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Urological cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
The widespread adoption of multiparametric MR with which index lesions of significant prostate cancer can be identified radiologically has shown that in some men the cancer will be predominately anterior and often not accessible by a transrectal biopsy. For this reason, transperineal biopsy is often undertaken enabling more widespread sampling of the entire gland.
Reproductive system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
There are two biopsy approaches; transrectal (Fig. 8.35c) and transperineal biopsy [121]. Bleeding can occur during transrectal biopsy, and this may lead to sepsis, so a course of prophylactic broad-spectrum antibiotics is prescribed for 1 week prior to biopsy. The risk of infection is greatly reduced in transperineal biopsy. Local anaesthetic should be infiltrated into the peri-prostatatic region for a transperineal biopsy [122].
The prostate and seminal vesicles
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
If there is suspicion of prostate cancer, because of local findings, a raised PSA or metastatic disease, then a prostate biopsy using an automated gun is recommended (Figure78.21). This is usually performed transrectally, although increasingly the transperineal approach is being used. In a standard transrectal biopsy about 12 systematic biopsy cores are obtained as well as biopsy of any suspicious areas. Broad-spectrum antibiotic cover is given to all patients to reduce the incidence of sepsis, which is greater with transrectal than transperineal biopsy. Transperineal biopsy usually involves sedation or general anaesthetic while transrectal biopsy can be performed under local anaesthetic. Increasingly, areas appearing suspicious for prostate cancer on multiparametric magnetic resonance imaging (mp-MRI) can be targeted for biopsy to increase the diagnostic yield.
A significant percentage of patients with transrectal biopsy-related infections have positive blood cultures but negative urine cultures. A literature review and meta-analysis
Published in Infectious Diseases, 2018
Stamatis Karakonstantis, Dimitra Kalemaki
All types of original studies providing concurrent urine and blood culture data in symptomatic patients with transrectal biopsy-related infectious complications were considered. Articles not written in English were not evaluated. Studies of transperineal biopsy were not considered because of the significantly lower rate of infectious complications with a near-zero risk of sepsis [16–18]). Studies evaluating the rate of post-biopsy bacteriuria and bacteremia in asymptomatic patients were not considered, because such episodes of bacteremia are most commonly transient and remain asymptomatic [7,19–22]. Case reports and case series of selected non-consecutive patients were not considered, as such cases are likely not representative for calculation of the pooled discordance rate. Finally, studies that excluded patients with negative urine cultures (i.e. studies in which a positive urine culture was a necessary inclusion criterion) were not considered, as this would underestimate the discordance rate. Although discordance as a result of different microbiological isolates is possible in cases with positive urine cultures, this is rarely the case in UTIs, and blood cultures are predominantly useful in cases with negative urine cultures [4].
The Swedish national guidelines on prostate cancer, part 1: early detection, diagnostics, staging, patient support and primary management of non-metastatic disease
Published in Scandinavian Journal of Urology, 2022
Ola Bratt, Stefan Carlsson, Per Fransson, Camilla Thellenberg Karlsson, Johan Stranne, Jon Kindblom
Because of the low prevalence of fluoroquinolone-resistant bacteria in Sweden, the guidelines recommend a single dose of ciprofloxacin as standard prophylaxis before prostate biopsy. A recent meta-analysis suggests that rectal cleansing with povidone-iodine reduces infectious complications after transrectal prostate biopsy [13]. The European guidelines since 2021 recommend rectal povidone-iodine cleansing and the Swedish guidelines now also do so. Another way to reduce post-biopsy infection is using the transperineal route. Transperineal prostate biopsy is in Sweden routinely done only at a few centres, but the 2022 guidelines stress the importance of implementing the transperineal biopsy technique to reduce the risk of post-biopsy infection.
PI-RADS v2 and periprostatic fat measured on multiparametric magnetic resonance imaging can predict upgrading in radical prostatectomy pathology amongst patients with biopsy Gleason score 3 + 3 prostate cancer
Published in Scandinavian Journal of Urology, 2018
Lingyun Zhai, Yu Fan, Shaoshuai Sun, Huihui Wang, Yisen Meng, Shuai Hu, Xiaoying Wang, Wei Yu, Jie Jin
This retrospective study was approved by our Institutional Review Board and the requirement for informed consent was waived. Between November 2013 and March 2018, we collected data on 336 patients who had undergone transrectal ultrasound (TRUS)–guided prostate 12 [25] or 13 [26] cores systematic needle biopsy and subsequent RP without a history of hormone therapy before RP at our institution. RP was performed within 3 months after biopsy. Of these 336 patients, 82 had a biopsy Gleason score of 6. Patients who had a prebiopsy multiparametric MRI (mp-MRI) performed in other institutions (n = 23) and those who received transperineal biopsy (n = 3) were excluded. Therefore, 56 patients were enrolled for evaluation.