Risk Factors Analysis Related to Complications of Transrectal Ultrasound-Guided Prostate Needle Biopsy: The Influence of Asymptomatic Pyuria on Complications

Chae Han Jeon; Wonho Jung; Ji Yong Ha; Choal Hee Park; Chun Il Kim; Byung Hoon Kim

doi:10.14777/kjutii.2015.10.1.31

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Jeon, Jung, Ha, Park, Kim, and Kim: Risk Factors Analysis Related to Complications of Transrectal Ultrasound-Guided Prostate Needle Biopsy: The Influence of Asymptomatic Pyuria on Complications

Original Article

Korean J Urogenit Tract Infect Inflamm 2015;10(1):31-35.

Published online: 17 April 2015

DOI: https://doi.org/10.14777/kjutii.2015.10.1.31

Risk Factors Analysis Related to Complications of Transrectal Ultrasound-Guided Prostate Needle Biopsy: The Influence of Asymptomatic Pyuria on Complications

Chae Han Jeon, Wonho Jung, Ji Yong Ha, Choal Hee Park, Chun Il Kim, Byung Hoon Kim

Department of Urology, Keimyung University School of Medicine, Daegu, Korea

Correspondence to: Byung Hoon Kim, http://orcid.org/0000-0001-5272-6362, Department of Urology, Keimyung University School of Medicine, 56 Dalsung-ro, Jung-gu, Daegu 700-712, Korea Tel: +82-53-250-7605, Fax: +82-53-250-7643 E-mail: blackporori@dsmc.or.kr

Received 26 October 2014 Revised 28 October 2014 Accepted 28 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In clinical settings, patients with asymptomatic pyuria were common undergoing transrectal ultrasonography prostate needle biopsy (TRUSBx). The purpose of this study was to analyze the effects of asymptomatic pyuria on the occurrence of complications of TRUSBx.

Materials and Methods

A total of 1,054 patients underwent TRUSBx from January 2007 to December 2011. For these patients, complications, presence of asymptomatic pyuria, anti-coagulant usage, TRUSBx history, previous hospitalization within 1 month, prostate volume, diabetes, types of prophylactic antibiotics (quinolone or 3rd generation cephalosporin), and biopsy results were compared and analyzed.

Results

Of 1,054 cases, 26 (2.5%) developed complications requiring treatment. Seven cases (0.7%) had gross hematuria, 10 cases (0.9%) had dysuria, 7 cases (0.7%) had acute urinary retention, and 2 cases (0.2%) had sepsis. Asymptomatic pyuria was shown in 353 cases (33.4%). Complication rate of asymptomatic pyuria cases was 4.2% compared with 1.6% for non-pyuria cases (p=0.011). Higher complication rate was also observed in cases with previous TRUSBx history (p<0.001), hospitalization within 1 month (p< 0.001), and diabetes (p<0.001). However prostate volume, use of anticoagulant, type of antibiotics, and presence of prostate cancer were not significantly different. In multivariate analysis, previous TRUSBx history, hospitalization within 1 month, and diabetes were statistically significant with higher complication rate.

Conclusions

A high incidence of complications was observed for previous TRUSBx history, hospitalization within 1 month, and diabetes. In univariate analysis, a high incidence of complications was observed for asymptomatic pyuria cases. Therefore, detailed caution is required for patients with such factors during TRUSBx.

Keywords: Prostatic neoplasms, Biopsy, Complications

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Table 1.

Baseline characteristics of the patients (n=1,054)

Variable	Data
Age (y)	65.3±3.7 (40-92)
PSA (ng/ml)	9.1 (2.1-121)
Prostate volume (ml)	54.6 (18-197)
Pyuria	353 (33.5)
Anticoagulant agent	197 (18.7)
Prostate biopsy history	17 (1.6)
Hospitalization history	7 (0.7)
Diabetes	272 (25.8)
Antibiotics
Cephalosporin	1,017 (96.1)
Quinolone
Pathological finding	41 (3.9)
Benign	576 (54.6)
Malignancy	478 (45.4)

Values are presented as mean±standard deviation (range), median range), or number (%).PSA: prostate-specific antigen.

Table 2.

Complications that compared with the presence of asymptomatic pyuria

Complication	Total (n=1,054)	Pyuria(+) (n=353)	Pyuria(-) (n=701)
Overall	26	15	11
Gross hematuria	7	3	4
Dysuria	10	7	3
Acute urinary retention	7	3	4
Sepsis	2	2	0

Table 3.

Univariate analysis of risk factors related to complication of transrectal ultrasonography prostate needle biopsy

Variable (No. of patients)	Complication, n (%)	OR (95% CI)	p-value
Pyuria		2.808 (1.276-6.181)	0.011
Negative (703)	11 (1.6)
Positive (351)	15 (4.3)
Prostate biopsy History		33.967 (11.041-104.499)	<0.001
Negative (1,039)	20 (1.9)
Positive (15)	6 (40.0)
Hospitalization history		66.913 (10.666-419.762)	<0.001
Negative (1,049)	23 (2.2)
Positive (5)	3 (60.0)
Diabetes history		8.358 (3.473-20.114)	<0.001
Negative (783)	9 (1.1)
Positive (271)	17 (6.3)
Prostate volume (ml)		2.438 (0.726-8.187)	0.099
<40 (251)	3 (1.2)
≥40 (803)	23 (2.9)
Anticoagulant agent		1.635 (0.678-3.946)	0.193
Non-use (858)	19 (2.2)
Use (196)	7 (3.6)
Antibiotics		1.012 (0.134-7.658)	0.732
Cephalosporin (1,013)	25 (2.5)
Quinolone (41)	1 (2.5)
Pathological finding		0.888 (0.404-7.952)	0.464
Benign (578)	15 (2.6)
Malignancy (476)	11 (2.3)

OR: odds ratio, CI: confidence interval.

Table 4.

Multivariate analysis of risk factors related to complication of transrectal ultrasonography prostate needle biopsy

Variable	OR (95% CI)	p-value
Pyuria	1.855 (0.767-4.483)	0.170
Prostate biopsy history	154.316 (26.041-914.457)	<0.001
Hospitalization history	10.883 (1.572-75.364)	0.016
Diabetes	23.686 (5.398-103.938)	<0.001

OR: odds ratio, CI: confidence interval.

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