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

Yıl 2007, Cilt: 1 Sayı: 3, 177 - 181, 20.11.2007

Ahmet Tuncay Turgut

Öz

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.

Anahtar Kelimeler

transrectal ultrasound, biopsy, pain

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

Öz

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.

Anahtar Kelimeler

Prostat, transrektal ultrason, biyopsi, ağrı

Kaynakça

• 1 Clements R, Aideyan OU, Griffiths GJ, Peeling WB. Side effects and patient acceptability of transrectal biopsy of the prostate. Clin Radiol 1993;47:125-6.
• 2 Collins GN, Lloyd SN, Hehir M, McKelvie GB. Multiple transrectal ultrasound-guided prostatic biopsies-true morbidity and patient acceptance. Br J Urol 1993;71:460-3.
• 3 Desgrandchamps F, Meria P, Irani J, Desgrippes A, Teillac P, Le Duc A. The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography-guided biopsy of the prostate: a prospective randomized placebo-controlled study. BJU Int 1999;83:1007-9.
• 4 Crundwell MC, Cooke RW, Wallace DM. Patients’ tolerance of transrectal ultrasound guided prostate biopsy: an audit of 104 cases. BJU Int 1999;83:792-5.
• 5 Rodrigues LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol 1998;160: 2115-20.
• 6 Irani J, Fornier F, Bon D, Gremmo E, Dore B, Aubert J. Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol 1997;79: 608-10.
• 7 Nash PA, Bruce JE, Indudhara R, Shinohara K. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol 1996;155:607-9.
• 8 Soloway MS, Öbek C. Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol 2000;163:172-3.
• 9 Bastide C, Lechevallier E, Eghazarian C, Ortega JC, Coulange C. Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate-risk factors. Prostate Cancer P Dis 2003; 6:239-41.
• 10 Aus G, Damber JE, Hugosson J. Prostate biopsy and anesthesia: an overview. Scand J Urol Nephrol 2005;39:124.
• 11 Machado MT, Aragao AJ, Rodriguez AO, Wroclawski ER. Periprostatic local anesthesia in transrectal ultrasound-guided prostate biopsy: Is it possible to improve pain tolerance? Int Braz J Urol 2002;28:323-9.
• 12 Turgut AT, Yılmaz Ö, Koşar P, Koşar U. Transrektal ultra-sonografı eşliğinde prostat biyopsisi öncesi uygulanan pe-riprostatik lokal anestezinin etkinliği. Yeni Üroloji Dergisi 2007; 3:77-83.
• 13 Kaver I, Mabjeesh NJ, Matzkin H. Randomized prospective study of the periprostatic local anesthesia during transrectal ultrasound-guided prostate biopsy. Urology 2002;59:405-8.
• 14 Seymour H, Perry MJ A, Lee-Elliot C, Dundas D, Patel U. Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anesthesia. BJU Int 2001;88:540-4.
• 15 De Sio M, Massimo D, Di Lorenzo G, ve ark. The need to reduce patient discomfort during transrectal ultrasonography-guided prostate biopsy: what do we know? BJU Int 2005;96:977-83.
• 16 Turgut AT, Ergun E, Koşar U, Koşar P, Ozcan A. Sedation as an alternative method to lessen patient discomfort due to transrectal ultrasonography-guided prostate biopsy. Eur J Radiol 2006;57:148-53.
• 17 Mueller PR, Biswal S, Halpern EF, Kaufman J A, Lee MJ. Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication- a prospective study. Radiology 2000;215: 684-8.
• 18 Chang SS, Alberts G, Wells N, Smith J A Jr, Cookson MS. Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol. 2001;166:2178-80.
• 19 Peters JL, Thompson AC, McNicholas TA, Hines JE, Hanbury DC, Boustead GB. Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation. BJU Int 2001;87:827-30.
• 20 Djavan B, Waldert M, Zlotta A, ve ark. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol. 2001;166:856-60.
• 21 Von Knobloch R, Weber J, Varga Z, Feiber H, Heidenreich A, Hofmann R. Bilateral fine-needle administered local anaesthetic nerve block for pain control during TRUS-guided multi-core prostate biopsy: a prospective randomised trial. Eur Urol 2002 ;41:508-14.
• 22 Naughton CK, Ornstein DK, Smith DS, Catalona WJ. Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol 2000;163:168-71.
• 23 Song SH, Kim JK, Song K, Ahn H, Kim CS. Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound-guided prostate biopsy: a prospective randomized study. Int J Urol 2006;13:707-10.
• 24 Alavi AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL. Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods. J Urol 2001;166:1343-45.