A Randomized Controlled Trial Evaluating the Effect of Routine Probe Compression After Transrectal Prostate Biopsy on Bleeding and Infectious Complications

Hematuria (approximately 50%) and rectal bleeding (approximately 30%) are common complications following transrectal ultrasound-guided prostate biopsy. Although most cases are self-limited, a subset of patients require additional intervention. In cases of significant bleeding immediately after biopsy, ultrasound-guided probe compression has been used for hemostasis, with reported compression times ranging from 1 to 8 minutes (mean 2.9 minutes), suggesting that even short-duration compression may be effective.

Digital rectal compression for 5 minutes after biopsy has been shown to reduce intraprostatic hemorrhage (hematoma), thereby improving the accuracy of subsequent magnetic resonance imaging interpretation. However, no randomized controlled trials have evaluated clinically significant bleeding outcomes, such as hematuria or rectal bleeding, as primary endpoints.

While a stepwise approach to managing moderate-to-severe rectal bleeding (initial direct compression followed by endoscopic hemostasis or embolization if needed) is generally accepted, there is no consensus regarding the optimal duration of initial compression.

Infectious complications following transrectal prostate biopsy occur in approximately 0.1-7.0% of patients, with sepsis reported in 0.3-3.1%. Post-biopsy hematuria has been suggested as a potential clinical indicator of subsequent urinary tract infection. Therefore, reducing bleeding complications may also contribute to the prevention of infectious complications.

There is a clear need for randomized evidence evaluating the effect of routine probe compression and compression duration on both bleeding and infectious outcomes. This study aims to address this gap in the current evidence.