Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 28 • CUTTING EDGE - UROLOGY Prostate biopsy is considered a safe technique, with incidence of severe complications <1%; among these are themost dangerous infections of antibiotic-resistant germs. Severe postprocedural infections were initially reported in 1% of cases, but have increased as a consequence of antibiotic resistance [8–11]. Low-dose aspirin is no longer an absolute contraindication [86]. Percentage of complications per biopsy session, irrespective of the number of cores, are as follows: hematospermia 37.4%, hematuria >1 day 14.5%, rectal bleeding <2 days 2.2%, prostatitis 1%, fever >38.5 °C 0.8%, epididymitis 0.7, rectal bleeding >2 days +/− surgical intervention 0.7%, urinary retention%, and other complications requiring hospitalization 0.3% [11]. After transperineal biopsy, seldom is the formation of a hematoma at the site of entry of the needle (less than 0.5% of cases). The clinical complications following transperineal prostate biopsy in men submitted to extended vs. saturation biopsy are listed in Table 1 [68]. In less than 1% of cases, it is possible to observe the onset of high fever with shivering that may require hospitalization. After the “execution of the procedure is an appropriate observation period of about a” time to highlight the appearance of any immediate complications. After transperineal biopsy, a mild compression level with the entry of the needle could be instituted. References 1. Roobol MJ, Steyerberg EW, Kranse R et al (2010) A risk-based strategy improves prostate-specific antigen driven detection of prostate cancer. Eur Urol 57(1): 79–85. 2. Richie JP, Catalona WJ, Ahmann FR et al (1993) Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination. Urology 42(4):365–374. 3. Carvalhal GF, Smith DS, Mager DE et al (1999) Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng/mL or less. J Urol 161:835–839. 4. Okotie OT, Roehl KA, Han M et al (2007) Characteristics of prostate cancer detected by digital rectal examination only. Urology 70(6):1117–1120. 5. Eastham JA, Riedel E, Scardino PT, Polyp Prevention Trial Study Group et al (2003) Variation of serum prostate- specific antigen levels: an evaluation of yearto-year fluctuations. JAMA 289(20):2695–2700. 6. Stephan C, Klaas M, Muller C et al (2006) Interchangeability of measurements of total and free prostate specific antigen in serum with 5 frequently used assay combinations: an update. Clin Chem 52(1):59–64. 7. Fandella A, Benvenuto S, Guidoni E, Giampaoli M, Bertaccini A (2014) Empiric antibiotics therapy for mildly elevated prostate-specific antigen: helpful to avoid unnecessary biopsies. Arch Ital Urol Androl 86(3):202–204. 8. Bertaccini A, Fandella A, Prayer-Galetti T, Scattoni V, Galosi AB, Ficarra V, Trombetta C, Gion M, Martorana G, Italian Group for Developing Clinical Practice Guidelines on Performing Prostate Biopsy (2007) Systematic development of clinical practice guidelines for prostate biopsies: a 3-year Italian project. Anticancer Res 27(1B):659–666. 9. Liss MA, P eeples AN, Peterson EM (2011) Detection of fluoroquinolone resistant organisms from rectal swabs by use of selecti ve media prior to a transrectal prostate biopsy. J Clin Microbiol 49:1116. 10. Cuevas O, Oteo J, Lázaro E , Spanish EARS-Net Study Group et al (2011) Significant ecological impact on the progression of flu oroqu inolone resistance in Escherichia coli with increased community use of moxifloxacin, levofloxacin and amoxicillin/clavulanic acid. J Antimicrob Chemother 66(3):664–669. 11. Loeb S, Carter HB, Berndt SI et al (2011) Complications after prostate biopsy: data from SEERmedicare. J Urol 186(5):1830–1834. 12. Duplessis CA, Bavaro M, Simons MP et al (2012) Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce postprostatic biopsy infection rates. Urology 79:556–563. 13. von Knobloch R, Weber J, Varga Z et al (2002) Bilateral fine-needle administered local anaesthetic nerve block for pain control during TRUS-guided multi-core prostate biopsy: a prospective randomised trial. Eur Urol 41(5):508– 514; discussion 514. Cutting EDGE_Urology(SUN)_final.indd 28 27-Mar-18 10:00:30 AM