Efectos adversos de la biopsia prostática transrectal. un análisis de 303 procedimientos

Resumen

objetivo

Analizar los efectos adversos de la biopsia prostática transrectal en nuestro entorno

Material y métodos

Los datos se recogieron mediante cuestionario cumplimentado por 303 pacientes que acudieron a la realización ambulatoria de la biopsia, en el contexto de un programa de detección precoz del CaP. Estas se llevaron a cabo de manera randomizada, sextante y ecodirigida. Los pacientes fueron preparados con un enema de limpieza la noche previa a la prueba, así como con 100 mg de tobramicina intramuscular inmediatamente antes de la biopsia

Resultados

Noventa pacientes (29,7%) no presentaron complicaciones, y 136 (44,9%) manifestaron algún efecto adverso leve (hematuria, hemospermia, o disuria autolimitados). Por último, 77 (25,4%) presentaron complicaciones no leves -retención urinaria, fiebre, necesidad de asistencia médica (primaria u hospitalaria) o de tratamiento-. Treinta y cinco pacientes (11,5%) manifestaron haber presentado fiebre tras la biopsia, 145 (47,8%) hematuria, 95 (31,3%) hemospermia, 77 (25,4%) sangrado rectal, 67 (22,1%) dificultad miccional, y 9 (2,9%) retención urinaria. Hasta 39 (12,8%) acudieron al médico de cabecera, y 19 de ellos fueron remitidos al Hospital, donde sólo 6 (1,9%) permanecieron ingresados más de 24 horas. No se registraron ingresos en UCI ni fallecimientos

Conclusiones

El índice de efectos adversos de la biopsia transrectal es elevado en nuestra experiencia. Este fenómeno podría explicarse, en parte, por la recogida de datos mediante un cuestionario administrado al paciente. Probablemente pueda reducirse la tasa de fiebre post-biopsia mediante otro régimen de profilaxis antibiótica

Abstract

Introduction and objective

Prostate biopsy is a basic step towards prostate cancer (Pca) diagnosis, but usually not free from complications. In this article we have reviewed the adverse effects of this procedure in our setting

Material and methods

We studied in a prospective fashion the complications arising from transrectal prostate biopsy with the aid of a questionnaire fulfilled by 303 patients who underwent this procedure, within the context of a Pca screening program. All biopsies were transrectal ultrasound guided and randomly taken (sextant). A cleaning enema was applied the night before, and 100 mg of intramuscular tobramycin were administered prior of the procedure

Results

Ninety patients (29,7%) had no adverse effects at all, and 136 (44,9%) reported at least one minor complication (hematuria, hemospermia, or autolimited dysuria). Lastly, 77 (25,4%) presented with major complications –urinary retention, fever, need for medical assistance (primary or hospital care) or treatment. Thirty-five patients (11,5%) reported to present with fever after biopsy, 145 (47,8%) hematuria, 95 (31,3%) hemospermia, 77 (25,4%) rectal bleeding, 67 (22,1%) urinary difficulty, and 9 (2,9%) urinary retention. Up to 39 (12,8%) needed to visit their G.P., and 19 of them were referred to Hospital, where only 6 (1,9%) were admitted longer than 24 hours. No intensive care unit admittances or deaths were reported

Conclusions

The rate of post-transrectal biopsy adverse effects is high in our experience. This phenomenon could be explained, in part, due to data collecting by means of a self-administered questionnaire. Probably the high fever rate presented here could be diminished with other type of antibiotic prophylaxis