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Transrectal Ultrasound (TRUS)

Endorectal imaging of the prostate and pelvic structures

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Transrectal Ultrasound (TRUS)?

TRUS uses a high-frequency ultrasound probe (typically 7–10 MHz) inserted into the rectum to image adjacent pelvic structures.

It provides detailed views of the prostate gland (peripheral, transition and central zones), seminal vesicles, ejaculatory ducts and lower rectum.

The most common indication is image guidance for prostate needle biopsy, often performed as transrectal or transperineal approach.

TRUS-MRI fusion biopsy combines pre-biopsy multiparametric MRI with real-time TRUS imaging to target suspicious lesions.

TRUS also assists in evaluation of seminal vesicle pathology, prostate volume measurement, brachytherapy planning and rectal masses.

Symptoms

Indications include elevated PSA, abnormal digital rectal examination, suspicious MRI findings
Hematuria, hematospermia or evaluation of male infertility may prompt seminal vesicle imaging
Symptoms after biopsy: rectal bleeding, hematuria, hematospermia (often persists weeks), urinary retention or fever
Ejaculatory duct obstruction with reduced ejaculate volume and infertility
Cyclic pelvic pain related to prostatic or seminal vesicle pathology

Risk Factors

Indications for TRUS biopsy: PSA above age-specific threshold, rising PSA velocity, abnormal DRE, prior negative biopsy with persistent suspicion, MRI lesion (PI-RADS 3 or higher)
Procedure-related risks include infection (1–5 percent), urinary retention, hematuria and hematospermia
Antibiotic-resistant rectal flora (especially fluoroquinolone-resistant E. coli) increases post-biopsy infection risk
Anticoagulant or antiplatelet therapy increases bleeding risk
Prosthetic joint or heart valve may require additional antibiotic prophylaxis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent fever, chills or rigors within days after TRUS biopsy
  • Heavy or prolonged rectal bleeding
  • Inability to urinate or severe urinary retention after biopsy
  • Severe pain not controlled with simple analgesics
  • Signs of sepsis (fever, low blood pressure, confusion)
  • Persistent gross hematuria beyond a few days
  • Hematospermia is common and benign for weeks but consult if persistent beyond 2 months

Treatment Methods

01
Pre-procedure: review medications (hold anticoagulants per protocol), screen for high-risk infection (prior antibiotic-resistant rectal swab), explain risks and obtain consent
02
Antibiotic prophylaxis: targeted prophylaxis based on rectal swab culture is now preferred to standard fluoroquinolone-only regimens
03
Consider transperineal approach to reduce infectious complications
04
Bowel preparation with a small enema before procedure
05
Local anesthesia: periprostatic nerve block with lidocaine reduces pain effectively
06
Standard 12-core systematic biopsy plus targeted cores for MRI lesions when applicable
07
Post-procedure: monitor for 1–2 hours, ensure ability to void, review warning signs
08
Manage common complications: hematospermia (reassurance), hematuria (hydration, observation), mild bleeding (pressure, observation)
09
Severe complications (sepsis, urinary retention, heavy bleeding) require emergency department evaluation
10
Pathology review with multidisciplinary discussion if cancer detected

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.