Journal List > Urogenit Tract Infect > v.10(2) > 1084183

Jeong, Lee, Chung, and Lee: Characteristics of Patients Who Visited the Emergency Room after Prostate Biopsy: Single Center Retrospective Study

Abstract

Purpose:

To educate patients and prevent biopsy-related complications, it is helpful to understand the causes for visiting the emergency room (ER). Therefore, we want to analyze the causes and factors of complications that cause patients to visit the ER after prostate biopsy.

Materials and Methods:

We conducted a study of in-patients who visited the ER of Pusan National University Yangsan Hospital after prostate biopsy from December 2008 to July 2015. Age, postoperative interval before visiting the ER, Charlson comorbidity index (CCI) score, symptoms in ER, prostate size, pathologic result, and number of biopsy cores were analyzed retrospectively.

Results:

Among all 1,694 cases of patients who had undergone prostate biopsies during a 7-year period, only 37 patients (2.2%) visited the ER. Diabetes mellitus (DM) is the most common underlying disease among patients with accompanying infection-related symptoms compared to patients with accompanying non-infection-related symptoms (p<0.001). In univariate analysis, DM (p=0.004) and CCI score (p=0.030) were statistically significant risk factors for infection, but only DM was significant in multivariate analysis (p=0.004). Prostate size (p=0.044) was a significant risk factor for acute urinary retention (AUR) in univariate analysis, but not statistically significant in multivariate analysis. CCI score was a statistically significant risk factor for bleeding (p=0.005 [univariate], 0.035 [multivariate]).

Conclusions:

AUR after transrectal ultrasound-biopsy is the most common reason for visiting the ER. CCI score showed correlation with bleeding and DM showed correlation with infection. Consideration of risk factors of complications after prostate biopsy will be helpful to the patients in the treatment and prevention of complication.

REFERENCES

1.Rosario DJ., Lane JA., Metcalfe C., Donovan JL., Doble A., Goodwin L, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ. 2012. 344:d7894.
crossref
2.Quan H., Sundararajan V., Halfon P., Fong A., Burnand B., Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005. 43:1130–9.
crossref
3.Carlsson SV., Holmberg E., Moss SM., Roobol MJ., Schröder FH., Tammela TL, et al. No excess mortality after prostate biopsy: results from the European Randomized Study of Screening for Prostate Cancer. BJU Int. 2011. 107:1912–7.
crossref
4.Wei TC., Lin TP., Chang YH., Chen TJ., Lin AT., Chen KK. Transrectal ultrasound-guided prostate biopsy in Taiwan: a nationwide database study. J Chin Med Assoc. 2015. 78:662–5.
crossref
5.Pinsky PF., Parnes HL., Andriole G. Mortality and complications after prostate biopsy in the Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) trial. BJU Int. 2014. 113:254–9.
crossref
6.Loeb S., Carter HB., Berndt SI., Ricker W., Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011. 186:1830–4.
crossref
7.Puig J., Darnell A., Bermúdez P., Malet A., Serrate G., Baré M, et al. Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Eur Radiol. 2006. 16:939–43.
crossref
8.Loeb S., van den Heuvel S., Zhu X., Bangma CH., Schröder FH., Roobol MJ. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol. 2012. 61:1110–4.
crossref
9.Batura D., Gopal Rao G. The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother. 2013. 68:247–9.
crossref
10.Wagenlehner FM., van Oostrum E., Tenke P., Tandogdu Z., Çek M., Grabe M, et al. GPIU investigators. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol. 2013. 63:521–7.
crossref
11.Simsir A., Kismali E., Mammadov R., Gunaydin G., Cal C. Is it possible to predict sepsis, the most serious complication in prostate biopsy? Urol Int. 2010. 84:395–9.
crossref
12.de Jesus CM., Corrêa LA., Padovani CR. Complications and risk factors in transrectal ultrasound-guided prostate biopsies. Sao Paulo Med J. 2006. 124:198–202.
13.Zaytoun OM., Vargo EH., Rajan R., Berglund R., Gordon S., Jones JS. Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology. 2011. 77:1035–41.
crossref
14.Shigemura K., Matsumoto M., Tanaka K., Yamashita M., Arakawa S., Fujisawa M. Efficacy of combination use of Beta-lactamase inhibitor with penicillin and fluoroquinolones for antibiotic prophylaxis in transrectal prostate biopsy. Korean J Urol. 2011. 52:289–92.
crossref
15.Raheem OA., Casey RG., Galvin DJ., Manecksha RP., Varadaraj H., McDermott T, et al. Discontinuation of anticoagulant or antiplatelet therapy for transrectal ultrasound-guided prostate biopsies: a single-center experience. Korean J Urol. 2012. 53:234–9.
crossref
16.Nam RK., Saskin R., Lee Y., Liu Y., Law C., Klotz LH, et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol. 2013. 189(1 Suppl):S12–7. discussion S17-8.
crossref
17.Carignan A., Roussy JF., Lapointe V., Valiquette L., Sabbagh R., Pépin J. Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis? Eur Urol. 2012. 62:453–9.
crossref
18.Tal R., Livne PM., Lask DM., Baniel J. Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol. 2003. 169:1762–5.
crossref
19.Suzuki M., Kawakami S., Asano T., Masuda H., Saito K., Koga F, et al. Safety of transperineal 14-core systematic prostate biopsy in diabetic men. Int J Urol. 2009. 16:930–5.
crossref
20.Jeon SS., Woo SH., Hyun JH., Choi HY., Chai SE. Bisacodyl rectal preparation can decrease infectious complications of transrectal ultrasound-guided prostate biopsy. Urology. 2003. 62:461–6.
crossref
21.Utrera NM., Álvarez MB., Polo JM., Sánchez AT., Martínez JP., González RD. Infectious complications after transrectal ultrasound-guided prostatic biopsy. Analysis of our experience. Arch Esp Urol. 2011. 64:605–10.
22.Pal RP., Elmussareh M., Chanawani M., Khan MA. The role of a standardized 36 core template-assisted transperineal prostate biopsy technique in patients with previously negative transrectal ultrasonography-guided prostate biopsies. BJU Int. 2012. 109:367–71.
crossref
23.Loeb S., Carter HB., Berndt SI., Ricker W., Schaeffer EM. Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare. J Urol. 2013. 189:867–70.
crossref
24.Pinkhasov GI., Lin YK., Palmerola R., Smith P., Mahon F., Kaag MG, et al. Complications following prostate needle biopsy requiring hospital admission or emergency department visits: experience from 1000 consecutive cases. BJU Int. 2012. 110:369–74.
25.Lee SH., Chen SM., Ho CR., Chang PL., Chen CL., Tsui KH. Risk factors associated with transrectal ultrasound guided prostate needle biopsy in patients with prostate cancer. Chang Gung Med J. 2009. 32:623–7.
26.Zaytoun OM., Anil T., Moussa AS., Jianbo L., Fareed K., Jones JS. Morbidity of prostate biopsy after simplified versus complex preparation protocols: assessment of risk factors. Urology. 2011. 77:910–4.
crossref
27.de la Taille A., Antiphon P., Salomon L., Cherfan M., Porcher R., Hoznek A, et al. Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate. Urology. 2003. 61:1181–6.
crossref
28.Berger AP., Gozzi C., Steiner H., Frauscher F., Varkarakis J., Rogatsch H, et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol. 2004. 171:1478–80. discussion 1480-1.
crossref
29.Argyropoulos AN., Doumas K., Farmakis A., Liakatas I., Gkialas I., Lykourinas M. Time of administration of a single dose of oral levofloxacin and its effect in infectious complications from transrectal prostate biopsy. Int Urol Nephrol. 2007. 39:897–903.
crossref
30.Li H., Yan W., Zhou Y., Ji Z., Chen J. Transperineal ultrasound-guided saturation biopsies using 11-region template of prostate: report of 303 cases. Urology. 2007. 70:1157–61.
crossref
31.Raaijmakers R., Kirkels WJ., Roobol MJ., Wildhagen MF., Schrder FH. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology. 2002. 60:826–30.
crossref
32.Chiang IN., Chang SJ., Pu YS., Huang KH., Yu HJ., Huang CY. Major complications and associated risk factors of transrectal ultrasound guided prostate needle biopsy: a retrospective study of 1875 cases in taiwan. J Formos Med Assoc. 2007. 106:929–34.
crossref

Table 1.
Overall characteristics of patients who visited the emergency room after prostate biopsy
  Overall Infection group Non-infection group p-value
No. of patients 37 6 31  
Age (yr) 66.8±1.3 68.3±4.6 66.5±8.4 0.614
Interval (d) 3.4±0.6 4.2±3.3 3.3±3.9 0.612
CCI 3.8±0.2 5.0±1.4 3.5±1.3 0.014
DM 14/37 (37.8) 5/6 (83.3) 9/31 (29.0) <0.001
Prostate cancer 17/37 (46.0) 1/6 (16.7) 16/31 (51.6) 0.116
Admission 12/37 (32.4) 6/6 (100) 6/31 (19.4) <0.001
PSA (ng/ml) 17.7±4.6 15.3±25.0 18.2±29.0 0.82
Prostate size (ml) 50.0±2.7 50.6±14.0 49.9±17.3 0.921
No. of biopsy core 11.0±0.3 10.7±1.0 11.0±1.6 0.67

Values are presented as number, mean±standard deviation, or number/total number (%).

Infection group: infection-related symptoms group, Non-infection group: non-infection-related symptoms group, Interval: interval to revisit emergency room after biopsy, CCI: Charlson comorbidity index, DM: diabetes mellitus, Prostate cancer: prostate cancer diagnosed following prostate biopsy, PSA: prostate-specific antigen.

Table 2.
Risk factors for infection after transrectal ultrasound-guided prostate biopsy
Risk factor Infection-related symptoms (n=6, 16.2%)
Univariate RR 95% CI p-value Multivariate RR 95% CI p-value
Age 0.970 0.864-1.088 0.604 1.36 0.765-2.419 0.295
CCI 0.405 0.179-0.916 0.030 0.2 0.015-2.706 0.226
Prostate cancer 0.188 0.020-1.796 0.147 1.278 0.009-1.907 0.923
DM 3.375 3.093-3.865 0.004 3.375 3.092-3.682 0.004
PSA 1.004 0.970-1.040 0.814 0.992 0.906-1.087 0.870
Biopsy number 1.127 0.665-1.910 0.658 1.854 0.369-9.308 0.453
Prostate size 0.997 0.946-1.051 0.918 1.027 0.895-1.177 0.707

RR: relative risk, CI: confidence interval, CCI: Charlson comorbidity index, DM: diabetes mellitus, PSA: prostate-specific antigen.

Table 3.
Risk factors for acute urinary retention after transrectal ultrasound-guided prostate biopsy
Risk factor Acute urinary retention (n=13, 35.1%)
Univariate RR 95% CI p-value Multivariate RR 95% CI p-value
Age 0.950 0.867-1.041 0.075 0.098 0.811-1.018 0.097
CCI 1.055 0.642-1.734 0.083 5.340 0.771-3.697 0.090
Prostate cancer 2.667 0.664-10.704 0.167 6.292 0.519-7.625 0.149
DM 0.001 0.001-0.002 0.999 0.001 0.001-0.003 0.900
PSA 0.988 0.964-1.013 0.352 1.056 1.056-0.993 0.085
Biopsy number 1.531 0.922-2.544 0.100 2.559 0.973-6.727 0.057
Prostate size 0.914 0.914-0.999 0.044 0.905 0.811-1.010 0.075

RR: relative risk, CI: confidence interval, CCI: Charlson comorbidity index, DM: diabetes mellitus, PSA: prostate-specific antigen.

Table 4.
Risk factors for bleeding after transrectal ultrasound-guided prostate biopsy
Risk factor Bleeding (n=8, 21.6%)
Univariate RR 95% CI p-value Multivariate RR 95% CI p-value
Age 1.067 0.962-1.184 0.221 0.864 0.001-3.414 0.365
CCI 2.098 0.990-4.444 0.050 3.352 1.089-10.320 0.035
Prostate cancer 2.361 0.472-11.822 0.296 2.394 0.174-3.283 0.514
DM 0.375 0.040-3.551 0.392 2.290 0.079-6.615 0.629
PSA 0.995 0.968-1.022 0.697 0.910 0.827-1.001 0.053
Biopsy number 0.390 0.130-1.169 0.093 0.088 0.004-1.893 0.120
Prostate size 1.013 0.963-1.065 0.615 0.996 0.901-1.101 0.931

RR: relative risk, CI: confidence interval, CCI: Charlson comorbidity index, DM: diabetes mellitus, PSA: prostate-specific antigen.

TOOLS
Similar articles