Komplikacije transrektalne ultrazvučno vođene biopsije prostate: naša iskustva i pregled literature

Transrectal ultrasound guided prostate needle biopsy is the most important diagnostic procedure for early prostate cancer detection. It is a safe diagnostic tool with very few complications and well tolerated by patients. The aim of the study is to report complication rates after transrectal ultrasound guided prostate needle biopsy. All study patients, mean age 68.8 years, received antibiotic prophylaxis and a laxative was administered on the day prior to the procedure. A mean of 8.03 biopsy cores per patient were obtained. Laterally directed sextant biopsy plus two cores from transition zone of the prostate was performed along with biopsy of any hypo- or hyperechoic lesion seen on transrectal ultrasound. Results of 224 prostate biopsies performed in selected patients are reported. Biopsy proved negative in 54%, prostate cancer was confirmed in 31%, and prostatic intraepithelial neoplasia was detected in 15% of patients. Complications occurred in 35 (14%) patients: two were hospitalized for urinary retention, 15 (6.15%) patients had prolonged hematuria lasting for more than five days, and 18 patients showed clinical signs of urinary tract infection. The mean level of discomfort was 2.8 on a 10­point pain scale. Study results were generally consistent with other recent reports on complication rates, while showing a significantly lower rate of hematuria. Prostate biopsy is the only accurate method of preoperative prostate cancer detection; the more so, there is no need of hospitalization, regional or local anesthesia, and there are no false-positive results.Biopsija prostate kao najznačajnija dijagnostička metoda u otkrivanja raka prostate je indicirana većinom kod muškaraca bez kliničkih smetnja i vrlo je važno da je to siguran dijagnostički postupak s malo komplikacija koji bolesnici dobro podnose, iako ulazi u skupinu agresivnih dijagnostičkih pretraga. U radu su opisani rezultati biopsije prostate na ukupno 224 bolesnika s indikacijom. Prosječna starost je bila 68,8 godina, svi su prethodno dobili antibiotsku profilaksu i pripremljeni su davanjem laksativa dan ranije. Uzimalo se je prosječno 8,03 uzoraka po bolesniku. Svakom bolesniku je učinjena lateralna sekstant biopsija i transrektalnim ultrazvukom vidljive hipo- i hiperehogene lezije u prostati. Kod 54% bolesnika nalaz je bio negativan, 31% ih je imalo rak prostate, dok je u ostalih 15% nađena predmaligna lezija, prostatična intraepitelna neoplazija (PIN). Komplikacije su zabilježene kod 35 (14%) bolesnika, od kojih su dvojica liječeni bolnički zbog potpune retencije, hematurija duža od pet dana zabilježena je kod 15 (6,15%) bolesnika, a znakove upale ili febrilitet je imalo 18 (7,38%) bolesnika. Bolesnici su ocijenili razinu boli tijekom zahvata prosječnom ocjenom 2,8 na ljestvici od 1 do 10. Rezultati dobiveni u našem istraživanju sukladni su u većini parametara novijim studijama u kojima je obrađena ista tematika, a za razliku od drugih imali smo značajno manje hematurija. U zaključku se navodi kako je biopsija prostate jedina točna prijeoperacijska metoda otkrivanja raka prostate koja se radi ambulantno i bez potrebe za regionalnom ili lokalnom anestezijom, i nema lažno pozitivnih rezultata