Zusammenfassung
Fragestellung: Der Einfluss der Prostatastanzbiopsie auf das Wohlbefinden der Patienten scheint
unterschätzt zu werden. Wir führten eine prospektive Studie zur Häufigkeit von Angst,
Schmerzen und Komplikationen durch. Material und Methodik: Standardvorgehen bei der Biopsie war: 1. Antibiotikaprophylaxe (5 Tage), 2. keine
Sedierung oder Analgesie, 3. TRUS-Steuerung und 4. mindestens sechs Biopsien. Wir
verwendeten einen standardisierten Fragebogen, der Fragen über vorhergehende Biopsien,
Angst vor dem Eingriff, Fieber und andere Komplikationen nach dem Eingriff sowie zwei
visuell-analoge Skalen (VAS) zur Erhebung der Schmerzen während und nach der Prozedur
enthielt. 140 konsekutive Patienten wurden eingeschlossen. Die Rücksenderate des vor
der Untersuchung ausgehändigten Fragebogens betrug 83,6 % (n = 117). Ergebnisse: 32 Patienten (27,4 %) gaben Angst vor der Untersuchung an. 52 (44,4 %) der Patienten
hatten während der Biopsie Schmerzen, 56,3 % der Patienten mit Angst vor der Biopsie
hatten Schmerzen während des Eingriffs. 32 Männer (27,4 %) hatten postoperativ Schmerzen.
Es wurden folgende Komplikationen angegeben: Makrohämaturie (55,6 %), Schmerzen bei
der Miktion/Defäkation (23,9 %) und Fieber (3,4 %). 7 Männer würden eine erneute Biopsie
unter den gleichen Umständen ablehnen. Schlussfolgerung: Patienten, bei denen eine Prostatastanzbiopsie durchgeführt wird, haben häufig Angst
und/oder Schmerzen, wobei ängstliche Männer eher über Schmerzen klagen. Angst und
Schmerzen sollten weitestgehend minimiert werden, da die Prostatastanzbiopsie unverzichtbar
für die Diagnose des Prostatakarzinoms ist. Besonders ängstlichen Männern sollte eine
Sedierung und/oder Analgesie angeboten werden. Die Rate der Patienten mit Makrohämaturie
war beträchtlich hoch. Auch das Auftreten von Fieber trotz Antibiotikaprophylaxe war
bemerkenswert. Weitere Studien sind notwendig, um die Zweckmäßigkeit von zusätzlichen
Maßnahmen (z. B. antibiotischen oder desinfizierenden Spülungen) zu überprüfen.
Abstract
Purpose: The impact of prostate biopsy on patients' well-being seems to have been underestimated.
In order to evaluate the frequency of fear, pain and complications, we performed a
prospective trial. Materials and methods: Standard biopsy procedure was: 1. antiobiotic prophylaxis (5 days), 2. no analgesia
or sedation, 3. TRUS-guidance, and 4. a minimum of six cores. We used a standardised
questionnaire including questions on previous procedures, anxiousness before biopsy,
fever and other complications after the procedure as well as two visual analogue scales
(VAS) to assess pain during and after the procedure. A total of 140 consecutive patients
were included. The follow-up rate was 83.6 %. Results: 32 patients (27.4 %) reported that they were afraid of biopsy. 52 (44 %) had pain
during biopsy. Of those patients with fear, 56.3 % had pain during biopsy. 32 men
(27.4 %) had pain postoperatively. Complications were: gross hematuria (56 %), painful
voiding and/or defecation (24 %), and fever in 4 patients (3.4 %). 7 men would reject
a repeat biopsy under the same circumstances. Conclusions: Anxiety and pain are frequent in patients undergoing prostate biopsy. Even more important,
men with worries regarding the procedure are more likely to experience pain during
biopsy. Anxiety and pain should be minimized, as prostate biopsy is essential for
the diagnosis of prostate cancer. Anxious men in particular should be offered sedation
and/or analgesia. Regarding complications, the rate of hematuria was surprisingly
high. Also, the number of patients with fever despite antibiotic prophylaxis was high.
Further studies are necessary to evaluate additional procedures such as antibiotic
and bethadine enemas.
Schlüsselwörter
Prostatakarzinom - Diagnostik - Diagnostische Techniken - Schmerzen - Schmerzmessung
- Antibiotikaprophylaxe
Key words
Prostatic neoplasms - Diagnosis - Diagnostic techniques and procedures - Pain - Pain
measurement - Antibiotic prophylaxis
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Dr. med. N. Kreutzer
Klinik und Poliklinik für Urologie · Klinikum der Universität zu Köln
Joseph-Stelzmann-Str. 9
50924 Köln
Phone: 0221-4784687
Fax: 0221-4786256
Email: Kreutzer@uni-koeln.de
