Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2006 / Cilt: 32 - Sayı: 2
Transrektal prostat iğne biyopsisi yapılan risk faktörsüz hastalarda koruyucu antibiyotik tedavisinin etkinliği
- Sayfa
- 261–267
- DOI
- —
Özet
Bu çalışmada transrektal prostat iğne biyopsisi sonrasında olabilecek enfeksiyona bağlı istenmeyen yan etkileri önlemek için ağız yoluyla verilen siprofloksasin ve/veya rektal lavman ile uygulanan rifampisinin etkinliği araştırılmıştır. Bu çalışmaya transrektal prostat iğne biyopsisi yapılan 159 hasta alındı. Hastalar sadece 1000 mg/gün ağızdan siprofloksasin alan grup (n:39), siprofloksasin tedavisine ilave olarak 250 mg rifampisin içeren rektal lavman uygulanan grup (n:40), sadece 250 mg rifampisin içeren rektal lavman uygulanan grup (n:40) ve koruyucu tedavi verilmeyen grup (n:40 hasta) olarak randomize edildi. Biyopsi sonrasındaki ikinci günde tüm hastalara rutin idrar kültürü yapıldı ve biyopsi sonrasındaki 10 günlük süreç içerisinde >38 0C ateş, üç günden fazla süren irritatif alt üriner sistem semptomları, halsizlik, terleme ve titreme varlığında kontrol idrar ve kan kültürü alındı. Gruplar arasında yaş, serum total ve serbest prostat spesifik antijen düzeyi, prostat hacmi ölçütleri arasında anlamlı fark yoktu. Toplam enfeksiyona bağlı istenmeyen yan etki oranı %27.7 idi. Grup 1, 2, 3 ve 4'teki enfeksiyona bağlı istenmeyen yan etki oranları sırasıyla %35.7, %17, %25 ve %25 olarak saptandı (p>0.05). Prostat hacmi ile enfeksiyona bağlı istenmeyen yan etki gelişimi arasında anlamlı ilişki saptanmadı (p>0.05). Transrektal prostat biyopsisi sonrasında enfeksiyona bağlı istenmeyen yan etkilerin önlenmesi için risk faktörü olmayan hastalara ağızdan verilen siprofloksasin ve rektal lavman yolu ile uygulanan rifampisinin enfeksiyon oranlarını düşürücü etkisi gözlenmemiştir.
Abstract
Introduction: Transrectal prostate needle biopsy is a current standard urological procedure to detect prostate cancer. A recent survey of practicing urologists revealed wide variability in the prophylactic antibiotic regimens used. In addition to antibiotics, some urologists suggest various elaborate rectal cleansing methods, while some think that enemas are not necessary at all. We aimed to investigate the effectiveness of oral ciprofloxacin alone and/or together transrectal enemas with rifampicin in the prevention of possible infectious complications after transrectal prostate needle biopsy. Materials and Methods: Patients on whom transrectal prostate needle biopsy was planned due to either abnormal digital rectal examination findings and/or elevated blood prostate specific antigen (PSA) levels (>4 ng/ml) were included in our study. Patients with a history of previous prostatic biopsy or prostatic surgery, diabetes mellitus, abnormal blood leukocyte counts (<4600 WBC/ml and >10000 WBC/ml), neurogenic disease with voiding dysfunction, valvular heart disease; patients with active urinary tract infections; having been recently catheterized in the last 15 days; on any antibiotic, anticoagulant or immunosupressive treatments were excluded. A total of 159 patients were recruited. In addition to complete blood count, total and free PSA levels, midstream urine and blood cultures were obtained two days prior to transrectal prostate needle biopsy procedure on every patient. Patients were randomized into four groups: Patients in Group 1 (n=39) were took 1000 mg/d of oral ciprofloxacin starting the day before the biopsy and continued until day 3 for a total of four days. In Group 2 (n=40), patients received 250 mg of rifampicin in an enema solution containing 19 g of monobasic and 7 g of dibasic sodium phosphate just before the biopsy in addition to oral ciprofloxacin prophylaxis as in Group 1. Patients in Group 3 (n=40) received rifampicin containing enema only as in group 2. Finally, patients in Group 4 (n=40) received none of the prophylactic treatments above. A mid-stream urine culture was obtained on every patient two days following biopsy procedure. Patients were instructed to admit to the hospital if they have high fever (>38ºC), chills, irritative lower urinary tract symptoms lasting longer than 3 days, and feel weakness in the following 10 days. If the patients came to our clinic because of the complaints mentioned above, mid-stream urine and blood cultures were obtained. Results: The mean age and serum total PSA of the patients were 62.1 (43-79) years and 14.2 (2.2-65.4) ng/dl. There were no significant differences in terms of age, serum total PSA levels, total prostate volume among the groups. Total infectious complication rate was 27.7%. In Groups 1, 2, 3 and 4, infectious complications were observed in 37.7%, 17%, 25.0% and 25.0% of the patients, respectively (p>0.05). No significant relationship was found between the prostate volume and infectious complication (p>0.05). Conclusion: Antibiotic prophylaxis either with oral ciprofloxacin at 1000 mg/d or transrectal rifampicin at 250 mg in the form of rectal enema did not show any positive impact on the reduction of possible infectious complications after transrectal prostate needle biopsy in patients with no known risk factors.