BACKGROUND Transrectal (TR) ultrasound-guided prostate biopsy is one of the most commonly performed urologic procedures worldwide. The major drawback of this approach is the associated risk for infectious complications. Sepsis rates are increasing due to rising antibiotic resistance, representing a global issue. The transperineal (TP) approach for prostate biopsy has recently been adopted at many centres as an alternative to the TR biopsy, and it was shown to be associated with a lower risk for sepsis. The aim of this study was to assess safety and tolerability of TP prostate biopsy performed in local anaesthesia. METHODS We retrospectively analysed data of patients who had undergone office-based TP prostate biopsy in local anaesthesia, performed by a single surgeon between January 2015 and May 2019. We evaluated the patients' acceptance of the procedure by a pain score, as well as its safety and diagnostic performance. RESULTS Four hundred patients were included. Median age was 66 years [range, 49-86]. Median prostate-specific antigen (PSA) concentration was 6.4 ng/ml [range, 0.3-1400], median PSA density was 0.15 ng/ml2 [range, 0-31.1] and median prostate volume was 40 ml [range, 6-150]. A total of 118 (29.5%) and 105 (26.2%) patients had orally received two and one doses of 500 mg fluoroquinolone, respectively, and 177 (44.3%) patients did not receive any antibiotic prophylaxis. No infectious complications occurred. Median pain score was 2.0 (range, 0-8). Overall cancer detection rate was 64.5% (258/400). CONCLUSIONS Freehand TP prostate biopsy in local anaesthesia is a safe, effective and well-tolerated outpatient procedure with a high cancer detection rate. The elimination of infectious complications and its high accuracy make this technique a feasible alternative to the TR approach for the urological office. We assume that the single puncture and our trocar-like access sheath introduction technique diminish tissue trauma and bacterial exposition, and thus contribute to these promising results.

中文翻译：

---

手绘 MRI/US 认知融合经会阴前列腺活检在局部麻醉下作为办公室手术的可行性 - 对 400 名患者的经验。

背景经直肠 (TR) 超声引导下的前列腺活检是世界范围内最常用的泌尿外科手术之一。这种方法的主要缺点是感染并发症的相关风险。由于抗生素耐药性上升，败血症率正在上升，这是一个全球性问题。经会阴 (TP) 前列腺活检方法最近已被许多中心采用作为 TR 活检的替代方法，并且显示它与较低的败血症风险相关。本研究的目的是评估在局部麻醉下进行 TP 前列腺活检的安全性和耐受性。方法 我们回顾性分析了在 2015 年 1 月至 2019 年 5 月期间由一名外科医生在局麻下接受基于办公室的 TP 前列腺活检的患者的数据。我们评估了患者的 通过疼痛评分以及其安全性和诊断性能对该过程的接受程度。结果 包括四百名患者。中位年龄为 66 岁 [范围，49-86]。中位前列腺特异性抗原 (PSA) 浓度为 6.4 ng/ml [范围，0.3-1400]，中位 PSA 密度为 0.15 ng/ml2 [范围，0-31.1]，中位前列腺体积为 40 ml [范围，6-150] ]。共有 118 名 (29.5%) 和 105 名 (26.2%) 患者分别口服了两剂和一剂 500 毫克氟喹诺酮，177 名 (44.3%) 患者未接受任何抗生素预防。没有发生感染并发症。中位疼痛评分为 2.0（范围，0-8）。总体癌症检出率为 64.5% (258/400)。结论 局部麻醉下手绘 TP 前列腺活检是一种安全、有效且耐受性良好的门诊手术，癌症检出率高。感染并发症的消除及其高精度使该技术成为泌尿科诊所 TR 方法的可行替代方案。我们假设单次穿刺和我们的套管针式通路鞘引入技术减少了组织创伤和细菌暴露，从而促成了这些有希望的结果。