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To the Editor.—Transurethral procedures, including cystoscopy, urethral dilation, and transurethral resection of the prostate, have been associated with bacteremia frequencies as high as 17%, 24%, and 31%, respectively.¹ For this reason, the American Heart Association (AHA) recommends antibiotic prophylaxis for all patients with high- or moderate-risk cardiac conditions who undergo transurethral procedures.² On the other hand, the rate of bacteremia associated with gastrointestinal endoscopy is virtually always less than 10%, and mucosal biopsy does not increase this.² Taking into consideration this rather low frequency of bacteremia associated with gastrointestinal endoscopy, the AHA recommends optional prophylaxis only for patients with high-risk cardiac conditions but not for those with moderate-risk conditions.

However, the AHA recommendations do not address the need for prophylaxis for transrectal prostatic biopsy (TRPB). Although TRPB is performed through the gastrointestinal tract, it is associated with a bacteremia rate reported to be as high as about 70%.^3-4 This . . . [Full Text of this Article]

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