文章：

三级转诊学术中心经直肠磁共振-超声融合靶向前列腺活检的发病率：一项指导向经会阴途径过渡的审计研究

Morbidity of Transrectal MRI-Fusion Targeted Prostate Biopsy at a Tertiary Referral Academic Centre: An Audit to Guide the Transition to the Transperineal Approach

原文发布日期：11 December 2023

DOI: 10.3390/cancers15245798

类型: Article

开放获取: 是

英文摘要：

Despite transrectal prostate biopsy (TRPB) being still widespread globally, the EAU Guidelines strongly recommend the transperineal approach, due to the reported lower infectious risk. Our study aims to evaluate the impact of a standardized clinical pathway for TRPB on post-operative complications. We prospectively collected data from all patients undergoing mpMRI-targeted TRPB at our Academic Centre from January 2020 to December 2022. All patients followed a standardized, structured multistep pathway. Post-procedural complications were collected and classified according to the Clavien–Dindo (CD) Classification. Among 458 patients, post-procedural adverse events were reported by 203 (44.3%), of which 161 (35.2%) experienced CD grade 1 complications (hematuria [124, 27.1%], hematochezia [22, 4.8%], hematospermia [14, 3.1%], or a combination [20, 4.4%]), and 45 (9.0%) reported CD grade 2 complications (acute urinary retention or hematuria needing catheterization, as well as urinary tract infections, of which 2 cases required hospitalization). No major complications, including sepsis, were observed. At uni- and multivariable analysis, age > 70 years and BMI > 25 kg/ m2for patients were identified as predictors of post-operative complications. The results of our study confirm that TRPB is a safe and cost-effective procedure with a low risk of severe adverse events in experienced hands and following a standardized pathway.

摘要翻译： 

尽管经直肠前列腺穿刺活检（TRPB）在全球范围内仍广泛应用，但欧洲泌尿外科学会指南基于其较低的感染风险，强烈推荐采用经会阴穿刺途径。本研究旨在评估标准化临床路径对TRPB术后并发症的影响。我们前瞻性收集了2020年1月至2022年12月期间在本学术中心接受多参数磁共振成像靶向TRPB的所有患者数据。所有患者均遵循标准化、结构化的多步骤临床路径。术后并发症根据Clavien-Dindo分级系统进行收集和分类。在458例患者中，203例（44.3%）报告了术后不良事件，其中161例（35.2%）发生Clavien-Dindo 1级并发症（血尿[124例，27.1%]、便血[22例，4.8%]、血精[14例，3.1%]或上述症状组合出现[20例，4.4%]），45例（9.0%）报告Clavien-Dindo 2级并发症（急性尿潴留或需导尿的血尿，以及尿路感染，其中2例需要住院治疗）。未观察到包括脓毒症在内的严重并发症。通过单变量和多变量分析发现，年龄>70岁和体重指数>25 kg/m²是术后并发症的预测因素。本研究结果证实，在经验丰富的医师操作下并遵循标准化路径，TRPB是一种安全且具有成本效益的诊疗手段，其严重不良事件风险较低。

原文链接：

Morbidity of Transrectal MRI-Fusion Targeted Prostate Biopsy at a Tertiary Referral Academic Centre: An Audit to Guide the Transition to the Transperineal Approach