MP23-15 ALEXIS WOUND PROTECTOR/RETRACTOR REDUCES WOUND INFECTION DURING RADICAL CYSTECTOMY AND URINARY DIVERSION

Abstract

INTRODUCTION AND OBJECTIVES: Multiparametric MRI (mpMRI) and MR/TRUS fusion-guided transrectal prostate biopsy has improved the diagnosis of clinically significant prostate cancer (CaP). However, increasing rates of sepsis post-biopsy and antibiotic resistance associated with transrectal sampling have renewed interest in alternative techniques. Transperineal biopsy has been shown to reduce infectious complications but is currently limited to cognitive fusion, mechanical localization or in-gantry MRI targeted biopsy. Herein, we report the first clinical use of an electromagnetically (EM) tracked transperineal MR/US fusion-guided biopsy platform (tpFBx). METHODS: A total of 9 patients with suspicion or history of CaP underwent mpMRI, tpFBx followed by a transperineal systematic Bx (tpSBx). The biopsy was performed in dorsal lithotomy position using the UroNav system and custom built EM neutral transperineal stepper and grid (Invivo Healthcare, Gainesville, FL). Herein, we report the first clinical use of an electromagnetically (EM) tracked tpFBx platform. Patient, imaging, and histopathologic characteristics were collected and reported. RESULTS: Of 9 patients undergoing biopsy, all underwent tpFBx, and 8/9 had a tpSBx. Median age was 62.6 years and median PSA was 8.3ng/dl. 5 patients had prior history of sepsis after TRUS biopsy. Overall PIRADSv2 score was 3, 4, or 5 in 2, 3, and 3 men respectively, with no score assigned to 1 patient who did not receive contrast during mpMRI. The overall cancer detection rate was 77.8% (7/ 9) of which all were detected on tpFBx. CDR for tpSBx was 37.5% (3/8). The tpFBx identified three Gleason 6 and two Gleason 3+41⁄47 cancers missed by tpSBx alone in these 8 patients. No complications were identified. CONCLUSIONS: A novel EM tracked transperineal MR/TRUS fusion biopsy system is safe and feasible for targeting of suspicious prostate lesions identified on mpMRI. This modified fusion biopsy technique, with stable access to the prostate, may lower the risk of infection and has the potential for application in transperineal focal therapy for CaP.