einstein (São Paulo). 08/ago/2025;23:eAO1437.

Transrectal prostate biopsy complications: a prospective single center study in a mid-income country

Allan Jefferson

Schollemberg

, Flavio Lobo

Heldwein

, Suelen dos

Santos

, Vítor Maurício Merlin

Maschietto

, Erick

Schnorrenberger

, Kleber

Reinert

, Gabriela Garcia

Korczaguin

, Marcelo Langer

Wroclawski

DOI: 10.31744/einstein_journal/2025AO1437

Highlights

■ This prospective cohort study assessed prostate biopsy complications in 1,043 men.
■ The major outcomes included bleeding (Clavien-Dindo Grades 2–3 = 1.5%), infections (4.7%), and urinary retention (4.1%).
■ The key risk factors for infection were recent quinolone use, indwelling catheters, and high PSA levels.
■ Acute urinary retention was linked to untreated lower urinary tract symptoms, prostate volume, intravesical prostatic protrusion, and bladder wall thickness.

ABSTRACT

Objective:

To identify complications following transrectal posterior biopsies in a public Brazilian reference center, and to identify the risk factors associated with complications.

Methods:

This is a prospective cohort study that employed a form designed by the Global Prevalence Infections in Urology study. Data from 1,043 consecutive patients who underwent transrectal prostate biopsy at a single Brazilian center were analyzed, including patient characteristics, procedural characteristics, and self-assessed complications at 28 days. Complications were categorized according to the Clavien-Dindo (CD) classification.

Results:

Most bleeding complications were mild (CD Grade 1), although 1.5% reported Grades 2–3. Hypertension, younger age, and anticoagulant use were associated with bleeding (all p<0.001). A total of 4.7% reported infections (CD Grade 2: 0.5%, CD Grade 3: 3.6%, and CD Grade 4 [sepsis]: 0.6%), with risk factors being indwelling catheter use, recent urinary tract infection (p<0.001 for both), and quinolone use (OR= 3.01, 95%CI= 1.15–7.80, p=0.03). Urinary retention was observed in 4.1% (Grade 2), with severe symptoms (p=0.009), prostates >89mL (p=0.001), and prostatic protrusion ≥10mm (p=0.001) being associated with it

Conclusion:

Clinically significant (CD Grades 3–5) adverse effects of transrectal prostate biopsy are rare. Careful pre-procedure evaluation of antimicrobial use, particularly quinolones, along with the assessment of identified risk factors is essential for counseling patients and reducing potential risks.

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