Risk assessment of multi-factorial complications after transrectal ultrasound-guided prostate biopsy: a single institutional retrospective cohort study

• Published in: International journal of clinical oncology Vol. 26; no. 12; pp. 2295 - 2302
• Main Authors: Utsumi, Takanobu, Endo, Takumi, Sugizaki, Yuka, Mori, Takamichi, Somoto, Takatoshi, Kato, Seiji, Oka, Ryo, Yano, Masashi, Kamiya, Naoto, Suzuki, Hiroyoshi
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.12.2021; Springer Nature B.V
• Subjects: Biopsy; Bleeding; Body mass index; Cancer Research; Classification; Cohort analysis; Genitourinary tract; Medicine; Medicine & Public Health; Oncology; Original Article; Patients; Prophylaxis; Prostate cancer; Prostate-specific antigen; Rectum; Risk assessment; Risk factors; Risk groups; Surgical Oncology; Ultrasonic imaging; Ultrasound; Urinary retention; Rectal bleeding; Genitourinary tract infection; Urinary retention; Transrectal ultrasound-guided prostate biopsy; Prostate cancer
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-021-02010-x

Background Transrectal ultrasound-guided prostate biopsy (TRUSPB) is widely used to diagnose prostate cancer (PCa). The aim of this study was to evaluate the risk of multi-factorial complications (febrile genitourinary tract infection (GUTI), rectal bleeding, and urinary retention) after TRUSPB. Methods N  = 2053 patients were Japanese patients undergoing transrectal or transperineal TRUSPB for suspicious of PCa. To assess risk of febrile GUTI adequately, the patients were divided into four groups: low-risk patients before starting a rectal culture, low-risk patients after starting a rectal culture, high-risk patients, and patients undergoing transperineal TRUSPB. Furthermore, to identify risk of rectal bleeding and urinary retention, patients were divided into transrectal and transperineal group. Results Febrile GUTI significantly decreased owing to risk classification. The frequency of rectal bleeding was 1.43% (transrectal: 25/1742), while it did not happen in transperineal group. The patients with rectal bleeding had a significantly lower body mass index (BMI) ( P  < 0.01). The frequency of urinary retention was 5.57% (transrectal: 97/1742), while it did not happen in transperineal group. The patients with urinary retention had a significantly higher prostate-specific antigen (PSA) ( P  = 0.01) in transrectal group. Conclusions Risk classification, rectal swab culture, and selected antimicrobial prophylaxis for transrectal TRUSPB were extremely effective to reduce the risk of febrile GUTI. Furthermore, lower BMI and higher PSA were novel clinical predictors for rectal bleeding and urinary retention, respectively. When urologists perform transrectal TRUSPB to their patients, they can correctly understand and explain each complication risk to their patients based on these novel risk factors.