Wenzel Mike, Theissen Lena, Preisser Felix, Lauer Benedikt, Wittler Clarissa, Humke Clara, Bodelle Boris, Ilievski Valentina, Kempf Volkhard A J, Kluth Luis A, Chun Felix K H, Mandel Philipp, Becker Andreas
Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
University Hospital Frankfurt, Frankfurt, Germany.
Front Surg. 2020 Feb 28;7:7. doi: 10.3389/fsurg.2020.00007. eCollection 2020.
There is still an ongoing debate whether a transrectal ultrasound (TRUS) approach for prostate biopsies is associated with higher (infectious) complications rates compared to transperineal biopsies. This is especially of great interests in settings with elevated frequencies of multidrug resistant organisms (MDRO). Between 01/2018 and 05/2019 230 patients underwent a TRUS-guided prostate biopsy at the department of Urology at University Hospital Frankfurt. Patients were followed up within the clinical routine that was not conducted earlier than 6 weeks after the biopsy. Among 230 biopsies, 180 patients took part in the follow-up. No patients were excluded. Patients were analyzed retrospectively regarding complications, infections and underlying infectious agents or needed interventions. Of all patients with follow up, 84 patients underwent a systematic biopsy (SB) and 96 a targeted biopsy (TB) after MRI of the prostate with additional SB. 74.8% of the patients were biopsy-naïve. The most frequent objective complications (classified by Clavien-Dindo) lasting longer than one day after biopsy were hematuria (17.9%, = 32), hematospermia (13.9%, = 25), rectal bleeding (2.8%, = 5), and pain (2.2%, = 4). Besides a known high MDRO prevalence in the Rhine-Main region, only one patient (0.6%) developed fever after biopsy. One patient each (0.6%) consulted a physician due to urinary retention, rectal bleeding or gross hematuria. There were no significant differences in complications seen between SB and SB + TB patients. The rate of patients who consulted a physician was significantly higher for patients with one or more prior biopsies compared to biopsy-naïve patients. Complications after transrectal prostate biopsies are rare and often self-limiting. Infections were seen in <1% of all patients, regardless of an elevated local prevalence of MDROs. Severe complications (Clavien-Dindo ≥ IIIa) were only seen in 3 (1.7%) of the patients. Repeated biopsy is associated with higher complication rates in general.
经直肠超声（TRUS）引导下的前列腺活检与经会阴活检相比，是否会导致更高的（感染性）并发症发生率，目前仍存在争议。在多重耐药菌（MDRO）感染频率较高的情况下，这一问题尤其受到关注。2018年1月至2019年5月期间，230例患者在法兰克福大学医院泌尿外科接受了TRUS引导下的前列腺活检。患者在活检后至少6周的临床常规随访中接受随访。在230例活检中，180例患者参与了随访。无患者被排除。对患者的并发症、感染、潜在感染病原体或所需干预措施进行回顾性分析。在所有接受随访的患者中，84例患者在前列腺MRI检查后进行了系统活检（SB），96例患者进行了靶向活检（TB）并附加SB。74.8%的患者为初次活检。活检后持续超过一天的最常见客观并发症（根据Clavien-Dindo分类）为血尿（17.9%，n = 32）、血精（13.9%，n = 25）、直肠出血（2.8%，n = 5）和疼痛（2.2%，n = 4）。除了莱茵-美因地区已知的高MDRO患病率外，只有1例患者（0.6%）在活检后出现发热。各有1例患者（0.6%）因尿潴留、直肠出血或肉眼血尿咨询医生。SB组和SB + TB组患者的并发症发生率无显著差异。与初次活检患者相比，有一次或多次既往活检的患者咨询医生的比例显著更高。经直肠前列腺活检后的并发症罕见，且通常为自限性。无论当地MDRO患病率如何升高，所有患者中感染率均低于1%。严重并发症（Clavien-Dindo≥IIIa）仅在3例（1.7%）患者中出现。一般来说，重复活检与更高的并发症发生率相关。
