Boesen Lars, Nørgaard Nis, Bisbjerg Rasmus, Al-Hamadani Muhammad Munther Nasir, Sjölin Carl Sebastian, Løgager Vibeke
Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark.
Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark.
Eur Urol Open Sci. 2023 Dec 23;59:71-77. doi: 10.1016/j.euros.2023.12.002. eCollection 2024 Jan.
Advances in for magnetic resonance imaging (MRI)-guided transperineal biopsy (TPBx) techniques have facilitated outpatient prostate biopsies under local anaesthesia to lower postbiopsy infection rates. However, there is debate regarding antibiotic prophylaxis because of concerns regarding antibiotic resistance and interactions. Our objective was to assess the transition from office-based transrectal biopsy to TPBx performed under local anaesthesia without antibiotic prophylaxis despite potential risk factors for infectious complications.
We conducted a prospective assessment of 665 men undergoing office-based MRI-guided TPBx. The primary outcome was the rate of urosepsis or febrile urinary tract infections requiring hospitalisation and/or antibiotics within 2 wk after biopsy. Secondary outcomes included patient-reported procedure tolerability and the prostate cancer detection rate.
TPBx using a median of nine cores per patient (range 4-15) detected prostate cancer in 534/665 men (80%). Only four men (0.6%) were hospitalised for suspected postbiopsy infection; no patient experienced urosepsis. The TPBx procedure was well tolerated, with low pain scores (median Visual Analogue Scale score of 2, interquartile range [IQR] 1-3) and positive patient ratings (median rating 1 [no problem], IQR 1-2). Limitations include the single-centre analysis and lack of randomisation for antibiotic prophylaxis.
An office-based TPBx strategy under local anaesthesia without antibiotic prophylaxis is well tolerated and has a very low risk of side effects. This approach should be considered as the standard of care. Further studies may determine if a subgroup of predisposed men could benefit from antibiotic prophylaxis.
For prostate biopsy the sampling needle can be inserted through the rectum or through the perineum, which is the skin between the rectum and the scrotum. Our study confirms that in everyday clinical practice, prostate biopsy via the perineum can be carried out under local anaesthetic and without routine use of antibiotics because of its lower risk of infection. Patients reported low pain scores and positive ratings for the overall experience.
磁共振成像（MRI）引导下经会阴活检（TPBx）技术的进展推动了门诊局部麻醉下的前列腺活检，以降低活检后感染率。然而，由于对抗生素耐药性和相互作用的担忧，关于抗生素预防存在争议。我们的目的是评估尽管存在感染并发症的潜在危险因素，但从基于诊室的经直肠活检向局部麻醉下不进行抗生素预防的TPBx的转变。
我们对665名接受基于诊室的MRI引导TPBx的男性进行了前瞻性评估。主要结局是活检后2周内需要住院和/或使用抗生素的尿脓毒症或发热性尿路感染的发生率。次要结局包括患者报告的操作耐受性和前列腺癌检出率。
每位患者平均穿刺9针（范围4 - 15针）的TPBx在534/665名男性（80%）中检测到前列腺癌。只有4名男性（0.6%）因疑似活检后感染住院；没有患者发生尿脓毒症。TPBx操作耐受性良好，疼痛评分低（视觉模拟量表评分中位数为2，四分位间距[IQR] 1 - 3），患者评价积极（评分中位数为1[无问题]，IQR 1 - 2）。局限性包括单中心分析以及缺乏抗生素预防的随机分组。
基于诊室的局部麻醉下不进行抗生素预防的TPBx策略耐受性良好，副作用风险极低。这种方法应被视为标准治疗方案。进一步的研究可以确定是否有一部分易感男性可以从抗生素预防中获益。
对于前列腺活检，采样针可以通过直肠插入，也可以通过会阴插入，会阴是直肠和阴囊之间 的皮肤。我们的研究证实，在日常临床实践中，经会阴前列腺活检可以在局部麻醉下进行，且由于感染风险较低无需常规使用抗生素。患者报告疼痛评分低，对总体体验评价积极。
