Department of Urology, University Hospital Basel, Basel, Switzerland.
Uro Merian, Basel, Switzerland.
Prostate Cancer Prostatic Dis. 2020 Sep;23(3):429-434. doi: 10.1038/s41391-019-0201-y. Epub 2020 Jan 2.
Transrectal (TR) ultrasound-guided prostate biopsy is one of the most commonly performed urologic procedures worldwide. The major drawback of this approach is the associated risk for infectious complications. Sepsis rates are increasing due to rising antibiotic resistance, representing a global issue. The transperineal (TP) approach for prostate biopsy has recently been adopted at many centres as an alternative to the TR biopsy, and it was shown to be associated with a lower risk for sepsis. The aim of this study was to assess safety and tolerability of TP prostate biopsy performed in local anaesthesia.
We retrospectively analysed data of patients who had undergone office-based TP prostate biopsy in local anaesthesia, performed by a single surgeon between January 2015 and May 2019. We evaluated the patients' acceptance of the procedure by a pain score, as well as its safety and diagnostic performance.
Four hundred patients were included. Median age was 66 years [range, 49-86]. Median prostate-specific antigen (PSA) concentration was 6.4 ng/ml [range, 0.3-1400], median PSA density was 0.15 ng/ml [range, 0-31.1] and median prostate volume was 40 ml [range, 6-150]. A total of 118 (29.5%) and 105 (26.2%) patients had orally received two and one doses of 500 mg fluoroquinolone, respectively, and 177 (44.3%) patients did not receive any antibiotic prophylaxis. No infectious complications occurred. Median pain score was 2.0 (range, 0-8). Overall cancer detection rate was 64.5% (258/400).
Freehand TP prostate biopsy in local anaesthesia is a safe, effective and well-tolerated outpatient procedure with a high cancer detection rate. The elimination of infectious complications and its high accuracy make this technique a feasible alternative to the TR approach for the urological office. We assume that the single puncture and our trocar-like access sheath introduction technique diminish tissue trauma and bacterial exposition, and thus contribute to these promising results.
经直肠（TR）超声引导前列腺活检是全球最常进行的泌尿科程序之一。这种方法的主要缺点是与感染性并发症相关的风险。由于抗生素耐药性的上升，败血症的发生率正在增加，这是一个全球性问题。经会阴（TP）前列腺活检方法最近已在许多中心被采用作为 TR 活检的替代方法，并且已证明与败血症的风险较低相关。本研究的目的是评估局部麻醉下进行的 TP 前列腺活检的安全性和耐受性。
我们回顾性分析了 2015 年 1 月至 2019 年 5 月期间由一位外科医生在局部麻醉下进行的门诊 TP 前列腺活检的患者数据。我们通过疼痛评分评估患者对该程序的接受程度，以及其安全性和诊断性能。
共纳入 400 例患者。中位年龄为 66 岁（范围，49-86 岁）。中位前列腺特异性抗原（PSA）浓度为 6.4ng/ml（范围，0.3-1400），中位 PSA 密度为 0.15ng/ml（范围，0-31.1），中位前列腺体积为 40ml（范围，6-150）。共有 118 例（29.5%）和 105 例（26.2%）患者分别口服 500mg 氟喹诺酮 2 剂和 1 剂，177 例（44.3%）患者未接受任何抗生素预防。未发生感染性并发症。中位疼痛评分为 2.0（范围，0-8）。总体癌症检出率为 64.5%（258/400）。
局部麻醉下徒手 TP 前列腺活检是一种安全、有效且耐受性良好的门诊程序，具有较高的癌症检出率。消除感染性并发症及其较高的准确性使该技术成为泌尿科门诊 TR 方法的可行替代方法。我们假设单次穿刺和我们的套管样进入鞘管引入技术减少了组织创伤和细菌暴露，从而为这些有希望的结果做出了贡献。
