Abstract
Introduction
Multi-parametric MRI (MP-MRI) prior to prostate biopsy is the investigation of choice for an elevated age-related PSA and abnormal digital rectal examination. MP-MRI in combination with transperineal template mapping biopsy has facilitated the development of the concept of targeted biopsies, either cognitively or with software fusion. Urinary retention is a recognised complication of transperineal prostate biopsy, with reported incidence being 1.6–11.4%. We present patient and procedure-related factors, which influence occurrence of urinary retention after transperineal template biopsy.
Patients and methods
Retrospective data collection of 243 consecutive cases of transperineal template biopsies performed at a single institution were recorded and analysed. Biopsies were taken using a standard 5-mm template in 4–6 sectors, depending on the prostate volume.
Results
31/243 (12.8%) patients developed urinary retention, defined as patient discomfort and inability to micturate and bladder scan of ≥ 600 ml. Patients in the retention group were significantly older (mean 68.7 vs. 65.8 years, P = 0.034). Prostate volume was significantly greater in comparison with the non-retention group (mean 75.4 vs. 57.2 cc, P = 0.0016). The number of biopsies taken was positively correlated with urinary retention (median 35 vs. 32 biopsies, P = 0.045), and this was independent of prostate size (R2 = 0.2). Presenting PSA, pre-operative flow and histopathological outcome were independent of urinary retention.
Conclusions
Factors resulting in an increased risk of urinary retention are advancing age (> 68.7 years); a larger prostate volume (> 75 cc); greater number of biopsies (> 35); greater severity of lower urinary tract symptoms prior to biopsy and diabetes. Targeted biopsies alone, instead of a full template, may avoid urinary retention in the high-risk groups identified.
Similar content being viewed by others
References
National Institute for Health and Care Excellence (2014) Prostate cancer: diagnosis and management. [CG175]. https://www.nice.org.uk/guidance/cg175. Accessed June 2017
Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389(10071):815–822
Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level ≤ 4.0 ng per milliliter. N Engl J Med 350(22):2239–2246
Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R et al (2013) Systematic review of complications of prostate biopsy. Eur Urol 64(6):876–892
Borghesi M, Ahmed H, Nam R, Schaeffer E, Schiavina R, Taneja S et al (2017) Complications after systematic, random, and image-guided prostate biopsy. Eur Urol 71(3):353–365
Ghai S, Haider MA (2015) Multiparametric-MRI in diagnosis of prostate cancer. Indian J Urol 31(3):194–201
National Institute for Health and Care Excellence (2010) Transperineal template biopsy and mapping of the prostate: interventional procedures guidance. [IPG364]. https://www.nice.org.uk/guidance/ipg364. Accessed June 2017
Bott SR, Henderson A, Halls JE, Montgomery BS, Laing R, Langley SE (2006) Extensive transperineal template biopsies of prostate: modified technique and results. Urology 68(5):1037–1041
National Institute for Health and Care Excellence (2009) Interventional procedures programme: Interventional procedure overview of transperineal template biopsy and mapping of the prostate. [IP793]. https://www.nice.org.uk/guidance/ipg364/evidence/transperineal-template-biopsy-of-the-prostate-overview2. Accessed June 2017
Serefoglu EC, Altinova S, Ugras NS, Akincioglu E, Asil E, Balbay MD (2012) How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer? Can Urol Assoc J 7(5–6):E293–E298
Pepe P, Garufi A, Priolo G, Pennisi M (2017) Transperineal versus transrectal MRI/TRUS fusion targeted biopsy: detection rate of clinically significant prostate cancer. Clin Genitourin Cancer 15(1):e33–e36
Smith JB, Popert R, Nuttall MC, Vyas L, Kinsella J, Cahill D (2014) Transperineal sector prostate biopsies: a local anesthetic outpatient technique. Urology 83(6):1344–1349
Pinkstaff DM, Igel TC, Petrou SP, Broderick GA, Wehle MJ, Young PR (2005) Systematic transperineal ultrasound-guided template biopsy of the prostate: three-year experience. Urology 65(4):735–739
Pepe P, Aragona F (2013) Morbidity after transperineal prostate biopsy in 3000 patients undergoing 12 vs. 18 vs. more than 24 needle cores. Urology 81(6):1142–1146
Merrick GS, Taubenslag W, Andreini H, Brammer S, Butler WM, Adamovich E, Allen Z, Anderson R, Wallner KE (2008) The morbidity of transperineal template-guided prostate mapping biopsy. BJU Int 101(12):1524–1529
Buskirk SJ, Pinkstaff DM, Petrou SP, Wehle MJ, Broderick GA, Young PR et al (2004) Acute urinary retention after transperineal template-guided prostate biopsy. Int J Radiat Oncol Biol Phys 59(5):1360–1366
Willis S, Bott S, Montgomery B (2012) Urinary retention following transperineal template prostate biopsy—study of risk factors. J Clin Urol 6(1):55–58
Huang S, Reeves F, Preece J, Satasivam P, Royce P, Grummet JP (2015) Significant impact of transperineal template biopsy of the prostate at a single tertiary institution. Urol Ann 7(4):428–432
Taira AV, Merrick GS, Galbreath RW, Andreini H, Taubenslag W, Curtis R et al (2009) Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting. Prostate Cancer Prostatic Dis 13(1):71–77
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there are no conflicts of interest.
Rights and permissions
About this article
Cite this article
Kum, F., Jones, A. & Nigam, R. Factors influencing urinary retention after transperineal template biopsy of the prostate: outcomes from a regional cancer centre. World J Urol 37, 337–342 (2019). https://doi.org/10.1007/s00345-018-2390-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-018-2390-8