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Risk factors for complications after prostate biopsy at the VA
Aaron Lay, MD1, Joshua Kaplan, MD1, Stephen Williams, MD2, Steven Chang, MD1, Mike Siroky, MD3, Ralph Orlando, MD3.
1Harvard Medical School/Brigham & Women's Hospital, Boston, MA, USA, 2Associated Urologists of Orange County, Santa Ana, CA, USA, 3Boston VA Healthcare System, Boston, MA, USA.

Risk factors for complications after prostate biopsy at the VA
Lay AH, Kaplan JR, Williams SB, Chang SL, Siroky MB, Orlando RP
Introduction and Objective:
Transrectal ultrasound (TRUS)-guided prostate biopsy is a standard method for diagnosing prostate cancer and is frequently performed. Morbidity associated with this procedure range from minor to life-threatening. Despite universal use of TRUS-biopsy among urologists, little is known about predisposing factors for these complications. We sought to identify the rate of complications after TRUS biopsy in a contemporary series of patients in order to identify risk factors and reduce morbidity.
Methods:
We retrospectively evaluated 1357 consecutive prostate biopsies performed at the Boston VA Healthcare System from 2006 to 2010. The electronic medical records were reviewed for any post-biopsy complication in the 30 days following biopsy. History of diabetes, recent hospitalization, previous biopsy history, previous urinary tract infection, antibiotic prophylaxis, anticoagulation use, prostate size (categorized as 100g), number of cores sampled, and pathology results were recorded. We performed univariate and multivariate logistic regression analyses.
Results:
The overall complication rates were categorized as infection (2.65%), sepsis (1.84%), urinary retention (1.11%), vasovagal (0.96%), bleeding (0.81%), and other (1.4%), which included culture-negative dysuria. In univariate analyses, prostate size was significantly associated with increased risk for urinary retention (OR 1.82, p=0.001) and any complication (OR 1.29, p=0.001). This association remained even when urinary retention was excluded as a complication (OR 1.21, p=0.020). In multivariate analyses, size (OR 1.3, p<0.001) and prior hospitalization within one year (OR 2.0, p=0.009) were significant risks for any complication. Previous history of urinary tract infection was associated with decreased risk for any complication (OR 0.24, p=0.007).
Conclusions:
Patients with large glands and hospitalization within 1 year prior to biopsy are at increased risk of biopsy complications. For every 20g increase in size, there is a 30% increase in odds of developing any complication after biopsy. Patients with history of urinary tract infection had a lower risk for complication, suggesting that being cognizant of increased risk may in fact lower morbidity for patients undergoing TRUS-biopsy.


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