MP58: Infections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia
MP58-18: Transrectal MRI/US Fusion Biopsy Doubles the Risk of Infectious Hospitalization - Analysis of a Statewide Collaborative
Friday, May 15, 2020
7:00 AM – 9:00 AM
Adam Cole, Ji QI, Colton Walker, Rich Wu, Susan Linsell, Anna Johnson, Karla Witzke, Sabry Mansour, Ryan Nelson, David Miller, Arvin George, for the Michigan Urological Surgery Improvement Collaborative
Introduction: Infectious complications following prostate biopsy remain a significant cause of patient morbidity driven by increasing antibiotic resistance. Fusion biopsy and transperineal biopsy are recently introduced biopsy techniques with increasing levels of adoption. We aim to evaluate effect of biopsy type with infectious complications.
Methods: The Michigan Urologic Surgery Improvement Collaborative (MUSIC) maintains a high quality, prospective prostate cancer registry with biopsy outcomes manually abstracted and reported at 30 days post-procedure. A review of all patients undergoing prostate biopsy from January 2012 – August 2019 was performed. Patient characteristics, biopsy-type, and 30-day complications were analyzed. Multivariable analysis was performed to assess risk factors for infectious complications and hospitalizations.
Results: A total of 66,525 biopsies were performed, of which 62,040 (93.26%) were transrectal ultrasound guided (TRUS), 1068 (1.61%) were transperineal (TP), 3322 (4.99%) were transrectal MRI-fusion (TRF), and 95 (0.14%) were transperineal MRI-fusion (TPF). In total, 1081 (1.62%) patients experienced an infectious-complication and 515 (0.77%) were hospitalized with for an infection-related indication. There were 83 (2.5%) men in the TRF biopsy group with an infectious complication compared to 989 (1.59%) in the TRUS, 9 (0.84%) in the TP and 0 (0%) in the TPF groups. When controlling for patient characteristics, TRF biopsy type was associated with increased odds of an infectious complication (OR 1.62, p<0.001) and infectious hospitalization (OR 2.16, p<0.001) when compared to TRUS patients. Total cores and diabetes were associated with an increased risk of an infectious complication. The transperineal approach and biopsies performed after the implementation of a state-wide antibiotic pathway designed to decrease these complications were less likely to result in an infection-related hospitalization.
Conclusions: Transrectal fusion biopsy was associated with an increased risk of post-biopsy infectious complications and hospitalizations. Alternative biopsy techniques, including transperineal fusion biopsy, may mitigate this risk. Source of
Funding: Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnership program