| ObjectiveTo compare the complications rates of transrectal ultrasound guided prostate biopsies with transperineal approach and transrectal approach,to find out the causes then explore the prevention and treatment methods,providing evidence for clinicians to select the appropriate biopsy approach under different conditions.Data and MethodsRetrospective Statistical analysis was performed on a total of 609 patients who underwent prostate biopsy in the 307 th Hospital of PLA and Air Force General Hospital of PLA from January 2010 to December 2016.the patients were divided into transperineal group and transrectal group.The transperineal prostate biopsy group contains 295 cases in the 307 th Hospital of PLA,Among them,100 patients were in PSA grey area(PSA grey area is defined that serum PSA is in the range of 4~10 ng/ml).meanwhile,the transrectal group contains 314 cases in Air Force General Hospital of PLA,110 cases were in PSA grey area.Counting the time of operation and the number of puncture needles among the two groups,comparing the convenience between the two groups,counting and comparing the detection rate of total prostate cancer and that in PSA grey area between the two groups.Counting and analyzing the complications related to biopsy,comparing the incidence of hematuria,bloody stool,fever,pain,urinary retention and pyemia between the two groups.We defined a non-transient fever above 38.5 degrees Centigrad,bacteremia,serious hematuria and bloody stool which lead to prolonged hospitalization as severe complications,Comparing the incidence of total complications and the severe complications between the two groups.The data were analyzed by SPSS 21.0.Variance analysis is adopted to compare the average level of the normal distribution measurement data.The comparison of the average level of the data disobeying the normal distribution data uses the rank sum test,comparing the incidences of complications between the two groups by chi square test or Fisher,s exact test,the differences are statistical significance when P<0.05.To explore the convenience and safety of transrectal prostate biopsy and transperineal prostate biopsy.ResultsThere was no significant difference between the average age and the concentration of the serum prostate specific antigen(PSA)between the two groups.The operation time of the transperineal group is obviously longer than that of the transrectal group(30.86±6.30 vs 15.37±3.74,P<0.001),in the detection rate of prostate cancer,the perineal group was slightly higher than the transrectal group(45.08% vs 44.90%,P=0.936),but the difference was not statistically significant,for the patients in PSA gray area,the transperineal group was significantly higher than the transrectal group(37% vs 23.63%,P=0.035).The number of puncture needles in the transperineal group was significantly more than that of the transrectal group(20.67±5.27 vs 10±0,P<0.001),However,as to the incidence of total complications,the transrectal group was higher than that of transperineal group,the difference was statistically significant(55.09% vs42.03%,P=0.001),comparing the rates of serious complications,the transrectal group was higher than that of transperineal group,the difference was statistically significant(4.46% vs 0.68%,P<0.001),the transrectal group was higher than that of transperineal group in the incidence of bloody stool,the difference was statistically significant(19.75% vs 0.68%,P<0.001),as the incidence of fever,the transrectal group was statistically significantly higher than that of transperineal group(6.37% vs 2.03%,P=0.008),besides,comparing the incidence of pyemia,the transrectal group was higher than that of transperineal group,the difference was statistically significant(1.59% vs 0,P<0.001).Additionally,there was no significant difference of incidence of hematuria and pain between the two groups.In the PSA gray area,the incidence of complications:the incidence of total complications in transrectal group was significantly higher than that of the transperineal group(55.45% vs 41%,P= 0.036).The incidence of fever in the transrectal puncture group was 3.64%(4/110),and the transperineal puncture group was 2%(2/100),P=0.477,and the difference was not statistically significant;The incidence of bacteremia was 0.91%(1/110)and 0 in transperineal group,the difference was not statistically significant,P=1;the incidence of blood stool in the transrectal puncture group was 20%(22/110),significantly higher than that of the transperineal group(0/100),P<0.001,and the incidence of pain in the transrectal and transperineal group was 2.73%(3/110)and 4%(4/100,respectively).There was no statistical difference between the two groups,P=0.608;the incidence of hematuria in the transrectal and transperineal group was 28.18%(31/110)and 35%(35/100)respectively.There was no statistically significant difference between the two groups,and the incidence of the transrectal puncture group was 3.64%(4/110,2 cases had high fever).1cases of blood culture positive,1 cases of severe rectal bleeding,and 0 of the transperineal puncture group,there was no significant difference between the two groups(P =0.123).ConclusionTransrectal ultrasound guided prostate biopsy is the gold standard of the diagnosis of prostate cancer.There are two biopsy approaches in clinical practice,transrectal approach and transperineal approach,they both are recommended by the guidance..This study found that there was no significant difference in the total detection rate of prostate cancer in the two methods,but for patients in PSA gray area,the detection rate of prostate cancer by transperineal approach is significantly higher than by transrectal approach.However transrectal approach is more convenient and timesaving than transperineal approach;it is commonly used in clinical practice at present.Meanwhile,the procedure of transperineal prostate biopsy is more complex and time-consuming,but comparing the detection rate of prostate cancer in PSA grey area,and the incidence of overall complication ? serious complication ? bloody stool ? fever and pyemia,the transperineal group was remarkably lower than that of transrectal group,therefore,transperineal approach is safer than the transrectal approach,so that for the patients in PSA gray area or with high risk factors such as bleeding or infection,transperineal biopsy is the better choice. |
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