Reducing the risk of infection for transrectal prostate biopsy with povidone-iodine: a systematic review and meta-analysis.

PURPOSE: To evaluate the efficacy of povidone-iodine (PI) in reducing the risk of infectious complications following transrectal prostate biopsy (TRPB).

METHODS: Eligible randomized controlled trials (RCTs) were identified from electronic databases (Cochrane CENTRAL, MEDLINE, and EMBASE). The database search, quality assessment, and data extraction were performed independently by two reviewers. The main outcome for the efficacy of PI was the incidence of infectious complications after TRPB.

RESULTS: Seven trials, including 2,049 patients, met the inclusion criteria. Data from the seven included RCTs favored the use of PI before TRPB to prevent infectious complications. PI for "PI versus blank control" significantly reduced fever, bacteriuria, and bacteremia compared with that for control [relative risk (RR) 0.31; 95 % confidence interval (CI) 0.21-0.45, P < 0.00001]. With PI versus antibiotics (ATB), patients treated with ATB alone had a significantly greater risk of bacteremia (RR 0.38; 95 % CI 0.16-0.90, P = 0.03). In "PI plus ATB versus ATB" trials, the risk of fever (RR 0.11; 95 % CI 0.02-0.85, P = 0.03) and bacteremia (RR 0.25; 95 % CI 0.08-0.75, P = 0.01) was diminished in the "PI plus ATB" group.

CONCLUSIONS: Rectal disinfection with PI provides a safe and effective method to reduce the risk of infectious complications following TRPB, regardless of mono-prophylaxis and combined prophylaxis with PI and ATB. Large, multicenter, and prospective RCTs of good quality trials are needed to confirm the efficacy of PI.