Massive rectal bleeding following transrectal ultrasound-guided prostate biopsy

Background and Study Aims: Rectal bleeding is frequently seen in patients u ndergoing transrectal ultrasound (TRUS)-guided prostate biopsy, but is usua lly mild and stops spontaneously. We report five cases of life-threatening hemorrhage following this procedure, which were treated successfully by end oscopic injection. Patients and Methods: A total of 550 consecutive patients underwent TRUS-gu ided prostate biopsy in an outpatient setting. TRUS was performed using a S ono-layer 140 A (Toshiba) unit with a 7-MHz biplane transrectal probe, whic h was covered with two prophylactic sheaths. Sextant prostatic biopsies wer e systematically performed with a 16-gauge or 18-gauge needle without antib iotic prophylaxis. Results: Five patients (1%) presented rectal bleeding with hypovolemic symp toms shortly after the procedure. Emergency colonoscopy revealed active ble eding from biopsy sites in the anterior rectal wall, Endoscopic injection o f epinephrine and polidocanol achieved control of bleeding and permanent he mostasis in all cases. The patients required hospitalization acid a mean of 4 packed red blood cell units (range 2-7), The patients were discharged, w ith uneventful recoveries. Conclusions: Colonoscopy should be carried out in patients presenting sever e rectal bleeding after TRUS-guided prostate biopsy Endoscopic: treatment c an be used to deal with this rare complication.