Preparation and management of complications in prostate biopsies

Abstract

Transrectal ultrasonography-guided biopsy plays a key role in prostate sampling for cancer detection. Among interventional procedures, it is one of the most frequent procedures performed by radiologists. Despite the safety and low morbidity of such procedure, possible complications should be promptly assessed and treated. The standardization of protocols and of preprocedural preparation is aimed at minimizing complications as well as expediting their management. The authors have made a literature review describing the possible complications related to transrectal ultrasonography-guided prostate biopsy, and discuss their management and guidance to reduce the incidence of such complications. Keywords: Prostate; Needle biopsy; Interventional ultrasonography; Complications.A biópsia transretal da próstata guiada por ultrassonografia tem papel fundamental na coleta de amostra para o diagnóstico do câncer prostático. Dentro do contexto intervencionista, constitui um dos principais procedimentos realizados pelo radiologista. Embora seja segura e com baixa morbimortalidade, complicações devem ser prontamente avaliadas e tratadas. O uso da padronização das condutas e do preparo antes do procedimento tem a finalidade de minimizar as complicações, assim como agilizar o seu tratamento. Dessa forma, o objetivo deste trabalho foi fazer uma revisão da literatura sobre as complicações relacionadas à biópsia transretal de próstata guiada por ultrassonografia, discutir seu manejo e orientações para reduzir sua incidência. Unitermos: Próstata; Biópsia por agulha; Ultrassonografia de intervenção; Complicações. AbstractResumo

Complication of trans-rectal prostate biopsy based on Clavien index: 5 years of experience

“…4 Potential complications on trans-rectal prostate biopsy include hematospermia (6.5-74.4%), hematuria (<14.5%), and rectal bleeding (2.2%). 5 There have been historical concerns about performing trans-rectal prostate biopsy for patients on anticoagulation/antiplatelet therapy due to its bleeding complications. However, Raheem et al 6 reported that there was no statistical difference in rectal bleeding event between treatment (with anti-coagulation/anti-platelet therapy) and control groups (without anti-coagulation/anti-platelet therapy), suggesting the safety of continuation of anti-coagulant/anti-platelet treatment before trans-rectal prostate biopsy.…”

“…Other post-biopsy complications are infection (6.6%), severe rectal bleeding (1%), urinary obstruction (<4.6%), acute bacterial prostatitis, and urosepsis (0.3%). 5 Due to the lack of a uniform reporting system, there is a considerable inconsistency from the available data. Terms like major and minor complications have been used, but not standardized, which causes difficulties in comparison of complications.…”

Ressonância magnética multiparamétrica de próstata: a evolução de uma técnica

“…In cases where at least one of such parameters is altered, biopsy is indicated, generally under transrectal ultrasonography (TRUS) guidance ( 2 ) . This diagnostic method presents low complication rates ( 3 , 4 ) , despite some recognized and significant limitations related to a less than ideal sensitivity and underestimation of the tumor volume and grade ( 5 ) . Besides TRUS in prostate biopsy, magnetic resonance imaging (MRI) is other fundamental imaging method for assessing prostate cancer.…”