CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2021; 30(04): e265-e270
DOI: 10.1055/s-0041-1740375
Artículo Original | Original Article

Biopsia de próstata, acceso transperineal bajo anestesia local[*]

Prostate Biopsy, Transperineal Access under Local Anesthesia
1   Facultad de Medicina y Ciencias de la Salud, Universidad Militar Nueva Granada Bogotá, Colombia
,
Andres Gomez
2   Urólogo, Hospital Manuela Beltran
,
Carlos Torres
3   Urólogo Graduado, Hospital Manuela Beltran
,
Luis Fernando Solano
4   Médico General, Unidad de Cuidados Intensivos Adultos, Fundación Hospital San Carlos
› Author Affiliations

Resumen

Objetivo La biopsia de próstata es una ayuda esencial en el diagnóstico de cáncer, siendo el método más utilizado la biopsia transrectal guiada por ultrasonido (TRUS), con una tasa diagnóstica entre el 37% y el 45%, aunque no exenta de complicaciones como infecciones, dolor o sangrado.

El enfoque alternativo y seguro a las biopsias TRUS se encuentra en la biopsia transperineal (BTP), realizada comúnmente bajo anestesia regional o general.

El objetivo de este estudio fue determinar la efectividad de la BTP bajo anestesia local y guía ultrasonográfica transrectal, con el impacto sobre la sensibilidad del estudio y la tasa de readmisión hospitalaria por infección.

Métodos Estudio de cohorte retrospectiva en el que se evaluaron 83 pacientes sometidos a BTP con anestesia local y guía ultrasonográfica transrectal de enero de 2017 a agosto de 2018 en una ciudad intermedia de Colombia. La muestea incluyó todos los hombres mayores de 18 años con datos de historia clínica disponibles para su análisis, así como los reportes histopatológicos de las biopsias. Se excluyeron casos de rebiopsia o con datos insuficientes.

El análisis de datos nominales se realizó mediante la prueba de chi cuadrado, y el de los datos numéricos, con las prubas t de Student o de Mann-Whitney.

Resultados Un total de 83 pacientes, con media de edad de 65 ± 7.9 años fueron sometidos al análisis del estudio histopatológico. Se excluyeron nueve pacientes que no tenían información disponible en el registro clínico sistematizado, ni en historia clínica de formato físico. Se encontró una proporción de positividad y diagnóstico de cáncer de prostata en el 39.7% (33) de los pacientes, distribuidos así: grado de grupo 1 (69.7%; 23); grado de grupo 2 )15.2%; 5); grados de grupos 3 y 4 (3% cada uno de ellos; 2); y grado de grupo 5 (9%; 3). En total, 60% (50) fueron negativos para malignidad y, de estos el 54% (27) tuvo hiperplasia. El antibiótico profiláctico indicado en el 96.7% (80) de los casos fue una cefalosporina de primera generación, administrada en el 15% (12) por vía parenteral preoperatoria. En esta serie de casos, no se documentaron ingresos hospitalarios asociados a infección después del procedimiento.

Conclusiones La biopsia de próstata por vía transperineal es una técnica con rendimiento diagnostico similar al del abordaje transrectal: es segura, rápida, de fácil acceso, con bajo costo y, sobre todo, con un riesgo insignificante de infección y sepsis. Sus beneficios son altamente representativos en un sistema de salud como el de nuestro país, y la BTP facilita el acceso de la población vulnerable del área rural y de ciudades intermedias, en las que no se dispone de un urólogo experto.

Abstract

Objective Prostate biopsy is an essencial aid in cancer diagnosis, and the the most widely-used method is known as transrectal ultrasound-guided (TRUS) biopsy, with a diagnostic rate ranging from 37% to 45%; however, it is not free of complications such as infections, pain, or bleeding.

The alternative and safe approach lies in the transpineal biopsy (TPB), commonly performed under regional or general anesthesia.

The objetive of the present study was to determine the effectiveness of TPBunder local anesthesia and transrectal ultrasound guidance, with the impact of the sensitiviy of the study and the rate of hospital readmission due to infection.

Methods Retrospective cohort study in which 83 patients underwent TPB with local anesthesia and transrectal ultrasound guidance from january 2017 and august 2018 in an intermediate city in Colombia. The sample included all male subjects older than 18 years of age with medical history data available for analysis, as well as the histopathological reports of the biopsies. Cases of rebiopsy or with insufficient data were excluded.

The analysis of the nominal data was performed using the chi-squared test, and that of the numerical data, with the Student t or the Mann-Whitney test.

Results A total of 83 patientswith an average age was of 65 ± + 7.9 years, had their histopathological studies analyzed. We excluded nine patients who did not have information available in the systematized clinical registry nor in the medical history in physical format. Positivity and a diagnosis of prostate cancer was found in 39.7% (33) of the patients, who were distributed like this: grade group 1 (69.7%; 23); grade group 2 (15.2%; 5); grade groups 3 and 4 (each with 3%; 2); and grade group 5 (9%; 3). In total, 60% (50) were negative for malignancy, and, of these, 54% (27) had glandulostromal hyperplasia. The indicated prophylactic antibiotic in 96.7% (80) of the cases was a first generation cephalosporin and, in 15% (12) of the cases it was administered through a preoperative parenteral route. Hospital admissions after the procedure associated with infection were not documented in the present series of cases.

Conclusions Transperineal prostate biopsy is a technique with diagnostic performance similar to that of the transrectal approach: it is safe, fast, easy to access, has a low cost and, above all, presents a minimum risk of infection and sepsis. Its benefits are highly representative in a health system like that of our country, and TPB facilitates the access of the vulnerable population of the rural area and of intermediate cities in which there is no availability of an expert urologist.

* Estudio desarrollado en el E.S.E Hospital Regional Manuela Beltrán, Socorro, Santander, Colombia.




Publication History

Received: 29 June 2020

Accepted: 22 December 2020

Article published online:
22 December 2021

© 2021. Sociedad Colombiana de Urología. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referencias

  • 1 Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis. World J Surg Oncol 2019; 17 (01) 31 DOI: 10.1186/s12957-019-1573-0.
  • 2 Nam RK, Saskin R, Lee Y. et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2013; 189 (1, Suppl) discussion S17–S18 S12-S17 DOI: 10.1016/j.juro.2012.11.015.
  • 3 Ong WL, Weerakoon M, Huang S. et al. Transperineal biopsy prostate cancer detection in first biopsy and repeat biopsy after negative transrectal ultrasound-guided biopsy: the Victorian Transperineal Biopsy Collaboration experience. BJU Int 2015; 116 (04) 568-576 DOI: 10.1111/bju.13031.
  • 4 Grummet JP, Weerakoon M, Huang S. et al. Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy?. BJU Int 2014; 114 (03) 384-388 DOI: 10.1111/bju.12536.
  • 5 Nafie S, Mellon JK, Dormer JP, Khan MA. The role of transperineal template prostate biopsies in prostate cancer diagnosis in biopsy naïve men with PSA less than 20 ng ml(-1.). Prostate Cancer Prostatic Dis 2014; 17 (02) 170-173 DOI: 10.1038/pcan.2014.4.
  • 6 Raaijmakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology 2002; 60 (05) 826-830 DOI: 10.1016/s0090-4295(02)01958-1.
  • 7 Thurtle D, Starling L, Leonard K, Stone T, Gnanapragasam VJ. Improving the safety and tolerability of local anaesthetic outpatient transperineal prostate biopsies: A pilot study of the CAMbridge PROstate Biopsy (CAMPROBE) method. J Clin Urol 2018; 11 (03) 192-199 DOI: 10.1177/2051415818762683.
  • 8 Namekawa T, Fukasawa S, Komaru A. et al. Prospective evaluation of the safety of transrectal ultrasound-guided transperineal prostate biopsy based on adverse events. Int J Clin Oncol 2015; 20 (06) 1185-1191 DOI: 10.1007/s10147-015-0831-6.
  • 9 Pepe P, Aragona F. Morbidity after transperineal prostate biopsy in 3000 patients undergoing 12 vs 18 vs more than 24 needle cores. Urology 2013; 81 (06) 1142-1146 DOI: 10.1016/j.urology.2013.02.019.
  • 10 Zaytoun OM, Vargo EH, Rajan R, Berglund R, Gordon S, Jones JS. Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology 2011; 77 (05) 1035-1041 DOI: 10.1016/j.urology.2010.12.067.
  • 11 Skouteris VM, Crawford ED, Mouraviev V. et al. Transrectal Ultrasound-guided Versus Transperineal Mapping Prostate Biopsy: Complication Comparison. Rev Urol 2018; 20 (01) 19-25 DOI: 10.3909/riu0785.
  • 12 Pepdjonovic L, Tan GH, Huang S. et al. Zero hospital admissions for infection after 577 transperineal prostate biopsies using single-dose cephazolin prophylaxis. World J Urol 2017; 35 (08) 1199-1203 DOI: 10.1007/s00345-016-1985-1.
  • 13 Shen P, Zhu Y, Wei W, Li Y, Yang J, Li Y. et al. The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis. Asian J Androl 2012; Mar;14 (02) 310-315
  • 14 Kaufmann S, Russo GI, Thaiss W. et al. Cognitive versus Software-Assisted Registration: Development of a New Nomogram Predicting Prostate Cancer at MRI-Targeted Biopsies. Clin Genitourin Cancer 2018; 16 (04) e953-e960 DOI: 10.1016/j.clgc.2018.03.013.
  • 15 Chang DTS, Challacombe B, Lawrentschuk N. Transperineal biopsy of the prostate–is this the future?. Nat Rev Urol 2013; 10 (12) 690-702 DOI: 10.1038/nrurol.2013.195.
  • 16 Lopera Toro AR, Correa Ochoa JJ, Martínez González CH, Velez Hoyos A, Riveros Angel M. Revisión de biopsias de próstata en un centro de nivel iv de complejidad: ¿realmente hay diferencias?. Urología Colombiana. 2016; 25 (03) 214-218
  • 17 Bass EJ, Donaldson IA, Freeman A. et al. Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach. Prostate Cancer Prostatic Dis 2017; 20 (03) 311-317 DOI: 10.1038/pcan.2017.13.
  • 18 Marra G, Marquis A, Tappero S. et al. Transperineal Free-hand mpMRI Fusion-targeted Biopsies Under Local Anesthesia: Technique and Feasibility From a Single-center Prospective Study. Urology 2020; 140: 122-131
  • 19 Salagierski M, Kania P, Wierzchołowski W, Poźniak-Balicka R. The role of a template-assisted cognitive transperineal prostate biopsy technique in patients with benign transrectal prostate biopsies: a preliminary experience. Cent European J Urol 2019; 72 (01) 15-18 DOI: 10.5173/ceju.2018.1840.