Rare Complication after a Transrectal Ultrasound Guided Prostate Biopsy: A Giant Retroperitoneal Hematoma

Abstract

Common complications related to transrectal ultrasound (TRUS) guided prostatic needle biopsy are hematuria, hematospermia, and hematochezia. To the best of our knowledge, we report the second case of a very large hematoma extending from the pelvis into the retroperitoneal space in literature.

A 66-year-old man with a serum prostate-specific antigen (PSA) of 5.4 ng/ml was admitted to our department for a TRUS-guided prostatic needle biopsy. Laboratory values on the day before biopsy, including coagulation studies, were all normal. The patients did not take any anticoagulant drugs. No immediate complications were encountered. Nevertheless, 7 hours after the biopsy, the patient reached our emergency department with severe diffuse abdominal pain, hypotension, tachycardia, and confusional state. He underwent an ultrasonography and then a computed tomography (CT) scan that showed “a blood collection in the pelvis that extending to the lower pole of left kidney associated with a focus of active contrast extravasation, indicating active ongoing prostate bleeding.” Consequently, he underwent a diagnostic angiography that showed no more contrast extravasation, without the need of embolization. Management of hematoma has been conservative and hematoma was completely reabsorbed 4 months later.

Keywords

Embolization Prostatic biopsy Prostatic bleeding Retroperitoneal hematoma

Get full access to this article

View all access options for this article.

References

Loeb

Vellekoop

Ahmed

. Systematic review of complications of prostate biopsy. Eur Urol. 2013; 64 (6): 876–892.

Kaneko

Suzuki

Matsushita

Yoshida

[Transcatheter arterial embolization for bleeding of prostatic artery after prostate biopsy]. Nippon Hinyokika Gakkai Zasshi. 2003; 94 (7): 693–695.

Grabe

Bartoletti

Bjerklund Johansen

T.E.

Cai

Çek

Köves

Naber

K.G.

Pickard

R.S.

Tenke

Wagenlehner

Wullt

Guidelines on Urological Infections;

EAU Guidelines. 2015 (pag.57, Table 24).

Pinsky

Parnes

Andriole

Mortality and complications after prostate biopsy in the Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) trial. BJU Int. 2014; 113 (2): 254–259.

Pinkhasov

Lin

Palmerola

. Complications following prostate needle biopsy requiring hospital admission or emergency department visits: experience from 1000 consecutive cases. BJU Int. 2012; 110 (3): 369–374.

Guo

Sadler

Gray

Intraprostatic hematoma with active bleeding post-prostate biopsy. Can Urol Assoc J. 2014; 8 (11-12).

Bekarma

Smart

The use of a urinary catheter and rectal sponge to tamponade severe bleeding following TRUS prostate biopsy. Ann R Coll Surg Engl. 2014; 96 (7): 555.

Petroski

Griewe

Schenkman

Delayed life-threatening hemorrhage after transrectal prostate needle biopsy. Prostate Cancer Prostatic Dis. 2003; 6 (2): 190–192.

Martins Pisco

Pereira

Rio Tinto

Fernandes

Bilhim

How to perform prostatic arterial embolization. Tech Vasc Interv Radiol. 2012; 15 (4): 286–289.

10.

Yuan

Wong

Lin

Kang

Liu

Hsu

Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma. Scand J Trauma Resusc Emerg Med. 2012; 20 (1): 46.