Prostate cancer is a common malignancy, and magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) fusion biopsy provides physicians with precise information in suspected cases. This study investigates the probability of post-biopsy acute urinary retention requiring catheterization, offering valuable insights into patient care.

This study involved patients who underwent MRI/TRUS fusion-guided transperineal prostate biopsy due to clinical suspicion of prostate cancer, indicated by elevated levels of prostate-specific antigen (PSA) or abnormal findings on digital rectal examination. The study also encompassed an examination of additional demographic variables, including age, anesthesia methods, tumor stage, PSA levels, prostate volume, the zones of the lesions identified on MRI, Prostate Imaging Reporting and Data System (PI-RADS) scores, the number of regions of interest (ROI) and systemic biopsies, the Gleason score determined from the MRI prostate fusion biopsy, and the occurrence of postoperative complications.

In this study, a total of 222 men were included for analysis, with an average age of 64 years and a mean PSA level of 17.7 ng/mL at the time of biopsy. The average prostate volume measured 46 cm^3, resulting in a mean PSA density of 0.38. The mean PI-RADS score was 4, and the average number of biopsies was 21, including ROIs and systemic biopsies. Regarding the anesthesia method, 64 patients underwent endotracheal general anesthesia (GA), 144 received mask GA, 5 were administered intravenous GA, and 1 underwent spinal anesthesia. Only one patient had a postoperative fever, but 68 patients experienced acute urinary retention (AUR) and required catheterization. Subgroup analysis was performed among these patients, and no statistical significance was found between AUR and PSA level, prostate volume, PI-RADS score, number of biopsies, zone of lesions, or tumor stage.

The results of this study provide valuable insights into the incidence of acute urinary retention (AUR) following MRI fusion biopsy for suspected prostate cancer in a cohort of 222 men with an average age of 64 years and a mean PSA level of 17.7 ng/mL. Despite a broad range of prostate volumes and PSA densities, the occurrence of AUR necessitating catheterization in 68 patients highlights a significant clinical concern associated with the biopsy procedure. Notably, the method of anesthesia, varying from endotracheal and mask general anesthesia to intravenous and spinal anesthesia, did not seem to influence the incidence of AUR significantly, as indicated by the subgroup analysis.

Furthermore, the analysis revealed no statistically significant correlation between the incidence of AUR and various clinical parameters such as PSA level, prostate volume, PI-RADS score, the number of biopsies, the zone of lesions, or the tumor stage. This suggests that the risk of AUR post-MRI fusion biopsy may be relatively independent of these factors, challenging the notion that certain pre-biopsy characteristics could predispose individuals to higher catheterization risks.

These findings underscore the complexity of predicting AUR following prostate biopsies and suggest that factors leading to AUR may be multifactorial and not solely dependent on the clinical and procedural variables typically considered. This warrants further investigation into other potential predictors of AUR, including patient-specific factors or procedural details not captured in this study, to better identify men at risk and potentially mitigate this complication.

There is no significant correlation between the clinical variables we examined and the occurrence of AUR. This indicates that routine catheterization following MRI/TRUS fusion prostate biopsy may not be necessary.