Factors Influencing Urinary Retention After Transperineal Template Biopsy of the Prostate: Outcomes from a Regional Cancer Centre

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.

In our retrospective review of 243 cases of transperineal template biopsies performed at a single institution, 31/243 (12.8%) patients developed urinary retention, defined as patient discomfort and inability to micturate and bladder scan of >600mls. Patients in the retention group were significantly older (mean 68.7vs.65.8years, P=0.034). Prostate volume was significantly greater in comparison with the non-retention group (mean 75.4vs.57.2cc, 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. Presence of diabetes was found to be significantly associated with a greater risk of urinary retention as 16.1% of patients who developed retention were diabetic (5/31), compared with 5.2% (11/212) in the non-retention group (P=0.02). Other medical comorbidities such as hypertension, cardiovascular disease and hypercholesterolaemia appeared not to influence development of urinary retention.

In summary, factors resulting in an increased risk of urinary retention are advancing age (>68.7years); a larger prostate volume (>75cc); 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 in suitable patients may avoid urinary retention in the high-risk groups identified.

Written by: Francesca Kum MBBS, BSc, MEd, MRCS, Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, UK

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