Complications and risk factors in transrectal ultrasound-guided prostate biopsies

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.

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Complications of Prostate Biopsy: A Prospective, Single-institution Study

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2430779 ◽

2020 ◽

pp. 271-279

Author(s):

Colette M. Antoine ◽

Belinda F. Morrison ◽

Michael E. Brooks

Keyword(s):

Urinary Tract ◽

Urinary Retention ◽

Prostate Biopsy ◽

Public Hospital ◽

Retention Rate ◽

Tertiary Care ◽

Transrectal Ultrasound ◽

Final Analysis ◽

Infectious Complications ◽

Prostate Biopsies

Aims: This study aimed to determine the prevalence rates of transrectal ultrasound-guided prostate biopsy-related complications among patients receiving treatment at the large tertiary-care urology clinic of Kingston Public Hospital (KPH), Jamaica. Study Design: Prospective cohort study. Place and Duration of Study: Kingston Public Hospital (KPH), Jamaica from July 2018 to April 2019. Methodology: Our study population included men who underwent prostate biopsy at KPH. Data on demographics and clinical characteristics were collected using purpose-designed questionnaires from consenting patients who underwent prostate biopsy during the stated period. Patients were then followed up for complications 30 days post biopsy. Details regarding hospitalization due to biopsy-related complications were obtained from the medical records. Results: Data from 185 men were included in the final analysis. Among the patients biopsied, 49% were diagnosed with prostate cancer, while 72% experienced at least one complication, mainly non-infectious complications such as hematuria (46%), lower urinary tract symptoms (24%), rectal bleeding (23%), hematospermia (9%), and urinary retention (16%). Overall, a 15% risk of developing infectious complications was observed, with 9% experiencing fever and 3% experiencing both urinary tract infection and epididymo-orchitis. Our data showed a 6% hospitalization rate within 30 days, with all available records suggesting infectious complications. One death from a prostatic abscess was noted. The present study showed that most prostate biopsy complications were minor. Moreover, although bleeding and infectious complications as well as hospitalization rates were consistent with those reported in larger series, our population experienced a slightly higher mortality and urinary retention rate. Conclusion: Overall, our results showed that prostate biopsies performed within our institution are generally safe and well tolerated. Nonetheless, further studies are needed to determine whether morbidity of the procedure remains acceptable.

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Hospitalization after prostate biopsy in Iceland: Results from a nationwide study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.113 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 113-113

Author(s):

Birgitta Ã“lafsdÃ³ttir ◽

Rafn Hilmarsson ◽

Jon Orn Fridriksson ◽

Sigurdur Gudmundsson ◽

Sigurdur Gudjonsson

Keyword(s):

Risk Factors ◽

Antibiotic Resistance ◽

Prostate Biopsy ◽

Transrectal Ultrasound ◽

Infectious Agent ◽

Primary Outcome Measure ◽

Infectious Agents ◽

Multivariable Logistic Regression Model ◽

Prostate Biopsies ◽

Bacterial Antibiotic Resistance

113 Background: The best method to confirm prostate cancer diagnosis is by performing a transrectal ultrasound guided biopsy. This procedure does not come without risks as international reports suggest that frequency of hospitalization after biopsy are increasing. This study aimed to estimate incidence and risk factors for hospitalization after prostate biopsy in Iceland. Methods: Every patient in Iceland who had undergone a prostate biopsy during the years 2013-2017 was included in the study. Primary outcome measure was hospitalization within fifteen days from the biopsy. We also studied the type of infectious agents and resistance to ciprofloxacin or trimethoprim. Multivariable logistic regression model was used to identify risk factors for hospitalization. Results: Of 2076 men who had prostate biopsies 59 (2.8%) were hospitalized within fifteen days. Of these men 45 (76.3%) were hospitalized because of infection, 6 (10.2%) were hospitalized because of bleeding and 8 (13.5%) were hospitalized for other reasons. Risk factor for hospitalization was higher age (OR 1.06 p < 0.001). An antibiotic prescription within 6 months of biopsy was a protecting factor (OR 0.57 p = 0.04). E.coli was the most common infectious agent (73.3%). Pseudomonas, Staphylococcus and Streptococcus dysgalactiae where other agents. Of those admitted to hospital with infection 57.1% of the agents were resistant to ciprofloxacin and 54% to trimethoprim. 31.4% of the infectious agents were resistant to both antibiotics. Conclusions: Despite the invasive nature of the procedure and increasing bacterial antibiotic resistance the rate of hospitalization was relatively low (2.8%). Antibiotic resistance to ciprofloxacin or trimethoprim might prompt a change in common prophylactic practice and a need for new clinical practice guidelines in Iceland.

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Risk factors for infectious complications following transrectal ultrasound-guided prostate biopsy

Infection and Drug Resistance ◽

10.2147/idr.s171162 ◽

2018 ◽

Vol Volume 11 ◽

pp. 1491-1497 ◽

Cited By ~ 4

Author(s):

Yu-Peng Wu ◽

Xiao-Dong Li ◽

Zhi-Bin Ke ◽

Shao-Hao Chen ◽

Ping-Zhou Chen ◽

...

Keyword(s):

Risk Factors ◽

Prostate Biopsy ◽

Transrectal Ultrasound ◽

Infectious Complications ◽

Ultrasound Guided

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A Novel Enema Method Can Prevent Infectious Complications of Transrectal Ultrasound-Guided Prostate Biopsy: A Single-Center Experience

10.22541/au.163251245.59063450/v1 ◽

2021 ◽

Author(s):

Fatih Gokalp ◽

Omer Koras ◽

Didar GURSOY ◽

Hakan Sigva ◽

Sefa Burak PORGALI ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Prostate Biopsy ◽

Protective Factor ◽

Multivariable Analysis ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Infectious Complications ◽

Significant Difference ◽

Group 1

Background: Transrectal ultrasound biopsy is the preferred method for diagnosing prostate cancer, but it can cause infectious complications as a result of fluoroquinolone resistance. We aimed to explore the potential protective effect of a second rectal enema before biopsy. Methods: Between January 2015 and December 2020, 419 patients were assessed retrospectively. Patients with a history of anticoagulant use, uncontrolled diabetes, urological surgery, prostate biopsy, or recent hospitalization or overseas travel, as well as those with previous prostatitis, were excluded from the study. The patients were subsequently divided into two groups: Group 1 (n=223) had received one enema, on the morning of the biopsy, and Group 2 (n=196) had received two, with the additional enema administered half an hour before the procedure. Results: There was no significant difference between the groups in terms of age, BMI, diabetes, prostate-specific antigen (PSA) level, and prostate size (p=0.076, p=0.489, p=0.265, p=0.193, and p=0.661, respectively) or in relation to cancer detection (p=0.428). The median hospitalization date was significantly higher in Group 1 (p=0.003) as was UTI development (p=0.004). However, there was no significant difference in terms of fever and sepsis (p=0.524 and p=0.548, respectively). Additionally, subgroup analysis demonstrated that UTI was significantly lower in patients with diabetes mellitus who had received a second enema (p=0.004), though there was no significant difference in UTI between the groups in those without diabetes mellitus (p=0.215). Multivariable analysis showed that age and diabetes were significant risk factors for the development of UTI (p=0.002andp=0.003, respectively). Furthermore, the second enema was a significant protective factor for preventing UTI (p<0.001). Conclusion: Older age and the presence of diabetes mellitus are independent risk factors for UTI after prostate biopsy. A second enema procedure before biopsy may protect patients from related infectious complications and could therefore be used as an alternative preventative method.

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1164 IS THE USE OF EMPIRIC ANTIBIOTICS FOR ELEVATED PROSTATE SPECIFIC ANTIGEN A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AFTER TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY?

The Journal of Urology ◽

10.1016/j.juro.2013.02.801 ◽

2013 ◽

Vol 189 (4S) ◽

Cited By ~ 1

Author(s):

Ryan Holland ◽

Laura Gamble ◽

Jill Williams ◽

Rowena Desouza ◽

Alex Gomelsky ◽

...

Keyword(s):

Risk Factor ◽

Prostate Specific Antigen ◽

Prostate Biopsy ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Infectious Complications ◽

Ultrasound Guided ◽

Empiric Antibiotics ◽

Antigen A

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A rare case of delayed massive rectal bleeding, after transrectal ultrasound- guided prostate biopsy, requiring a multidisciplinary approach treatment

Acta Medica Saliniana ◽

10.5457/ams.v49i1.512 ◽

2019 ◽

Vol 49 (1) ◽

Author(s):

Stefano Manno ◽

Camilla Capretti ◽

Teresa Del Giudice ◽

Olga Bisaccia ◽

Lucio Dell Atti

Keyword(s):

Risk Factors ◽

Active Surveillance ◽

Prostate Carcinoma ◽

Rectal Bleeding ◽

Prostate Biopsy ◽

Rare Case ◽

Multidisciplinary Approach ◽

Transrectal Ultrasound ◽

Ultrasound Guided ◽

Massive Rectal Bleeding

Rectal bleeding seen after a transrectal ultrasound-guided prostate biopsy is often mild and self-limiting. We report a rare case of delayed massive rectal bleeding, post transrectal ultrasound-guided biopsy, in a man in active surveillance for prostate carcinoma, without risk factors for bleeding. We managed this complication with a successfully angiographic embolization.We present this case in detail and we analyze the possible causes of this complication.

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