Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
Eur Urol Focus. 2020 Mar 15;6(2):370-375. doi: 10.1016/j.euf.2018.06.014. Epub 2018 Jul 13.
Transrectal ultrasound-guided prostate biopsy (TRBx) or transperineal Bx (TPBx) are considered alternative approaches for the diagnosis of prostate cancer (PCa). However, urinary tract infection (UTI) or other complications could be more frequent in the TRBx approach.
To determine the complication rate following different antimicrobial prophylaxis (AMP; fosfomycin trometamol [FT] vs ß-lactame or fluorochinolones [FQ]) in patients undergoing TRBx or TPBx.
DESIGN, SETTING, AND PARTICIPANTS: The analyses were based on prospectively collected data of a cohort of patients who underwent TRBx or TPBx for elevated prostate-specific antigen (PSA; ≥4ng/ml) or clinical suspicion of PCa, between September 2016 and March 2017. Patients received a single dose of 3g oral FT (group A) or, alternatively, FQ or ß-lactame (group B).
TRBx versus TPBx.
Adjustment variables consisted of age, PSA, biopsy technique (TPBx vs TRBx), and antibiotic prophylaxis (FT vs ß-lactame or FQ) using 1:1 propensity-score matching. Overall, 526 patients were considered, of whom 258 received FT (group A) and the other 258 received ß-lactame or FQ (group B).
Overall complications occurred in 390 (75.58%) and major complications in 67/516 (12.98%). Lower prevalence of UTIs was detected in group A (34.1%) compared with that in group B (43.4%; p=0.03), while similar rates of haematuria (54.7% vs 55.4%), haemospermia (39.5% vs 33.0%), and acute urinary retention (11.6% vs 9.3%) were detected in groups A and B. We found that group B (odds ratio [OR]: 1.54; p=0.03), I grade haematuria (OR: 6.17; p<0.01), and II grade haematuria (OR: 5.13; p<0.01) were significantly associated with increased risk of UTIs.
AMP with fluoroquinoles or ß-lactam antibiotics increased the rate of UTIs, when compared with FT, in patients undergoing TRBx or TPBx. The appearance of haematuria or haemospermia is associated with UTIs, suggesting the possibility of tailoring the strategy for prophylaxis in this category of patients.
In this study, comparing complications after transrectal ultrasound-guided prostate biopsy versus transperineal biopsy, prophylaxis with fluoroquinoles or ß-lactam antibiotics increased the rate of urinary tract infections when compared with fosfomycin trometamol, regardless of the type of biopsy approach.
经直肠超声引导前列腺活检（TRBx）或经会阴活检（TPBx）被认为是诊断前列腺癌（PCa）的替代方法。然而，TRBx 方法可能会导致更多的尿路感染（UTI）或其他并发症。
确定接受 TRBx 或 TPBx 的患者接受不同抗菌预防（AMP；福司氟霉素[FT]与β-内酰胺或氟喹诺酮[FQ]）后的并发症发生率。
设计、设置和参与者：该分析基于 2016 年 9 月至 2017 年 3 月期间因前列腺特异性抗原（PSA；≥4ng/ml）升高或临床怀疑 PCa 而接受 TRBx 或 TPBx 的患者的前瞻性收集数据。患者接受单次 3g 口服 FT（A 组）或替代使用 FQ 或β-内酰胺（B 组）。
TRBx 与 TPBx。
使用 1:1 倾向评分匹配调整年龄、PSA、活检技术（TPBx 与 TRBx）和抗生素预防（FT 与β-内酰胺或 FQ）等变量。总共考虑了 526 例患者，其中 258 例接受 FT（A 组），另外 258 例接受β-内酰胺或 FQ（B 组）。
总体并发症发生率为 390 例（75.58%），主要并发症发生率为 67/516 例（12.98%）。与 B 组（43.4%）相比，A 组（34.1%）UTI 的发生率较低（p=0.03），而血尿（54.7%与 55.4%）、血精（39.5%与 33.0%）和急性尿潴留（11.6%与 9.3%）的发生率在 A 组和 B 组相似。我们发现 B 组（比值比[OR]：1.54；p=0.03）、I 级血尿（OR：6.17；p<0.01）和 II 级血尿（OR：5.13；p<0.01）与 UTI 风险增加显著相关。
与 FT 相比，TRBx 或 TPBx 中使用氟喹诺酮或β-内酰胺抗生素的 AMP 会增加 UTI 的发生率。血尿或血精的出现与 UTI 相关，提示在这一类患者中可能需要调整预防策略。
在这项研究中，比较了经直肠超声引导前列腺活检与经会阴活检后的并发症，与福司氟霉素相比，使用氟喹诺酮或β-内酰胺抗生素的预防会增加 UTI 的发生率，而与活检方式无关。
