Complications of transrectal aspiration biopsy of the prostate

Four cases of coli-sepsis, one with a fatal outcome have been observed after more than 14 000 transrectal aspiration biopsies (TAB) of the prostate performed at Karolinska Sjukhuset with Franzén's apparatus. A few cases of transient febrile reaction and urinary contamination after TAB of the prostate have also been recognised. One of the patients with sepsis and two with febrile reactions belonged to a relatively small group of patients referred from the Department of Rheumatology. These observations prompted the present study. The records of all the patients referred for TAB of the prostate from the Department of Rheumatology were reviewed. Four complications (three patients with febrile reaction and growth of E. coli in the urine and one case of sepsis) were observed after 63 biopsies in 51 patients (6.3%). The patient with sepsis and two other patients with complications belonged to a group of 32 patients with proven rheumatic disease (chronic polyarthritis): 42 biopsies had been performed in this particular group of patients, bringing the incidence of complication to 7.1%. For comparison the records of 294 patients from the Department of Urology submitted to TAB of the prostate were also reviewed. Complications in the form of transient febrile reactions were found in five cases after 508 biopsies (1.0%). In addition, three cases of coli-sepsis not belonging to the above-mentioned groups are briefly described as case reports. Patients with rheumatic disease (chronic polyarthritis) seem to run a higher risk of complications after TAB of the prostate. Sepsis from E. coli is a rare but serious complication which can develop into, often fatal, endotoxin shock. TAB of the prostate should therefore be restricted to cases with clinical suspicion of prostatic malignancy.