title: An Update of the American Urological Association White Paper on the Prevention and Treatment of the More Common Complications Related to Prostate Biopsy.
abstract: In this white paper update we identify and discuss the prevalence and prevention of common complications of prostate needle biopsy.
  
  
  
  A literature review was performed on prostate biopsy complications via queries of PubMed and EMBASE®databases for prostate biopsy complications from January 1, 2010 until June 1, 2015. We focused on infection, bleeding, urinary retention, needle tract seeding and erectile dysfunction. A total of 346 articles were identified for full text review and 119 are included in the final data synthesis.
  
  
  
  Infection is the most common complication of prostate biopsy with fluoroquinolone resistant Escherichia coli having a prominent role. Reported rates of infectious complications range from 0.1% to 7.0%, and sepsis rates range from 0.3% to 3.1% depending on antibiotic prophylaxis regimens. Mild, self-limiting and transient bleeding is also a common complication. Other complications are extremely rare.
  
  
  
  This white paper provides a concise reference document for the more common prostate biopsy complications and prevention strategies. Risk assessment should be performed for all patients to identify known risk factors for harboring fluoroquinolone resistance. If infection incidence increases check the local antibiogram, current equipment and cleaning practices, and consider alternate approaches to antibiotic prevention such as needle cleaning, risk basked augmentation, rectal culture with targeted prophylaxis and transperineal biopsy. If infection occurs, actively re-situate the patient and start empiric intravenous treatment with carbapenems, amikacin or second and third generation cephalosporins.
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, Texas. Electronic address: liss@uthscsa.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.affiliation: New York University, New York, New York.
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.affiliation: University of California San Francisco, San Francisco, California.
authors.forename: Maxwell V
authors.initials: MV
authors.lastname: Meng
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.affiliation: Society of Urologic Nurses Association, Pitman, New Jersey.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Spears
authors.affiliation: Naval Medical Center San Diego, San Diego, California.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
mesh_terms: D001706:Biopsy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D011467:Prostate / Q000473:pathology*
keywords: biopsy; complications; high-intensity focused; infection; prostate; transrectal; ultrasound