Complications of Transrectal Prostate Biopsy

Open access


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.


  • 1. Klečka J, Holubec L, Pešta M, Hora M, Topolčan O, Eret V. Nádorové markery karcinómu prostaty. Ces Urol 2008; 12(3): 173-185.

  • 2. Sigebara K, Miyagi T, Nakashima T, Shimamura M. Acute bacterial prostatitis after transrectal nedele biopsy: clinical analysis. J Clin Chemother 2008; 14: 40-43.

  • 3. Webb NR, Woo HH. Antibiotic prophylaxis for prostate biopsy. BJU International 2002; 89: 824-828.

  • 4. EAU Guidelines 2013; Prostate cancer; 6. p: 18.

  • 5. Ecke TH, Gunia S, Bartel P, Hallmann S, Koch S, Ruttloff J. Complications and risk factors of transrectal ultrasound guided nedele biopsies of the prostate evaluated by questionnaire. Urol Oncol 2008; 26: 474-478.

  • 6. Sieber P, Rommel F, Theodoran C. Contemporary prostate biopsy complication rates in community-based urology practice. Urology 2007; 70(3): 498-500.

  • 7. Ghani K, Dundas D, Patel U. Bleeding after transrectal ultrasonography-guided prostate biopsy: a study of 7- day morbidity after a six, eight and 12-core biopsy protocol. BJU Int 2004; 94(7): 1014-1020.

  • 8. Raaijmakers R, Kirkels WJ, Roobol MJ. Complication rates and risc factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology 2002; 60: 826-830.

  • 9. Javorka K jr., Švihra J, Ľupták J, Eliáš B, Kliment J. Hodnotenie kvality života po transrektálnej biopsii prostaty pod ultrazvukovou kontrolou a jej komplikácie. Klinická onkologie 2000; 139: 758-761.

  • 10. Peyromaure M, Ravery V, Messas A, Toublanc M, Boccon-Gibod L. Pain and morbidity of an extensive prostate 10-biopsy protocol: a prospective study in 289 patients. J Urol. 2002; 167(1): 218-221.

  • 11. Collins GN, Lloyd SN, Hehir M, McKelvie GB. Multiple transrectal ultrasound-guided prostatic biopsies-true morbidity and patient acceptance. BJ Urol 1993; 71: 460-463.

  • 12. Kirkels WJ, Rietbergen JBW, Boeken Kruger AE, Kranse R, Schroder FH. Complication rates and risk factors of ultrasound-guided transrectal core biopsies of the prostate in a population based screening program. J Urol 1997; 146: 75-77.

  • 13. Kreutzer N, Wolter S, Haupt G, Engelmann U. Schmerzwahrnehmung und Komplikationen bei der transrektalen Prostatabiopsie. Aktuel Urol 2012; 33: 277-282.

  • 14. Zisman, A., Leibovici, D., Siegel, Y.I., Lindner, A. Complications and Quality of Life Impairment After Ultrasound Guided Prostate Biopsy - A Prospective Study 1999 Selected Abstracts from American Urological Association annual meeting.

  • 15. Pushkar’ Dlu., Govorov A.V. Complications of transrectal biopsy of the prostate. Urology 2005; 112(2): 40-42.

  • 16. Paul R, Scholer S, van Randenborgh H. Morbidity of prostatic biopsy for different biopsy strategies: is there a relation to core number and sampling region? Eur Urology 2004; 45: 450-456.

  • 17. Naughton CK. A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: Impact on cancer detection. J Urol 2000; 163: 168-171.

  • 18. Lugg J, Lettieri J, Stass H, Agarwal V. Determination of the concentration of ciprofloxacin in prostate tissue following administration of a single, 1000 mg, extended-release dose. J Chemother 2008; 20: 213-218.

  • 19. Lindstedt S, Lindstrom U, Ljunggren E, Wullt B, Grabe M. Single-dose antibiotic prophylaxis in core prostate biopsy: Impact of timing and identification of risk factors. Eur Urol 2006; 50: 832-837.

  • 20. Tobias-Machado M, Correa TD, De Baros EL, Wroclawski ER. Antibiotic prophylaxis in prostate biopsy. A comperative randomized clinical assay between ciprofloxacin, norfloxacin and chloramphenicol. Int Braz J Urol 2003; 29(4): 313-319.

  • 21. Aron M, Rajeen TP, Gupta NP. Antibiotic prophylaxis for transrectal nedele biopsy of the prostate: a randomized controlled study. BJU Int 2000; 85: 492-494.

  • 22. Larsson P, Norming U, Tornblom M, Gustafsson O. Antibiotic prophylaxis for prostate biopsy: benefits and costs. Prostate Cancer Prostatic Dis. 1999; 2: 88-90.

  • 23. Schaeffer AJ, Montorsi F, Scattoni V, Perroncel R, Song J, Haverstock DC, Pertel PE. Comparison of a 3-day with a 1-day regimen of an extended-release formulation of ciprofloxacin as antimicrobial prophylaxis for patients undergoing transrectal nedele biopsy of the prostate. BJU Int 2007; 100: 51-57.

Acta Medica Martiniana

The Journal of Comenius University in Bratislava

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 18 18 18
PDF Downloads 1 1 1