Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co INTERVENTIONAL ULTRASOUND: TRANSPERINEAL AND TRANSRECTAL PROSTATIC BIOPSY • 27  After a Previous Positive Biopsy The re-biopsy is provided in most of the protocol for the patient in the active surveillance. Possible Complications of Biopsy The prostate biopsy is a safe procedure and generally associated with few complications. During the execution of the biopsy, with both transperineal and transrectal approaches, the patient may experience pain even after executing anesthesia. Rarely, the patient may experi- ence a general malaise characterized by increased sweating and feeling of loss of consciousness. Exceptional is the appearance of allergic reactions to the local anesthetic. After the procedure, a rare complication (less than 2% of cases) can be represented by the inability to empty the bladder spontaneously. In such a case, the placement of a urinary catheter which may be held in place for a few days or removed immediately is necessary. For a few weeks after the biopsy with transrectal approach, you can assist in the loss of blood from the rectum (rectal). Such event is observed in 10–40% of cases. The presence of blood in urine (hematuria) and/or urethrorrhagia is common in both the transrectal and the transperineal biopsies. Both are observed in approximately 30–60% of cases; they persist for ome days and generally disappear spontaneously. Table 1: Complications following transperineal prostate biopsy in 3,000 patients submitted to 12 vs. 18 vs. >24 needle cores. Complications 12 cores* 915 pts vs. 18 cores*° 1330 pts vs. >24 cores° 630 pts Hematuria 92 (8.1%) 130 (9.7%) 66 (10.4%) Urethrorrhagia 20 (2%) 30 (1.5%) 19 (3%) Hematospermia 98 (10.7%) 280 (21%) 192 (30.4%) Acute urinary retention 38 (4.1%) 95 (7.1%) 70 (11.1%) Prostatitis 6 (0.6%) 10 (0.7%) 6 (0.9%) Sepsis – – – Orchiepididymitis 4 (0.4%) 7 (0.5%) 4 (0.6%) Urinary tract i nfection 27 (3%) 30 (2.2%) 16 (2%) Perineal hemat oma 3 (0.3%) 4 (0.3%) 5 (0.8%) Vagal syndrome 9 (0.9%) – – Fever 4 (0.4%) 8 (0.6%) 5 (0.8%) Systemic adverse events a,b 1 (0.1%) – – Hospital admission (within 20 days) 9 (1%) 18 (1.3%) 10 (1.6%) Emergency department visit (within 20 days) 55 (6%) 128 (9.6%) 91 (14.4%) a Prostate biopsy performed under local anesthesia (*) or sedation (°) [72] b Acute cardiac ischemia Cutting EDGE_Urology(SUN)_final.indd 27 27-Mar-18 10:00:30 AM