Quinlan Mark R, Bolton Damien, Casey Rowan G
Department of Urology, Austin Hospital, Heidelberg, Melbourne, Australia.
Department of Urology, Colchester Cancer Centre, Colchester NHS University Foundation Trust, Essex, United Kingdom.
Can Urol Assoc J. 2018 Mar;12(3):E146-E153. doi: 10.5489/cuaj.4660. Epub 2017 Dec 22.
Since the advent of prostate-specific antigen (PSA)-based testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a standard part of the diagnostic pathway for prostate cancer (PCa). Rectal bleeding is one of the common side effects of this transrectal route. While rectal bleeding is usually mild and self-limiting, it can be life-threatening. In this article, we examine rectal bleeding post-TRUS-guided prostate biopsy and explore the literature to evaluate techniques and strategies aimed at preventing and managing this common and important complication.
A PubMed literature search was carried out using the keywords "transrectal-prostate-biopsy-bleed." A search of the bibliography of reviewed studies was also conducted. Additionally, papers in non-PubMed-listed journals of which the authors were aware were appraised.
Numerous modifiable risk factors for this bleeding complication exist, particularly anticoagulants/antiplatelets and the number of core biopsies taken. Successfully described corrective measures for such rectal bleeding include tamponade (digital/packs/catheter/tampon/condom), endoscopic sclerotherapy/banding/clipping, radiological embolization, and surgical intervention.
We advocate early consultation with the colorectal/gastroenterology and interventional radiology services and a progressive, stepwise approach to the management of post-biopsy rectal bleeding, starting with resuscitation and conservative tamponade measures, moving to endoscopic hemostasis ± radiological embolization ± transanal surgical methods. Given the infrequent but serious nature of major rectal bleeding after TRUS biopsy, we recommend the establishment of centralized databases or registries forthwith to prospectively capture such data. To the best of our knowledge, this is the first comprehensive look specifically at the management of post-TRUS biopsy rectal bleeding.
自从基于前列腺特异性抗原（PSA）的检测出现以来，经直肠超声（TRUS）引导下的前列腺活检已成为前列腺癌（PCa）诊断途径的标准组成部分。直肠出血是这种经直肠途径常见的副作用之一。虽然直肠出血通常较轻且具有自限性，但也可能危及生命。在本文中，我们研究了TRUS引导下前列腺活检后的直肠出血情况，并查阅文献以评估旨在预防和处理这种常见且重要并发症的技术和策略。
使用关键词“经直肠 - 前列腺活检 - 出血”在PubMed数据库进行文献检索。还对综述研究的参考文献进行了检索。此外，对作者知晓的未列入PubMed的期刊上的论文进行了评估。
存在许多可改变的导致这种出血并发症的风险因素，特别是抗凝剂/抗血小板药物以及所取活检组织芯的数量。已成功描述的针对此类直肠出血的纠正措施包括压迫止血（指压/纱布填塞/导管/棉塞/避孕套）、内镜硬化治疗/套扎/夹闭、放射栓塞以及手术干预。
我们主张早期咨询结直肠/胃肠病学和介入放射学服务部门，并采用渐进的、逐步的方法来处理活检后直肠出血，首先进行复苏和保守压迫止血措施，然后采用内镜止血±放射栓塞±经肛门手术方法。鉴于TRUS活检后严重直肠出血虽不常见但性质严重，我们建议立即建立集中数据库或登记系统以前瞻性收集此类数据。据我们所知，这是首次专门全面探讨TRUS活检后直肠出血的处理。
