Publication: Transrektal ultrasonografi eşliğinde prostat biyopsisinin komplikasyonları
Abstract
Amaç: Transrektal ultrasonografi (TRUS) prostatın anatomisini tüm ayrıntılarıyla ortaya koyabilmekte ve bu nedenle prostat kanserinin doku tanısında TRUS eşliğinde yapılan prostat biyopsisi altın standart olarak kabul edilmektedir. İşlemin rektal yolla yapılıyor olması ve invazif özelliği, başta enfeksiyon olmak üzere olası komplikasyonları da beraberinde getirmektedir. İlk çalışmalarda yüksek oranda enfeksiyon görülmesi sonrasında antibiyotik profilaksisi rutin olarak kullanılmaya başlanmıştır. Bu çalışmada özel bir tanı merkezinde, antibiyotik profilaksisi uygulanmak kaydıyla yapılmış olan 281 TRUS eşliğinde prostat biyopsisinin komplikasyonları araştırıldı. Hastalar ve Yöntem: Tüm hastalar biyopsiden bir gün önce başlamak ve daha sonra 4 gün devam etmek kaydıyla 400 mg/gün fluoroquinolone kullandılar. Hastalardan TRUS eşliğinde periferal zondan 6 adet, transizyonel zondan 2 adet sistematik ve görülen şüpheli lezyonlardan ek biyopsiler alındı. Bulgular: Sonuçta, toplam 89 (%31.6) hastada histopatolojik inceleme sonucunda prostat adenokanseri belirlendi. Tüm çalışma grubunda toplam 4 (%1.4) hastada biyopsiye bağlı komplikasyonlar nedeniyle hospitalizasyon gerekti. Bunlarda 3 tanesinde üriner sistem enfeksiyonu saptanmış, içlerinden birisinde de kan kültüründe de üreme görülmüştür. Bu hastalar hastaneye yatırılarak uygun intra-venöz antibiyotik tedavisi uygulanmış ve sorunsuz olarak taburcu edilmişlerdir. Bir hastada ise ciddi rektal kanama ile karşılaşılmıştır. Bu hasta da hastaneye yatırılarak konservatif metodla tedavi edilmiştir. Sonuç: Sonuç olarak TRUS eşliğinde prostat biyopsisi kolay uygulanabilir, antibiyotik profilaksisi altında komplikasyon oranı son derece düşük, güvenilir bir tanı yöntemidir. Ancak çok düşük oranda da görülse olası komplikasyonlar konusunda hastaların bilgilendirilmesi ve biyopsi sonrası takibi uygun olacaktır.
Purpose: Transrectal ultrasonography (TRUS) provides detailed anatomy of the prostate and can direct biopsy needle precisely into the regions of the prostate. Contemporarily, systematic prostate biopsies under TRUS guidance is the standard procedure in the diagnosis of prostate cancer. The aim of this study was to define the complications of TRUS guided biopsies performed under antibiotic prophylaxis. Patients and Method: A total of 281 patients were admitted with lower urinary tract symptoms underwent TRUS guided prostate biopsies owing to elevated prostate specific antigen (PSA>4 ng/ml) and/or abnormal digital rectal examination findings. All biopsies were performed with a systematic random approach (3 specimens taken from the base, midgland, apex of the right and left sides of PZ) and lesion directed biopsies plus systematic random TZ biopsies (one core taken from each side). All biopsies were done as an outpatient procedure under antibiotic prophylaxis starting the day before the biopsy and continued for 4 days. Results: Prostate cancer was detected in 89 patients (31.6%) undergoing biopsy. Overall 4 (1.4%) patients were hospitalized. Among them 3 had urinary tract infections including one with positive blood culture. All of these patients received appropriate intravenous antibiotics. The remaining patient had severe rectal bleeding which was managed conservatively. All patients were discharged without further problem. Conclusion: In conclusion, TRUS guided prostate biopsy under antibiotic prophylaxis remains as an easy, fast, and well tolerated procedure with considerably low morbidity. However, patients should be informed about the possible complications although there is a very limited risk.
Purpose: Transrectal ultrasonography (TRUS) provides detailed anatomy of the prostate and can direct biopsy needle precisely into the regions of the prostate. Contemporarily, systematic prostate biopsies under TRUS guidance is the standard procedure in the diagnosis of prostate cancer. The aim of this study was to define the complications of TRUS guided biopsies performed under antibiotic prophylaxis. Patients and Method: A total of 281 patients were admitted with lower urinary tract symptoms underwent TRUS guided prostate biopsies owing to elevated prostate specific antigen (PSA>4 ng/ml) and/or abnormal digital rectal examination findings. All biopsies were performed with a systematic random approach (3 specimens taken from the base, midgland, apex of the right and left sides of PZ) and lesion directed biopsies plus systematic random TZ biopsies (one core taken from each side). All biopsies were done as an outpatient procedure under antibiotic prophylaxis starting the day before the biopsy and continued for 4 days. Results: Prostate cancer was detected in 89 patients (31.6%) undergoing biopsy. Overall 4 (1.4%) patients were hospitalized. Among them 3 had urinary tract infections including one with positive blood culture. All of these patients received appropriate intravenous antibiotics. The remaining patient had severe rectal bleeding which was managed conservatively. All patients were discharged without further problem. Conclusion: In conclusion, TRUS guided prostate biopsy under antibiotic prophylaxis remains as an easy, fast, and well tolerated procedure with considerably low morbidity. However, patients should be informed about the possible complications although there is a very limited risk.