经直肠前列腺穿刺活检中抗生素的价值

本文 8 3例经直肠穿剌前列腺活检术 ,术前后未用抗生素但无感染并发症 ,证明了该手术的安全性。作为一家说 ,不用任何抗菌药是可以的 ,但短期应用抗生素是目前多数泌尿科医生的方法 ,也无可非议。最终还有待实践的结论。宋建达     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

降钙素原动态变化对经直肠前列腺穿刺活检后抗生素应用的指导价值

目的:探讨降钙素原(PCT)动态变化对经直肠前列腺穿刺活检后抗生素应用的指导价值。方法:前列腺穿刺活检术患者129例为研究对象,其中59例为对照组,术后常规使用3 d抗生素,根据病情变化调整抗生素的应用;另外70例为试验组,检测所有患者术前2 h、术后36 h、3 d及7 d血清PCT水平,试验组依据PCT变化调整抗生素应用。记录两组的抗生素应用时间、抗生素费用、穿刺感染及感染性休克。结果:对照组和试验组术前2 h、术后36 h、3 d血清PCT比较差异无统计学意义(P0.05),对照组术后7 d血清PCT明显高于试验组,差异有统计学意义(P0.05)。对照组和试验组的抗生素应用时间、抗生素费用、穿刺感染率比较差异均有统计学意义(P0.05)。结论:经直肠前列腺穿刺活检后动态监测血清PCT水平,可以指导抗生素的应用,减少抗生素应用时间、抗生素费用及穿刺感染率。     

内毒素测定评价预防性抗生素在前列腺穿刺活检中的应用价值

目的 :探讨内毒素 (ET)测定在评价经直肠前列腺穿刺活检的感染危险性和预防性抗生素中的应用价值。方法 :4 8例患者随机分成无预防性处理组 (A组 ,12例 )、预防性抗生素组 (B组 ,13例 )、术前灌肠组 (C组 ,12例 )和联合处理组 (D组 ,11例 )共 4组 ,穿刺前、后分别留取血液和尿液 ,用于细菌培养和ET测定。其中ET采用鲎试验的偶氮显色法 (LQACT)测定。　结果 :前列腺穿刺前、后各组血清ET浓度变化和血培养结果无统计学意义 (P >0 .0 5 ) ;A和B组穿刺后尿ET明显升高 (P <0 .0 5 ) ,而C和D组无明显升高 (P >0 .0 5 ) ;A和B组穿刺后尿培养细菌阳性率明显增高 (P <0 .0 5 ) ,而C和D组无明显增高 (P >0 .0 5 )。　结论 :前列腺穿刺活检引起内毒素血症可能性很小 ;术前灌肠和 /或联合预防性抗生素可减少前列腺穿刺引起尿路感染 ;血液、尿液ET测定对经直肠前列腺穿刺活检所致感染的诊断意义较大。     

经直肠直视下穿刺法在前列腺穿刺活检中的应用

目的探讨经直肠直视下前列腺穿刺活检方法的可行性。方法采用改良的俯卧位前列腺直视下穿刺方法行经直肠前列腺穿刺活检56例。利用庤上黏膜环形缝扎器（PPH）套件中的部分组件,即环形肛管扩张器及镜芯、肛镜缝扎器以协助显露直肠段前列腺。结果经直肠直视下前列腺穿刺活检方法可直视穿刺,穿刺深度和方向易控制。针刺布局规范,患者体位舒适,耐受适应好。无严重并发症发生。穿刺效果良好。结论经直肠直视下俯卧位前列腺穿刺活检方法简便,穿刺准确,值得推广。     

经直肠超声引导经会阴前列腺穿刺活检与经直肠前列腺穿刺活检的临床效果对比分析

目的 分析经直肠超声引导下经会阴前列腺穿刺活检术的临床结果.方法 选取作者单位2019年1月至2019年12月收治的需行前列腺穿刺以及后续手术治疗患者共404例,其中符合研究价值的患者共385例,作为研究组,实施经直肠超声引导经会阴前列腺穿刺活检.并选取以往住院的385例侧卧位经直肠穿刺活检患者资料作为对照组.对比两组...     

靶向穿刺联合经会阴前列腺模板穿刺在前列腺癌诊断中的应用

目的:评估靶向穿刺联合模板穿刺在前列腺癌诊断中的临床价值。方法:2018年9月～2019年4月110例患者在我院接受靶向穿刺联合模板穿刺。在靶向穿刺患者中,有90例接受认知融合穿刺,20例患者接受软件辅助的多参数MRI-US融合穿刺。所有穿刺在全麻下经会阴路径完成,术中采用前列腺电穿孔局部治疗穿刺设备及定位模板,以BK双探头超声或者多参数MRI-US融合图像作为引导。穿刺采用18G一次性穿刺针。每个患者穿刺20+x针。分别统计110例患者的总穿刺阳性率、临床有意义前列腺癌的阳性率以及穿刺相关并发症。结果:所有110例靶向穿刺+模板穿刺病例均顺利完成,患者平均年龄为(66.5±3.5)岁,每例患者穿刺平均针数为(23±2)针,穿刺平均时间为(25±5) min。总的阳性率为50.0%(55/110),其中临床有意义前列腺癌(Gleason评分≥4+3=7分)为37例,前者的阳性率为33.6%。靶向穿刺阳性率为40.9%(45/110),其中临床有意义前列腺癌33例,前者阳性率为30.0%。模板穿刺阳性率为45.4%(50/110),其中临床有意义的前列腺癌34例,前者的阳性率为30.9%...     

直肠根治术后经会阴超声引导下经会阴前列腺穿刺活检确诊前列腺癌1例

<正>1 病例资料患者,83岁,2021年7月13日因外院体检发现前列腺特异抗原(prostate specific antigen, PSA)异常升高1月无法行多参数磁共振检查入院。患者外院查tPSA:9.32 ng/mL,无明显下尿路症状,无肉眼血尿。既往于2006年因直肠癌行经腹会阴联合直肠根治术,肛门已闭,造瘘口位于左下腹。入院查体：会阴部皮肤毛发正常,无异常红肿及破溃。实验室检查：PSA 10.10 ng/mL,     

利多卡因凝胶在经直肠前列腺穿刺活检中的应用

1999年 1月至 2 0 0 0年 12月 ,我们对行经直肠超声引导前列腺系统穿刺活检术的患者直肠内灌注 2 %利多卡因凝胶作为局麻药 ,观察其镇痛效果。报告如下。资料与方法　直肠指诊阳性和 (或 )ＰＳＡ >4ｎｇ/ｍｌ的患者 10 0例。年龄 5 1～ 86岁 ,平均 70岁。患者随机分为两组 ,每组 5 0例。分别于穿刺活检前 10ｍｉｎ直肠内灌注 2 %利多卡因凝胶 10ｍｌ(Ａ组 ) ,开塞露 10ｍｌ(Ｂ组 )。两组均于穿刺活检结束后采用视觉模拟评分 (ｖｉ ｓｕａｌａｎａｌｏｇｕｅｓｃｏｒｅ ,ＶＡＳ)评估疼痛程度 ,0分为无痛 ,10分为不能忍受的剧痛。根据患者的得…     

The morbidity of transperineal template-guided prostate mapping biopsy

OBJECTIVE

To evaluate the effect of transperineal template‐guided prostate mapping biopsy (TTMB) on urinary, bowel and erectile function.

PATIENTS AND METHODS

In all, 129 men had TTMB; a median of 56 biopsy cores were obtained per patient. Tamsulosin (0.8 mg daily) was initiated 2 days before TTMB and continued for 2 weeks. The International Prostate Symptom Score (IPSS), Rectal Function Assessment Score (R‐FAS), International Index of Erectile Function (IIEF)‐6 and the postvoid residual volume (PVR) were assessed at baseline and after 30 days, except for the IPSS, which was also assessed at 7 days. Several variables were evaluated as predictors of TTMB‐induced morbidity.

RESULTS

The mean patient age was 64.7 years with a mean prostate volume of 74.3 mL; 60 men (46.5%) were diagnosed with prostate cancer. After TTMB, 39.4%, 7.1% and 1.6% of patients remained catheter‐dependent at 0, 3 and 6 days. The median catheter‐dependency was 0, 1, 2 and 3 days for prostate volumes of <60, 60–90, 90–120 and >120 mL, respectively. No patient remained catheter‐ dependent for >12 days or required a transurethral resection secondary to TTMB. The mean IPSS before TTMB was 10.4, and was 4.6 and 3.8 at 7 and 30 days. At baseline and 30 days the mean PVR was 35 and 40 mL, and the median R‐FAS and IIEF scores for patients potent before TTMB were 2.0 and 2.2, and 27.0 and 26.0, respectively.

CONCLUSIONS

TTMB is a promising procedure for diagnosing prostate cancer. TTMB‐related morbidity differs from that of standard TRUS biopsy primarily in the incidence of temporary urinary retention, and is comparable in terms of urinary, bowel and erectile function.     

The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis

This systematic review was performed to compare the efficacy and complications of transperineal (TP) vs. transrectal (TR) prostate biopsy. A systematic research of PUBMED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer (PCa) detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen (PSA) levels and digital rectal examination (DRE) findings. The Cochrane Collaboration's RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials (RCTs) and four case-control studies (CCS), met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups (risk difference (RD), -0.02; 95% confidence interval (CI), -0.08-0.03; P=0.34). Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group (RD, -0.01; 95% CI, -0.05-0.04; P=0.81). There was no significant difference in PCa detection rate between the saturation TR and TP approaches (31.4% vs. 25.7%, respectively; P=0.3). There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.     

Infective complications after transrectal ultrasound-guided prostate biopsy following a new protocol for antibiotic prophylaxis aimed at reducing hospital-acquired infections

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add?

• ? Clostridium Difficile infections have been a serious problem throughout the NHS and have forced clinicians to change the types of antibiotics they routinely prescribe.
• ? Ciprofloxacin is a good choice of prophylactic agent for TRUSP Bx.
• ? Co‐amoxiclav and gentamicin have never been studied in combinations as prophylaxis for TRUSP Bx.

• ? Co‐amoxiclav and gentamicin in combination are an inferior choice of prophylactic agent compared to Ciprofloxacin.
• ? Development of Clostridium Difficile infection does not appear to be a concern when using Ciprofloxacin as prophylaxis for TRUSP Bx.
• ? Any change in antibiotic usage should take into account local knowledge of antiobiotic resitance as well as published evidence.

OBJECTIVE

? To compare the infective complications between two different antibiotic regimens used as prophylaxis for transrectal ultrasound‐guided prostate biopsy (TRUSP Bx).

PATIENTS AND METHODS

? The records of 709 consecutive patients undergoing TRUSP Bx over a period of 20 months at a UK teaching hospital were examined retrospectively. ? All clinic letters, microbiology reports and admission records were examined for each patient.

RESULTS

? Within the study period a total of 454 patients received prophylaxis with ciprofloxacin; 11 of these patients (2.4%) developed an infective complication within 4 weeks of the TRUSP Bx. ? A total of 255 patients received prophylaxis with co‐amoxiclav and gentamicin; 33 patients (12.9%) in this group had an infective complication. ? No cases of Clostridium difficile infection were recorded for any of these patients within 1 month of receiving antibiotics. ? Re‐introduction of the original regimen led to a fall in infective complications.

CONCLUSION

? Understandable concerns about the development of hospital‐acquired infection led to a new protocol for antibiotic prophylaxis which in turn led to a number of patients being put at increased risk of potentially serious infective complications. Antibiotic prophylaxis must reflect tissue penetration, the organisms encountered and their susceptibilities, as well as being based on objective evidence.     

The role of a standardized 36 core template-assisted transperineal prostate biopsy technique in patients with previously negative transrectal ultrasonography-guided prostate biopsies

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Template assisted transperineal biopsy of the prostate has become increasingly popular over the past decade. Several studies have demonstrated that transperineal prostate biopsy (TPB) is associated with an increased rate of cancer detection, increased histological concordance with final prostatectomy samples and an increase in anterior and apical prostate cancers than standard TRUS biopsy. However, interpretation of the literature is difficult due to considerable variation between studies in terms of technique and equipment. We examined a small cohort (n= 40) of patients using a standardized 36 core template assisted TPB technique. We show that utilising this technique is associated with high cancer (68%) detection rate in patients with two previous negative TRUS biopsies. Of patients were found to have anterior gland tumours which would not have been detected by standard TRUS guided biopsy.

OBJECTIVE

? To determine the efficacy and safety of a standardized 36 core template‐assisted transperineal biopsy technique for detecting prostate cancer in patients with previously negative transrectal ultrasonography‐guided prostate biopsies and elevated prostate‐specific antigen (PSA) levels.

PATIENTS AND METHODS

? Between April 2008 to September 2010, a total of 40 patients with a mean (range) age of 63 (49–73) years, a mean (range) elevated PSA level of 21.9 (4.7–87) ng/mL and two previous sets of negative TRUS‐guided prostate biopsies underwent standardized 36 core template‐assisted transperineal prostate biopsies under general anaesthetic as a day case procedure. ? The cancer detection rate and complications for all cases were evaluated.

RESULTS

? In total, 27 of 40 (68%) patients were found to have adenocarcinoma of the prostate, two patients (5.0%) had atypical small acinar proliferation, one had high‐grade prostatic intraepithelial neoplasia (2.5%), four (10%) had chronic active inflammation and six (15%) had benign histology. ? Gleason scores were in the range 6–9, with a median Gleason score of 7. ? There were no cases of urosepsis, urinary tract infections or haematuria. A single patient experienced acute urinary retention, with a subsequent succesful trial without a catheter, and haematospermia was common, although minor.

CONCLUSIONS

? Our standardized 36 core template‐assisted transperineal prostate biopsy technique is safe and associated with a high detection rate of prostate cancer. ? This technique should be considered in patients with elevated PSA levels and previously negative TRUS‐guided prostate biopsies.     

One preoperative dose randomized against 3‐day antibiotic prophylaxis for transrectal ultrasonography‐guided prostate biopsy

OBJECTIVE

To compare the incidence of infective events between a single dose and 3‐day antibiotic prophylaxis for transrectal ultrasonography (TRUS)‐guided prostate biopsy.

PATIENTS AND METHODS

Patients were randomized to receive either one preoperative dose consisting of two ciprofloxacin 500 mg tablets 2 h before prostate biopsy, or 3 days of ciprofloxacin treatment. They had a clinical examination at study inclusion, the day of the biopsy and 3 weeks later. The day after the procedure all patients were contacted by telephone to inquire about any significant event. Biological testing and urine cultures were conducted 5 days before and then 5 and 15 days after the biopsy; a self‐administered symptom questionnaire was completed by the patient 5 days before and then at 5 and 15 days.

RESULTS

The study group included 288 men, of whom 139 were randomized to the single‐dose arm and 149 to the 3‐day arm. Six patients in each group had an asymptomatic bacteriuria with no leukocyturia. One patient in each group had documented prostatitis, with Escherichia coli identified on urine culture. The strain identified in the patient from the 3‐day group was resistant to ciprofloxacin. There was no difference between groups in symptoms at 5 and 21 days after biopsy.

CONCLUSIONS

Current TRUS‐guided prostate biopsy techniques lead to very few clinical infectious complications when accompanied by antibiotic prophylaxis. We found no argument to advocate the use of more than one dose of antibiotic prophylaxis.     

Clinical staging of prostate cancer: a computer-simulated study of transperineal prostate biopsy

OBJECTIVE: To identify the precise location of prostate cancer within the gland and thus possibly permit more aggressive therapy of the lesion, while potentially sparing the noncancerous gland from ablative therapy. MATERIALS AND METHODS: Three-dimensional "solid" computer models were reconstructed for 86 autopsy specimens and 20 stage T1c radical prostatectomy specimens. Transperineal biopsies were simulated for grid sizes of 5-mm (method A) and 10-mm (method B) with an 18 G, 23-mm long biopsy needle. One or two biopsies per grid point were obtained for a total of 12-108 biopsies, depending on the size of the prostate. Clinically threatening cancers were defined as having volumes of > or = 0.5 mL or Gleason sum > or = 7. RESULTS: Method A detected significantly more carcinomas than method B in both the autopsy and prostatectomy specimens (autopsy, 72 vs 51; prostatectomy, 50 vs 32, both P < 0.001). Method A also detected more clinically threatening cancers found at autopsy (38/40 vs 31/40, P = 0.008). Among autopsy patients with negative sextant biopsies whose disease was localized to one side, method A detected 72% and method B detected 29-43% (P < 0.001). CONCLUSIONS: The results of this computer simulation show that 5- and 10-mm grid biopsies detect three-quarters and a third, respectively, at autopsy, of patients with the disease localized to one side of the prostate, which may be useful when planning highly selective ablative treatments in the future.