Descriptive analysis of adverse events associated with transrectal prostatic biopsy after 603 procedures

To establish the incidence of complications secondary to performance of transrectal prostatic biopsy, and to establish the hypothetical relationship between the rate of fever and the type of antibiotic prophylaxis employed. All patients undergoing transrectal prostatic biopsy between January 1992 and December 2003 were included in this prospective nonrandomized study. Patients were given a self-administered questionnaire to obtain data about complications related to biopsy that included the following variables: fever, hematuria, rectal bleeding, hemospermia, voiding difficulties, acute urinary retention, need to visit primary care physician or an emergency department, hospital admissions and need of medication. The incidence of observed complications was calculated and the relationship between post-biopsy fever and type of antibiotic prophylaxis employed (oral ciprofloxacin vs. intramuscular tobramycin) was studied by means of the chi-square test, using the SPSS 11.5 for Windows; a p < 0.05 was considered significant. Overall, 705 questionnaires were received; 603 (85.5%) were considered valid for processing. Almost three quarters (73.9%) of the patients undergoing biopsy presented some complications, being hematuria the most frequent (53% of the cases). 40 patients presented fever (6.64%). Among 360 patients treated with oral ciprofloxacin for three days 16 developed fever (4.4%), in comparison to 24 patients out of 243 treated with intramuscular tobramycin (9.87%) (p = 0.009). Ultrasound guided transrectal prostatic biopsy is associated with frequent complications, although most of them are mild. The most frequent complication is hematuria; fever is the most severe. To prevent post-biopsy fever, antibiotic prophylaxis with ciprofloxacin for three days is more effective than single dose intramuscular tobramycin. However, prospective randomize studies are required to confirm it.