621 例局部麻醉下无标准抗生素预防的经会阴 MRI-TRUS 融合活检后的感染率和并发症。
Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis.
机构信息
Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany.
Department of Urology, Oslo University Hospital, Oslo, Norway.
出版信息
World J Urol. 2021 Oct;39(10):3861-3866. doi: 10.1007/s00345-021-03699-1. Epub 2021 Apr 18.
PURPOSE
The aim of this study was to assess the post biopsy infection rate, feasibility and prostate cancer (PCa) detection rate (CDR) by performing transperineal MRI-TRUS fusion biopsy of the prostate (TPBx) under local anesthesia (LA) without antibiotic prophylaxis (AP).
METHODS
We prospectively screened 766 men with suspicious lesions on mpMRI, an elevated PSA level or a suspect digital examination undergoing MRI-TRUS-TPBx in LA, from May 2019 to July 2020. Patients with the need for antibiotic prophylaxis or without a PI-RADS target lesion were excluded from final analyses. We reported CDR, perioperative pain (0-10) and postoperative complications. PCa with an ISUP grade ≥ 2 was classified as clinically significant PCa (csPCa).
RESULTS
We included 621 patients with a median age of 68 years (IQR 62-74), a PSA of 6.43 ng/mL (IQR 4.72-9.91) and a prostate volume of 45 cc (IQR 32-64). In median, 4 targeted (TB) (IQR 3-4) and 6 (IQR 5-7) systematic biopsies (SB) detected in combination overall 416 (67%) PCa and 324 (52%) csPCa. Overall CDR of TB for PI-RADS 3, 4 and 5 was 26%, 65% and 84%, respectively. Patients reported a median perioperative pain level of 2 (IQR 1-3). Four patients (0.6%) developed a post biopsy infection, one experienced urosepsis.
CONCLUSION
Our results demonstrate that transperineal MRI-TRUS fusion-guided prostate biopsy under LA without AP is feasible, safe and well tolerated.
目的
本研究旨在评估在局部麻醉（LA）下不进行抗生素预防（AP），经会阴 MRI-TRUS 融合前列腺活检（TPBx）的活检后感染率、可行性和前列腺癌（PCa）检出率（CDR）。
方法
我们前瞻性筛选了 2019 年 5 月至 2020 年 7 月期间因 MRI 可疑病变、PSA 水平升高或可疑数字检查而接受 MRI-TRUS-TPBx 的 766 名男性患者。最终分析排除了需要抗生素预防或没有 PI-RADS 靶病变的患者。我们报告了 CDR、围手术期疼痛（0-10 分）和术后并发症。ISUP 分级≥2 的 PCa 被归类为临床显著 PCa（csPCa）。
结果
我们纳入了 621 名中位年龄为 68 岁（IQR 62-74）、PSA 为 6.43ng/mL（IQR 4.72-9.91）和前列腺体积为 45cc（IQR 32-64）的患者。中位数 4 个靶向（TB）（IQR 3-4）和 6 个（IQR 5-7）系统活检（SB）联合检测出 416 例（67%）PCa 和 324 例（52%）csPCa。TB 的 PI-RADS 3、4 和 5 的总体 CDR 分别为 26%、65%和 84%。患者报告的中位围手术期疼痛水平为 2 分（IQR 1-3）。4 名患者（0.6%）发生活检后感染，1 名患者发生尿脓毒症。
结论
我们的结果表明，LA 下经会阴 MRI-TRUS 融合引导的前列腺活检在不进行 AP 的情况下是可行的、安全的且可耐受。
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