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Urology255 papers

Infection of prostate

Last edited: 4/14/2026

Overview

Infection of the prostate, often associated with procedures like transrectal ultrasound-guided prostate biopsy, can lead to complications such as urinary tract infections and bacteremia. Proper prophylaxis and management strategies are crucial to mitigate these risks.

Diagnosis

  • Clinical Symptoms: Fever, urinary symptoms, and signs of systemic infection 3345.
  • Laboratory Tests: Elevated white blood cell count, urinalysis showing pyuria or bacteriuria 3345.
  • Imaging: Ultrasound can help identify prostatic abnormalities but does not directly reflect histopathology 1920.
  • Culture and Sensitivity: Blood cultures and urine cultures to identify causative organisms 3345.

    • Management

  • Antibiotic Prophylaxis: Not routinely recommended for transperineal prostate biopsy 2.
  • Targeted Antibiotics: Initiate based on culture and sensitivity results 33.
  • Supportive Care: Fluid hydration, pain management, and monitoring for complications 116.
  • Sedation: Use of propofol or remimazolam for procedural sedation in elderly patients 15.

    • Special Populations

  • Elderly Patients: Increased susceptibility to complications; careful monitoring and tailored sedation protocols are essential 15.
  • Comorbidities: Patients with comorbidities like diabetes or immunosuppression may require more aggressive prophylactic measures 33.

    • Key Recommendations

  • Avoid Routine Antibiotic Prophylaxis for Transperineal Prostate Biopsy: Not necessary due to similar complication rates with and without prophylaxis 2 (Evidence: Strong).
  • Monitor for Bacteremia Post-Biopsy: Given the recognized risk of bacteremia following transrectal procedures 45 (Evidence: Moderate).
  • Tailored Sedation for Elderly Patients: Use propofol or remimazolam under careful supervision to manage procedural discomfort 15 (Evidence: Moderate).

    • References

    1 Fukano K, Fukuda Y, Chiba Y, Kondo S, Sawada I, Miyazawa K et al.. Comparison of remimazolam versus propofol under deep sedation for elderly patients during prostate biopsy: a protocol for a randomised controlled trial. BMJ open 2026. link 2 Chiu PK, Kasivisvanathan V, Gandaglia G. Moving the Needle: Antibiotic Prophylaxis Is No Longer Required in the Era of Transperineal Prostate Biopsy. European urology 2023. link 3 Loughlin KR. The Prostate as an Endocrine Organ: Its Modulation of Serum Testosterone. The Urologic clinics of North America 2022. link 4 Kapogiannis F, Fasoulakis K, Fragkoulis C, Tsiampa E, Fasoulakis C. Reed Miller Nesbit: Broadening the Horizon of Genitourinary Surgery. Surgical innovation 2021. link 5 Suksompong S, Limratana P, Saengsomsuan N, Wongsawang N, Chaikittisilpa N. Propofol with or without fentanyl for pain relief after transrectal ultrasound-guided prostate (TRUS-P) biopsy: a randomized controlled study. Brazilian journal of anesthesiology (Elsevier) 2021. link 6 Li Q, Yang L, Duan Y, Xiang F, McCarthy CJ, Thabet A et al.. A Low-Cost Highly Configurable Phantom for Simulation of Imaging-Guided Endocavitary Procedures. Ultrasound quarterly 2019. link 7 Alukal JP, Lepor H. Testosterone Deficiency and the Prostate. The Urologic clinics of North America 2016. link 8 Calgani A, Iarlori M, Rizi V, Pace G, Bologna M, Vicentini C et al.. Serum 25(OH)D seasonality in urologic patients from central Italy. Journal of photochemistry and photobiology. B, Biology 2016. link 9 Davis JW, Miki T, Akdas A, Watanabe H, Kirkali Z, Wang R et al.. The International Prostate Forum introduction and history. Asian journal of andrology 2015. link 10 . Medical Devices; Gastroenterology-Urology Devices; Classification of the Prostate Lesion Documentation System. Final order. Federal register 2015. link 11 Park J, Lee DG, Suh B, Cho SY, Chang IH, Paick SH et al.. Establishment of Reference Ranges for Prostate Volume and Annual Prostate Volume Change Rate in Korean Adult Men: Analyses of a Nationwide Screening Population. Journal of Korean medical science 2015. link 12 Grundmark B, Holmberg L, Garmo H, Zethelius B. Reducing the noise in signal detection of adverse drug reactions by standardizing the background: a pilot study on analyses of proportional reporting ratios-by-therapeutic area. European journal of clinical pharmacology 2014. link 13 Kerfoot BP, Brotschi E. Online spaced education to teach urology to medical students: a multi-institutional randomized trial. American journal of surgery 2009. link 14 Josef Marx F, Karenberg A. History of the term prostate. The Prostate 2009. link 15 Lim CH, Quinlan DM. Are doctors examining prostates in university hospital?. Urology 2007. link 16 Turgut AT, Ergun E, Koşar U, Koşar P, Ozcan A. Sedation as an alternative method to lessen patient discomfort due to transrectal ultrasonography-guided prostate biopsy. European journal of radiology 2006. link 17 Barclay WW, Woodruff RD, Hall MC, Cramer SD. A system for studying epithelial-stromal interactions reveals distinct inductive abilities of stromal cells from benign prostatic hyperplasia and prostate cancer. Endocrinology 2005. link 18 Cohen MB. Atypical prostatic stromal lesions. Advances in anatomic pathology 1998. link 19 Tobocman W, Resnick MI, Pretlow TG. Ultrasound reflections fail to reflect the histopathology of the prostate. The Prostate 1997. link1097-0045(19970101)30:1<33::aid-pros5>3.0.co;2-m) 20 David V. MR imaging of the prostate and seminal vesicles. Magnetic resonance imaging clinics of North America 1996. link 21 Aarnink RG, De La Rosette JJ, Debruyne FM, Wijkstra H. Reproducibility of prostate volume measurements from transrectal ultrasonography by an automated and a manual technique. British journal of urology 1996. link 22 Pollack HM. Imaging of the prostate gland. European urology 1991. link 23 Alpern HD. Malakoplakia of the prostate. International urology and nephrology 1991. link 24 Hering F, Müller S. 31P MR spectroscopy and 1H MR imaging of the human prostate using a transrectal probe. Urological research 1991. link 25 Roos LL, Sharp SM, Cohen MM. Comparing clinical information with claims data: some similarities and differences. Journal of clinical epidemiology 1991. link90050-j) 26 Schnall MD, Pollack HM. Magnetic resonance imaging of the prostate gland. Urologic radiology 1990. link 27 Saw D, Schwartz MK, Smith C, Schwartz DC, Fleisher M, Levine J. Comparison of assays for prostatic and total acid phosphatase. Clinical biochemistry 1990. link80040-p) 28 Donjacour AA, Rosales A, Higgins SJ, Cunha GR. Characterization of antibodies to androgen-dependent secretory proteins of the mouse dorsolateral prostate. Endocrinology 1990. link 29 Botticelli AR, Di Gregorio C, Losi L, Fano RA, Manenti A. Melanosis (pigmented melanocytosis) of the prostate gland. European urology 1989. link 30 Mulholland SG. The impact of radiology on the management of prostatic disease: a clinician's perspective. Seminars in ultrasound, CT, and MR 1988. link 31 Vilmann P, Hancke S, Strange-Vognsen HH, Nielsen K, Sørensen SM. The reliability of transabdominal ultrasound scanning in the determination of prostatic volume. An autopsy study. Scandinavian journal of urology and nephrology 1987. link 32 Servadio C, Leib Z, Lev A. Diseases of prostate treated by local microwave hyperthermia. Urology 1987. link90169-5) 33 Sathe VS, Sheth NA, Phadke MA, Sheth AR, Zaveri JP. Biosynthesis and localization of inhibin in human prostate. The Prostate 1987. link 34 Jacobs DM, Weiss MA. Basal cells of prostate in fine-needle aspiration. American journal of clinical pathology 1987. link 35 Iko BO, Monu JU, Mangete ED, Nduka NR. Ultrasonography of the prostate: a preliminary report from Nigeria. International urology and nephrology 1987. link 36 Aumüller G, Enderle-Schmitt U, Seitz J, Müntzing J, Chandler JA. Ultrastructure and immunohistochemistry of the lateral prostate in aged rats. The Prostate 1987. link 37 Martin DS. Prostatic ultrasonography: applicability in a small hospital. Southern medical journal 1986. link 38 Wernert N, Seitz G, Goebbels R, Dhom G. Immunohistochemical demonstration of cytokeratins in the human prostate. Pathology, research and practice 1986. link80042-5) 39 Weidner W. Use of transrectal ultrasonography of the prostate gland and seminal vesicles in andrology--3 years experience. Acta Europaea fertilitatis 1985. link 40 Dorn A, Müller M, Bernstein HG, Pajunen A, Järvinen M. Rat prostate gland--a good model for demonstration of ornithine decarboxylase by immunohistochemistry. The Histochemical journal 1985. link 41 Aumüller G, Braun BE, Seitz J, Müller T, Heyns W, Krieg M. Effects of sexual rest or sexual activity on the structure and function of the ventral prostate of the rat. The Anatomical record 1985. link 42 Aumüller G, Seitz J, Bischof W. Immunohistochemical study on the initiation of acid phosphatase secretion in the human prostate. Cytochemistry and biochemistry of acid phosphatases IV. Journal of andrology 1983. link 43 Eaton AC. The safety of transrectal biopsy of the prostate as an out-patient investigation. British journal of urology 1981. link 44 Greenberg M, Neiman HL, Brandt TD, Falkowski W, Carter M. Ultrasound of the prostate. Analysis of tissue texture and abnormalities. Radiology 1981. link 45 Thompson PM, Talbot RW, Packham DA, Dulake C. Transrectal biopsy of the prostate and bacteraemia. The British journal of surgery 1980. link 46 Carstens PH. Perineural glands in normal and hyperplastic prostates. The Journal of urology 1980. link56092-9) 47 Romas NA, Hsu KC, Tomashefsky P, Tannenbaum M. Counter immunoelectrophoresis for detection of human prostatic acid phosphatase. Urology 1978. link90376-x) 48 Hendry WF, Williams JP. Transrectal prostatic biopsy. British medical journal 1971. link

    Original source

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      Comparison of remimazolam versus propofol under deep sedation for elderly patients during prostate biopsy: a protocol for a randomised controlled trial. — Fukano K, Fukuda Y, Chiba Y, Kondo S, Sawada I, Miyazawa K et al. BMJ open (2026)
    2. [2]
      Moving the Needle: Antibiotic Prophylaxis Is No Longer Required in the Era of Transperineal Prostate Biopsy. — Chiu PK, Kasivisvanathan V, Gandaglia G European urology (2023)
    3. [3]
      The Prostate as an Endocrine Organ: Its Modulation of Serum Testosterone. — Loughlin KR The Urologic clinics of North America (2022)
    4. [4]
      Reed Miller Nesbit: Broadening the Horizon of Genitourinary Surgery. — Kapogiannis F, Fasoulakis K, Fragkoulis C, Tsiampa E, Fasoulakis C Surgical innovation (2021)
    5. [5]
      Propofol with or without fentanyl for pain relief after transrectal ultrasound-guided prostate (TRUS-P) biopsy: a randomized controlled study. — Suksompong S, Limratana P, Saengsomsuan N, Wongsawang N, Chaikittisilpa N Brazilian journal of anesthesiology (Elsevier) (2021)
    6. [6]
      A Low-Cost Highly Configurable Phantom for Simulation of Imaging-Guided Endocavitary Procedures. — Li Q, Yang L, Duan Y, Xiang F, McCarthy CJ, Thabet A et al. Ultrasound quarterly (2019)
    7. [7]
      Testosterone Deficiency and the Prostate. — Alukal JP, Lepor H The Urologic clinics of North America (2016)
    8. [8]
      Serum 25(OH)D seasonality in urologic patients from central Italy. — Calgani A, Iarlori M, Rizi V, Pace G, Bologna M, Vicentini C et al. Journal of photochemistry and photobiology. B, Biology (2016)
    9. [9]
      The International Prostate Forum introduction and history. — Davis JW, Miki T, Akdas A, Watanabe H, Kirkali Z, Wang R et al. Asian journal of andrology (2015)
    10. [10]
      Medical Devices; Gastroenterology-Urology Devices; Classification of the Prostate Lesion Documentation System. Final order. Federal register (2015)
    11. [11]
      Establishment of Reference Ranges for Prostate Volume and Annual Prostate Volume Change Rate in Korean Adult Men: Analyses of a Nationwide Screening Population. — Park J, Lee DG, Suh B, Cho SY, Chang IH, Paick SH et al. Journal of Korean medical science (2015)
    12. [12]
      Reducing the noise in signal detection of adverse drug reactions by standardizing the background: a pilot study on analyses of proportional reporting ratios-by-therapeutic area. — Grundmark B, Holmberg L, Garmo H, Zethelius B European journal of clinical pharmacology (2014)
    13. [13]
      Online spaced education to teach urology to medical students: a multi-institutional randomized trial. — Kerfoot BP, Brotschi E American journal of surgery (2009)
    14. [14]
      History of the term prostate. — Josef Marx F, Karenberg A The Prostate (2009)
    15. [15]
      Are doctors examining prostates in university hospital? — Lim CH, Quinlan DM Urology (2007)
    16. [16]
      Sedation as an alternative method to lessen patient discomfort due to transrectal ultrasonography-guided prostate biopsy. — Turgut AT, Ergun E, Koşar U, Koşar P, Ozcan A European journal of radiology (2006)
    17. [17]
      A system for studying epithelial-stromal interactions reveals distinct inductive abilities of stromal cells from benign prostatic hyperplasia and prostate cancer. — Barclay WW, Woodruff RD, Hall MC, Cramer SD Endocrinology (2005)
    18. [18]
      Atypical prostatic stromal lesions. — Cohen MB Advances in anatomic pathology (1998)
    19. [19]
      Ultrasound reflections fail to reflect the histopathology of the prostate. — Tobocman W, Resnick MI, Pretlow TG The Prostate (1997)
    20. [20]
      MR imaging of the prostate and seminal vesicles. — David V Magnetic resonance imaging clinics of North America (1996)
    21. [21]
      Reproducibility of prostate volume measurements from transrectal ultrasonography by an automated and a manual technique. — Aarnink RG, De La Rosette JJ, Debruyne FM, Wijkstra H British journal of urology (1996)
    22. [22]
      Imaging of the prostate gland. — Pollack HM European urology (1991)
    23. [23]
      Malakoplakia of the prostate. — Alpern HD International urology and nephrology (1991)
    24. [24]
      31P MR spectroscopy and 1H MR imaging of the human prostate using a transrectal probe. — Hering F, Müller S Urological research (1991)
    25. [25]
      Comparing clinical information with claims data: some similarities and differences. — Roos LL, Sharp SM, Cohen MM Journal of clinical epidemiology (1991)
    26. [26]
      Magnetic resonance imaging of the prostate gland. — Schnall MD, Pollack HM Urologic radiology (1990)
    27. [27]
      Comparison of assays for prostatic and total acid phosphatase. — Saw D, Schwartz MK, Smith C, Schwartz DC, Fleisher M, Levine J Clinical biochemistry (1990)
    28. [28]
      Characterization of antibodies to androgen-dependent secretory proteins of the mouse dorsolateral prostate. — Donjacour AA, Rosales A, Higgins SJ, Cunha GR Endocrinology (1990)
    29. [29]
      Melanosis (pigmented melanocytosis) of the prostate gland. — Botticelli AR, Di Gregorio C, Losi L, Fano RA, Manenti A European urology (1989)
    30. [30]
      The impact of radiology on the management of prostatic disease: a clinician's perspective. — Mulholland SG Seminars in ultrasound, CT, and MR (1988)
    31. [31]
      The reliability of transabdominal ultrasound scanning in the determination of prostatic volume. An autopsy study. — Vilmann P, Hancke S, Strange-Vognsen HH, Nielsen K, Sørensen SM Scandinavian journal of urology and nephrology (1987)
    32. [32]
      Diseases of prostate treated by local microwave hyperthermia. — Servadio C, Leib Z, Lev A Urology (1987)
    33. [33]
      Biosynthesis and localization of inhibin in human prostate. — Sathe VS, Sheth NA, Phadke MA, Sheth AR, Zaveri JP The Prostate (1987)
    34. [34]
      Basal cells of prostate in fine-needle aspiration. — Jacobs DM, Weiss MA American journal of clinical pathology (1987)
    35. [35]
      Ultrasonography of the prostate: a preliminary report from Nigeria. — Iko BO, Monu JU, Mangete ED, Nduka NR International urology and nephrology (1987)
    36. [36]
      Ultrastructure and immunohistochemistry of the lateral prostate in aged rats. — Aumüller G, Enderle-Schmitt U, Seitz J, Müntzing J, Chandler JA The Prostate (1987)
    37. [37]
      Prostatic ultrasonography: applicability in a small hospital. — Martin DS Southern medical journal (1986)
    38. [38]
      Immunohistochemical demonstration of cytokeratins in the human prostate. — Wernert N, Seitz G, Goebbels R, Dhom G Pathology, research and practice (1986)
    39. [39]
      Use of transrectal ultrasonography of the prostate gland and seminal vesicles in andrology--3 years experience. — Weidner W Acta Europaea fertilitatis (1985)
    40. [40]
      Rat prostate gland--a good model for demonstration of ornithine decarboxylase by immunohistochemistry. — Dorn A, Müller M, Bernstein HG, Pajunen A, Järvinen M The Histochemical journal (1985)
    41. [41]
      Effects of sexual rest or sexual activity on the structure and function of the ventral prostate of the rat. — Aumüller G, Braun BE, Seitz J, Müller T, Heyns W, Krieg M The Anatomical record (1985)
    42. [42]
      Immunohistochemical study on the initiation of acid phosphatase secretion in the human prostate. Cytochemistry and biochemistry of acid phosphatases IV. — Aumüller G, Seitz J, Bischof W Journal of andrology (1983)
    43. [43]
      The safety of transrectal biopsy of the prostate as an out-patient investigation. — Eaton AC British journal of urology (1981)
    44. [44]
      Ultrasound of the prostate. Analysis of tissue texture and abnormalities. — Greenberg M, Neiman HL, Brandt TD, Falkowski W, Carter M Radiology (1981)
    45. [45]
      Transrectal biopsy of the prostate and bacteraemia. — Thompson PM, Talbot RW, Packham DA, Dulake C The British journal of surgery (1980)
    46. [46]
      Perineural glands in normal and hyperplastic prostates. — Carstens PH The Journal of urology (1980)
    47. [47]
      Counter immunoelectrophoresis for detection of human prostatic acid phosphatase. — Romas NA, Hsu KC, Tomashefsky P, Tannenbaum M Urology (1978)
    48. [48]
      Transrectal prostatic biopsy. — Hendry WF, Williams JP British medical journal (1971)
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