Complications and risk factors in transrectal ultrasound-guided prostate biopsies
Keywords:
Needle biopsy, Prostatic neoplasms, Risk factors, Ultrasonography, ProstateAbstract
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, Facul- dade de Medicina de Botucatu. METHODS: Transrectal ultrasound (TRUS) guided prostate biopsies were carried out in 174 patients presenting either abnormality in digital rectal ex- aminations (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 infec- tious 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 complica tions. The use of aspirin was not an absolute contraindication for TRUS.
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References
American Cancer Society. Overview: Prostate Cancer. How Many Men Get Prostate Cancer? Available from URL: http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_men_get_prostate_cancer_36.asp?sitearea. Accessed in: 2006 (Jul 31).
Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR. Incidence and clinical significance of false-negative sextant prostate biopsies. J Urol. 1989;159(4):1247-50.
Epstein JI, Walsh PC, Sauvageot J, Carter HB. Use of repeat sextant and transition zone biopsies for assessing extent of prostate cancer. J Urol. 1997;158(5):1886-90.
Rifkin MD, Alexander AA, Pisarchick J, Matteucci T. Palpable masses in the prostate: superior accuracy of US-guide biopsy compared with accuracy of digitally guided biopsy. Radiology. 1991;179(1):41-2.
Clements R, Aideyan OU, Griffiths GJ, Peeling WB. Side effects and patient acceptability of transrectal biopsy of the prostate. Clin Radiol. 1993;47(2):125-6.
Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol. 1998;160(6 Pt 1):2115-20.
Irani J, Fournier F, Bon D, Gremmo E, Dore B, Aubert J. Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol. 1997;79(4):608-10.
Collins GN, Lloyd SN, Hehir M, McKelvie GB. Multiple transrectal ultrasound-guided prostatic biopsies--true morbidity and patient acceptance. Br J Urol. 1993;71(4):460-3.
Lee F, Torp-Pedersen S, Littrup PJ, et al. Hypoechoic le- sions of the prostate: clinical relevance of tumor size, digital rectal examination, and prostate-specific antigen. Radiology. 1989;170(1 Pt 1):29-32.
Hodge KK, McNeal JE, Terris MK, Stamey TA. Random system- atic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989;142(1):71-4; discussion 74-5.
Kapoor DA, Klimberg IW, Malek GH, et al. Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology. 1998;52(4):552-8.
Aus G, Ahlgren G, Bergdahl S, Hugosson J. Infection after tran- srectal core biopsies of the prostate--risk factors and antibiotic prophylaxis. Brit J Urol. 1996;77(6):851-5.
Naughton CK, Miller DC, Mager DE, Ornstein DK, Cata- lona WJ. A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol. 2000;164(2):388-92.
Raaijmakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology. 2002;60(5):826-30.
Rietbergen JB, Kruger AE, Kranse R, Schröder FH. Complica- tions of transrectal ultrasound-guided systematic sextant biopsies of the prostate: evaluation of complication rates and risk fac- tors within a population-based screening program. Urology. 1997;49(6):875-80.
Sieber PR, Rommel FM, Agusta VE, Breslin JA, Huffnagle HW, Harpster LE. Antibiotic prophylaxis in ultrasound guided transrectal prostate biopsy. J Urol. 1997;157(6):2199-200.
Djavan B, Waldert M, Zlotta A, et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of prospective European prostate cancer detec- tion study. J Urol. 2001;166(3):856-60.
Deliveliotis C, John V, Louras G, et al. Multiple transrectal ultrasound guided prostatic biopsies: morbidity and tolerance. Int Urol Nephrol. 1999;31(5):681-6.
Fong IW, Struthers N, Honey RJ, Simbul M, Boisseau DA. A randomized comparative study of the prophylactic use of trim- ethoprim-sulfamethoxazole versus netilmycin-metronidazole in transrectal prostatic biopsy. J Urol. 1991;146(3):794-7.
Ruebush TK 2nd, McConville JH, Calia FM. A double-blind study of trimethoprim-sulfamethoxazole prophylaxis in pa- tients having transrectal needle biopsy of the prostate. J Urol. 1979;122(4):492-4.
Ravery V, Billebaud T, Toublanc M, et al. Diagnostic value of ten systematic TRUS-guided prostate biopsies. Eur Urol. 1999;35(4):298-303.
Levine MA, Ittman M, Melamed J, Lepor H. Two consecu- tive sets of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostate cancer. J Urol. 1998;159(2):471-5; discussion 475-6.
