Complications following prostate needle biopsy requiring hospital admission or emergency department visits - Experience from 1000 consecutive cases

Study Type - Harms (cohort series) Level of Evidence 2b What's known on the subject? and What does the study add? Population-based studies implicate an increased incidence of complications after prostate needle biopsy. Such information is essential for adequate patient counselling before the procedure. A limitation of population-based studies is the absence of individual patient data to better characterize the nature of post-biopsy complications. This study of 1000 consecutive patients treated at a single centre highlights hospital admissions as well as Emergency Department visits for patients after prostate needle biopsy. Importantly, it allows for characterization of specific complications, aetiologies, management and outcomes for affected patients. OBJECTIVE To review a contemporary cohort of patients undergoing a transrectal ultrasound-guided prostate needle biopsy (TRUS PNBx) at a single centre to determine the incidence of major complications necessitating hospital admission or emergency department (ED) visits. PATIENTS AND METHODS The charts of 1000 consecutive patients undergoing TRUS PNBx were reviewed. All patients received peri-procedural antibiotic prophylaxis with either ciprofloxacin or co-trimoxazole. Hospital admission and ED visits within 30 days of the procedure were identified for indication, management and outcome. Patient comorbidities and biopsy characteristics were reviewed for association with complications. RESULTS Of the 1000 patients, 25 (2.5%) had post-biopsy complications requiring hospital admission or an ED visit. Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy. Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone-resistant Escherichia coli organisms. All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion. No demographic or biopsy variables were particularly associated with development of a post-procedure complication. CONCLUSIONS In this large contemporary series of TRUS PNBx, we observed a 2.5% rate of major complications requiring hospital admission or an ED visit. No clinical or biopsy variables were directly associated with development of complications. These data may be valuable when counselling patients before biopsy.