Background

Transrectal ultrasound-guided prostate biopsy (TRUSPB) is widely used to diagnose prostate cancer (PCa). The aim of this study was to evaluate the risk of multi-factorial complications (febrile genitourinary tract infection (GUTI), rectal bleeding, and urinary retention) after TRUSPB.

Methods

N = 2053 patients were Japanese patients undergoing transrectal or transperineal TRUSPB for suspicious of PCa. To assess risk of febrile GUTI adequately, the patients were divided into four groups: low-risk patients before starting a rectal culture, low-risk patients after starting a rectal culture, high-risk patients, and patients undergoing transperineal TRUSPB. Furthermore, to identify risk of rectal bleeding and urinary retention, patients were divided into transrectal and transperineal group.

Results

Febrile GUTI significantly decreased owing to risk classification. The frequency of rectal bleeding was 1.43% (transrectal: 25/1742), while it did not happen in transperineal group. The patients with rectal bleeding had a significantly lower body mass index (BMI) (P < 0.01). The frequency of urinary retention was 5.57% (transrectal: 97/1742), while it did not happen in transperineal group. The patients with urinary retention had a significantly higher prostate-specific antigen (PSA) (P = 0.01) in transrectal group.

Conclusions

Risk classification, rectal swab culture, and selected antimicrobial prophylaxis for transrectal TRUSPB were extremely effective to reduce the risk of febrile GUTI. Furthermore, lower BMI and higher PSA were novel clinical predictors for rectal bleeding and urinary retention, respectively. When urologists perform transrectal TRUSPB to their patients, they can correctly understand and explain each complication risk to their patients based on these novel risk factors.

中文翻译：

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经直肠超声引导下前列腺活检后多因素并发症的风险评估：一项单一机构回顾性队列研究

背景

经直肠超声引导下的前列腺活检 (TRUSPB) 被广泛用于诊断前列腺癌 (PCa)。本研究的目的是评估 TRUSPB 后多因素并发症（发热性泌尿生殖道感染 (GUTI)、直肠出血和尿潴留）的风险。

方法

N  = 2053 名日本患者因怀疑 PCa 而接受经直肠或经会阴 TRUSPB。为了充分评估发热性 GUTI 的风险，将患者分为四组：开始直肠培养前的低风险患者、开始直肠培养后的低风险患者、高风险患者和接受经会阴 TRUSPB 的患者。此外，为了确定直肠出血和尿潴留的风险，将患者分为经直肠组和经会阴组。

结果

由于风险分类，发热性 GUTI 显着降低。直肠出血发生率为1.43%（经直肠：25/1742），经会阴组未发生。直肠出血患者的体重指数（BMI）显着降低（P  < 0.01）。尿潴留发生率为5.57%（经直肠：97/1742），经会阴组未发生。 经直肠组尿潴留患者前列腺特异性抗原（PSA）显着升高（P =0.01）。

结论

风险分类、直肠拭子培养和经直肠 TRUSPB 的选择性抗菌预防对降低发热性 GUTI 风险极为有效。此外，较低的 BMI 和较高的 PSA 分别是直肠出血和尿潴留的新临床预测指标。当泌尿科医生对他们的患者进行经直肠 TRUSPB 时，他们可以根据这些新的风险因素正确理解和解释给患者带来的每一种并发症风险。