Bleeding after transrectal ultrasonography-guided prostate biopsy: a study of 7-day morbidity after a six-, eight- and 12-core biopsy protocol

Abstract

Objective: To compare, in a prospective study, bleeding (in three categories, i.e. haematuria, haematospermia and rectal) and consultations with the general practitioner (GP), after a six-, eight- or 12-core prostate biopsy, as data on whether taking more prostate core biopsies increases bleeding complications are not conclusive.

Patients and methods: Over a 5-year period, patients undergoing outpatient transrectal ultrasonography (TRUS)-guided prostate biopsy (six, eight or 12-core biopsy) completed a self-administered questionnaire. The prevalence and duration of the three bleeding complications and GP or hospital visits for a biopsy-related complication were assessed and compared for the 7 days after biopsy. The contribution of local anaesthetic (LA) injection to bleeding rates was also assessed.

Results: Of 1384 patients biopsied, 1000 were given questionnaires and 884 (88%) forms were returned. Of these, 760 were suitable for analysis (307 after six-core, 325 eight-core and 128 12-core biopsies); 351 patients were given LA before biopsy. The prevalence of bleeding complications (six-, eight- and 12-core, respectively) was: haematuria 44%, 41% and 39%; haematospermia 13%, 16% and 12%; and rectal bleeding 17%, 26% and 27%. Rectal bleeding was significantly more prevalent in the eight- and 12-core groups (P = 0.0037 and 0.019). The duration of bleeding was not significantly greater in any biopsy group. Subgroup analysis showed no significant difference in the prevalence and duration of rectal bleeding after LA. About 5% of patients in each group consulted their GP because of a complication and 2.4% consulted because of bleeding. Three men with major complications required hospitalization, of which only one was caused by bleeding.

Conclusions: Only rectal bleeding was more prevalent after taking more than six cores, but the duration was no greater. Giving LA did not affect the rectal bleeding rate. With all strategies the major complication and hospitalization rate was very low.