Safety profile of chlorhexidine and povidone-iodine in rectal mucosa cleansing during prostate biopsy

Objective To evaluate the use of rectal mucosal cleansings before transrectal ultrasound-guided prostate biopsy with a transrectal approach, comparing the safety profile of chlorhexidine and povidone-iodine. Methods We conducted a retrospective analysis of our prospectively maintained database between August 2019 to September 2020 in a high-volume hospital in Cali, Colombia. 428 consecutive patients who underwent TRUS-PB with a transrectal approach were included in this study. 117 patients received povidone-iodine and 311 patients received chlorhexidine for rectal mucosa cleansings. After the procedure, we conducted telephone follow-ups at 48 hours, 7 days, and 30 days. The complications were registered in our database. Analysis was performed using STATA 15. Results There was a statistically significant increased risk of hematuria, urinary retention, and rectal bleeding in those patients exposed to Chlorhexidine (p <0.001, <0.001, and 0.01 respectively). We did not find any differences in sepsis (p 0.18) or urinary tract infection (p 0.77) rates between the groups. Rectal antisepsis with chlorhexidine significantly increased the risk of non-infectious complications. Conclusions In terms of infectious complications, there were no differences between the use of povidone-iodine and chlorhexidine for rectal mucosal cleansing prior to TRUS-PB. Povidone iodine appeared to be a safer option, as it is associated with fewer risks of hematuria, rectal bleeding, and urine retention.