Transrektal Ultrasonografi (TRUS) Eşliğinde Prostat Biyopsisinde Hasta Rahatsızlığına İlişkin Risk Faktörlerinin Değerlendirilmesi

Abstract

Prostat kanseri tanısında “altın standart” olarak kabul edilen transrektal ultrasonografi (TRUS) eşliğinde prostat biyopsi uygulamalarına ilişkin literatürde kayda değer oranlarda hasta rahatsızlığı bildirilmiştir. Bu çalışmada belirtilen yakınmaya yönelik risk faktörlerinin belirlenmesi amaçlanmıştır. Çalışmaya TRUS eşliğinde prostat biyopsisi uygulanan, yaşlan 43 ile 96 arasında değişen (ortalama ± SD, 67.3 ± 8.3) toplam 320 hasta dahil edilmiştir. İşlem öncesinde veya işlem sırasında hastalara anestezi uygulanmamıştır. Biyopsi sonrasında hastalardan tüm işlem boyunca hissettikleri rahatsızlığı vizüel analog skalası yardımıyla belirtmeleri istenmiş olup elde edilen skorlar hafif derecede (0-3) ve orta-ileri derecede rahatsızlık (4-10) olmak üzere iki gruba ayrılmıştır. Hasta yaşı (<50, 51-60, 61-70, >60), biyopsi sırası (primer-rebiyopsi), total PSA değeri (ng/ml) (2.6-4, 4-10, >10), prostat hacmi (mİ) (<50, 51-60, 61-70, >60), histopatolojik tanı (benign, HGPIN, kanser) ve uygulayıcı tecrübesinin (tecrübeli-az tecrübeli) elde edilen VAS skorlanna etkisi istatistiksel olarak araştırılmıştır. Orta-ileri derecede rahatsızlık skorları tecrübeli ve az tecrübeli uygulayıcı tarafından gerçekleştirilen biyopsi uygulamalarında sırasıyla % 44.7 (34/76) ve %70.8 (172/243) oranında saptanmış olup iki uygulayıcı arasındaki farklılık anlamlı bulunmuştur (p<0.001). Aynı şekilde, uygulayıcının az tecrübeli olması durumunda orta-ileri derecede rahatsızlık riskinin arttığı saptanmıştır. (OR=2.93, p< 0.001). Diğer yandan, hasta yaşının azalmasıyla orta-ileri derecede rahatsızlık riskinin istatistiksel olarak anlamlı olmamakla birlikte artış gösterdiği görülmüştür (OR=0.75, p< 0.068). Biyopsi sırası, total PSA değeri, prostat gland hacmi ve histopatolojik tanı ile tanımlanan rahatsızlık arasında anlamlı ilişki saptanmamıştır. Uygulayıcı tecrübesi ve hasta yaşı TRUS eşliğinde prostat biyopsisine bağlı hasta rahatsızlığı riski üzerinde belirleyici olan temel faktörler arasında yer almaktadır.

Keywords

• Prostat
• transrektal ultrason
• biyopsi
• ağrı

THE EVALUATION OF RISK FACTORS FOR PATIENT DISCOMFORT ASSOCIATED WITH TRUS-GUIDED PROSTATE BIOPSY

Abstract

Significant rates of patient discomfort have been reported in the literature for transrectal ultrasound-guided prostate biopsy, which has been accepted as the “gold standard” for the detection of prostate cancer. In this study, it is aimed to determine the risk factors for the complaint.s. A total of 320 patients undergoing transrectal ultrasound-guided prostate biopsy with ages ranging from 43 to 96 (mean ± SD, 67.3 ± 8.3) were included to the study. No anesthesia has been applied before or during the biopsy procedure. All patients were requested to express the overall discomfort they experienced during the whole procedure by means of visual analogous scale and the relevant scores were grouped as mild (0-3) and moderate-severe (4-10). The effect of patient age (<50, 51-60, 61-70, >60), the sequence of the biopsy (primary biopsy-rebiopsy), total PSA value (ng/ml) (2.6-4, 4-10, >10), prostate volume (ml) (<50, 51-60, 61-70, >60), histopathological diagnosis (benign, HGPIN, cancer) and operator experience (specialistassistant) on the expressed VAS scores were investigated statistically. A statistically significant difference was detected between the specialist and the assistant for the rates for moderate-severe degrees of discomfort which were 44.7% (34/76) and 70.8% (172/243), respectively (p<0.001). Similarly, the risk for moderate-severe degree of discomfort has been found to increase in case the operator is the assistant (OR=2.93, p<0.001). On the other hand, the rate for moderate-severe degree of discomfort was found to increase with decreased patient age despite being statistically insignificant (OR—0.75, p<0.068). No significant association was detected between the sequence of the biopsy, total PSA value, prostate glandular volume and the histopathological diagnosis and the patient discomfort. Operator experience and patient age are among the factors determining the risk for the patient discomfort associated with transrectal ultrasound-guided prostate biopsy.

Keywords

• transrectal ultrasound
• biopsy
• pain

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