Agrawal Shashank, Patil Vivek Dadasaheb, Prasad Vishnu, Menon Arun Ramadas, Pooleri Ginil Kumar
Fellow in Uro-oncology and Robotic Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Uro-oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Indian J Urol. 2024 Oct-Dec;40(4):229-234. doi: 10.4103/iju.iju_36_24. Epub 2024 Oct 1.
In this study, we evaluated the risk factors for urinary retention after freehand transrectal ultrasound (TRUS) guided transperineal prostate biopsy (TPB).
Data from 102 cases of freehand TPB at a single institution were retrospectively collected and analyzed. All patients underwent magnetic resonance imaging (MRI)-TRUS cognitive fusion TPB using a transperineal needle guide, with systematic biopsies from 10 prostate sectors and additional MRI-guided targeted biopsies. Exclusions comprised patients with coagulation abnormalities, prior prostate surgeries including biopsy, active urinary tract infection, or a lack of pre-biopsy multiparametric MRI.
14/102 (13.72%) had urinary retention and required urethral catheterization for voiding difficulty or discomfort along with a bladder volume of ≥500 ml. Patients with retention exhibited significantly larger prostate volumes (median 75 cc vs. 40 cc; < 0.05). Receiver operating curve analysis revealed a prostate volume threshold of 57.5 cc and a core number cutoff of 23 for predicting post-TPB urinary retention, with sensitivities of 78.57% and 85.71%, specificities of 75% and 82.95%, positive predictive values of 33.33% and 44.44%, and negative predictive values of 95.75% and 97.33%, respectively, whereas the number of biopsy cores correlated positively with the development of urinary retention (median 25 vs. 22; < 0.05). Urinary retention was independent of the patient's age, comorbidities, presenting prostate-specific antigen levels, prebiopsy severity of lower urinary tract symptoms, and use of alpha-blockers.
Patients with larger prostates and higher number of biopsy cores are at a higher risk of postfreehand TPB urinary retention and should receive appropriate counselling. Targeted biopsies alone, rather than a full template, may help mitigate urinary retention in these high-risk groups.
在本研究中，我们评估了徒手经直肠超声（TRUS）引导下经会阴前列腺穿刺活检（TPB）后尿潴留的危险因素。
回顾性收集并分析了一家机构102例徒手TPB的数据。所有患者均使用经会阴针引导器进行磁共振成像（MRI）-TRUS认知融合TPB，对10个前列腺区域进行系统活检，并额外进行MRI引导下的靶向活检。排除标准包括凝血异常患者、既往有前列腺手术史（包括活检）、活动性尿路感染或活检前缺乏多参数MRI检查的患者。
102例中有14例（13.72%）出现尿潴留，因排尿困难或不适以及膀胱容量≥500 ml而需要导尿。尿潴留患者的前列腺体积明显更大（中位数75 cc对40 cc；P<0.05）。受试者工作曲线分析显示，预测TPB后尿潴留的前列腺体积阈值为57.5 cc，活检针数截断值为23，敏感性分别为78.57%和85.71%，特异性分别为75%和82.95%，阳性预测值分别为33.33%和44.44%，阴性预测值分别为95.75%和97.33%，而活检针数与尿潴留的发生呈正相关（中位数25对22；P<0.05）。尿潴留与患者年龄、合并症、前列腺特异性抗原水平、活检前下尿路症状严重程度以及α受体阻滞剂的使用无关。
前列腺体积较大且活检针数较多的患者在徒手TPB后发生尿潴留的风险较高，应接受适当的咨询。仅进行靶向活检而非完整模板活检，可能有助于降低这些高危人群的尿潴留发生率。
