Non-infectious complications following transrectal prostate needle biopsy - Outcomes from over 8000 procedures

Adrian Sosenko; Russell G Owens; Ae Lim Yang; Ahmad Alzubaidi; Thomas Guzzo; Edouard Trabulsi; John Danella; Gregory Diorio; Adam Reese; Jeffrey Tomaszewski; Serge Ginzburg; Marc Smaldone; Claudette Fonshell; Kaynaat Syed; Bruce Jacobs; Eric A Singer; Jay D Raman

doi:10.1016/j.prnil.2022.04.002

Non-infectious complications following transrectal prostate needle biopsy - Outcomes from over 8000 procedures

Prostate Int. 2022 Sep;10(3):158-161. doi: 10.1016/j.prnil.2022.04.002. Epub 2022 Apr 23.

Authors

Adrian Sosenko¹, Russell G Owens², Ae Lim Yang², Ahmad Alzubaidi¹, Thomas Guzzo³, Edouard Trabulsi⁴, John Danella⁵, Gregory Diorio⁶, Adam Reese⁷, Jeffrey Tomaszewski⁸, Serge Ginzburg⁹, Marc Smaldone¹⁰, Claudette Fonshell¹¹, Kaynaat Syed¹¹, Bruce Jacobs¹², Eric A Singer¹³, Jay D Raman¹

Affiliations

¹ Department of Urology, Penn State Health, Hershey, PA, USA.
² Penn State College of Medicine, Hershey, PA, USA.
³ Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA.
⁴ Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
⁵ Department of Urology, Geisinger Surgery Institute, Danville, PA, USA.
⁶ MidLantic Urology, Main Line Health Physician Partners, Bala Cynwyd, PA, USA.
⁷ Department of Urology, Temple Health, Philadelphia, PA, USA.
⁸ Division of Urology, MD Anderson Cancer Center at Cooper, Camden, NJ, USA.
⁹ Department of Urology, Einstein Health Care Network, Philadelphia, PA, USA.
¹⁰ Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
¹¹ Health Care Improvement Foundation, Philadelphia, PA, USA.
¹² Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹³ Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.

Abstract

Background: Prostate needle biopsy (PNB) remains the referent standard for diagnosing prostate cancer. Contemporary data highlight an increase in PNB-related infections particularly when performed transrectally. Non-infectious complications, however, may similarly contribute to biopsy-related morbidity. We review the incidence and predictors of non-infectious complications following transrectal PNB in a large statewide quality registry.

Methods: Transrectal ultrasound-guided prostate needle biopsies performed between 2015 and 2018 were retrospectively reviewed. The incidence and distribution of non-infectious complications were annotated. Clinical, demographic, and biopsy variables of interest were evaluated by logistic regression for potential association with specific types of non-infectious complications.

Results: Of 8,102 biopsies, 277 (3.4%) biopsies had reported post-procedure complications including 199 (2.5%) non-infectious and 78 (0.9%) infectious. Among the non-infectious complications, the most common events included urinary or rectal bleeding (74; 0.9%), urinary retention (70, 0.9%), vasovagal syncope (13, 0.2%), and severe post-operative pain (10, 0.1%). Approximately 56% of these non-infectious complications required an Emergency Department visit (111/199) and 27% (54/199) hospital admission for monitoring. Increasing transrectal ultrasound prostate volume was associated with post-procedure urinary retention (Odds ratio (OR) 1.07, 1.02-1.11, p = 0.002). No specific variables noted association with post-biopsy bleeding.

Conclusion: Non-infectious complications occurred 2.5 times more often than infectious complications following transrectal ultrasound prostate needle biopsies. Larger prostate size was associated with a greater risk of post-procedure urinary retention. These data originating from experience from over 100 urologists across different health systems provide an important framework in counseling patients regarding expectations following transrectal prostate biopsy.

Keywords: Biopsy; Complications; Non-infectious; Prostate.