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Home / Patient Instructions / Prostate Biopsy Pre-Op and Post-Op Instructions

🚨 CRITICAL REQUIREMENT: Fleet® Enema

You MUST complete a Fleet® enema EXACTLY 2 hours before your scheduled arrival time.

This is not optional. It is required for:

  • Clear ultrasound imaging - Empty rectum allows precise visualization
  • Accurate needle guidance - Our KOELIS system requires optimal imaging
  • Infection prevention - Transperineal approach minimizes infection risk
  • Patient safety - Ensures best possible outcome

Fleet enemas are available without prescription at any pharmacy (CVS, Walgreens, Kroger, etc.). Purchase before your procedure day.

Pre-Operative Instructions Timeline

7 Days Before Your Biopsy

Blood Thinners & Antiplatelet Medications

Follow your doctor's specific instructions for stopping these medications:

Medication Typical Stop Time Notes
Aspirin 5-7 days before Unless for cardiac stent
Plavix (clopidogrel) 5-7 days before Coordinate with cardiologist
Warfarin (Coumadin) 5 days before May need INR check
Eliquis (apixaban) 2-3 days before DOAC - shorter half-life
Xarelto (rivaroxaban) 2-3 days before DOAC - shorter half-life
Pradaxa (dabigatran) 2-3 days before DOAC - shorter half-life

⚠️ IMPORTANT: Never stop blood thinners without approval!

If you take blood thinners for heart stent, atrial fibrillation, stroke prevention, or blood clots, you MUST coordinate with the prescribing doctor (cardiologist, primary care) before stopping. Stopping without approval can be dangerous.

Supplements to Stop

Also stop these 7 days before:

  • Fish oil / Omega-3 fatty acids
  • Vitamin E (high doses)
  • Ginkgo biloba
  • Garlic supplements
  • Ginseng
  • St. John's Wort
  • Saw Palmetto

1 Day Before Your Biopsy

  • Diet: Eat light, easily digestible meals throughout the day
  • Hydration: Drink plenty of water (but stop at midnight)
  • Purchase Fleet enema: Buy from any pharmacy - no prescription needed
  • Arrange driver: Confirm adult driver to take you home (REQUIRED)
  • Clothing: Prepare comfortable, loose-fitting clothing for tomorrow
  • After midnight: NOTHING to eat or drink

Day of Procedure - Critical Morning Steps

STEP 1: Fasting (from midnight onward)

  • ❌ NO food
  • ❌ NO water, coffee, juice
  • ❌ NO gum, mints, candy
  • ✅ ONLY small sip of water if taking approved morning medications

STEP 2: Fleet® Enema (EXACTLY 2 hours before arrival)

If your appointment is at 10:00 AM, complete enema at 8:00 AM

How to Use Fleet Enema:

  1. Read the package instructions completely
  2. Remove protective shield from enema tip
  3. Lie on left side with knees drawn to chest
  4. Gently insert tip into rectum
  5. Squeeze bottle steadily until nearly all liquid is expelled
  6. Remain in position for 1-5 minutes
  7. Move to toilet when you feel strong urge

What to Expect:

  • Urge to have bowel movement within 1-5 minutes
  • Stay near bathroom for 30-60 minutes
  • Multiple bowel movements are normal
  • Goal is clear, liquid bowel movements

Forgot to do enema? Call 678-344-8900 immediately. Your procedure may need to be rescheduled.

STEP 3: Shower with Antibacterial Soap

  • Take thorough shower with antibacterial soap
  • Pay special attention to genital and perineal (between scrotum and rectum) areas
  • Clean thoroughly but gently

STEP 4: What to Bring

  • ✅ Photo ID (driver's license)
  • ✅ Insurance card(s) - primary and secondary
  • ✅ List of all current medications with doses
  • ✅ Adult driver (MANDATORY - you cannot drive after anesthesia)
  • ✅ Comfortable, loose clothing

Post-Operative Instructions

First 24 Hours After Biopsy

Activity

  • REST: Take it easy - no strenuous activity, heavy lifting (>10 lbs), or exercise
  • Walking: Light walking is encouraged
  • NO driving: Do not drive for 24 hours after general anesthesia
  • Work: Most desk workers can return in 1-2 days

Hydration & Diet

  • Drink plenty of water: 8-10 glasses throughout the day
  • Helps flush bladder and reduce bleeding
  • Diet: Start with light foods, advance as tolerated
  • Avoid: Alcohol for 24 hours

Pain Management

  • Tylenol (acetaminophen): Take as directed for discomfort
  • Dosing: 650-1000 mg every 6 hours as needed
  • AVOID NSAIDs (ibuprofen, Advil, Aleve, naproxen) for 48 hours - they increase bleeding risk
  • Ice packs: Can apply to perineal area for 20 minutes at a time

What is Normal After Biopsy (Don't Worry)

✅ Expected Symptoms

  • Blood in urine (hematuria)
    • Common for 2-5 days
    • May last up to 2 weeks
    • Color: bright red, pink, or rust
    • Should gradually improve
  • Blood in semen (hematospermia)
    • Can persist 4-12 weeks
    • Color: red, brown, or rust
    • Completely normal
    • Will resolve on its own

✅ Also Normal

  • Mild soreness in perineum (between scrotum and anus)
  • Burning with first few urinations
  • Frequency/urgency for 2-3 days
  • Small rectal spotting for 1-2 days
  • Fatigue from anesthesia

Activity Restrictions - Important!

Timeframe Allowed Activities Avoid
0-24 hours Rest, light walking, normal daily activities Strenuous activity, driving, heavy lifting
Days 1-3 Light activity, desk work OK Heavy lifting (>10 lbs), vigorous exercise
Days 4-7 Resume most activities, light exercise Swimming, hot tubs, saunas
Sexual activity Wait 7 full days Before day 7
After 1 week Resume all normal activities None (unless otherwise directed)

Medications After Biopsy

  • Antibiotics: If prescribed, take the COMPLETE course
    • Finish all pills even if you feel perfectly fine
    • Helps prevent infection
    • Do not skip doses
  • Pain medication: Tylenol (acetaminophen) as needed for discomfort
  • Resuming blood thinners: ONLY restart when your doctor specifically tells you to
    • Timing is critical for safety
    • Usually 24-48 hours after biopsy, but varies
    • We will give you specific instructions
  • All other regular medications: Resume as normal unless told otherwise

🚨 Call 678-344-8900 Immediately If You Experience:

  • 🌡️ Fever over 100.4°F or shaking chills
  • 🩸 Heavy bleeding that doesn't slow down or large blood clots
  • 😖 Severe pain not relieved by Tylenol
  • 🚫 Unable to urinate or very little urine output
  • 🤢 Persistent nausea or vomiting
  • 😵 Dizziness, weakness, or feeling faint
  • 🔥 Increasing pain, swelling, or redness in perineal area

📞 Office Hours: 678-344-8900

Monday-Friday, 8:00 AM - 5:00 PM

After hours or weekends: Go to nearest Emergency Room

Understanding Your Biopsy Results

Timeline for Results

  • Standard pathology: 5-7 business days
    • Examines tissue for cancer cells
    • Provides Gleason score if cancer found
    • Determines cancer grade and extent
  • Advanced genomic testing: Additional 7-14 days (if ordered)
    • MDX Health GPS: If positive, assesses tumor aggressiveness
    • ConfirmMDx: If negative, checks for hidden cancer markers
  • Results review: Your doctor will call to discuss or schedule follow-up appointment

Next Steps

Based on your results, your doctor will discuss:

  • Whether cancer was found and its characteristics
  • Risk category and staging
  • Treatment options appropriate for your situation
  • Active surveillance vs treatment
  • Timeline for next steps

Frequently Asked Questions

How long will blood in urine last?

Typically 2-5 days, but can persist up to 2 weeks. Drinking plenty of water helps flush it out faster. Contact us if bleeding is heavy or doesn't improve.

When can I return to work?

Most patients with desk jobs return in 1-2 days. Physical labor or jobs requiring heavy lifting may need 3-5 days off.

Is blood in semen dangerous?

No, it's completely normal and can last 4-12 weeks after biopsy. It will gradually fade from red to brown to clear.

Can I take a shower?

Yes, you can shower normally starting the day after your biopsy. Pat the area dry gently. Avoid bathtubs for 5-7 days.

What if I'm constipated?

Use stool softeners (Colace) if needed. Avoid straining. Drink plenty of fluids and eat fiber-rich foods.

When will pain improve?

Most discomfort resolves in 2-3 days. Persistent or worsening pain beyond 3-4 days should be reported to our office.

Why We Use Transperineal Approach

Advanced Urology uses the transperineal approach (through the skin between scrotum and anus) rather than the older transrectal method. Benefits include:

✅ Lower Infection Risk

  • Avoids passing through rectum
  • Significantly reduces sepsis risk
  • Cleaner approach

✅ Better Access

  • Reaches anterior and apical lesions easier
  • More precise targeting
  • KOELIS navigation optimized for this approach

✅ Less Discomfort

  • Many patients report less pain
  • Performed under general anesthesia
  • Faster recovery

✅ Superior Technology

  • KOELIS MRI-ultrasound fusion
  • Micro-ultrasound imaging
  • Precision targeting

Additional Resources

For more detailed information about prostate biopsy:

  • Visit: learn.advancedurology.com/education/prostate-cancer/prostate-biopsy
  • Call our office with questions: 678-344-8900