Rush University Medical Centre, Chicago, IL, USA.
Rush University College of Medicine, Chicago, IL, USA.
BJU Int. 2022 Jul;130(1):54-61. doi: 10.1111/bju.15590. Epub 2021 Dec 23.
To assess the utility of antimicrobial prophylaxis when performing freehand systematic transperineal (TP) biopsy.
From January 2012 to February 2020, freehand TP prostate biopsy via angiocatheters or the PrecisionPoint Transperineal Access System was performed on consecutive men with clinical suspicion of prostate cancer (PCa) or confirmed PCa. Biopsies were performed by a single urologist (developer of the PrecisionPoint system). Clinical data were collected retrospectively. Pre-procedural antibiotics were given to all patients up until 6 September 2016. After this date, antibiotics were omitted from those without risk factors (chronic catherization, concurrent endoscopic procedure, history of sepsis after transrectal [TR] biopsy, history of TR biopsy within the last year, prosthetic joints/heart valves). Patients were assessed 1 week after biopsy for symptoms, emergency department visits, and hospital admissions. Patients who received antimicrobial prophylaxis were compared with those who did not, and infectious complications were analysed. Additionally, oncological outcomes were reported.
A total of 988 biopsies (median prostate-specific antigen level 7.7 ng/mL) were included in the analysis on 756 patients. Prophylaxis was given in 538 of the biopsies (54.4%) and in 450 (48.6%) it was not. There was a statistical difference in median age (67 vs 69 years; P < 0.001), abnormal digital rectal examination (13% vs 5%; P < 0.001), and history of multiparametic magnetic resonance imaging (15% vs 31%; P < 0.001) between the prophylaxis and no-prophylaxis cohorts, respectively. There were no documented complications in those who received antibiotics. Within the no-prophylaxis cohort, there were three (0.66%) complications (P = 0.09). Two patients (0.44%) had urinary tract infections and one patient (0.22%) experienced post-procedural urinary retention. No patient required hospital admission or an emergency department visit. Clinically significant cancer was detected in 152 (40.0%) and 64 patients (39.0%) on initial biopsy and prior negative biopsy, respectively.
These data suggest that antimicrobial prophylaxis may be safely omitted in selected patients when using the freehand TP approach.
评估徒手经会阴（TP）系统活检时使用抗菌预防措施的效果。
2012 年 1 月至 2020 年 2 月，对临床疑似前列腺癌（PCa）或确诊 PCa 的连续男性患者，通过血管导管或 PrecisionPoint 经会阴入路系统进行徒手 TP 前列腺活检。活检由一位泌尿科医生（PrecisionPoint 系统开发者）进行。回顾性收集临床数据。所有患者在 2016 年 9 月 6 日之前均给予术前抗生素。此后，无危险因素（慢性置管、同期内镜手术、经直肠活检后脓毒症史、最近 1 年内经直肠活检史、人工关节/心脏瓣膜）的患者则不使用抗生素。活检后 1 周评估患者症状、急诊就诊和住院情况。比较接受抗菌预防和未接受抗菌预防的患者，并分析感染性并发症。此外，还报告了肿瘤学结局。
共纳入 756 例患者的 988 次活检（中位前列腺特异性抗原水平为 7.7ng/ml）。538 次活检（54.4%）给予了预防措施，450 次活检（48.6%）未给予预防措施。预防组和未预防组的中位年龄（67 岁比 69 岁；P＜0.001）、异常直肠指诊（13%比 5%；P＜0.001）和多参数磁共振成像史（15%比 31%；P＜0.001）有统计学差异。接受抗生素的患者中未发现有并发症。在未预防组中，有 3 例（0.66%）出现并发症（P=0.09）。2 例患者（0.44%）出现尿路感染，1 例患者（0.22%）出现经尿道前列腺电切术后尿潴留。无患者需要住院或急诊就诊。初始活检和既往阴性活检时分别有 152 例（40.0%）和 64 例（39.0%）患者发现临床显著癌症。
这些数据表明，在使用徒手 TP 方法时，对于某些特定患者，可以安全地省略抗菌预防措施。
