Age and DRE-assessed anal sphincter tone are associated with vasovagal reactions during transrectal ultrasound-guided prostate biopsy

Abstract Objective To identify clinically accessible predictors of vasovagal reactions during TRUS-guided prostate biopsy, with particular emphasis on age and anal sphincter strength assessed during digital rectal examination. Methods Clinical data from 663 patients who underwent transrectal ultrasound-guided prostate biopsy between May 2022 and May 2024 were retrospectively analyzed. Patients were categorized into vasovagal reaction and non-vasovagal reaction groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of vasovagal reactions, and model performance was evaluated using receiver operating characteristic analysis. Results Vasovagal reactions occurred in 30 patients (4.52%). Multivariate analysis identified age < 65 years (OR = 6.006, 95% CI: 2.379–15.165) and grade 3 anal sphincter contraction strength (OR = 16.484, 95% CI: 4.910–55.344) as independent predictors. A predictive model incorporating these factors demonstrated good discriminative ability, with an area under the curve of 0.846 (95% CI: 0.781–0.912). Conclusion Age and elevated anal sphincter contraction strength are significant predictors of vasovagal reactions during transrectal ultrasound-guided prostate biopsy. Pre-procedural identification of these features may facilitate risk stratification and enable targeted preventive strategies to enhance procedural safety.