Ghani Khurshid R, Dundas Derek, Patel Uday
Department of Urology Research and Radiology, St George's Hospital and Medical School, London, UK.
BJU Int. 2004 Nov;94(7):1014-20. doi: 10.1111/j.1464-410X.2004.05096.x.
To compare, in a prospective study, bleeding (in three categories, i.e. haematuria, haematospermia and rectal) and consultations with the general practitioner (GP), after a six-, eight- or 12-core prostate biopsy, as data on whether taking more prostate core biopsies increases bleeding complications are not conclusive.
Over a 5-year period, patients undergoing outpatient transrectal ultrasonography (TRUS)-guided prostate biopsy (six, eight or 12-core biopsy) completed a self-administered questionnaire. The prevalence and duration of the three bleeding complications and GP or hospital visits for a biopsy-related complication were assessed and compared for the 7 days after biopsy. The contribution of local anaesthetic (LA) injection to bleeding rates was also assessed.
Of 1384 patients biopsied, 1000 were given questionnaires and 884 (88%) forms were returned. Of these, 760 were suitable for analysis (307 after six-core, 325 eight-core and 128 12-core biopsies); 351 patients were given LA before biopsy. The prevalence of bleeding complications (six-, eight- and 12-core, respectively) was: haematuria 44%, 41% and 39%; haematospermia 13%, 16% and 12%; and rectal bleeding 17%, 26% and 27%. Rectal bleeding was significantly more prevalent in the eight- and 12-core groups (P = 0.0037 and 0.019). The duration of bleeding was not significantly greater in any biopsy group. Subgroup analysis showed no significant difference in the prevalence and duration of rectal bleeding after LA. About 5% of patients in each group consulted their GP because of a complication and 2.4% consulted because of bleeding. Three men with major complications required hospitalization, of which only one was caused by bleeding.
Only rectal bleeding was more prevalent after taking more than six cores, but the duration was no greater. Giving LA did not affect the rectal bleeding rate. With all strategies the major complication and hospitalization rate was very low.
在一项前瞻性研究中,比较在进行6针、8针或12针前列腺穿刺活检后出血情况(分为血尿、血精和直肠出血三类)以及与全科医生(GP)的会诊情况,因为关于增加前列腺穿刺活检针数是否会增加出血并发症的数据尚无定论。
在5年期间,接受门诊经直肠超声(TRUS)引导下前列腺穿刺活检(6针、8针或12针活检)的患者完成一份自行填写的问卷。评估并比较活检后7天内三种出血并发症的发生率和持续时间,以及因活检相关并发症而看全科医生或前往医院就诊的情况。还评估了局部麻醉(LA)注射对出血率的影响。
在1384例接受活检的患者中,1000例收到问卷,884份(88%)问卷被返还。其中,760例适合分析(6针活检后307例,8针活检后325例,12针活检后128例);351例患者在活检前接受了局部麻醉。出血并发症的发生率(6针、8针和12针活检后分别为):血尿44%、41%和39%;血精13%、16%和12%;直肠出血17%、26%和27%。直肠出血在8针和12针活检组中明显更常见(P = 0.0037和0.019)。任何活检组的出血持续时间均无显著延长。亚组分析显示,局部麻醉后直肠出血的发生率和持续时间无显著差异。每组约5%的患者因并发症咨询全科医生,2.4%的患者因出血咨询。三名有严重并发症的男性需要住院治疗,其中只有一例是由出血引起的。
仅在穿刺针数超过6针后直肠出血更常见,但持续时间并无延长。给予局部麻醉不影响直肠出血率。采用所有策略时,严重并发症和住院率都非常低。