Prospective evaluation of the safety of transrectal ultrasound-guided transperineal prostate biopsy based on adverse events.
BACKGROUND
Although transperineal (TP) prostate biopsy is growing in popularity, its safety has not been evaluated based on extensive studies. We prospectively assessed the adverse events associated with transrectal ultrasound (TRUS)-guided TP 16-core prostate biopsy at a single institution.


METHODS
We enrolled 2,086 males who underwent first-time TRUS-guided TP prostate biopsy under lumbar spinal anesthesia at Chiba Cancer Center between 2009 and 2013. Eight adverse events were assessed prospectively using a purpose-designed questionnaire. The prevalence and duration of all adverse events were evaluated. We performed subgroup analyses for hematuria and urinary retention in relation to clinical factors.


RESULTS
Questionnaires were collected from 1,663 cases (79.7 %). The cancer detection rate was 53.5 % in all patients. The prevalence and duration of complications were as follows: hematuria, 73.4 % and 4.51 ± 2.88 days; perineal bleeding, 7.1 % and 2.20 ± 2.24 days; hematospermia 14.4 %; dysuria, 15.7 % and 3.12 ± 2.71 days; urinary tract pain, 49.5 % and 2.43 ± 2.08 days; perineal pain, 35.5 % and 3.53 ± 2.59 days; fever ≥37 °C, 1.7 % and 1.79 ± 1.72 days; and headache, 22.1 % and 3.40 ± 2.10 days. Seventeen patients (1.1 %) required indwelling urethral catheterization for grade 2 urinary retention. Pre-biopsy International Prostate Symptom Score (p = 0.014) was an independent related factor for hematuria. Prostate volume (p = 0.001) was an independent related factor for grade 2 urinary retention.


CONCLUSIONS
TRUS-guided TP prostate biopsy under lumbar spinal anesthesia can be performed safely with only minor adverse events.
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Takeshi
T
Namekawa
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Satoshi
S
Fukasawa
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Atsushi
A
Komaru
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Masayuki
M
Kobayashi
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Yusuke
Y
Imamura
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Takayuki
T
Ohzeki
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Kimiaki
K
Takagi
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan.
Yosuke
Y
Sato
Division of Urology, Japan Community Health Care Organization, Tokyo Shinjuku Medical Center, Tokyo, Japan.
Koichiro
K
Akakura
Department of Urology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana-cho, Chuo-ku, Chiba, 260-8670, Japan.
Tomohiko
T
Ichikawa
Prostate Center and Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 260-8717, Japan. urolccc@yahoo.co.jp.
Takeshi
T
Ueda
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D053159:Dysuria / Q000209:etiology; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects*; D005334:Fever / Q000209:etiology; D006261:Headache / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D051516:Hemospermia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010502:Perineum; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D011795:Surveys and Questionnaires; D016055:Urinary Retention / Q000209:etiology
Adverse events; Prostate cancer; Questionnaire; Transperineal biopsy