Hospital Arnau de Vilanova, Valencia, España.
Hospital Universitario de Salamanca, Salamanca, España.
Actas Urol Esp (Engl Ed). 2020 Apr;44(3):196-204. doi: 10.1016/j.acuro.2019.11.004. Epub 2020 Feb 29.
Prostate cancer is the most common visceral neoplasm in men and the second one in the United States with the highest mortality behind lung cancer and ahead of colorectal cancer. While prostate cancer mortality rates have been reduced in the United States, Austria, United Kingdom and France, 5-year survival rates have been incremented in Sweden, probably due to a higher diagnostic activity and non-lethal tumor detection. TRPB usually has low rates of serious complications, with a not negligible number of minor complications. Mortality directly associated with this procedure is low and usually related to septic shock. The main complications derived from prostate biopsy can be infectious (mild or severe) and non-infectious (hematuria consistent with hemorrhage, urethral bleeding, rectal bleeding or hemospermia, acute urinary retention, pain or vasovagal reactions).
The objective of the study is to compare three usual TRPB protocols and their relationship with the incidence of complications. Retrospective multicenter observational study conducted in three countries (Spain, Italy and Portugal). We have reviewed the medical records of 3350 men who underwent TRPB to evaluate the existence of prostate cancer, with a minimum evolutionary control of 6months.
The mean age was 65,50years, median 66, range 43-79. The subgroup analysis showed that younger patients had higher rates of acute urine retention (AUR) (P=.0000001). Likewise, our results revealed that younger patients presented more procedural pain (P=.0000001) than older patients. Regarding PSA, the mean value was 10.44, SD 7.73, median 8.15, range 0.98-68.09. A higher body mass index (BMI) was not associated with further infection (P=.000004). When performing the multivariate analysis, it was found that the significant variables in the general group were: age (P=.0013), PSA (P=.0402), local infiltration anesthesia (P=.0001) and prophylaxis with metronidazole +tobramycin +amoxicillin/clavulanic acid +gentamicin (P=.0001), presenting a normal distribution with high confidence interval (95%) and significant correlation. Prophylaxis is the most significant variable for no complications and pain (P=.0001), age (P=.0013) and prophylaxis (P=.0001) are for bleeding, age (P=.0013), prophylaxis and PSA (P=.0001) are for infection, and finally, age (P=.0013), anesthesia with local infiltration and prophylaxis (P=.0001) and PSA (P=.0402) are for AUR.
Sedation has fewer side effects and complications related to the transrectal prostate biopsy procedure with respect to transrectal local anesthesia. The choice of the antibiotic prophylaxis scheme is decisive in the onset of complications arising from the performance of a transrectal prostate biopsy.
前列腺癌是男性最常见的内脏肿瘤，也是美国第二大癌症，死亡率仅次于肺癌，高于结直肠癌。尽管美国、奥地利、英国和法国的前列腺癌死亡率有所下降，但瑞典的 5 年生存率却有所提高，这可能是由于诊断活动和非致命性肿瘤检测的增加。TRPB 通常具有较低的严重并发症发生率，但也有不可忽视的少数并发症。与该手术直接相关的死亡率较低，通常与感染性休克有关。前列腺活检的主要并发症可以是感染性的（轻度或重度）或非感染性的（血尿伴出血、尿道出血、直肠出血或血精、急性尿潴留、疼痛或血管迷走性反应）。
本研究的目的是比较三种常用的 TRPB 方案及其与并发症发生率的关系。这是一项在三个国家（西班牙、意大利和葡萄牙）进行的回顾性多中心观察性研究。我们回顾了 3350 名接受 TRPB 以评估前列腺癌存在的男性的医疗记录，最低随访时间为 6 个月。
平均年龄为 65.5 岁，中位数为 66 岁，范围为 43-79 岁。亚组分析显示，年轻患者发生急性尿潴留（AUR）的比例更高（P=.0000001）。同样，我们的结果显示，年轻患者的手术疼痛发生率高于老年患者（P=.0000001）。至于 PSA，平均值为 10.44，标准差为 7.73，中位数为 8.15，范围为 0.98-68.09。较高的体重指数（BMI）与进一步感染无关（P=.000004）。在进行多变量分析时，发现一般组中显著的变量是：年龄（P=.0013）、PSA（P=.0402）、局部浸润麻醉（P=.0001）和使用甲硝唑+妥布霉素+阿莫西林/克拉维酸+庆大霉素预防（P=.0001），呈正态分布，置信区间高（95%）且相关性显著。预防是无并发症和疼痛的最重要变量（P=.0001），年龄（P=.0013）和预防（P=.0001）是出血的最重要变量，年龄（P=.0013）、预防和 PSA（P=.0001）是感染的最重要变量，最后，年龄（P=.0013）、局部浸润麻醉和预防（P=.0001）以及 PSA（P=.0402）是 AUR 的最重要变量。
与经直肠局部麻醉相比，镇静具有较少与经直肠前列腺活检手术相关的副作用和并发症。抗生素预防方案的选择对经直肠前列腺活检引起的并发症的发生有决定性影响。
