Skip to main content
SpringerLink
Log in

Komplikationen der transrektalen Prostatabiopsie

Eine Standortbestimmung

  • Leitthema
  • Published:
Der Urologe, Ausgabe A Aims and scope Submit manuscript

Zusammenfassung

Die Prostatabiopsie hat in den letzten 2 Dekaden einen dramatischen Wandel erfahren. Durch die Einführung des prostataspezifischen Antigens (PSA) in die Diagnostik des Prostatakarzinoms und die zeitgleiche Entwicklung moderner Biopsietechniken hat die Anzahl von transrektalen Prostatabiopsien deutlich zugenommen. Gleichzeitig sind die schwerwiegenden Komplikationen seltener geworden.

Zu den schwerwiegenden Komplikationen nach Biopsie gehören septische Komplikationen (ca. 1%), rektale Blutungen (ca. 0,1%) und Harnverhaltungen (0,5%). Weniger schwerwiegende Komplikationen, wie das Auftreten von Fieber ohne septische Zeichen, findet sich in einer Häufigkeit von ca. 3,5%.

Zu den häufigen, jedoch im Regelfall nicht behandlungsbedürftigen Komplikationen zählt die Makrohämaturie die bei nahezu 50% aller Patienten beobachtet wird. Das Gleiche gilt für die Hämatospermie in ähnlicher Größenordnung.

Bei den insgesamt selten schwerwiegenden Komplikationen nach Prostatabiopsie ist ein rasches, zielgerichtetes Handeln erforderlich. Damit ist heute die Prostatabiopsie ein insgesamt komplikationsarmes, sicheres diagnostisches Verfahren mit einem außerordentlich hohen Stellenwert in der täglichen urologischen Praxis.

Abstract

The procedure for prostate biopsy has undergone a dramatic change in the last 2 decades. The introduction of PSA into diagnostics for prostate carcinoma and simultaneous development of modern biopsy techniques have led to a marked increase in transrectal prostate biopsies. At the same time, serious complications have become less frequent.

Grave complications after biopsy include septic complications (approximately 1%), rectal hemorrhages (approximately 0.1%), and ischurias (0.5%). Less severe complications such as occurrence of fever without septic signs account for 3.5%.

One of the frequent complications that usually do not require treatment is gross hematuria, which is observed in nearly 50% of all patients. The same applies to hematospermia with a similar frequency.

In the rare cases of the altogether serious complications after prostate biopsy, appropriate action is essential.

All in all, prostate biopsy nowadays represents a safe diagnostic procedure with few complications and an extraordinarily high level of usefulness for everyday urological practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1.
Abb. 2.
Abb. 3.
Abb. 4.

Literatur

  1. Ostroff EB, Almario J, Kramer H (1975) Transrectal needle method for biopsy of the prostate: review of 90 cases. Am Surg 41: 659

    CAS  PubMed  Google Scholar 

  2. Hodge KK, McNeal JE, Stamey TA (1989) Ultrasound guided transrectal core biopsies of the palpably abnormal prostate. J Urol 142: 66

    CAS  PubMed  Google Scholar 

  3. Hodge KK, McNeal JE, Terris MK et al. (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142: 71

    CAS  PubMed  Google Scholar 

  4. Thompson PM, Talbot RW, Packham DA et al. (1980) Transrectal biopsy of the prostate and bacteraemia. Br J Surg 67: 127

    CAS  PubMed  Google Scholar 

  5. Thompson PM, Pryor JP, Williams JP et al. (1982) The problem of infection after prostatic biopsy: the case for the transperineal approach. Br J Urol 54: 736

    CAS  PubMed  Google Scholar 

  6. Crawford ED, Haynes AL Jr, Story MW et al. (1982) Prevention of urinary tract infection and sepsis following transrectal prostatic biopsy. J Urol 127: 449

    CAS  PubMed  Google Scholar 

  7. Roberts RO, Bergstralh EJ, Besse JA, Lieber MM, Jacobsen SJ (2002) Trends and risk factors for prostate biopsy complications in the pre-PSA and PSA eras, 1980 to 1997. Urology 59: 79–84

    Article  PubMed  Google Scholar 

  8. Djavan B, Waldert M, Zlotta A et al. (2001) Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 166: 856–860

    CAS  PubMed  Google Scholar 

  9. Raaijmakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH (2002) Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology 60: 826–830

    Article  PubMed  Google Scholar 

  10. Meisel F, Jacobi C, Kollmar R, Hug A, Schwaninger M, Schwab S (2003) Akute Meningitis nach transrektaler Prostatabiopsie. Persönliche Mitteilung 2003 (eingereicht zur Publikation)

  11. Kumagai A, Ogawa D, Koyama T, Takeuchi I, Oyama I (2002) A case report of Fournier's gangrene in a diabetic patient induced bytransrectal prostate biopsy (TRPB). Nippon Hinyokika Gakkai Zasshi 93: 648–651

    PubMed  Google Scholar 

  12. Brullet E, Guevara MC, Campo R (2000) Massive rectal bleeding following transrectal ultrasound-guided prostate biopsy. Endoscopy. 32: 792–795

    Google Scholar 

  13. Herget EJ, Saliken JC, Donnelly BJ, Gray RR, Wiseman D, Brunet G (1999) Transrectal ultrasound-guided biopsy of the prostate: relation between ASA use and bleeding complications. Can Assoc Radiol J 50: 173–176

    CAS  PubMed  Google Scholar 

  14. Wammack R, Djavan B, Remzi M, Susani M, Marberger M (2001) Morbidity of transrectal ultrasound-guided prostate needle biopsy in patients receiving immunosuppression. Urology 58: 1004–1007

    Article  CAS  PubMed  Google Scholar 

  15. Enlund AL, Varenhorst E (1997) Morbidity of ultrasound-guided transrectal core biopsy of the prostate without prophylactic antibiotic therapy. A prospective study in 415 cases. Br J Urol 79: 777–780

    CAS  PubMed  Google Scholar 

  16. Kapoor DA, Klimberg IW, Malek GH et al. (1998) Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology 52: 552–558

    Article  CAS  PubMed  Google Scholar 

  17. Borboroglu PG, Comer SW, Riffenburgh RH, Amling CL (2000) Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J Urol 163: 158–162

    CAS  PubMed  Google Scholar 

  18. Griffith BC, Morey AF, Ali-Khan MM, Canby-Hagino E, Foley JP, Rozanski TA (2002) Single dose levofloxacin prophylaxis for prostate biopsy in patients at low risk. J Urol 168: 1021–1023

    CAS  PubMed  Google Scholar 

  19. Aus G, Hermansson CG, Hugosson J, Pedersen KV. (1993) Transrectal ultrasound examination of the prostate: complications and acceptance by patients. Br J Urol 71: 457–459

    CAS  PubMed  Google Scholar 

  20. Carey JM, Korman HJ (2001) Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? J Urol 166: 82–85

    Google Scholar 

  21. Tal R, Livne PM, Lask DM, Baniel J (2003) Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol 169: 1762–1765

    PubMed  Google Scholar 

  22. Bachor R, Gottfried HW, Hautmann R (1995) Minimal invasive therapy of prostatic abscess by transrectal ultrasound-guided perineal drainage. Eur Urol 28: 320–324

    CAS  PubMed  Google Scholar 

  23. Babaian RJ, Toi A, Kamoi K et al. (2000) A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 163: 152–157

    CAS  PubMed  Google Scholar 

  24. Presti JC Jr, Chang JJ, Bhargava V, Shinohara K (2000) The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 163: 163–167

    PubMed  Google Scholar 

  25. Durkan GC, Sheikh N, Johnson P, Hildreth AJ, Greene DR. (2002) Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol. BJU Int 89: 33–39

    Article  CAS  PubMed  Google Scholar 

  26. Taylor JA 3rd, Gancarczyk KJ, Fant GV, Mcleod DG (2002) Increasing the number of core samples taken at prostate needle biopsy enhances the detection of clinically significant prostate cancer. Urology 60: 841–845

    Article  PubMed  Google Scholar 

  27. Presti JC Jr, O'Dowd GJ, Miller MC, Mattu R, Veltri RW (2003) Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 169: 125–129

    PubMed  Google Scholar 

  28. Naughton CK, Ornstein DK, Smith DS, Catalona WJ (2000) Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol 163: 168–171

    CAS  PubMed  Google Scholar 

  29. Naughton CK, Miller DC, Yan Y (2001) Impact of transrectal ultrasound guided prostate biopsy on quality of life: a prospective randomized trial comparing 6 versus 12 cores. J Urol 165: 100–103

    CAS  PubMed  Google Scholar 

  30. Obek C, Onal B, Ozkan B, Onder AU, Yalcin V, Solok V (2002) Is periprostatic local anesthesia for transrectal ultrasound guided prostate biopsy associated with increased infectious or hemorrhagic complications? A prospective randomized trial. J Urol 168: 558–561

    PubMed  Google Scholar 

  31. Seymour H, Perry MJ, Lee-Elliot C, Dundas D, Patel U (2001) Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anaesthesia. BJU Int 88: 540–544

    Article  CAS  PubMed  Google Scholar 

  32. Addla SK, Adeyoju AA, Wemyss-Holden GD, Neilson D (2003) Local anaesthetic for transrectal ultrasound-guided prostate biopsy: a prospective, randomized, double blind, placebo-controlled study. Eur Urol 43: 441–443

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung Urologie und Kinderurologie, Urologische Universitätsklinik und Poliklinik, Ulm

    H. W. Gottfried & B. Volkmer

  2. Abteilung Urologie und Kinderurologie, Urologische Universitätsklinik, Prittwitzstraße 43, 89075, Ulm

    H. W. Gottfried

Authors
  1. H. W. Gottfried
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Volkmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. W. Gottfried.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gottfried, H.W., Volkmer, B. Komplikationen der transrektalen Prostatabiopsie. Urologe [A] 42, 1022–1028 (2003). https://doi.org/10.1007/s00120-003-0400-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-003-0400-x

Schlüsselwörter

Keywords

Search

Navigation