Loading...
Please wait, while we are loading the content...
Similar Documents
The Role of Transperineal Template Biopsies in the Diagnosis of Prostate Cancer
| Content Provider | Semantic Scholar |
|---|---|
| Author | Chetwood, Andrew Fernando, Archana Langley, Stephen E. M. Montgomery, Bruce Bott, Simon |
| Copyright Year | 2018 |
| Abstract | biopsies Transperineal template biopsies (TTBs) were developed from the set-up used for brachytherapy with an alpha-numerically number grid placed in front of the perineum to facilitate precise biopsy needle insertion at systematic 5mm intervals [1]. Biopsies are usually performed under a general anaesthetic with prophylactic perioperative antibiotics and alpha-blockers to reduce the risk of infection and urinary retention respectively. The patient is placed in extended lithotomy position such that the hips are flexed 10 degrees beyond the vertical to rotate the pubic arch anteriorly allowing access to the anterior prostate. A urethral catheter may be placed to help identify the urethra. A bi-planar brachytherapy TRUS probe (attached to a Stepping unit) is used to image the prostate and in contrast to transrectal biopsies, the prostate is biopsied via the perineum in a longitudinal fashion. The prostate is centred on the grid in the axial plane and volume measurements are taken. The prostate is divided into right / left, anterior / posterior and medial / lateral respectively, giving eight defined areas of the prostate. Biopsies are taken from each of the eight areas of the prostate and placed onto histological sponges and then pots for the pathologist. The amount of biopsies taken can vary depending on whether a standard saturation, limited saturation or multi-parametric magnetic resonance imaging (mpMRI) targeted technique is being employed. With the knowledge that TRUS biopsies were missing 20-30% of significant prostate cancers, we adopted an approach to ensure we did not miss cancer in men who still had a clinical suspicion of prostate cancer despite multiple negative TRUS biopsies. So, initially a saturation approach was used with biopsies taken throughout the prostate every 5mm to completely 'map' the gland. This can require the deployment of a number of biopsies through the same entry point, depending on the length of the prostate, to ensure that larger glands are fully sampled from apex to base as well as medial to lateral, left and right. This technique can require a large number of biopsy cores, sometimes in excess of 100, and can generate morbidity including retention and erectile dysfunction. Things have moved on and now this technique is not routinely used outside research. With the advent of multi-parametric MRI the location of tumours can be identified, enabling targeted biopsies to be taken (Figure 1). This can be supplemented with some sampling biopsies from the remaining regions within the prostate. Post-procedure, the urine is checked for haematuria and a catheter is removed (if placed). We expect two voids prior to discharge. Patients continue their antibiotics and tamsulosin post-procedure. The patient usually goes home within a few hours of the procedure. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.urologynews.uk.com/media/14262/uroma14-template.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
