Complications of Transrectal Prostate Biopsy

Objective: The aim of our study is to evaluate complications In patients who underwent a Transrectal Ultrasound Guided Prostate Biopsy (TRUS BP) at the Department of Urology of JFM CU and UHM in 2007-2008 and at the Department of Urology in Bojnice Hospital in 2009-2012.

Methodology, disclosures: In our study, patients with positive digital rectal examination (DRE) and/or with hig- her prostate specific antigen (PSA) levels (>4 ng/ml) are included. We excluded patients with PSA levels greater than 50ng/ml. as well as patients with less than 8 biopsy cores. The number of examined patients fulfilling the criteria was 474. An average age of them was 66.3 years (SD±8.3years). As an antibacterial prophylaxis, the patients were given fluoroquinolons in a dose of 500mg twice a day during a 3-day course of antibiotics, while the first dose was given one day before the procedure. In high risk patients, we used a single intramuscular dose of gentamycin 160mg right before the procedure followed by fluoroquinolons for the next five days.

Results: The most severe complication was vasovagal reaction, which occurred in 9 (1.9%) cases. Haematuria occurred in 122 (25.7%) cases up to 3 days and in 10 (2.1%) patients up to 7 days. Six patients (1.3%) required hospital admission for severe haematuria. Dysuria occurred in 71 patients (15%). Rectal bleeding occurred in 90 (19%) cases with an average 2 days of bleeding, from which 7 patients were admitted to hospital and administered haemostyptics. From the mentioned count. 2 (0.4%) patients underwent a rectal tamponade and one (0.2%) patient with arterial bleeding underwent an arterial ligation of a stricken artery. Haemospermia occurred in 71 (15%) cases. 23 (4.9%) patients suffered fever above 38°C. within whom in 7 (1.5%) cases was microscopicaly proven uri- nary tract infection requiring hospitalisation lasting 7 days on average. Sepsis occurred in 3 (0.6%) patients, symp- tomatic bacterial prostatitis in 6 (1.2%) cases and urinary retention occurred in one (0.2%) patient. There was not arty significant higher amount of complications in between 8-core and 10-core biopsy (P=0.26), not even in betwe- en 8-core and 12-core biopsy (P=0.32).

Conclusion: TRUS PB is a sale procedure with quite a low risk of complications. An important moment is a close monitoring right after the procedure. The most of the complications may persist for around two weeks and are trea- ted conservatively without persistent effects. Prophylaxis with broad spectrum antibiotics may provide an adequa- te coverage and lowers the risk of infectious complications.