Wei Tzu-Chun, Lin Tzu-Ping, Chang Yen-Hwa, Chen Tzeng-Ji, Lin Alex T L, Chen Kuang-Kuo
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2015 Nov;78(11):662-5. doi: 10.1016/j.jcma.2015.04.011. Epub 2015 Aug 1.
For patients with an elevated prostate specific antigen (PSA) level or a suspected lesion detected by digital rectal examination, transrectal ultrasound-guided (TRUS) prostate biopsy is the standard procedure for prostate cancer diagnoses. In Taiwan, TRUS prostate biopsy has not been well-studied on a nationwide scale. This article aimed to study TRUS prostate biopsy in Taiwan and its related complications, according to the claims generated through the National Health Insurance (NHI) program.
We applied for access to claims from the NHI Research Database of Taiwan of all patients who visited the urology clinic during the period of 2006 to 2010. In the 5-year urology profile, we obtained all records, which included admission and ambulatory clinical records. The definition of TRUS biopsy included codes for ultrasound-guided procedure and for prostate puncture; other codes involving complications such as postbiopsy voiding difficulty, significant bleeding, or infection requiring treatment were also included. Risk factors included age, diagnosis of prostate cancer, hospitalization or nonhospitalization, and the Charlson Comorbidity Index (CCI; with a value of 0, 1, 2 or ≥ 3). Descriptive and comparative analyses were also performed.
In the 5-year urology profile, 12,968 TRUS biopsies performed of which 6885 were in-patient procedures and 6083 were ambulatory clinic procedures. After the procedures, 1266 (9.76%) biopsies were associated with voiding difficulty; 148 (1.14%) biopsies, with significant bleeding; and 855 (6.59%) biopsies, with infection that required treatment. The prostate cancer diagnosis rate was 36.02%. The overall biopsy-related mortality rate within 30 days was 0.25%, and the postbiopsy sepsis-related mortality rate was 0.13%. Age, diagnosis of cancer, hospitalization, and CCI value ≥ 1 were all significant factors in univariate analysis and multivariate analysis for postbiopsy voiding difficulty and severe infection. A diagnosis of cancer and a CCI value ≥ 2 were significant factors for significant bleeding after biopsy. Patients diagnosed as having prostate cancer had fewer bleeding complications after biopsy.
The most frequent complication was postbiopsy voiding difficulty, followed by infection that required treatment and significant bleeding. The sepsis-related mortality rate was 0.13%. Significant risk factors for postbiopsy complications included age, diagnosis of prostate cancer, hospitalization, and the CCI value.
对于前列腺特异性抗原（PSA）水平升高或经直肠指检发现可疑病变的患者，经直肠超声引导（TRUS）前列腺活检是前列腺癌诊断的标准程序。在台湾，尚未在全国范围内对TRUS前列腺活检进行充分研究。本文旨在根据通过国民健康保险（NHI）计划产生的索赔数据，研究台湾的TRUS前列腺活检及其相关并发症。
我们申请获取2006年至2010年期间在台湾泌尿科门诊就诊的所有患者的NHI研究数据库中的索赔数据。在5年的泌尿科概况中，我们获取了所有记录，包括住院和门诊临床记录。TRUS活检的定义包括超声引导程序和前列腺穿刺的代码；还包括其他涉及活检后排尿困难、严重出血或需要治疗的感染等并发症的代码。风险因素包括年龄、前列腺癌诊断、住院或非住院以及Charlson合并症指数（CCI；值为0、1、2或≥3）。还进行了描述性和比较性分析。
在5年的泌尿科概况中，共进行了12968例TRUS活检，其中6885例为住院手术，6083例为门诊手术。手术后，1266例（9.76%）活检与排尿困难有关；148例（1.14%）活检与严重出血有关；855例（6.59%）活检与需要治疗的感染有关。前列腺癌诊断率为36.02%。30天内总体活检相关死亡率为0.25%，活检后败血症相关死亡率为0.13%。年龄、癌症诊断、住院以及CCI值≥1在活检后排尿困难和严重感染的单因素分析和多因素分析中均为显著因素。癌症诊断和CCI值≥2是活检后严重出血的显著因素。被诊断为前列腺癌的患者活检后出血并发症较少。
最常见的并发症是活检后排尿困难，其次是需要治疗的感染和严重出血。败血症相关死亡率为0.13%。活检后并发症的显著风险因素包括年龄、前列腺癌诊断、住院和CCI值。
