503 who did not. Of these, 32 patients (4.2%) experienced post-biopsy UTIs, with 8 requiring admission (all without formalin use). Infection rates were more than double in the group that did not receive formalin (5.2% vs 2.3%, P = 0.085). More patients in the formalin group had undergone prior biopsies (73.9% vs 31.8%, Po0.001). On multivariable analysis, prior UTI (odds ratio (OR) 3.77, P = 0.006) was a significant predictor for post-biopsy infection, whereas formalin disinfection trended towards a protective effect (OR 0.41, P = 0.055). CONCLUSION: Infectious complications following prostate biopsy may be mitigated by the use of formalin disinfection of the biopsy needle between cores.