MP75-07 A TERRITORY-WIDE STUDY ON THE PREDICTORS OF 30-DAY COMPLICATIONS IN TRANSRECTAL VERSUS TRANSPERINEAL PROSTATE BIOPSY

Abstract

INTRODUCTION AND OBJECTIVE: As the "trexit" initiative continues to gain popularity around the world, we aimed to conduct a territory-wide study to investigate the complications rates of transrectal (TR) versus transperineal (TP) prostate biopsy, and to investigate for predictors of complications. METHODS: All data were extracted from a territory-wide electronic patient record system, which records details of every emergency attendance and hospital admission in all public hospitals in Hong Kong. Consecutive patients with transrectal or transperineal prostate biopsies performed in all public hospitals in Hong Kong from January 2016 to October 2019 were included. Baseline characteristics including age, PSA level, diabetes, and drug use (alpha-blockers, anti-cholinergic, antiplatelet, and anti-coagulants) were recorded. 30-day complications requiring emergency attendance or hospital admission, including per-rectal bleeding, hematuria, acute urinary retention, urine culture proven urinary tract infection (UTI), and blood culture proven sepsis were recorded. Multivariate logistic regression analyses were performed to investigate for predictors of complications. RESULTS: The cohort included 9918 TR prostate biopsy and 1001 TP prostate biopsy patients. The TP group had a higher PSA level (67.2±402.6ng/mL vs 54.8±373.8ng/mL, p<0.001) and higher proportion of diabetes (12.9% vs 10.8%, p<0.001). The TR group had higher rates of per-rectal bleeding (0.6% vs 0%, p=0.015), urine culture proven UTI (3.3% vs 1.7%, p=0.007) and blood culture proven sepsis (1.5% vs 0.3%, p=0.002). The TP group had a higher rate of acute urinary retention (5.3% vs 3.2%, p<0.001). The overall complication rates were similar between the TR and TP groups (8.3% vs 8.1%, p=0.805). Multivariate analysis showed that TP biopsy was a significant protective factor for UTI (OR 0.57, 95%CI 0.35-0.93, p=0.025) and sepsis (OR 0.23, 95% CI 0.07-0.72, p=0.012). TP biopsy was a significant risk factor for acute urinary retention (OR 1.81, 95%CI 1.32-2.47, p<0.001). Prior use of alpha-blocker was a significant risk factor of per-rectal bleeding (OR 1.96, 95%CI 1.08-3.56, p=0.028), acute urinary retention (OR 2.72, 95%CI 2.15-3.43, p<0.001) and overall complications (OR 1.71, 95%CI 1.45-2.01, p<0.001). CONCLUSIONS: Transperineal approach could reduce post-biopsy UTI and sepsis. However, our results suggested a higher rate of acute urinary retention especially in TP patients with pre-existing benign prostatic obstruction requiring use of alpha-blockers. Source of Funding: nil