前列腺切片针数为术後尿道感染的独立预测因子.ppt

,按一下以編輯母片標題樣式,*,按一下以編輯母片,第二層,第三層,第四層,第五層,本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Introduction(1),Infection is a well-known complication of transrectal ultrasound guided prostate biopsy(TRUSP-Bx).,Wide variability in antibiotics prophylaxis has been reported,.,The European Association of Urology(EAU)guidelines on prostate cancer state that“quinolones are the drug of choice in TRUSP-Bx.”,Introduction(2),Sieber et al reported the increase of the complicated UTI after TRUSP-Bx was insignificant from sextant biopsy to 10 or 12-core biopsy in a 1000 patients cohort,.,Urology.70:498-500,2007,Recent literatures have demonstrated an emergence of increasing infectious complications and fluoroquinolone(FQ)-resistant infections following TRUSP-Bx,.,To determine whether the biopsy core number is associated with febrile urinary tract infection(fUTI)after transrectal ultrasound guided prostate biopsy(TRUSP-Bx),.,PATIENTS AND METHODS,Patients and methods(1),Retrospectively reviewed the electronic medical records of consecutive males receiving levofloxacin 500mg single dose prophylaxis in TRUSP-Bx in National Taiwan University Hospital(NTUH)between January 2005 and December 2010,Indications for biopsy:(1)an increased PSA level and/or(2)abnormal digital rectal examination(DRE).,Exclusion:,(1),a pre-existing diagnosis of prostate cancer,(2),those,who did not follow the TRUSP-Bx protocol.,Patients and methods(2),Definition of febrile UTI:,(1)Body temperature greater than 38,。,C in two weeks,after biopsy,(2)New-onset lower urinary tract symptoms or acute,epididymitis,(3)Absence of other sources of infection.,Patients and methods(3),Transrectal Ultrasound Guided Prostate Biopsy Protocol in NTUH,Levofloxacin 500mg single dose one hour before biopsy.,Inpatient setting,sextant biopsy or 12-core biopsy(with/without finger-guided nodular biopsy)with general anesthesia or spinal anesthesia,.,Outpatient setting,only sextant biopsy in consideration of discomfort related to solely perianal-intrarectal topical lidocaine gel anesthesia.,DRE before the procedure to avoid“trans-fecal”biopsy.,Rectal disinfection with iodine swab.,RESULTS,Result,A total of 2951 TRUSP-Bx was included between January 2005 and December 2010.,The median age was 68 years(ranges 25 to 95).,The median PSA level was 9.7 ng/ml(ranges 0.1 to 7500),962(32.6%)males were diagnosed as prostate cancer after biopsy.,92(3.1%)males pathology reports revealed histological prostatitis,median test,(1.12%),Multivariate study,Multivariate model with logistic regression analysis which included biopsy core number and age,.,Biopsy core number(12core)was still the predictor of febrile UTI with,p,value=0.024.,Result,35(1.12%)patients experienced febrile UTI after TRUSP-Bx.,24(68.6%)had positive urine and/or blood cultures:,E.coli in 19(79.2%)-16(84.2%)FQ-resistant.,Klebsialla pneumoniae in 2(8.3%),Enterobacter cloacae in 1(4.2%),Serratia marcescens in 1(4.2%),Enterococcus species in 1(4.2%).,DISCUSSION,Discussion(1),2010 EAU guidelines on prostate cancer,the cumulative infection rate following TRUSP biopsy was 2.5%,.,In our study,the febrile UTI rates after TRUSP biopsy range from 0.60 to 1.75%from 2005 to 2010.(overall 1.12%),Our results suggest that levofloxacin remains an effective prophylaxis for TRUS-guided prostate biopsy.,Discussion(2),This is the largest study for examining the efficacy of single dose levofloxacin prophylaxis in TRUSP-Bx.(A total of 2951 cases),In our study,12core biopsy was the independent predictor of febrile UTI compared to sextant biopsy.,Sieber et al reported increase insignificantly in the complicated UTI from sextant biopsy to 10 to 12-core biopsy in a 1000 patients cohort,.,Urology.70:498-500,2007,Discussion(3),Retrospective study by reviewing electronic medical records in a tertiary referral center.,Failed to evaluate all the potential risk factors of infectious complications.,CONCLUSION,Conclusion,Biopsy core number,serves as the predictor of febrile UTI following TRUSP-Bx.,THANK YOU,