1435 MORBIDITY OF PROSTATE BIOPSY FOLLOWING SIMPLIFIED VERSUS COMPLEX PREPARATION PROTOCOLS: ASSESSMENT OF THE RISK FACTORS

Abstract

INTRODUCTION AND OBJECTIVES: Although transrectal ultrasound (TRUS) guided prostate biopsy is considered a generally safe and well tolerated procedure, it is associated with significant complications. We determined whether prostate biopsy complications were affected by two varying pre-biospy protocols implemented at our institution. METHODS: We retrospectively evaluated a total of 1438 TRUS guided prostate biopsies between January 2001 and June 2008 from our institutional review board approved database. In group (A), 931 men had only one dose of a quinolones antibiotic immediately before the procedure and no enema was performed. Group (B) was comprised of 507 men who underwent a pre-biopsy enema and were given oral antibiotics starting the day before the procedure for a total of 3 days. We analyzed demographics and biopsy complications between the 2 groups including age, prostate volume, number of biopsy cores, number of previous biopsies and recent use of anticoagulant or antiplatelets therapy. RESULTS: The overall complication rates for both groups were categorized as infection (2.2%), urine retention (0.8%), haematuria (4.4%), rectal bleeding (1.5%), vasovagal syncope (3%), sepsis (0.2%). There was no significant statistical difference in the incidence of infection or sepsis between the two groups (2.7% vs. 1.4%, p 0.157 and 0.1% vs. 0.4% p 0.285, respectively). Both the incidences of haematuria and clinically relevant haematospermia were greater in the second group (7.9% vs. 2.5%, p 0.001 and 2% vs. 0.2%, p 0.001 respectively). Prostate size was a significant risk for both haematuria (OR: 1.7 (1.2–2.44), p 0.003) and acute urinary retention (OR: 4.45 (2.01– 9.84), p 0.001). CONCLUSIONS: The current study demonstrates that a single antibiotic dose before prostate biopsy may be sufficient. Additionally, use of pre-biopsy enemas is unnecessary to decrease overall complication rates.