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Factors influencing urinary retention after transperineal template biopsy of the prostate: outcomes from a regional cancer centre

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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.

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Authors and Affiliations

  1. Department of Urology (c/o Mr Raj Nigam), Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK

    Francesca Kum, Adam Jones & Raj Nigam

Authors
  1. Francesca Kum
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  2. Adam Jones
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  3. Raj Nigam
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Correspondence to Francesca Kum.

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The authors declare that there are no conflicts of interest.

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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

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  • DOI: https://doi.org/10.1007/s00345-018-2390-8

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