Urinary retention following transperineal template prostate biopsy – study of risk factors

Abstract

Background: As greater numbers of transperineal template prostate biopsies (TTPBs) are being performed, we have noticed that a considerable number of patients experience urinary retention post-procedure. We wanted to quantify this, and to examine factors that might predict which patients will experience retention. Patients and methods: Data analysis was performed on a prospectively maintained database on 93 consecutive patients undergoing template prostate biopsy over a 12-month period. Results: Mean patient age was 66 years (range 46-79). Mean prostate-specific antigen (PSA) was 8.34 ng/ml (1-31), mean transrectal ultrasonography (TRUS) volume 51 cc (10-133) and mean number of cores 52 (11-84). Twenty-five patients had muscle relaxant as part of their anaesthetic (27%). Fifteen patients had haematuria immediately postprocedure (16%). Twenty-six procedures were performed by a urology trainee (28%). Sixteen patients experienced retention post-template biopsy (17%). Their mean age was 67 years, mean PSA 8.9 ng/ml, mean TRUS volume 68 cc and mean number of cores 58. Of the retention group, 10 patients had muscle relaxant (63%), one patient had haematuria (6%) and four procedures were performed by a trainee (25%). Factors that significantly correlated with retention were TRUS volume (r = 0.36, p = 0.0004) and the use of muscle relaxant (r = 0.37, p = 0.0003). Age, PSA, number of cores taken, haematuria post-biopsy, and intra-operative furosemide, paracetamol, diclofenac, morphine and dexamethasone were not correlated with retention (p > 0.05). Conclusion: Patients with higher TRUS volumes are at increased risk of retention post-TTPB and should be counselled accordingly. Due to anti-muscarinic effects, muscle relaxants should not be used.

The predictive efficacy of hypoechoic lesion in ultrasound for prostate cancer in Chinese people: five-year experience in a moderated 10-core transperineal prostate biopsy procedure

“…Although TTBP has a higher diagnostic value than conventional 10-core TRUS-guided prostatic biopsies, the average number of core biopsies taken in a mapping TTBP is significantly high and patients are more likely to suffer a degree of pain and discomfort after TTBP [ 41 ]. Besides, the complication of acute urinary retention is reported in about 17% of patients who underwent TTBP [ 42 – 44 ]. Therefore, it remains controversial whether TTBP can completely replace TRUS-guided biopsy.…”

Complications of transperineal template‐guided prostate biopsy: A single centre experience in 109 cases

“…The most commonly‐observed complication resulting from TPB was AUR, which occurred in 5.5 per cent of patients. Previous research has recorded rates of AUR to be 1.7–39.4 per cent following TPB, compared to 0.2–0.8 per cent for the TRB technique …”

“…21 Two studies compared the number of prostate cores taken during TPB between those who developed AUR and those who did not, with neither identifying a significant correlation on multivariate analysis. 18,20 Nevertheless, one study found a significant association, 6 while Buskirk et al recorded the number of needle incursions as the only prognostic factor significant for AUR. 26 These varying analyses, coupled with often a small number of AUR event rates, makes drawing a definitive conclusion to this issue problematic.…”

“…In a study of 5957 TRB, Berger et al reported no difference in AUR rates when taking six, 10 or 15 biopsy cores . Two studies compared the number of prostate cores taken during TPB between those who developed AUR and those who did not, with neither identifying a significant correlation on multivariate analysis . Nevertheless, one study found a significant association, while Buskirk et al recorded the number of needle incursions as the only prognostic factor significant for AUR .…”

“…Of note, a number of studies reported that the amount of biopsy cores taken during TPB increased with the size of the prostate . Increased prostate volume itself is associated with a higher incidence of AUR following TPB, and therefore, could be a potentially confounding factor when considering the link between the number of biopsy samples and AUR. The correlation between greater prostate volume and AUR has been consistently reported.…”