Lindert K A, Kabalin J N, Terris M K
Department of Urology, Stanford University Medical Center, Stanford California, USA.
J Urol. 2000 Jul;164(1):76-80.
We determined the incidence and predisposing factors of bacteremia and bacteriuria after prostate biopsy with specific emphasis on the value of a pre-biopsy enema.
We randomized 50 men undergoing ultrasound and biopsy to rule out prostate cancer to receive a preoperative (25) or no (25) enema. Preoperatively urine was obtained for culture, and questionnaires regarding urological history and voiding symptoms were completed. The initial prostate biopsy, biopsy needle, and postoperative urine and blood specimens were cultured. The following day a symptom questionnaire was completed.
Bacterial growth in post-procedure cultures did not correlate with the number of biopsies, prostate specific antigen, obstructive voiding symptoms, prostate volume, cancer or post-biopsy hematuria. Bacteriuria was noted in 44% of the cases and bacteremia was present in 16% of the patients, of whom 87.5% did not receive an enema (p = 0.0003). Only 1 patient had chills and fever greater than 37.5C, requiring additional antibiotics. On the followup questionnaire 12% of patients described dysuria, including 84% with bacteriuria after biopsy.
Bacteremia and bacteriuria after multiple biopsies are common but usually asymptomatic. Bacteria is apparently introduced into the urine and/or blood from the rectum via the biopsy needle, which may be minimized by a pre-biopsy enema. Dysuria or a history of urinary tract infection did not predict problems after biopsy.
我们确定了前列腺活检后菌血症和菌尿症的发生率及诱发因素，特别强调了活检前灌肠的价值。
我们将50名接受超声检查和活检以排除前列腺癌的男性随机分为两组，一组（25名）接受术前灌肠，另一组（25名）不接受术前灌肠。术前采集尿液进行培养，并完成关于泌尿系统病史和排尿症状的问卷调查。对初次前列腺活检组织、活检针以及术后尿液和血液标本进行培养。第二天完成症状问卷调查。
术后培养中的细菌生长与活检次数、前列腺特异性抗原、梗阻性排尿症状、前列腺体积、癌症或活检后血尿均无相关性。44%的病例出现菌尿症，16%的患者出现菌血症，其中87.5%未接受灌肠（p = 0.0003）。只有1名患者出现寒战和体温高于37.5℃，需要额外使用抗生素。在随访问卷中，12%的患者描述有排尿困难，其中活检后有菌尿症的患者占84%。
多次活检后菌血症和菌尿症很常见，但通常无症状。细菌显然是通过活检针从直肠进入尿液和/或血液的，活检前灌肠可能会将这种情况降至最低。排尿困难或泌尿系统感染史并不能预测活检后的问题。
