The management of rectal bleeding following transrectal prostate biopsy: A review of the current literature

Abstract

We advocate early consultation with the colorectal/gastroenterology and interventional radiology services and a progressive, stepwise approach to the management of post-biopsy rectal bleeding, starting with resuscitation and conservative tamponade measures, moving to endoscopic hemostasis ± radiological embolization ± transanal surgical methods. Given the infrequent but serious nature of major rectal bleeding after TRUS biopsy, we recommend the establishment of centralized databases or registries forthwith to prospectively capture such data. To the best of our knowledge, this is the first comprehensive look specifically at the management of post-TRUS biopsy rectal bleeding.

Hemostatic effect and psychological impact of an oxidized regenerated cellulose patch after transrectal ultrasound-guided prostate biopsy

“…The incidence of rectal bleeding after prostate biopsy varies from 1.3% to 58.6%. [14,18] The rectal bleeding frequency in the present study was 42.7% in Group I and 26.7% in Group II. The relatively high rates of rectal bleeding in the current study could be attributed to different methods of assessing rectal bleeding rate, differences in the definition of rectal bleeding, selection bias during patient recruitment, methods of data collection, and patient concern about rectal bleeding due to informed consent before the procedure.…”

Late-onset rectal bleeding with hemorrhagic shock after transrectal prostate needle biopsy

“…Several case reports have been published regarding patients who required aggressive treatment, including blood transfusion, because of late-onset massive rectal bleeding. 2 , 3 , 4 Recently, several risk factors for rectal bleeding have been suggested, such as increasing biopsy core numbers, advanced age, poorly controlled hypertension, and constipation, whereas the influence of antiplatelets remains controversial. 2 Because these risk factors would increase according to the age of patients and the expansion of prostate biopsy indications, a risk of severe rectal bleeding should be considered.…”

“… 2 , 3 , 4 Recently, several risk factors for rectal bleeding have been suggested, such as increasing biopsy core numbers, advanced age, poorly controlled hypertension, and constipation, whereas the influence of antiplatelets remains controversial. 2 Because these risk factors would increase according to the age of patients and the expansion of prostate biopsy indications, a risk of severe rectal bleeding should be considered. Furthermore, appropriate perioperative education of patients regarding the initial response to bleeding is equally important.…”

“…Presently, colorectal endoscopy is chosen when conservative treatment for managing severe rectal bleeding fails. 2 , 3 The advantages of colorectal endoscopy are as follows: it can pinpoint the bleeding site and provide an expanded view; it can achieve hemostasis (after pinpointing the bleeding site) immediately using epinephrine injection, clipping, or banding; it can be performed without anesthesia and using antiplatelet or anticoagulation medications. Therefore, colorectal endoscopy is safe and effective in arresting severe rectal bleeding.…”

“…According to few case reports, angiography could reveal the existence of bleeding or abnormality of the superior rectal artery or prostate artery, resulting in rectal bleeding with or without retroperitoneal bleeding, and arterial embolization could arrest the bleeding. 2 , 4 , 5 Because arterial embolization was advantageous in a patient with retroperitoneal hemorrhage who could not be managed using colorectal endoscopy, it can be stated that arterial embolization is a definitive method for arresting rectal bleeding.…”