Chapter

The Role of Anticoagulant Therapy During Prostate Biopsy

In book: Prostate Biopsy
Source: InTech
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    ABSTRACT: Transrectal ultrasound guided needle biopsy of the prostate is routinely performed to diagnose and stage prostate cancer. We prospectively evaluated the true incidence of complications and identified risk factors of needle biopsy. We prospectively studied 128 patients who underwent transrectal ultrasound guided needle biopsy. A pre-biopsy questionnaire provided demographic information. Immediate complications were recorded by the surgical team at the procedure. Information on delayed complications was obtained by telephone interview. Univariate and multivariate analyses were performed. There was 1 major and 135 minor complications in 77 patients with at least 1 complication in 63.6%. Most patients tolerated the procedure with minimal discomfort regardless of the number and location of biopsies but younger patients had significantly more discomfort than older men (R = -0.26, p = 0.005). The most common complication was persistent hematuria in 47.1% of cases. None of the hemorrhagic complications was related to previous aspirin or nonsteroidal anti-inflammatory drug use, or the total number of biopsies performed. Infectious complications were rare with only a 1.7% incidence of fever. This rate was associated with the choice of antibiotic combination used (R = 0.25, p = 0.006). Transrectal ultrasound guided needle biopsy is safe for diagnosing prostate cancer with few major but frequent minor complications. Patients are likely to have persistent hematuria for up to 3 to 7 days after the procedure. Recent use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication for this procedure. Additional analgesics are not required in patients who undergo anterior or multiple biopsies but they may be useful in younger patients.
    The Journal of Urology 01/1999; 160(6 Pt 1):2115-20. · 3.70 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    BJU International 11/2004; 94(7):1014-20. · 3.05 Impact Factor
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    ABSTRACT: An increasing number of studies suggest that 6-sector transrectal ultrasound guided biopsy of the prostate provides insufficient material to detect all clinically important prostate cancers and more cores may improve detection rates. We performed a prospective, randomized study to determine the effect of increasing the number of cores from 6 to 12 on pain and other morbidity associated with the biopsy procedure. A total of 160 men (44 black, 28%) with a mean age plus or minus standard deviation of 65+/-8 years who had serum prostate specific antigen between 2.5 and 20.0 ng./ml. and/or digital rectal examination findings suspicious for cancer were prospectively randomized to undergo 6 or 12-core biopsy. Patients completed a self-administered questionnaire addressing pain and other morbidity before, and immediately and 2 and 4 weeks after biopsy. There was no difference between groups in mean pain scale with time for abdominal and rectal pain. For probe insertion, needle insertion and overall pain there was a significant increase in pain recalled at 2 which persisted at 4 weeks compared to immediately after biopsy. However, there was no difference for these 3 post-biopsy pain measures between the 6 and 12-core groups. In the 12-core group there was a statistically significant increase in hematochezia and hematospermia (24% versus 10%, p = 0.04 and 89% versus 71%, p = 0.01, respectively) but no significant difference between groups reporting morbidity as a moderate or major problem. There was no significant change in International Prostate Symptom Score, fever or hospitalization in the 12-core group. The 12-core prostate biopsy procedure is generally well tolerated and can be safely performed with no significant difference in pain or morbidity compared to the 6-core procedure.
    The Journal of Urology 02/2000; 163(1):168-71. · 3.70 Impact Factor

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