Wang F, Ding X F, Xu J N, Xu Y Z, Zhou Y Q, Luan Y, Lu S M, Tao H Z
Department of Urology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China.
Zhonghua Yi Xue Za Zhi. 2019 Feb 12;99(6):428-431. doi: 10.3760/cma.j.issn.0376-2491.2019.06.009.
To assess the complications of transperineal template-guided prostate mapping biopsy (TTMB). Between May 2017 and March 2018, 142 consecutive patients with prior negative transrectal biopsy results and persistently elevated prostate-specific antigen (PSA) were divided into the observation group and the control group randomly. The observation group underwent TTMB and the control group underwent transperineal template-guided prostate saturation biopsy (TTSB). Bleeding, infection, urinary function were recorded after prostate biopsy. Erectile function (ED) was measured at baseline, 1 month, 3 months and 6 months after prostate biopsy using the International Index of Erectile Function (IIEF-5). A mean of 59 cores (from 33 to 116 cores) were obtained in TTMB, and a mean of 23 cores (from 11 to 44 cores) were obtained in TTSB. The positive rate was 50.0% (30/60) in TTMB, and 32.9% (27/82) in TTSB, and there were significant differences between two groups (0.05). The incidence of severe hematuria and urinary retention was 8.3% (5/60) and 11.7% (7/60) respectively in TTMB, while 1.2% (1/60) and 11.7% (7/60) respectively in TTSB. There were significant differences between two groups (0.05). But there were no significant differences between two groups in the incidence of mild, moderate and total hematuria, hematospermia, perineal hematoma, infection (0.05). Rectal bleeding was not observed. In TTMB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.1±4.5), (17.4±4.8), (18.6±4.5), (19.0±4.0), respectively. In TTSB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.7±4.3), (18.2±4.5), (19.1±4.1), (19.6±4.2), respectively. There were significant differences between baseline and 1 month after prostate biopsy in two groups (0.05), but there were no significant differences of IIEF-5 score between the two groups (0.05). TTMB can improve the positive rate for patients with prior negative transrectal biopsy results and persistently elevated PSA. TTMB has low complication rates, and most side-effects are self-limited. Compared with TTSB, the incidence of urinary retention and severe hematuria increases, but they can be recovered after clinical intervention. ED is transient, and affected for 1 month after the biopsy, but it will be recovered to the baseline after 3 to 6 months. Therefore, TTMB is a safe and reliable procedure.
评估经会阴模板引导前列腺靶向活检（TTMB）的并发症。2017年5月至2018年3月，142例既往经直肠活检结果为阴性但前列腺特异性抗原（PSA）持续升高的连续患者被随机分为观察组和对照组。观察组接受TTMB，对照组接受经会阴模板引导前列腺饱和活检（TTSB）。记录前列腺活检后的出血、感染及排尿功能情况。采用国际勃起功能指数（IIEF-5）在前列腺活检前、活检后1个月、3个月及6个月测量勃起功能（ED）。TTMB平均获取59个芯组织（范围33至116个芯组织），TTSB平均获取23个芯组织（范围11至44个芯组织）。TTMB的阳性率为50.0%（30/60），TTSB的阳性率为32.9%（27/82），两组间差异有统计学意义（P<0.05）。TTMB中严重血尿和尿潴留的发生率分别为8.3%（5/60）和11.7%（7/60），而TTSB中分别为1.2%（1/60）和11.7%（7/60），两组间差异有统计学意义（P<0.05）。但两组在轻度、中度和总血尿、血精、会阴血肿、感染的发生率方面差异无统计学意义（P>0.05）。未观察到直肠出血。TTMB组在基线、1个月、3个月和6个月时的IIEF-5评分分别为（19.1±4.5）、（17.4±4.8）、（18.6±4.5）、（19.0±4.0）。TTSB组在基线、1个月、3个月和6个月时的IIEF-5评分分别为（19.7±4.3）、（18.2±4.5）、（19.1±4.1）、（19.6±4.2）。两组在前列腺活检后基线与1个月时差异有统计学意义（P<0.05），但两组间IIEF-5评分差异无统计学意义（P>0.05）。TTMB可提高既往经直肠活检结果为阴性且PSA持续升高患者的阳性率。TTMB并发症发生率低，多数副作用为自限性。与TTSB相比，尿潴留和严重血尿的发生率增加，但经临床干预后可恢复。ED是短暂的，活检后1个月受影响，但3至6个月后恢复至基线水平。因此，TTMB是一种安全可靠的检查方法。
