Wammack R, Djavan B, Remzi M, Susani M, Marberger M
Department ofUrology, University Hospital of Vienna, Vienna, Austria.
Urology. 2001 Dec;58(6):1004-7. doi: 10.1016/s0090-4295(01)01406-6.
To prospectively evaluate the safety and early and delayed morbidity of transrectal ultrasound-guided needle biopsies in patients receiving immunosuppressive therapy.
A total of 59 men receiving immunosuppressive agents after kidney transplantation, with a total prostate-specific antigen level between 4 and 10 ng/mL, were prospectively studied. All patients underwent transrectal ultrasound (TRUS)-guided sextant biopsy plus two additional transition zone biopsies. Biopsy samples were also obtained from suspicious areas identified during TRUS and digital rectal examination. The immediate and delayed morbidity, patient satisfaction, and complication rates were recorded and compared with the morbidity data recorded in the same period from 1051 men in the European Prostate Cancer Detection study.
Of the 59 subjects, prostate cancer was detected in 17; 231 men were found to have cancer in the European Prostate Cancer Detection Study. Minor or no discomfort was observed in 88% and 92% of the transplant recipients and controls, respectively (P = 0.31). Twelve percent versus 8% experienced pain. Early morbidity included rectal bleeding (2.6% versus 2.1%, P = 0.19), severe hematuria (0.8% versus 0.7%, P = 0.08), and moderate to severe vasovagal episodes (1.9% versus 2.8%, P = 0.04). Late morbidity included fever (3.5% versus 2.9%, P = 0.1), hematospermia (11.0% versus 9.8%, P = 0.1), recurrent mild hematuria (17.4% versus 16.8%, P = 0.08), persistent dysuria (6.4% versus 7.2%, P = 0.2), and urinary tract infections (12.0% versus 10.9%, P = 0.08). Major complications were rare: urosepsis (0% versus 0.1%).
The results of our study demonstrate that TRUS-guided biopsy of the prostate is generally well tolerated, with minor morbidity, in patients receiving immunosuppression. No differences were noted in pain apprehension or early and delayed morbidity, suggesting that TRUS-guided biopsies can be performed safely in these patients.
前瞻性评估接受免疫抑制治疗的患者经直肠超声引导下穿刺活检的安全性、早期及延迟并发症。
对59例肾移植后接受免疫抑制剂治疗、总前列腺特异性抗原水平在4至10 ng/mL之间的男性患者进行前瞻性研究。所有患者均接受经直肠超声（TRUS）引导的六分区活检加另外两个移行区活检。还从TRUS和直肠指检期间发现的可疑区域获取活检样本。记录即时和延迟并发症、患者满意度及并发症发生率，并与欧洲前列腺癌检测研究中1051例男性同期记录的并发症数据进行比较。
59例受试者中，17例检测出前列腺癌；欧洲前列腺癌检测研究中231例男性被发现患有癌症。分别有88%的移植受者和92%的对照组受试者出现轻微不适或无不适（P = 0.31）。12%的移植受者和8%的对照组受试者经历疼痛。早期并发症包括直肠出血（2.6%对2.1%，P = 0.19）严重血尿（0.8%对0.7%，P = 0.08）以及中度至重度血管迷走神经发作（1.9%对2.8%，P = 0.04）。晚期并发症包括发热（3.5%对2.9%，P = 0.1）、血精（11.0%对9.8%，P = 0.1）、复发性轻度血尿（17.4%对16.8%，P = 0.08）、持续性排尿困难（6.4%对7.2%，P = 0.2）以及尿路感染（12.0%对10.9%，P = 0.08）。主要并发症罕见：尿脓毒症（0%对0.1%）。
我们的研究结果表明，在接受免疫抑制治疗的患者中，TRUS引导下的前列腺活检一般耐受性良好，并发症轻微。在疼痛感知或早期及延迟并发症方面未发现差异，提示在这些患者中可安全地进行TRUS引导下的活检。
