經由會陰攝護腺切片術在局部麻醉下是可行的嗎?
黃冠霖、江博暉
高雄長庚醫院泌尿科
Is trans-perineal prostate biopsy applicable under local anesthesia? A single center preliminary study.
Guan-Lin, Huang、Po-Hui Chiang
Kaohsiung Chang Gung Memorial hospital, department of urology
Purpose:
Comparisons of the cancer detection and complication rates between transperineal and transrectal approaches in initial primary prostate biopsy. Evaluation of the feasibility of trans-perineal biopsy under local anesthesia.
Materials and Methods:
Two hundred and thirty-eight outpatient primary prostate biopsy cases were enrolled in a single center prospectively. One hundred and thirty patients were included in the transperineal prostate biopsy group with 98 and 32 patients under local or intravenous general anesthesia, respectively, from May 2015 to Dec 2017. Another 108 patients receiving the transrectal prostate biopsy were set as control group. Age, PSA, DRE finding, prostate volume, and biopsy core numbers were collected as characteristics. We compared the cancer detection rate, complications, admission rate and visual analog scale during procedure between the transperineal and transrectal prostate biopsy group.
Results:
There were 58(45%) and 53(49%) patients detected as prostate cancer in transperineal and transrectal biopsy, respectively(p=0.492). Transrectal prostate biopsy has higher infectious complications such as prostatitis(4.6%), UTI(12.0%), fever(6.4%) and hospitalization rate(7.4%). Transperineal biopsy has no epididymitis(0%), prostatitis(0.7%), UTI(2.2%), fever(0%) and hospitalization rate(0%). Except for epididymitis and prostatitis, all infection related complications were significantly higher in the transrectal prostate biopsy group. (p<0.05) Median visual analog scale[25-75 quartile] during the operation showed 3[3-4], 4[3-5] and 1[1-2] in transrectal biopsy, transperineal biopsy under local anesthesia and transperineal prostate biopsy under intravenous general anesthesia group respectively. Biopsy under intravenous anesthesia had significantly less pain scores than local anesthesia. (p <0.001) However, the pain scores showed no difference between transrectal and transperineal prostate biopsy under local anesthesia. (p =0.269)
Conclusion:
In primary prostate biopsy, transperineal prostate biopsy has comparable cancer detection rate but less infection related complications compared with transrectal prostate biopsy. Transperineal biopsy under local anesthesia is feasible when there are concerns about infection and high general anesthesia-risk patients.