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Complications of prostate biopsy cont’d

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I was discussing the possible side effects of having a prostate sample test. I discussed the most common, but milder and self-limiting side effects such as pain, rectal discomfort, bleeding from the anus, blood in the semen or urine passage, prostate swelling with difficulty passing urine and urinary stoppage. I also discussed urinary bladder infection. Today, I will look at an infection that is predictable and dangerous. As we discussed, a prostate sample test is done through the rectum, which is filled with bugs{{more}}. These bugs or bacteria have a potential for causing a prostate infection when a needle is passed from the rectum into the prostate. I, therefore, put everyone on a course of antibiotics, starting a day or two before the biopsy and continuing for another few days after the biopsy. This usually prevents most infections. Unfortunately, about one in 20 men will contract a prostate infection and about half of these will suffer what we call septicemia or blood poisoning. This is despite the use of antibiotics. This scenario arises from the prior abuse or use of antibiotics which causes development of resistant strains of bacteria that live in and on our bodies. These resistant strains of bacteria may be present in the urine or urine passage or in the rectum, so that when a sample test of the prostate, is performed, these resistant bugs invade the prostate then the blood stream to cause a prostate and blood infection.

So, how do you know if you will contract a blood infection? We really don’t “know”, but we can have an idea of who will. Obviously, people with bladder, prostate and urine infection before the biopsy are at risk, as are men who are diabetics, are taking medications which suppress the immune system, like steroids, or have illnesses like kidney and liver disease. As before mentioned, men who have been using antibiotics for a long time before the biopsy or those not taking the proper preventive antibiotics before the sample test are at higher risk than the usual.

What are the signs of blood poisoning? There are early and late signs and some specific and non-specific signs. Because most men undergoing a biopsy are over 60, their bodies do not cope very well with blood infections, so they can have non-specific signs like vomiting, fainting, feeling weak, long before they start to experience burning on urination, fever, chills, shaking and ague, as though they had the “flu”. Men who have septicemia after a biopsy also experience weakness and tiredness and if the blood infection continues for a time without treatment with appropriate antibiotics, then they may experience septic shock. Septic shock is a condition that occurs when the heart and blood vessels are “weakened” from the infection, so the circulation fails and the body goes into infection or septic shock and the man collapses. Septic shock is life threatening.

When a man experiences septicemia after a biopsy, it is essential that he be given the appropriate antibiotics quickly; so I always inform all men of the possible risk and ask them to either come back to the office or go to the emergency room or the local DMO if they develop a fever after the sample test. Unfortunately, not all men follow instructions, simply because they are not aware how serious the condition is and others simply forget the information, even though it is written down for them because they come for the sample test alone! Something I always tell them, not to do, that is, to come to the doctor’s office alone, especially for a minor procedure. Unfortunately, most men behave as though they are islands and need no one in their lives. It’s amazing that nobody has died in St Vincent from septicemia following a prostate biopsy as yet. It has happened in other countries, thankfully not here as yet. I, therefore, urge all men coming for biopsies to bring someone with them, as these people are more likely to remember the post procedure instructions and hence avoid a rare, but potentially fatal complication.

For comments or question contact:

Dr Rohan Deshong

Tel: (784) 456-2785

email:deshong@vincysurf.com

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