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

To identify complications following transrectal posterior biopsies in a public Brazilian reference center, and to identify the risk factors associated with complications. 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. 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. 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. ■ 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. This prospective study conducted in a mid-income country evaluated the risk factors associated with complications after transrectal prostate biopsy and highlighted significant correlations with hemorrhagic events, infections, and acute urinary retention.