title: Complications After Systematic, Random, and Image-guided Prostate Biopsy.
abstract: Prostate biopsy (PB) represents the gold standard method to confirm the presence of cancer. In addition to traditional random or systematic approaches, a magnetic resonance imaging (MRI)-guided technique has been introduced recently.
  
  
  
  To perform a systematic review of complications after transrectal ultrasound (TRUS)-guided, transperineal, and MRI-guided PB.
  
  
  
  We performed a systematic literature search of Web of Science, Embase, and Scopus databases up to October 2015, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Complications and mortality following random, systematic, and image-guided PBs were reviewed. Eighty-five references were included.
  
  
  
  The most frequent complication after PB was minor and self-limiting bleeding (hematuria and hematospermia), regardless of the biopsy approach. Occurrence of rectal bleeding was comparable for traditional TRUS-guided and image-guided PBs. Almost 25% of patients experienced lower urinary tract symptoms, but only a few had urinary retention, with higher rates after a transperineal approach. Temporary erectile dysfunction was not negligible, with a return to baseline after 1-6 mo. The incidence of infective complications is increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI-targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, regardless of biopsy technique.
  
  
  
  Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. The patient's general health status, risk factors, and likelihood of antimicrobial resistance should be carefully appraised before scheduling a PB.
  
  
  
  We reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, complications seldom represent a problem for the patient. The most troublesome complications are infections. To minimize this risk, the patient's medical condition should be carefully evaluated before biopsy.
authors.affiliation: Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy. Electronic address: mark.borghesi1@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Hashim
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: Division of Urology, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Nam
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Schaeffer
authors.affiliation: Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Department of Urology, Pediatric Urology and Andrology, University Clinic of Giessen, Giessen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weidner
authors.affiliation: Department of Urology, New York University, New York, NY, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
mesh_terms: D001706:Biopsy / Q000379:methods; D019160:Endosonography; D007172:Erectile Dysfunction / Q000453:epidemiology; D006417:Hematuria / Q000453:epidemiology; D051516:Hemospermia / Q000453:epidemiology; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D020127:Recovery of Function; D012002:Rectal Diseases / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D016055:Urinary Retention / Q000453:epidemiology
keywords: Complications; Hospitalization; Infection; MRI-guided biopsy; Mortality; Prostate biopsy