Patients' tolerance and early complications of transrectal sonographically guided prostate biopsy: Prospective study of 300 patients

• Published in: Journal of clinical ultrasound 2005-12, Vol.33 (9), p.452-456
• Main Authors: Sheikh, Mehraj, Hussein, Ali Y. T., Kehinde, Elijah O., Al-Saeed, Osama, Rad, Am B, Ali, Yusuf M., Anim, Jehoram T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia, Local; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; complications; Hematuria - etiology; Humans; Male; Middle Aged; Pain - etiology; patient tolerance; Prospective Studies; Prostate - diagnostic imaging; Prostate - pathology; prostate biopsy; Prostatic Neoplasms - diagnostic imaging; Rectum; Sepsis - etiology; transrectal sonography; Ultrasonography - methods
• ISSN: 0091-2751; 1097-0096
• DOI: 10.1002/jcu.20168

Purpose To determine the degree of pain and discomfort associated with transrectal sonography (TRS)‐guided biopsy of the prostate and to analyze the complications associated with this procedure. Methods Three hundred men referred as part of an investigation to exclude prostate cancer were studied. The reasons for referral were suspected prostate cancer due to increased serum prostate‐specific antigen level (>4 ng/ml), the finding of a palpable nodule or greater firmness of one prostatic lobe than the other on digital rectal examination, or the finding of a suspicious area of neoplasm of the prostate on TRS biopsy. All TRS‐guided biopsies were performed as outpatient procedures without anesthesia. Ciprofloxacin prophylaxis was used in all patients before biopsy. Tolerance of the procedure was recorded immediately after the examination and graded on a scale of 0–4 as follows: 0, no pain; 1, very mild pain; 2, moderate pain; 3, severe pain; 4, intolerable pain. Complications recorded in the first week after the procedure were analyzed. They included mild pain, self‐limiting hematuria, hematospermia, rectal bleeding, severe hematuria, septicemia, severe hemorrhage of the anus, and vasovagal attack. Results Out of 300 TRS‐guided biopsies, 10 early complications were recorded. The most frequent was septicemia, which was seen in 5 cases (1.7%). Hematuria occured in 29 patients, 3 of which were severe. Rectal bleeding and vasovagal attack occurred in 1 patient each. All patients made a full recovery with appropriate conservative management. Ten cases (3.33%) of severe pain (grade 3) and intolerable pain (grade 4) were observed. Three out of these 10 patients completed the procedure. The procedure was terminated in 1 patient, and 6 patients required local anesthetic due to perianal disease. Conclusions TRS‐guided prostate biopsy can be performed without local anesthesia in 90% of patients. Prophylactic antibiotics are mandatory to minimize approximately infectious complications. © 2005 Wiley Periodicals, Inc. J Clin Ultrasound 33:452–456, 2005