急性尿潴留前列腺穿刺的意义

目的探讨是否应该对PSA升高的急性尿潴留患者先进行前列腺穿刺活检。方法回顾分析2003年1月～2009年4月我科收治的109例血清PSA浓度均大于4ng/mL的男性急性尿潴留患者(无尿道狭窄,神经原性膀胱等病因)。根据是否活检分为2组,20例为前列腺穿刺活检组,年龄54～85(68.90±7.64)岁,前列腺体积38～130(70.94±27.97)ml,血清PSA4.30～487.46(48.12±106)L。89例为未活检组,年龄54～97(71.78±8.64)岁,前列腺体积16～293(61.79±43.77)ml,血清PSA4.06～411.2(24.90±52.61)ng/mL,2组间年龄、前列腺体积和血清PSA比较无统计学差异(P>0.05);未活检组56例经尿道前列腺切除术(TURP),5例经开放手术。结果活检组20例,病理发现前列腺癌5例,阳性率25%;未活检组89例手术标本发现前列腺癌4例,均为经TURP者。阳性率4.49%。活检组和未活检组间比较有显著统计学差异(P<0.01)。结论经直肠前列腺穿刺活检发现PSA升高的急性尿潴留患者前列腺癌的发生率至少在25%以上,比未经穿刺而经手术发现的前列腺癌发生率高21%,有显著统计学差异,而手术发现的前列腺癌给再次根治性手术增加了难度。本研究证明PSA升高的急性尿潴留患者应该先进行前列腺穿刺活检。

Objective To explore whether a prostate biopsy should fi rst conduct in patients with acute urinary retention combined with elevated serum PSA.Methods A total of 109 cases of men with acute urinary retention were retrospectively studied,and patients with urethral stricture and neurogenic bladder were excluded.Serum PSA concentration greater than 4ng/mL for selected.divided into two groups according to whether to biopsy or not.For 20 cases of prostate biopsy group,aged 54-85（68.90±7.64）years old,prostate volume of 38-130（70.94±27.97）ml,serum PSA 4.30-487.46（48.12±106.92）ng/mL.For 89 cases of non-biopsy group,aged 54-97（71.78±8.64）years old,prostate volume of 16-293（61.79±43.77）mL,serum PSA 4.06-411.2（24.90±52.61）ng/mL.In the non-biopsy group 56 cases conducted transurethral resection of prostate（TURP）,5 cases conducted open surgery.There were no statistically differences between the two groups in age,serum PSA and prostate volume（P0.05）.Results：For 20 cases of prostate biopsy group,5 cases of prostate cancer,the positive rate was 25%;For 89 cases of non-biopsy group,4 cases of prostate cancer,all were diagnosed by TURP,the positive rate was 4.49%.There were statistically signifi cant differences between the two groups（P0.01）.Conclusion The incidence of prostate cancer diagnosed by transrectal prostate biopsy in patients with acute urinary retention combined with elevated serum PSA was at least more than 25%,21% higher than which diagnosed by surgery without biopsy,there were signifi cant statistically differences,these operations without biopsy increased the diffi culty of radical surgery.This study demonstrate that a prostate biopsy should fi rst conduct in patients with acute urinary retention combined with elevated serum PSA.