RISKS AND COMPLICATIONS OF TRANSRECTAL ULTRASOUND-GUIDED PROSTATE NEEDLE-BIOPSY - A PROSPECTIVE-STUDY AND REVIEW OF THE LITERATURE

Purpose: Transrectal ultrasound guided needle biopsy of the prostate i s routinely performed to diagnose and stage prostate cancer. We prospe ctively evaluated the true incidence of complications and identified r isk factors of needle biopsy. Materials and Methods: We prospectively studied 128 patients who underwent transrectal ultrasound guided needl e biopsy. A pre-biopsy questionnaire provided demographic information. Immediate complications were recorded by the surgical team at the pro cedure. Information on delayed complications was obtained by telephone interview. Univariate and multivariate analyses were performed. Resul ts: There was 1 major and 135 minor complications in 77 patients with at least 1 complication in 63.6%. Most patients tolerated the procedur e with minimal discomfort regardless of the number and location of bio psies but younger patients had significantly more discomfort than olde r men (R = -0.26, p = 0.005). The most common complication was persist ent hematuria in 47.1% of cases. None of the hemorrhagic complications was related to previous aspirin or nonsteroidal anti-inflammatory dru g use, or the total number of biopsies performed. Infectious complicat ions were rare with only a 1.7% incidence of fever. This rate was asso ciated with the choice of antibiotic combination used (R = 0.25, p = 0 .006). Conclusions: Transrectal ultrasound guided needle biopsy is saf e for diagnosing prostate cancer with few major but frequent minor com plications. Patients are likely to have persistent hematuria for up to 3 to 7 days after the procedure. Recent use of aspirin or nonsteroida l anti-inflammatory drugs is not an absolute contraindication for this procedure. Additional analgesics are not required in patients who und ergo anterior or multiple biopsies but they may be useful in younger p atients.