Massive Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy

Brullet, Enric; Guevara, M C; Campo, Ricardo Lopez del; Falco, Jacopo; Puig, Jordi; Prera, A.; Prats, J.; Rosario, Jonas D. Del

doi:10.1055/s-2000-7709

Cited by 55 publications

(49 citation statements)

References 12 publications

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“…Rare but life-threatening complications reported for prostate biopsy include urosepsis (2.2%) 19 and rectal bleeding (0.9%). 20 Of these, rectal bleeding does not occur with TP. Critical complications therefore should be rarer in TP than in TR.…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy

Takenaka

Hara

Ishimura

et al. 2007

Prostate Cancer Prostatic Dis

113

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The aim of this study is to elucidate the diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy for prostate cancer. We prospectively randomized 200 consecutive men into two groups to undergo systematic prostate biopsy. Overall positivity for cancer was similar (47% by transperineal and 53% by transrectal; P ¼ 0.480). However, in case with 'gray zone' PSA (from 4.1 to 10.0 ng/ml), significantly more cores were positive when approach was transperineal, especially among transition zone cores. Therefore, urologist preferences are sufficient for choosing an approach, except for a possible small advantage of transperineal biopsy when PSA is in gray zone.

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Section: Discussionmentioning

confidence: 99%

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy

Takenaka

Hara

Ishimura

et al. 2007

Prostate Cancer Prostatic Dis

113

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“…12 Significant rectal bleeding has been reported at an incidence of 0.1% to 1%. 1,2, 13 The incidence of bleeding complications has not been shown to increase with either coumadin use or with the use of acetylsalicylic acid. 14,15 Our approach to managing significant or massive bleeding is to initially apply pressure to contain the bleeding or tamponade using an inflated Foley catheter in the rectum.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Toren

Razik

Trachtenberg

2013

CUAJ

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We report 2 cases of catastrophic complications following routine transrectal ultrasound guided prostate biopsy. The first patient incurred near-fatal septic shock due to multi-resistant Escherichia coli. Due to the severity of his shock, he developed bilateral leg gangrene requiring amputations. The second patient incurred significant hemorrhage eventually requiring an emergent general anesthesia and surgical management to control hemorrhage after other measures failed. While rare events, these reports emphasize the caution needed for physicians who routinely order prostate biopsies.Can Urol Assoc J 2010;4(1):E12-E14 Case 1A 63-year-old diabetic underwent transrectal ultrasound (TRUS)-guided prostate biopsy for an elevated PSA of 5.7 ng/mL and no findings on digital rectal examination (DRE). His past medical history included coronary bypass surgery, dyslipidemia and previous hospital admission for bronchitis. He smoked half a pack of cigarettes per day for 25 years.The day prior to his biopsy, he was initiated on ciprofloxacin 500 mg orally, 2 times a day. The night after his biopsy, he presented to the emergency room with a fever, chills, pain and breathlessness. He appeared septic, with a systolic blood pressure of 75 mmHg, temperature 39º C. Initial white blood count (WBC) was 1.1, with a critically low neutrophil count of 0.44. He was given fluids, ceftriaxone and flagyl in the emergency room. Subsequently, he was transferred to the intensive care unit (ICU) and started on ionotropes and empiric meropenem. He developed hypoxia and was intubated and sedated.During the first 4 days of admission, he continued to be unstable and hypotensive requiring ionotropic support and developing shock liver and renal failure. Solucortef and caspofungin were started; he also received a dose of amikacin. His WBC peaked at 42 on the fourth day of admission. Platelets remained very low at 21 and his international normalized ratio (INR) increased from normal to 2.13. Multi-resistant Escherichia coli was cultured from his blood and was initially only sensitive to amikacin, but eventually also found to be sensitive to meropenem.Against expectations, he survived and slowly recovered. A tracheostomy was performed, and he was eventually weaned off ventilation. As a result of his severe sepsis, he developed bilateral feet gangrene requiring bilateral below knee amputations. Further, he incurred ototoxicity requiring hearing aids. His thrombocytopenia, renal and liver failure resolved over time. He was in the ICU for a total of 46 days and in hospital for 85 days.His prostate biopsy did not show any evidence of malignancy. Case 2A 65-year-old pediatrician was sent for a TRUS biopsy of the prostate for a prostate-specific antigen (PSA) of 10.56 mg/L and a suspicious DRE. His medical history included coronary artery disease with previous coronary artery bypass grafting, hypertension and hypercholesterolemia. He had a mitral valve annuloplasty for mitral regurgitation. He experienced bleeding at the biopsy site immediately after ...

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“…In most of the cases, hemostasis was achieved with rectal tamponade by means of fleece tamponing, by urine balloon catheter inserted and inflated in the rectum by a condom filled with fluid in the rectal cavity, or after endoscopic intervention with injection of adrenaline or sclerosing solutions (polidocanol or pure ethanol), thermocoagulation and band ligation [9][10][11][12][13]25] . In our case, neither rectal tamponade nor manual compression of bleeding sites by a urologist succeeded in achieving hemostasis.…”

Section: Discussionmentioning

confidence: 99%

“…Severe rectal bleeding is traditionally managed by the urologist, with rectum tamponade as the initial and simplest conservative method, or, when necessary, balloon compression by means of a transrectally inserted catheter [8] . Endoscopic intervention with injection of adrenaline and sclerosing solutions, thermocoagulation and band ligation have also been used successfully in some cases [9][10][11][12][13] . We describe, possibly for the first time, the use of endoclipping for the treatment of severe rectal bleeding following TRUSguided prostate multiple biopsy.…”

Section: Introductionmentioning

confidence: 99%

Endoclipping treatment of life-threatening rectal bleeding after prostate biopsy

Katsinelos¹,

Kountouras²,

Dimitriadis³

et al. 2009

WJG

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Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound (TRUS)-guided multiple biopsy of the prostate, but is usually mild and stops spontaneously. We report what is believed to be the first case of life-threatening rectal bleeding following this procedure, which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding. This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy. Additionally, current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure, are described.

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Massive Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy

Abstract: Colonoscopy should be carried out in patients presenting severe rectal bleeding after TRUS-guided prostate biopsy. Endoscopic treatment can be used to deal with this rare complication.

Cited by 55 publications

References 12 publications

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Endoclipping treatment of life-threatening rectal bleeding after prostate biopsy

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