Complications and risk factors in transrectal ultrasound-guided prostate biopsies

Abstract

CONTEXT AND OBJECTIVE: Prostate biopsy is not a procedure without risk. There is concern about major complications and which antibiotics are best for routine use before these biopsies. The objective was to determine the rate of complications and the possible risk factors in prostate biopsies. DESIGN AND SETTING: Prospective study, Faculdade de Medicina de Botucatu. METHODS: Transrectal ultrasound (TRUS) guided prostate biopsies were carried out in 174 patients presenting either abnormality in digital rectal examinations (DRE) or levels higher than 4 ng/ml in prostate-specific antigen (PSA) tests, or both. RESULTS: Hemorrhagic complications were the most common (75.3%), while infectious complications occurred in 19% of the cases. Hematuria was the most frequent type (56%). Urinary tract infection (UTI) occurred in 16 patients (9.2%). Sepsis was observed in three patients (1.7%). The presence of an indwelling catheter was a risk factor for infectious complications (p < 0.05). Higher numbers of biopsies correlated with hematuria, rectal bleeding and infectious complications (p < 0.05). The other conditions investigated did not correlate with post-biopsy complications. CONCLUSIONS: Post-biopsy complications were mostly self-limiting. The rate of major complications was low, thus showing that TRUS guided prostate biopsy was safe and effective. Higher numbers of fragments taken in biopsies correlated with hematuria, rectal bleeding and infectious complications. An indwelling catheter represented a risk factor for infectious complications. The use of aspirin was not an absolute contraindication for TRUS.

Characteristics of Patients Who Visited the Emergency Room after Prostate Biopsy: Single Center Retrospective Study

“…However, other studies from North America [12,13] reported lower rates of sepsis (0.6%), and an Asian study [14] reported that 0.5% of prostate biopsy cases had fever, similar to the data of our study.…”

“…Earlier studies reported that the complication rate of AUR after prostate biopsy ranges from 0.2% to 1.7% [12,[24][25][26][27][28][29][30]. Raaijmakers et al [31] reported that risk factors of urinary retention after prostate biopsy included prostate size, ratio of transition zone size to total size, and an IPSS.…”

Is It Possible to Predict Sepsis, the Most Serious Complication in Prostate Biopsy?

“…The most serious complications after prostate biopsy are febrile urinary infection and sepsis. After several studies aimed at preventing infections after biopsy, a consensus was reached about prophylaxis with quinolone antibiotics and enema during the procedure [6,[12][13][14][15][16][17][18][19] . Several studies have been conducted in order to avoid sepsis after a diagnostic procedure, which is a life-threatening clinical manifestation.…”

Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

“…Simsir et al [11] reported a rate of sepsis of 3.06% in a sample of 2,023 patients in Turkey. De Jesus et al [12] reported a 14.4% rate of post-PB IC consisting of 1.7% sepsis, 9.2% UTI, 0.6% orchitis, and 0.6% prostatitis. A nationwide survey conducted in Japan that included the information from 212,065 PB performed between 2004 and 2006, reported a 2.22% rate of IC, with epididymitis occurring in 0.06%, prostatitis in 0.9%, UTI in 0.09%, and sepsis in 0.07% of the cases [13].…”