The impact of prostate biopsy on patient well-being: A prospective study of voiding impairment

Purpose: We studied the possible association of transrectal ultrasound guid ed prostate biopsy with voiding impairment. Materials and Methods: A total of 211 consecutive patients were prospective ly enrolled. International Prostate Symptom Score (I-PSS), subjective voidi ng complaints and retention were recorded in 3 personal interviews before b iopsy, and on postoperative days 7 and 30. Results: Of the 204 patients who voided via the urethra at biopsy 52 (25%) reported subjective voiding impairment on postoperative day 7, including 12 % who defined difficult voiding as mild-1 to 2 points on a 0 to 5 scale, 8% as moderate-3/5 and 5% as severe-4 to 5/5. In 5 of the latter cases (2.5%) acute urinary retention necessitated urethral catheter insertion. Transiti on zone volume, which was 42 ml. or larger in all patients in urinary reten tion, was the only independent variable associated with patient report of s ubjective difficult voiding and acute urinary retention during week 1 after biopsy (p = 0.03). Baseline I-PSS greater than 20 points indicated a risk of an acute transient increase in I-PSS on postoperative day 7. Conclusions: Transient voiding impairment may be precipitated by ultrasound guided prostate biopsy. To decrease this morbidity appropriate evaluation and possible treatment for bladder outlet obstruction are justified in pati ents with a larger transition zone and in those with preoperative baseline I-PSS greater than 20 points.