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Chen D, Liu G, Xie Y, Chen C, Luo Z, Liu Y. Safety of transrectal ultrasound-guided prostate biopsy in patients receiving aspirin: An update meta-analysis including 3373 patients. Medicine (Baltimore) 2021; 100:e26985. [PMID: 34449467 PMCID: PMC8389937 DOI: 10.1097/md.0000000000026985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The management of aspirin before transrectal prostate puncture-guided biopsy continues to be controversial. The conclusions in newly published studies differ from the published guideline. Therefore, an updated meta-analysis was performed to assess the safety of continuing to take aspirin when undergoing a transrectal ultrasound-guided prostate biopsy (TRUS-PB). METHODS We searched the following databases for relevant literature from their inception to October 30, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Medline, Web of Science, Sinomed, Chinese National Knowledge Internet, and WANGFANG. Studies that compared the bleeding rates between aspirin that took aspirin and non-aspirin groups were included. The quality of all included studies was evaluated using the Newcastle-Ottawa Scale. Revman Manger version 5.2 software was employed to complete the meta-analysis to assess the risk of hematuria, hematospermia, and rectal bleeding. RESULTS Six articles involving 3373 patients were included in this meta-analysis. Our study revealed that compared with the non-aspirin group, those taking aspirin exhibited a higher risk of rectal bleeding after TRUS-PB (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.09-1.49], P = .002). Also, the meta-analysis results did not reveal any significant difference between the 2 groups for the risk of hematuria (RR = 1.02, 95%CI [0.91-1.16], P = .71) and hematospermia (RR = 0.93, 95%CI [0.82-1.06], P = .29). CONCLUSION Taking aspirin does not increase the risk of hematuria and hematospermia after TRUS-PB. However, the risk of rectal bleeding, which was slight and self-limiting, did increase. We concluded that it was not necessary to stop taking aspirin before undergoing TRUS-PB.
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Affiliation(s)
- Di Chen
- Department of Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
| | - Gang Liu
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yurun Xie
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Changsheng Chen
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhihua Luo
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yujun Liu
- Department of Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
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Falahatkar S, Esmaeili S, Rastjou Herfeh N, Kazemnezhad E, Falahatkar R, Yeganeh M, Jafari A. The safety of continued low dose aspirin therapy during Complete Supine Percutaneous Nephrolithotomy (csPCNL). Prog Urol 2021; 32:458-464. [PMID: 34154964 DOI: 10.1016/j.purol.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Using anticoagulants and antiplatelet drugs in patients with cardiovascular and medical comorbidities is prevalent. Because of hyper vascular nature of kidney, physicians tend to stop using aspirin before percutaneous nephrolithotomy (PCNL). We have shown the effects of remaining on low dose aspirin in complete supine PCNL (csPCNL). MATERIAL AND METHODS The records of 643 patients who underwent csPCNL between 2012 and 2018 were analyzed. Surgical outcomes and complications of patients who were on aspirin therapy and continued it daily (group A) were compared with those not taking aspirin (group B). RESULTS Of the 643 csPCNLs, 40 (6%) were performed in patients of group A and the rest of 603 (94%) cases were in group B. The differences between the mean age of groups were statistically significant (60.08±9.45, group A and 48.66±12.32, group B) (P<0.001). Thirty-nine (97.5%) of patients in group A and 548 (90.9%) of group B were stone free by the end of the study which was not statistically significant (P=0.118). The mean operative time between groups A and B (43.20±21.37 and 44.83±16.83, respectively) was not considered significant (P=0.561). There was also no significant difference between 2 groups in any types of complications. Multivariate analysis showed that, perioperative aspirin use was not a significant predictor of transfusion, Hb drop, operative time and other complications. CONCLUSIONS Remaining on aspirin does not increase the risk of bleeding, transfusionand other complications. Consequently, continuing aspirin prioperatively in csPCNL appears safe. There is no fear for continuing aspirin in csPCNL. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- S Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - S Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - N Rastjou Herfeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - E Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - R Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - M Yeganeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - A Jafari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Lee MS, Moon MH, Kim CK, Park SY, Choi MH, Jung SI. Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management. Korean J Radiol 2020; 21:422-430. [PMID: 32193890 PMCID: PMC7082664 DOI: 10.3348/kjr.2019.0576] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/12/2019] [Indexed: 11/15/2022] Open
Abstract
The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Perán Teruel M, Lorenzo-Gómez M, Veiga Canuto N, Padilla-Fernández B, Valverde-Martínez L, Migliorini F, Jorge Pereira B, Pires Coelho H, Osca García J. Complications of transrectal prostate biopsy in our context. International multicenter study of 3350 patients. Actas Urol Esp 2020; 44:196-204. [PMID: 32127231 DOI: 10.1016/j.acuro.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prostate cancer is the most common visceral neoplasm in men and the second one in the United States with the highest mortality behind lung cancer and ahead of colorectal cancer. While prostate cancer mortality rates have been reduced in the United States, Austria, United Kingdom and France, 5-year survival rates have been incremented in Sweden, probably due to a higher diagnostic activity and non-lethal tumor detection. TRPB usually has low rates of serious complications, with a not negligible number of minor complications. Mortality directly associated with this procedure is low and usually related to septic shock. The main complications derived from prostate biopsy can be infectious (mild or severe) and non-infectious (hematuria consistent with hemorrhage, urethral bleeding, rectal bleeding or hemospermia, acute urinary retention, pain or vasovagal reactions). MATERIAL AND METHOD The objective of the study is to compare three usual TRPB protocols and their relationship with the incidence of complications. Retrospective multicenter observational study conducted in three countries (Spain, Italy and Portugal). We have reviewed the medical records of 3350 men who underwent TRPB to evaluate the existence of prostate cancer, with a minimum evolutionary control of 6months. RESULTS The mean age was 65,50years, median 66, range 43-79. The subgroup analysis showed that younger patients had higher rates of acute urine retention (AUR) (P=.0000001). Likewise, our results revealed that younger patients presented more procedural pain (P=.0000001) than older patients. Regarding PSA, the mean value was 10.44, SD 7.73, median 8.15, range 0.98-68.09. A higher body mass index (BMI) was not associated with further infection (P=.000004). When performing the multivariate analysis, it was found that the significant variables in the general group were: age (P=.0013), PSA (P=.0402), local infiltration anesthesia (P=.0001) and prophylaxis with metronidazole +tobramycin +amoxicillin/clavulanic acid +gentamicin (P=.0001), presenting a normal distribution with high confidence interval (95%) and significant correlation. Prophylaxis is the most significant variable for no complications and pain (P=.0001), age (P=.0013) and prophylaxis (P=.0001) are for bleeding, age (P=.0013), prophylaxis and PSA (P=.0001) are for infection, and finally, age (P=.0013), anesthesia with local infiltration and prophylaxis (P=.0001) and PSA (P=.0402) are for AUR. CONCLUSIONS Sedation has fewer side effects and complications related to the transrectal prostate biopsy procedure with respect to transrectal local anesthesia. The choice of the antibiotic prophylaxis scheme is decisive in the onset of complications arising from the performance of a transrectal prostate biopsy.
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Tanabe K, Hattori T, Kobayashi H, Koike K, Maki Y, Arai T, Otsuka T, Suzuki Y, Kondo Y, Kawamura N. Is it safe to continue antithrombotic agents before prostate biopsy? Prostate Int 2019; 7:78-81. [PMID: 31384610 PMCID: PMC6664272 DOI: 10.1016/j.prnil.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/06/2018] [Accepted: 06/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background Whether antithrombotic agents should be stopped before prostate biopsy is unsettled. We investigated the impact of antithrombotic agents on bleeding complications after prostate biopsy. Materials and methods Among the patients who underwent transrectal ultrasound-guided prostate biopsy from June 2006 to December 2013 at Ebina General Hospital, Kanagawa, Japan, 1817 cases were retrospectively assessed. Patients were divided into two groups: those not taking antithrombotic agents (control group) and those taking them (experimental group). The frequency and severity of bleeding complications after the procedure were compared. The severity of bleeding events was graded using the Common Terminology Criteria for Advanced Events vol. 4.0. Results Hemorrhagic complications were classified into grades 1 to 3. Patients with complications of Grade 2 and above needed treatment. As for the Grade 1 event, there were no differences between two groups. The frequency of more than Grade 2 bleeding events was 1.7% and 3.5% in the control and experimental group, respectively; the odds ratio was 2.18 (P = 0.039). Grade 3 events occurred in seven patients of the control group (0.5%) and four patients of the experimental group (1.2%). Conclusions The present study showed that continuation of antithrombotic agents increased the frequency of hemorrhagic complications requiring intervention. It suggests that attention should be paid to the patients taking antithrombotic agents before prostate biopsy.
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Key Words
- AA, antithrombotic agent
- AC, anticoagulant agent
- AP, antiplatelet agent
- ASA, acetylsalicylic acid
- Anticoagulants
- Biopsy
- Hemorrhage
- MAP, major antiplatelet agent
- OR, odds ratio
- PSA, prostate-specific agent
- Platelet aggregation inhibitors
- Prostate
- RR, relative risk
- SD, standard deviation
- TE, thromboembolism
- TPV, total prostate volume
- TRUS, transrectal ultrasound
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Affiliation(s)
- Kuniaki Tanabe
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Tomotaka Hattori
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
- Corresponding author. 1320 Kawaharaguchi, Ebinashi, Kanagawa 243-0433, Japan.
| | | | - Kyoko Koike
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
| | - Yasuhiro Maki
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
| | - Takashi Arai
- Department of Urology Kitakyushu General Hospital, Fukuoka, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Yasutomo Suzuki
- Department of Urology, Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Naoki Kawamura
- Department of Urology, Ebina General Hospital, Kanagawa, Japan
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Alexander SE, Kinsella J, McNair HA, Tree AC. National survey of fiducial marker insertion for prostate image guided radiotherapy. Radiography (Lond) 2018; 24:275-282. [PMID: 30292494 DOI: 10.1016/j.radi.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/29/2018] [Accepted: 06/15/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the United Kingdom fiducial marker IGRT is the second most common verification method employed in radical prostate radiotherapy yet little evidence exists to support centres introducing or developing this practice. We developed a survey to elicit current fiducial marker practices adopted in the UK, to recommend standardisation of practice. METHODS A 16 question survey was distributed across UK Radiotherapy centres via promotion at the British Uro-Oncology Group Conference, 2016. Included were questions relating to workforce planning, patient preparation, insertion procedure and verification methods. The survey was open from September 2016 to January 2017. RESULTS Results from 15 centres routinely inserting fiducial markers for prostate IGRT are presented. Eleven professional groups insert fiducial markers across the UK. Fourteen centres insert fiducial markers trans-rectally; one trans-perineally. Centres adopting a trans-rectal approach administer prophylactic ciprofloxacin as a single agent or combined with gentamicin or metronidazole; poor agreement between regimes presented. One centre has introduced targeted antibiotic prophylaxis. Five brands of fiducial markers are utilised nationally. Fourteen centres standardly insert three single fiducial markers, two common configurations emerged. Coupled fiducial markers are routinely implanted by one centre. All centres delay at least one week between fiducial marker insertion and planning CT; seven centres wait two weeks. The most common fiducial verification method is two-dimensional, paired kilo Voltage imaging. CONCLUSION Variation in fiducial marker practice across the UK is considerable. Standardisation is required to support centres and healthcare professionals developing this service. Seven recommendations, to unify practice, have been proposed based on survey results and literature.
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Affiliation(s)
| | - J Kinsella
- The Royal Marsden NHS Foundation Trust, UK.
| | - H A McNair
- The Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UK.
| | - A C Tree
- The Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UK.
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Quinlan MR, Bolton D, Casey RG. The management of rectal bleeding following transrectal prostate biopsy: A review of the current literature. Can Urol Assoc J 2017; 12:E146-E153. [PMID: 29283091 DOI: 10.5489/cuaj.4660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Since the advent of prostate-specific antigen (PSA)-based testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a standard part of the diagnostic pathway for prostate cancer (PCa). Rectal bleeding is one of the common side effects of this transrectal route. While rectal bleeding is usually mild and self-limiting, it can be life-threatening. In this article, we examine rectal bleeding post-TRUS-guided prostate biopsy and explore the literature to evaluate techniques and strategies aimed at preventing and managing this common and important complication. METHODS A PubMed literature search was carried out using the keywords "transrectal-prostate-biopsy-bleed." A search of the bibliography of reviewed studies was also conducted. Additionally, papers in non-PubMed-listed journals of which the authors were aware were appraised. RESULTS Numerous modifiable risk factors for this bleeding complication exist, particularly anticoagulants/antiplatelets and the number of core biopsies taken. Successfully described corrective measures for such rectal bleeding include tamponade (digital/packs/catheter/tampon/condom), endoscopic sclerotherapy/banding/clipping, radiological embolization, and surgical intervention. CONCLUSIONS We advocate early consultation with the colorectal/gastroenterology and interventional radiology services and a progressive, stepwise approach to the management of post-biopsy rectal bleeding, starting with resuscitation and conservative tamponade measures, moving to endoscopic hemostasis ± radiological embolization ± transanal surgical methods. Given the infrequent but serious nature of major rectal bleeding after TRUS biopsy, we recommend the establishment of centralized databases or registries forthwith to prospectively capture such data. To the best of our knowledge, this is the first comprehensive look specifically at the management of post-TRUS biopsy rectal bleeding.
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Affiliation(s)
- Mark R Quinlan
- Department of Urology, Austin Hospital, Heidelberg, Melbourne, Australia
| | - Damien Bolton
- Department of Urology, Austin Hospital, Heidelberg, Melbourne, Australia
| | - Rowan G Casey
- Department of Urology, Colchester Cancer Centre, Colchester NHS University Foundation Trust, Essex, United Kingdom
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Hamano I, Hatakeyama S, Yoneyama T, Tobisawa Y, Soma O, Matsumoto T, Yamamoto H, Imai A, Yoneyama T, Hashimoto Y, Koie T, Ohyama C. Safety of heparin bridging therapy for transrectal ultrasound-guided prostate biopsy in patients requiring temporary discontinuation of antithrombotic agents. SPRINGERPLUS 2016; 5:1917. [PMID: 27867824 PMCID: PMC5097055 DOI: 10.1186/s40064-016-3610-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Safety of heparin bridging therapy for transrectal ultrasound-guided prostate (TRUS) biopsy in patients requiring temporary discontinuation of antithrombotic therapy is unknown. This study aimed to assess the relationship between heparin bridging therapy and the incidence of complications after TRUS biopsy. METHODS From January 2005 to November 2015, we performed 1307 consecutive TRUS biopsies on 1134 patients in our hospital. The patients were assigned to two groups: those without heparin bridging (the control group) and those with temporary discontinuation of antithrombotic agents with heparin bridging therapy (the bridging group). A 10-12-core TRUS biopsy was performed; the patients were evaluated for bleeding-related complications. RESULTS Of 1134 patients, 1109 (1281 biopsies) and 25 (26 biopsies) were assigned to the control and bridging group, respectively. Patient background did not significantly differ between the control and bridging groups, except for age, history of diabetes, cardiovascular diseases, and CHADS2 scores. Compared with the control group, the bridging group showed a significantly higher rate of complication for any complication (35 vs. 8.3%, P < 0.001), bleeding-related complications (27 vs. 4.4%), and urinary tract infection (7.7 vs. 1.2%). No thromboembolic event was observed in the present study. Multivariate logistic analysis showed that heparin bridging therapy was a significant risk factor for the incidence of any complication and bleeding-related complications. CONCLUSIONS Heparin bridging therapy with temporal discontinuation of antithrombotic agents may increase the risk of complications after TRUS biopsy. Further, large-scale studies are required to clarify the safety of heparin bridging therapy.
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Affiliation(s)
- Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Osamu Soma
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Teppei Matsumoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Atsushi Imai
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan ; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Vasudeva P, Kumar N, Kumar A, Singh H, Kumar G. Safety of 12 core transrectal ultrasound guided prostate biopsy in patients on aspirin. Int Braz J Urol 2016; 41:1096-100. [PMID: 26742966 PMCID: PMC4756934 DOI: 10.1590/s1677-5538.ibju.2015.0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/27/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: To prospectively assess safety outcome of TRUS guided prostate biopsy in patients taking low dose aspirin. Materials and methods: Consecutive patients, who were planned for 12 core TRUS guided prostate biopsy and satisfied eligibility criteria, were included in the study and divided into two Groups: Group A: patients on aspirin during biopsy, Group B: patients not on aspirin during biopsy, including patients in whom aspirin was stopped prior to the biopsy. Parameters included for statistical analysis were: age, serum prostate specific antigen (PSA), prostate volume, hemoglobin (Hb %), number of hematuria episodes, number of patient reporting hematuria, hematuria requiring intervention, number of patient reporting hematospermia and number of patient reporting rectal bleeding. Results: Of 681 eligible patients, Group A and B had 191 and 490 patients respectively. The mean age, prostate volume, serum PSA and pre-biopsy hemoglobin were similar in both Groups with no significant differences noted between them. None of the post-biopsy complications, including number of hematuria episodes (p=0.83), number of patients reporting hematuria (p=0.55), number of patients reporting hematospermia (p=0.36) and number of patients reporting rectal bleeding (p=0.65), were significantly different between Groups A and B respectively. None of the hemorrhagic complication in either group required intervention and were self limiting. Conclusion: Continuing low dose aspirin during TRUS guided prostate biopsy neither alters the minor bleeding episodes nor causes major bleeding complication. So, discontinuation of low dose aspirin prior to TRUS guided prostate biopsy is not required.
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Affiliation(s)
- Pawan Vasudeva
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Niraj Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Anup Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Harbinder Singh
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
| | - Gaurav Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi 110029, India
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Öztürk H. Elective Urological Surgery Following Coronary Stent Implantation: To Whom, How To Do It? Curr Urol 2015. [PMID: 26195945 DOI: 10.1159/000365670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Coronary artery disease is one of the most common diseases today and the primary cause of sudden death. The development of atherosclerosis and the incidence of symptomatic heart and vascular diseases increase depending on the average life expectancy in the elderly population. Stent applications in the treatment of coronary artery disease are quite widespread and are a standard procedure. Stent applications are applied to approximately 2 million people in the United States every year. Therefore, there is an increase in the number of patients with stents. This increase is an important and complex situation for patients who are planned for urological elective surgery. The necessity of treating the patient with the least morbidity and mortality, and supplying the balance in terms of the dose and duration of antiplatelet agents which are used for patients with stents who are planned for elective urological surgery, is main subject of our review. To whom and what should be the treatment are assessed accompanied by the literature.
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Affiliation(s)
- Hakan Öztürk
- Department of Urology, School of Medicine, Sifa University, Izmir, Turkey
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Leavitt DA, Theckumparampil N, Moreira DM, Elsamra SE, Waingankar N, Hoenig DM, Smith AD, Okeke Z. Continuing aspirin therapy during percutaneous nephrolithotomy: unsafe or under-utilized? J Endourol 2015; 28:1399-403. [PMID: 25393457 DOI: 10.1089/end.2014.0235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Aspirin, as an inhibitor of platelets, is traditionally discontinued prior to percutaneous nephrolithotomy (PCNL) given the concern for increased surgical hemorrhage. However, this practice is based on expert opinion only, and mounting evidence suggests holding aspirin perioperatively can be more harmful than once thought. We sought to compared PCNL outcomes and complications in patients continuing aspirin to those stopping aspirin perioperatively. METHODS A retrospective review was performed of 321 consecutive PCNLs done between July 2012 and March 2014. Patients were separated into two groups. The on-aspirin group consisted of patients continuing aspirin throughout the perioperative period. The off-aspirin group had aspirin held temporarily pre- and postoperatively. Surgical outcomes and complications were compared between groups. RESULTS Of the 321 PCNLs, 60 (18.7%) occurred in patients chronically taking aspirin. The on-aspirin group included 17 PCNLs (5.2%), while the off-aspirin group included 43 PCNLs (13.4%). There were no differences between groups in terms of operative time (77 minutes vs 74 minutes, p=0.212), hemoglobin change (p=0.522), stone size (21 mm vs 22 mm, p=1.0), stone-free rate (p=0.314), median length of hospitalization (p=0.642), transfusion rate (p=0.703), or total complications (p=1.0). No patient experienced a thromboembolic event. CONCLUSIONS PCNL is safe in patients continuing aspirin perioperatively and does not result in more blood transfusions, angioembolization procedures, or complications. Patients with large stone burdens who are at high risk for thromboembolic events appear to be able to safely undergo PCNL without discontinuing aspirin.
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Affiliation(s)
- David A Leavitt
- The Smith Institute for Urology , Hofstra North Shore Long Island Jewish School of Medicine, New Hyde Park, New York
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Ellis G, John Camm A, Datta SN. Novel anticoagulants and antiplatelet agents; a guide for the urologist. BJU Int 2015; 116:687-96. [DOI: 10.1111/bju.13131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gidon Ellis
- Department of Urology; Whittington Hospital; London UK
| | - Alan John Camm
- Department of Clinical Cardiology; St George's Healthcare NHS Trust; London UK
| | - Soumendra N. Datta
- Department of Urology; Colchester Hospital University Foundation Trust; Colchester UK
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Asano T, Kobayashi S, Yano M, Otsuka Y, Kitahara S. Continued administration of antithrombotic agents during transperineal prostate biopsy. Int Braz J Urol 2015; 41:116-23. [PMID: 25928517 PMCID: PMC4752064 DOI: 10.1590/s1677-5538.ibju.2015.01.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/26/2014] [Indexed: 11/22/2022] Open
Abstract
Purpose To determine the safety of continued administration of antithrombotic agents during transperineal (TP) prostate biopsy. Patients and Methods A total of 811 men who underwent transrectal ultrasound (TRUS)-guided TP biopsy from January 2008 to June 2012 at our two institutions were retrospectively analyzed. Among these 811 men, 672 received no antithrombotic agents (group I), 103 received and continued administration of antithrombotic agents (group II), and 36 interrupted administration of antithrombotic agents (group III). Overall complications were graded and hemorrhagic complications were compared (group I with group II) using propensity score matching (PSM) analysis. Results An overall complication rate of 4.6% was recorded. Hemorrhagic complications occurred in 1.8% and they were virtually identical in all the three groups, and no severe hemorrhagic complications occurred. One patient in group III required intensive care unit admission for cerebral infarction. PSM analysis revealed no statistical difference between groups I and II with regard to the incidence of gross hematuria, perineal hematoma, and rectal bleeding. Multiple regression analysis revealed that hemorrhagic complications were associated with lower body mass index (<21 kg/m2, P=0.0058), but not with administration of antithrombotic agents. Conclusions Continued administration of antithrombotic agents does not increase the risk of hemorrhagic complications; these agents are well tolerated during TP biopsy.
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Affiliation(s)
- Toko Asano
- Service of Urology, Omori Red Cross Hospital, Tokyo, Japan
| | | | - Masataka Yano
- Service of Urology, Tama-Nambu Chiiki Hospital, Tokyo, Japan
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Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR, White JR, Lightner DJ. Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review Paper. J Urol 2014; 192:1026-34. [DOI: 10.1016/j.juro.2014.04.103] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Daniel J. Culkin
- Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Emilio J. Exaire
- Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
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Fischer C, Lümmen G. [ASA and clopidogrel for urological operations. Perioperative management]. Urologe A 2014; 52:1597-605. [PMID: 24121474 DOI: 10.1007/s00120-013-3263-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In a systematic overview and meta-analysis among more than 50,000 patients at risk for coronary artery disease, not adhering to or discontinuing aspirin (acetylsalicylic acid, ASA) was associated with a significantly increased risk of non-fatal myocardial infarction or death. Withdrawal of low dose aspirin was correlated with a threefold increase in the risk of adverse cardiovascular events. This risk is present irrespective of the length of time patients had been taking low dose aspirin. Therefore, in patients on chronic low dose aspirin for secondary prevention of cardiovascular disease, aspirin should never be discontinued. In the few available studies in urological surgery the increase in bleeding does not translate into a significant increase in specific morbidity. This seems to be also true for the additional administration of clopidogrel to aspirin. Nevertheless, in patients with drug-eluting stents and dual antiplatelet therapy, urologists should ensure a multidisciplinary management of the perioperative course.
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Abstract
A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection and avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. Magnetic resonance imaging-guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers. Hematuria, hematospermia, and rectal bleeding are common complications of prostate needle biopsy, but are generally self-limiting and well tolerated. All men should receive antimicrobial prophylaxis before biopsy.
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Rossini R, Musumeci G, Visconti LO, Bramucci E, Castiglioni B, De Servi S, Lettieri C, Lettino M, Piccaluga E, Savonitto S, Trabattoni D, Capodanno D, Buffoli F, Parolari A, Dionigi G, Boni L, Biglioli F, Valdatta L, Droghetti A, Bozzani A, Setacci C, Ravelli P, Crescini C, Staurenghi G, Scarone P, Francetti L, D’Angelo F, Gadda F, Comel A, Salvi L, Lorini L, Antonelli M, Bovenzi F, Cremonesi A, Angiolillo DJ, Guagliumi G. Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: a consensus document from Italian cardiological, surgical and anaesthesiological societies. EUROINTERVENTION 2014; 10:38-46. [DOI: 10.4244/eijv10i1a8] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tyng CJ, Maciel MJS, Moreira BL, Matushita Jr. JPK, Bitencourt AGV, Poli MRB. Preparation and management of complications in prostate biopsies. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000600009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64:876-92. [PMID: 23787356 DOI: 10.1016/j.eururo.2013.05.049] [Citation(s) in RCA: 676] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/24/2013] [Indexed: 12/11/2022]
Abstract
CONTEXT Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment. OBJECTIVE To perform a systematic review of complications from prostate biopsy. EVIDENCE ACQUISITION A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality. EVIDENCE SYNTHESIS After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare. CONCLUSIONS Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
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Manocha D, Singh M, Mehta N, Murthy UK. Bleeding risk after invasive procedures in aspirin/NSAID users: polypectomy study in veterans. Am J Med 2012; 125:1222-7. [PMID: 23164486 DOI: 10.1016/j.amjmed.2012.05.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/24/2012] [Accepted: 05/31/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aspirin, by virtue of inhibition of platelet hemostatic function, is withheld before many invasive procedures because of the bleeding risk. American Society of Gastrointestinal Endoscopy guidelines acknowledge the paucity of "high quality data" to make recommendations regarding the use of aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) before endoscopic procedures. Yet the majority of endoscopists hold ASA/NSAIDs before polypectomy. METHODS This single-center, retrospective, cohort study was conducted at Veterans Affairs Medical Center, Syracuse, NY. The objectives were to assess the postpolypectomy bleeding risk in ASA/NSAID users in a large cohort of veterans undergoing colonoscopic polypectomy and to identify risk factors associated with postpolypectomy bleeding. All patients undergoing polypectomy between January 2002 and October 2007 were eligible. Patients on anticoagulants/other antiplatelet agents were excluded. Patients were selected randomly by cluster sampling techniques. Electronic medical and pharmacy records were reviewed for patient demographics, polypectomy techniques, and postpolypectomy bleeding rates. Univariate analysis was performed between patients on ASA and NSAIDs (group A) versus those not on ASA or NSAIDs (group B). Multiple regression analysis was performed to identify independent risk factors associated with postpolypectomy bleeding. RESULTS Five hundred two (43%) of 1174 patients (mean age 66 years, 92% white) were on ASA or NSAIDs, or both. There was no significant difference between postpolypectomy bleeding rates among the 2 groups (3.2% vs 3.0%). Age, sex, polyp characteristics, and polypectomy techniques were comparable between groups A and B. In multiple logistic regression analysis, ASA or NSAID use was not a significant risk factor for postpolypectomy bleeding. Number of polyps removed per patient was the only risk factor significantly associated with postpolypectomy bleeding (P <.01, odds ratio 1.3, 95% confidence interval, 1.18-1.43). CONCLUSIONS In this large study, use of ASA or NSAIDs did not increase the risk of postpolypectomy bleeding. Cessation of ASA/NSAIDs before colonoscopy/polypectomy is therefore unnecessary.
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Wang J, Zhang C, Tan G, Chen W, Yang B, Tan D. Risk of Bleeding Complications after Preoperative Antiplatelet Withdrawal versus Continuing Antiplatelet Drugs during Transurethral Resection of the Prostate and Prostate Puncture Biopsy: A Systematic Review and Meta-Analysis. Urol Int 2012; 89:433-8. [DOI: 10.1159/000343733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 11/19/2022]
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Madej A, Wilkosz J, Różański W, Lipiński M. Complication rates after prostate biopsy according to the number of sampled cores. Cent European J Urol 2012; 65:116-8. [PMID: 24578945 PMCID: PMC3921797 DOI: 10.5173/ceju.2012.03.art3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 05/31/2012] [Accepted: 06/01/2012] [Indexed: 11/22/2022] Open
Abstract
Introduction A prostate biopsy can result in such complications as: hematuria, rectal bleeding, pain in hypogastrium, perineum or urethra, fever, nausea, vomiting, retention of urine or other adverse events. The aim of this research was to estimate complication rates after a prostate biopsy based on the number of cores. Material and methods The complication rate was evaluated on the basis of questionnaires filled out by patients. Questions were related to the occurrence of mentioned complications on the first and second day after prostate biopsy. Patients were divided into two groups: 1st group (41 patients) 5-8 cores and 2nd group (73 patients) 12 or more cores. Results There was no significant statistical difference in the occurrence of complications mentioned in the questionnaires in both groups. The biggest difference was recorded for hematuria – 1st day: 39% in the 1st and 53% in the 2nd group (p = 0.1398); 2nd day: 15% in the 1st and 30% in the 2nd group (p = 0.0650). Rectal bleeding on the 1st day also seems to vary: 12% in the 1st and 26% in the 2nd group (p = 0.0835). Other complications occurred in 3-8% of patients. 32% of patients in the 1st and 29% in the 2nd group (p = 0.7419) had no complications at all. Conclusions The most common complications after a prostate biopsy are hematuria and rectal bleeding. Other complication rates are low. In general, complication rates after a prostate biopsy procedure are not related to the number of sampled cores.
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Affiliation(s)
- Adam Madej
- 2 Department of Urology, Medical University of Łódź, Poland
| | - Jacek Wilkosz
- 2 Department of Urology, Medical University of Łódź, Poland
| | | | - Marek Lipiński
- 2 Department of Urology, Medical University of Łódź, Poland
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Should more patients continue aspirin therapy perioperatively?: clinical impact of aspirin withdrawal syndrome. Ann Surg 2012; 255:811-9. [PMID: 22470078 DOI: 10.1097/sla.0b013e318250504e] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To provide an evidence-based focused review of aspirin use in the perioperative period along with an in-depth discussion of the considerations and risks associated with its preoperative withdrawal. BACKGROUND For patients with established cardiovascular disease, taking aspirin is considered a critical therapy. The cessation of aspirin can cause a platelet rebound phenomenon and prothrombotic state leading to major adverse cardiovascular events. Despite the risks of aspirin withdrawal, which are exacerbated during the perioperative period, standard practice has been to stop aspirin before elective surgery for fear of excessive bleeding. Mounting evidence suggests that this practice should be abandoned. METHODS We performed a PubMed and Medline literature search using the keywords aspirin, withdrawal, and perioperative. We manually reviewed relevant citations for inclusion. RESULTS/CONCLUSIONS Clinicians should employ a patient-specific strategy for perioperative aspirin management that weighs the risks of stopping aspirin with those associated with its continuation. Most patients, especially those taking aspirin for secondary cardiovascular prevention, should have their aspirin continued throughout the perioperative period. When aspirin is held preoperatively, the aspirin withdrawal syndrome may significantly increase the risk of a major thromboembolic complication. For many operative procedures, the risk of perioperative bleeding while continuing aspirin is minimal, as compared with the concomitant thromboembolic risks associated with aspirin withdrawal. Those cases where aspirin should be stopped include patients undergoing intracranial, middle ear, posterior eye, intramedullary spine, and possibly transurethral prostatectomy surgery.
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Raheem OA, Casey RG, Galvin DJ, Manecksha RP, Varadaraj H, McDermott T, Grainger R, Lynch TH. Discontinuation of anticoagulant or antiplatelet therapy for transrectal ultrasound-guided prostate biopsies: a single-center experience. Korean J Urol 2012; 53:234-9. [PMID: 22536465 PMCID: PMC3332133 DOI: 10.4111/kju.2012.53.4.234] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/22/2011] [Indexed: 11/29/2022] Open
Abstract
Purpose Historically, it was thought that hemorrhagic complications were increased with transrectal ultrasound-guided prostate biopsies (TRUS biopsy) of patients receiving anticoagulation/antiplatelet therapy. However, the current literature supports the continuation of anticoagulation/antiplatelet therapy without additional morbidity. We assessed our experience regarding the continuation of anticoagulation/antiplatelet therapy during TRUS biopsy. Materials and Methods A total of 91 and 98 patients were included in the anticoagulation/antiplatelet (group I) and control (group II) groups, respectively. Group I subgroups consisted of patients on monotherapy or dual therapy of aspirin, warfarin, clopidogrel, or low molecular weight heparin. The TRUS biopsy technique was standardized to 12 cores from the peripheral zones. Patients completed a questionnaire over the 7 days following TRUS biopsy. The questionnaire was designed to assess the presence of hematuria, rectal bleeding, and hematospermia. Development of rectal pain, fever, and emergency hospital admissions following TRUS biopsy were also recorded. Results The patients' mean age was 65 years (range, 52 to 74 years) and 63.5 years (range, 54 to 74 years) in groups I and II, respectively. The overall incidence of hematuria was 46% in group I compared with 63% in group II (p=0.018). The incidence of hematospermia was 6% and 10% in groups I and II, respectively. The incidence of rectal bleeding was similar in group I (40%) and group II (39%). Statistical analysis was conducted by using Fisher exact test. Conclusions There were fewer hematuria episodes in anticoagulation/antiplatelet patients. This study suggests that it is not necessary to discontinue anticoagulation/antiplatelet treatment before TRUS biopsy.
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Affiliation(s)
- Omer A Raheem
- Department of Urology, St James's Hospital, Dublin, Ireland.
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Gupta AD, Streiff M, Resar J, Schoenberg M. Coronary stent management in elective genitourinary surgery. BJU Int 2011; 110:480-4. [PMID: 22192977 DOI: 10.1111/j.1464-410x.2011.10821.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
What's known on the subject? and What does the study add? Withdrawal of dual antiplatelet therapy before the recommended, 12 months for drug-eluting stents and 1 month for bare-metal stents increases the rate of major adverse coronary events and mortality. However, in those undergoing surgery the risk of bleeding is increased substantially for those on antiplatelet agents. Successful management in patients with coronary stents who must undergo elective or non-elective urological surgery should be a multidisciplinary decision. This article reviews the literature and recommends a protocol for clinical management of patients undergoing urological procedures after coronary stent placement. To review the literature on coronary stents and genitourinary surgery and provide a protocol for perioperative. The keywords, 'elective surgery', 'aspirin', 'clopidogrel', 'guidelines for percutaneous coronary intervention', and 'antiplatelet therapy after coronary stent placement' were used to search PubMed for any relevant articles relating to coronary stents. Recommendations were made based on the whether the procedures patients were exposed to placed them at low-, moderate- or high-bleeding risk based on the extent of the procedure. All elective procedures should be delayed for 1 month after bare-metal stent placement and 1 year after drug-eluting stent placement. In patients classified as low risk (endoscopy and laser prostatectomy), aspirin should be continued throughout the perioperative period and dual antiplatelet therapy should continue 24-48 h postoperatively, if there is no concern for active bleeding. In those classified as moderate risk (scrotal procedures, transurethral resection of bladder tumours, transurethral resection of the prostate, urinary sphincter placement) dual antiplatelet therapy should be discontinued 5-7 days before the procedure and continued within 7 days after procedure, if there is no concern for active bleeding, in consultation with cardiology. In high-risk procedures (cystectomy, nephrectomy, prostatectomy, penile prosthesis placement) dual antiplatelet therapy should be discontinued 10 days before the procedure and continued postoperatively within 7-10 days of the procedure, when there is no longer a concern for active bleeding with the assistance of a cardiologist. Coronary artery disease is becoming more prominent in our society, increasing the use of coronary stents and antiplatelet agents. With the proposed protocol, it is safe to proceed with surgical intervention in those that have adequate stent endothelialisation.
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Affiliation(s)
- Angela D Gupta
- Departments of Urology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Carmignani L, Picozzi S, Bozzini G, Negri E, Ricci C, Gaeta M, Pavesi M. Transrectal ultrasound-guided prostate biopsies in patients taking aspirin for cardiovascular disease: A meta-analysis. Transfus Apher Sci 2011; 45:275-80. [DOI: 10.1016/j.transci.2011.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safety of Ultrasound-Guided Fine Needle Aspiration Biopsy of Neck Lesions in Patients Taking Antithrombotic/Anticoagulant Medications. Ultrasound Q 2011; 27:157-9. [DOI: 10.1097/ruq.0b013e31822b5681] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vasudeva P, Goel A, Sengottayan VK, Sankhwar S, Dalela D. Antiplatelet drugs and the perioperative period: What every urologist needs to know. Indian J Urol 2011; 25:296-301. [PMID: 19881119 PMCID: PMC2779948 DOI: 10.4103/0970-1591.56174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Antiplatelet agents like aspirin and clopidogrel are widely used for indications ranging from primary and secondary prevention of myocardial infarction or stroke to prevention of coronary stent thrombosis after percutaneous coronary interventions. When patients receiving antiplatelet drugs are scheduled for surgery, urologists commonly advise routine periprocedural withdrawal of these drugs to decrease the hemorrhagic risks that may be associated if such therapy is continued in the perioperative period. This approach may be inappropriate as stopping antiplatelet drugs often exposes the patient to a more serious risk, i.e. the risk of developing an arterial thrombosis with its potentially fatal consequences. Moreover, it has been seen that the increase in perioperative bleeding if such drugs are continued is usually of a quantitative nature and does not shift the bleeding complication to a higher risk quality. We, in this mini review, look at the physiological role and pathological implications of platelets, commonly used antiplatelet therapy and how continuation or discontinuation of such therapy in the perioperative period affects the hemorrhagic and thrombotic risks, respectively. Literature on the subject between 1985 and 2008 is reviewed. The consensus that seems to have emerged is that the policy of routine discontinuation of antiplatelet drugs in the perioperative period must be discouraged and risk stratification must be employed while making decisions regarding continuation or temporary discontinuation of antiplatelet therapy. Although antiplatelet drugs may be discontinued in patients at a low risk for an arterial thrombotic event, they must be continued in patients where the risks of bleeding and complications related to excessive bleeding are less than the risks of developing arterial thrombosis.
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Affiliation(s)
- Pawan Vasudeva
- Department of Urology, C.S.M.M.U (Upgraded King George Medical College), Lucknow, Uttar Pradesh, India
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Affiliation(s)
- Assaad El-Hakim
- Assistant Professor of Urology, McGill University, Montréal, QC
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Morbidity Of Prostate Biopsy After Simplified Versus Complex Preparation Protocols: Assessment of Risk Factors. Urology 2011; 77:910-4. [DOI: 10.1016/j.urology.2010.12.033] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 12/17/2010] [Accepted: 12/21/2010] [Indexed: 11/23/2022]
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Václavík J, Táborský M. Antiplatelet therapy in the perioperative period. Eur J Intern Med 2011; 22:26-31. [PMID: 21238889 DOI: 10.1016/j.ejim.2010.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/01/2010] [Accepted: 10/25/2010] [Indexed: 12/22/2022]
Abstract
The current practice of withdrawing aspirin 7-10 days preoperatively may be dangerous in certain groups of patients. The risk of cardiovascular events increases 3-fold after aspirin withdrawal. The average time between aspirin withdrawal and the manifestation of acute coronary syndrome is 8 to 11 days. The withdrawal of clopidogrel earlier than 4-6 weeks after bare metal stent implantation or less than 12 months after drug-eluting stent implantation is very risky and poses a high risk of stent thrombosis and high perioperative mortality. Continuing aspirin perioperatively leads to a 1.5-fold increase in perioperative bleeding complications but it does not lead to a higher severity of bleeding complications or higher mortality. The article analyzes current European and American guidelines for perioperative antiplatelet treatment and suggests an algorithm based on the guidelines to help make clinical decisions.
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Affiliation(s)
- Jan Václavík
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc and Palacký University Faculty of Medicine, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic.
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Poh CL, Ho P, Lee CH. Noncardiac surgery following percutaneous coronary intervention. Interv Cardiol 2010. [DOI: 10.2217/ica.10.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Eberli D, Chassot PG, Sulser T, Samama CM, Mantz J, Delabays A, Spahn DR. Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents. J Urol 2010; 183:2128-36. [DOI: 10.1016/j.juro.2010.02.2391] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel Eberli
- Urology Clinic, University Hospital Zürich, Zürich, Switzerland
| | - Pierre-Guy Chassot
- Department of Biology and Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - Tullio Sulser
- Urology Clinic, University Hospital Zürich, Zürich, Switzerland
| | - Charles Marc Samama
- Department of Anaesthesiology and Intensive Care, Hotel-Dieu University Hospital, Paris, France
| | - Jean Mantz
- Department of Anaesthesiology and Critical Care, Beaujon & Louis Mourier University Hospitals, Clichy, France
| | - Alain Delabays
- Department of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Donat R. Spahn
- Institute of Anaesthesiology, University Hospital Zürich, Zürich, Switzerland
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Kariotis I, Philippou P, Volanis D, Serafetinides E, Delakas D. Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin. Int Braz J Urol 2010; 36:308-16. [DOI: 10.1590/s1677-55382010000300007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2009] [Indexed: 05/26/2023] Open
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[Severe late rectal bleeding after biopsy of prostate: a case report]. Prog Urol 2010; 20:389-91. [PMID: 20471586 DOI: 10.1016/j.purol.2009.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 10/31/2009] [Accepted: 12/15/2009] [Indexed: 11/21/2022]
Abstract
The biopsy of the prostate is a common medical act, which is little invasive and can easily be practiced in external care. Some cases of early rectal or urinary bleedings, which mainly stopped spontaneously, have been described in the literature. The case reported here is that of a patient whose hemorrhagic syndrome arose more than two weeks after the biopsy and required an endoscopic haemostatic treatment.
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The Effect of Rectal Foley Catheterization on Rectal Bleeding Rates after Transrectal Ultrasound–guided Prostate Biopsy. J Vasc Interv Radiol 2008; 19:1344-6. [DOI: 10.1016/j.jvir.2008.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 06/01/2008] [Accepted: 06/03/2008] [Indexed: 11/23/2022] Open
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38
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Lee L, Pilcher J. The role of transrectal ultrasound and biopsy in the diagnosis and management of prostate cancer. IMAGING 2008. [DOI: 10.1259/imaging/41490379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Halliwell O, Yadegafar G, Lane C, Dewbury K. Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications. Clin Radiol 2008; 63:557-61. [DOI: 10.1016/j.crad.2007.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 09/21/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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40
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Lesur G, Fontaine E, Page B. [Severe lower gastrointestinal bleeding related to prostate biopsy]. ACTA ACUST UNITED AC 2008; 32:848-9. [PMID: 18394838 DOI: 10.1016/j.gcb.2008.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 01/08/2008] [Indexed: 10/22/2022]
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Giannarini G, Mogorovich A, Valent F, Morelli G, De Maria M, Manassero F, Barbone F, Selli C. Continuing or Discontinuing Low-Dose Aspirin Before Transrectal Prostate Biopsy: Results of a Prospective Randomized Trial. Urology 2007; 70:501-5. [PMID: 17688919 DOI: 10.1016/j.urology.2007.04.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 03/13/2007] [Accepted: 04/19/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine whether the incidence and duration of bleeding complications after transrectal prostate biopsy (PB) in patients not discontinuing low-dose aspirin (LDA) are greater than in those discontinuing it. METHODS A total of 200 consecutive subjects taking chronic LDA were enrolled in a prospective trial and were randomly assigned to undergo transrectal PB while continuing LDA (group 1, n = 67), replacing LDA with low-molecular-weight heparin (group 2, n = 67), or discontinuing LDA (group 3, n = 66). The incidence and duration of hematuria, rectal bleeding, and hematospermia for each group were assessed with a self-administered questionnaire. On days 14 and 30 after PB, all men were evaluated with an outpatient visit and a telephone interview, respectively. RESULTS The cohort comprised 196 assessable subjects. The median number of biopsy cores taken was 10 (range 6 to 10). The overall bleeding rate was 78.5%, 69.7%, and 81.5% in groups 1, 2, and 3, respectively (P = 0.26). No significant difference was found for hematuria, rectal bleeding, or hematospermia among the groups. No severe bleeding complications occurred. The median duration of hematuria and rectal bleeding was significantly greater statistically in groups 1 and 2 compared with group 3 (6, 4, and 2 days versus 3, 2, and 1 days, respectively; P <0.0001). The proportion of men still reporting hematospermia at 30 days after PB was 21.4%, 18.5%, and 9.3% in groups 1, 2, and 3, respectively (P = 0.2). CONCLUSIONS The continued use of LDA in men undergoing transrectal PB did not increase the incidence of mild bleeding complications, although it prolonged the duration of self-limiting hematuria and rectal bleeding. Its effect, however, on severe bleeding remains to be determined.
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Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis 2007; 10:283-7. [PMID: 17310259 DOI: 10.1038/sj.pcan.4500955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy (TRUS-PB). The true incidence of hemospermia, its duration and implications are not well established. We performed a prospective observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution. Sixty-three eligible men were included in the study. Most men (84%) undergoing TRUS-PB, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 3.5 (+/-1.7) weeks. The number of ejaculations before the complete resolution of hemospermia was 8 (+/-6.7). None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity.
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Affiliation(s)
- M Manoharan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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44
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Armstrong MJ, Schneck MJ, Biller J. Discontinuation of perioperative antiplatelet and anticoagulant therapy in stroke patients. Neurol Clin 2006; 24:607-30. [PMID: 16935191 DOI: 10.1016/j.ncl.2006.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Growing evidence suggests that perioperative withdrawal of ASA for secondary stroke prevention increases thromboembolic risk without the associated benefit of decreased bleeding complications. ASA maintenance is acceptable in many procedures, including invasive ones. Many procedures, in particular ophthalmologic, dermatologic, and dental surgeries, also are safe while continuing oral AC. Warfarin has been continued successfully even in some surgeries that have high bleeding risk. When the risk is too high, temporary bridging therapy with LWMH is safe in many populations. Although the exact thromboembolic risks associated with temporary cessation of AP and AC are unknown and likely low, morbidity and mortality associated with thromboembolism are high. Further studies investigating the risks and benefits of maintaining AP and AC during procedures, particularly invasive ones, are needed. Meanwhile, it is critical that physicians understand the risks and benefits of perioperative AP and AC and the variety of procedures in which these agents can be safely continued.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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Sadeghi-Nejad H, Simmons M, Dakwar G, Dogra V. Controversies in Transrectal Ultrasonography and Prostate Biopsy. Ultrasound Q 2006; 22:169-75. [PMID: 16957611 DOI: 10.1097/01.ruq.0000226875.35184.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transrectal ultrasound-guided biopsy of the prostate is the gold standard for the detection of prostate cancer. In its current form, transrectal gray-scale ultrasound is unable to differentiate malignant prostate tissue from benign tissue. The general indications for performing a sonographic guided biopsy of the prostate are an abnormal digital rectal examination or an abnormal prostate-specific antigen (PSA). Several controversial areas remain: the ideal number of biopsy cores, the use of PSA velocity, free PSA, PSA density, age- and race-adjusted PSA, the use of local anesthetics, and the overall best patient preparation methods, including such topics as routine antibiotic prophylaxis or bowel enemas, remain unsettled. There are also unanswered questions regarding repeat biopsy and protocols for managing patients with a diagnosis of high-grade intraepithelial neoplasia. This article will explore some of the current controversies and review the pertinent literature.
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Affiliation(s)
- Hossein Sadeghi-Nejad
- Center for Male Reproductive Medicine, Hackensack University Medical Center, Hackensack, and Section of Urology, VA New Jersey Health Care System, East Orange, NJ, USA
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Raja J, Ramachandran N, Munneke G, Patel U. Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer. Clin Radiol 2006; 61:142-53. [PMID: 16439219 DOI: 10.1016/j.crad.2005.10.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 09/11/2005] [Accepted: 10/07/2005] [Indexed: 11/18/2022]
Abstract
In contemporary practice, most prostate cancers are either invisible on ultrasound or indistinguishable from concurrent benign prostatic hyperplasia. Diagnosis therefore rests on prostate biopsy. Biopsies are not simply directed at ultrasonically visible lesions, as these would miss many cancers; rather the whole gland is sampled. The sampling itself is systematic, using patterns based on prostate zonal anatomy and the geographical distribution and frequency of cancer. This review explains the evolution of the prostate biopsy technique, from the classical sextant biopsy method to the more recent extended biopsy protocols (8, 10, 12, >12 and saturation biopsy protocols). Extended protocols are increasingly being used to improve diagnostic accuracy, especially in those patients who require repeat biopsy. This trend has been facilitated by the ongoing improvement in safety and acceptability of the procedure, particularly with the use of antibiotic prophylaxis and local anaesthesia. The technical details of these extended protocols are discussed, as are the current data regarding procedure-related morbidity and how this may be minimized.
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Affiliation(s)
- J Raja
- Department of Radiology, St George's Hospital, Tooting, London, UK.
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48
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Correct answers to multiple choice questions appearing in the European Urology Update Series 2005. BJU Int 2005. [DOI: 10.1111/j.1464-410x.2005.05978.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Ramachandran N, MacKinnon A, Allen C, Dundas D, Patel U. Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications. Clin Radiol 2005; 60:1130. [PMID: 16179175 DOI: 10.1016/j.crad.2005.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 04/28/2005] [Indexed: 11/21/2022]
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50
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Chappell B, McLoughlin J. Technical considerations when obtaining and interpreting prostatic biopsies from men with suspicion of early prostate cancer: Part I. BJU Int 2005; 95:1135-40. [PMID: 15877722 DOI: 10.1111/j.1464-410x.2005.05538.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Barnaby Chappell
- Department of Urology, West Suffolk Hospital, Bury St Edmunds, Suffolk, UK
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