Guided Prostate Needle Biopsy Research Articles

411. Characterization of Antibiotic Prophylaxis Prior to Trans Rectal Ultrasound Guided Prostate Needle Biopsy (TRUS PNB): A 5-Year Nationwide Study among Patients in the United States Veterans Health Administration

Abstract Background Prophylactic antibiotics are used prior to TRUS PNB to reduce risk for infectious complications such as UTI, prostatitis, epididymitis, orchitis, bacteremia and sepsis. Fluoroquinolones have been commonly used for prophylaxis, however, the incidence of post TRUS PNB infections caused by fluoroquinolone resistant Escherichia coli has increased. The purpose of this study was to characterize the prophylaxis agents used nationwide in the Veterans Health Administration (VHA) prior to TRUS PNB. Methods We conducted a review of records of all patients undergoing TRUS PNB in the VHA database from January 1st, 2013 to December 31st, 2018. We collected data about outpatient oral prophylaxis antibiotics, inpatient injectable antibiotics and microbiology results from rectal swabs and urine cultures performed within 90 days prior to the procedure. Results Of 153,055 patients undergoing prostate biopsy between January 1st, 2013 and December 31st, 2018, 27.6% (n=42,319) had urine cultures and 3.9% (n=5,294) had rectal swab cultures done within the 90-day window prior to the procedure. Among these who had urine and rectal swabs culture, 3.0% (n=1,292) and 20.1% (n=1,062) were positive for E. coli, respectively; 40.2% of E. coli isolates recovered from urine and 89.6% recovered from rectal swabs were resistant to fluoroquinolones. Table 1 shows the frequencies and percentages of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure. Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Conclusion Despite the high rate of recovery of fluoroquinolone-resistant E. coli in pre-procedure urine and rectal swabs, oral fluoroquinolones remained the most frequently used prophylactic agents prior to TRUS PNB. This inadequate prophylactic coverage may increase the risk of infectious complications following prostate biopsy. Disclosures Elie Saade, MD, MPH, FIDSA, Janssen: Advisor/Consultant.

EDITORIAL COMMENT

Transrectal ultrasound guided prostate needle biopsy is the standard prostate cancer diagnostic modality. Over the past decades, there has been an evolution of biopsy needle technology, number of cores taken, and improvements in pre-biopsy imaging to help with lesion identification. The goal is to identify clinically significant prostate cancers while decreasing those that are clinically insignificant, minimize both infectious, and non–infectious complications, and provide a tolerable procedure in terms of pain control, bleeding, and urinary function post-biopsy.

A Poly-vinyl Alcohol (PVA)-based phantom and training tool for use in simulated Transrectal Ultrasound (TRUS) guided prostate needle biopsy procedures

Trans-rectal ultrasound-guided needle biopsy is a well-established diagnosis technique for prostate cancer. To enhance the needle manoeuvring skills under ultrasound (US) guidance, it is preferable to train medical practitioners in needle biopsy on tissue-mimicking phantoms. This phantom should mimic the morphology as well as mechanical and acoustic properties of the human male pelvic region to provide a surgical experience and feedback. In this study, polyvinyl alcohol (PVA) was used and evaluated for prostate phantom development, that is stiffness tunable, US-compatible and durable phantom material. Three samples, each with 5%, 10%, and 15% concentration of PVA material, were prepared, and their mechanical and shrinkage characteristics were investigated. The anatomy of male pelvic region was used to develop an anatomically correct phantom. Later US-guided needle biopsy was performed on the phantom. The range of elastic moduli of the PVA samples was 2∼146 kPa. Their elastic moduli and volumes were found to remain statistically close from seventh to eighth freeze-thaw cycle (p>0.05). Initial US scans of the phantom resulted in satisfactory B-mode images, with a clear distinction between the prostate and its surrounding organs. This study demonstrated the applicability of PVA hydrogel as a phantom material for training in US-guided needle biopsy.

P0997 - Transrectal ultrasound guided prostate needle biopsy is still a standard of care for prostate cancer diagnosis – A multicentre Australian analysis of infection rates

P0997 - Transrectal ultrasound guided prostate needle biopsy is still a standard of care for prostate cancer diagnosis – A multicentre Australian analysis of infection rates

Comparison of Real-Time Virtual Sonography Navigation Versus BioJet Navigation on Magnetic Resonance Imaging-Guided Prostate Needle Biopsy: A Single Institutional Analysis.

Objective: To analyze the effectiveness and complication rate of MRI-guided prostate needle biopsies by using real-time virtual sonography (RVS) vs BioJet navigation. Methods: We retrospectively reviewed 171 patients who underwent an MRI-guided prostate needle biopsy at our institution. Patients whose prostate-specific antigen level was >4.0 ng/mL and who had suspicious prostate cancer (PCa) lesions by multiparametric MRI (mpMRI) underwent 2-core MRI-guided targeted biopsy (TB) and for MRI-guided TB: RVS and BioJet. RVS navigation synchronized mpMRI images with transrectal ultrasound (TRUS) images. BioJet navigation used a software program that merged images from mpMRI and TRUS to produce a composite image. We retrospectively compared the detection rate of PCa and the frequency of severe adverse events (AEs) between these two navigation systems, focusing on patients. In addition, we compared the detection rate of MRI-guided TB cores of two navigation systems regarding anatomical position (transitional zone [TZ] or peripheral zone [PZ]). Results: Data from RVS and BioJet biopsy groups were from 65 and 106 patients, respectively. Of these, RVS-TB included 141 cores (PZ: 49 cores, TZ: 92 cores), and BioJet-TB included 276 cores (PZ: 73 cores, TZ: 203 cores). In detecting PCa, by conducting both systematic biopsy and TB, and AEs in patients, a significant difference was not noted between RVS and BioJet navigation systems. In addition, there was no significant difference in the total detection rate for PCa in TB cores between the two methods. However, in the TZ, BioJet navigation showed a significantly higher detection rate of PCa than RVS navigation (35.0% vs 17.4%, p = 0.0023) by analyzing the cores of MRI-guided TB. Conclusion: When targeting TZ lesions, BioJet navigation had a greater detection rate for PCa compared with that of RVS navigation.

Histopathological spectrum of prostatic lesions and utility of p63 and Alpha-methylacyl-Co A racemase immunohistochemical markers in resolving suspicious cases

Histopathological spectrum of prostatic lesions and utility of p63 and Alpha-methylacyl-Co A racemase immunohistochemical markers in resolving suspicious cases - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.053, Indian Journal of Pathology and Oncology-Indian J Patho

Predictors of Infectious Complications after Targeted Prophylaxis for Prostate Needle Biopsy.

The incidence of infectious complications after transrectal ultrasound guided prostate needle biopsy is rising. We sought to identify the incidence and predictors of infection in a large cohort of men undergoing biopsy who receive targeted prophylaxis. We retrospectively reviewed the records of 5,214 consecutive patients who underwent transrectal ultrasound guided prostate needle biopsy from January 2013 to December 2014 at UroPartners, a large urology group comprising 28 clinics in metropolitan Chicago. At 1 microbiology laboratory all swabs were processed, the presence of fluoroquinolone resistant gram-negative rods was identified and sensitivity tests were performed. Prophylaxis for biopsy was guided by rectal swab culture. Characteristics of patients with and without infectious complications were compared using the Kruskal-Wallis and chi-square tests. Multivariable logistic regression was done to determine predictors of infectious complications. Analyses were performed with R, version 2.14.2 (https://www.r-project.org/). Of the 5,214 biopsies performed 56 infectious (1.1%) and 24 sepsis complications (0.46%) were found. On univariable analysis nonCaucasian race and fluoroquinolone resistant microbes were predictors of infection (p <0.05). On multivariable analysis fluoroquinolone resistant rectal vault flora (OR 9.98, 95% CI 3.79-26.3) and the number of biopsy cores taken (OR 1.28 per core, 95% CI 1.04-1.54) were independent predictors of infection. Despite targeted prophylaxis patients with fluoroquinolone resistant rectal vault flora have higher odds of infectious complications following transrectal ultrasound guided prostate needle biopsy. In these patients one should consider using other biopsy approaches or techniques to minimize risk.

A study of the pain score following TRUS guided prostate biopsy with and without periprostatic lignocaine infiltration

Introduction: Prostate cancer is one of the most common cancers in Western countries and is now increasing worldwide. Transrectal ultrasound guided prostate needle biopsy (TRUS) is the standard procedure to diagnose or exclude prostate cancer. TRUS-guided biopsy is associated with several complications and discomfort. We evaluated painless yet less invasive prostate biopsy. Material and Methods: A randomised xwas conducted in 30 consecutive men divided into two groups. Group I consisted of fifteen patients who did not receive any analgesia, and another fifteen constituted study group, Group II, who received periprostatic infiltration of 1 % lignocaine. Patient with suspected DRE findings or elevated PSA or both were advised to undergo TRUS guided prostate biopsy. Pain intensity during the procedure was evaluated using Visual Analogue Scale. A visual analog scale was used to assess the pain score. Statistical analysis of pain scores was performed using the Student t test. Chi-square/ Fisher Exact test was used to find the significance of study parameters on categorical scale between two. Results: In Group 2, there was a marked reduction in the pain experienced during the procedure. The Chi-squared test for trend showed a significant association between the periprostatic infiltration of 1 % lignocaine and reduction in pain on probe insertion and on taking the biopsy (P = 0.0001). Conclusion: The use of periprostatic infiltration of lignocaine before taking the needle biopsy significantly reduces the pain experienced by the patient during TRUS-guided prostate biopsy.

PD65-10 USING MP-MRI GUIDED PROSTATE NEEDLE BIOPSY SAMPLES TO IMPROVE PROSTATE CANCER DIAGNOSIS.

You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 2017PD65-10 USING MP-MRI GUIDED PROSTATE NEEDLE BIOPSY SAMPLES TO IMPROVE PROSTATE CANCER DIAGNOSIS. Jonathan OLIVIER, Jonathan Kay, Vasili Stravinides, Freeman Alex, Hashim Ahmed, Caroline Moore, Emberton Mark, and Whitaker Hayley Jonathan OLIVIERJonathan OLIVIER More articles by this author , Jonathan KayJonathan Kay More articles by this author , Vasili StravinidesVasili Stravinides More articles by this author , Freeman AlexFreeman Alex More articles by this author , Hashim AhmedHashim Ahmed More articles by this author , Caroline MooreCaroline Moore More articles by this author , Emberton MarkEmberton Mark More articles by this author , and Whitaker HayleyWhitaker Hayley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2960AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer is a heterogeneous disease both in terms of clinical presentation and pathology which can lead to very different clinical outcomes. Conventional prognostic factors, including serum PSA levels, Gleason score and pathological stage are often inaccurate and histological biomarkers could be useful in distinguishing indolent from aggressive prostate cancers. Tissue microarrays (TMAs) are useful for validating protein biomarker expression in large cohorts of patient samples using immunohistochemistry (IHC) but are often created from radical prostatectomy specimens which do not accurately represent diagnostic biopsies. The limited tumour availability in biopsy samples has led us to develop an improved method for constructing TMAs to study multiple biomarkers simultaneously on biopsy tissues. Objectives: Validate a new method of constructing TMA blocks from prostate needle biopsies and study the link between well known biomarkers (PSA, PSMA, p63,MSMB and AMACR) and mp-MRI data METHODS Patients attending UCLH with suspected prostate cancer were recruited to the PICTURE study and underwent a diagnostic mp-MRI scan and subsequent image-guided biopsy. This was analysed by a pathologist to confirm tumour Grade. Clinical and MRI data were routinely collected. We extracted the regions of tumour within biopsy samples and re-embedded them so that they could easily be repositioned into a recipient TMA block. Blocks were sectioned and stained using automated IHC for established prostate cancer biomarkers including p63, AMACR, PSMA, MSMB and PSA. RESULTS We have successfully produced TMA blocks containing representative regions of benign and tumour samples for 200 patients. 99.4% of the cores included were recovered in the TMAs slides. Biomarker expression correlates with Grade of cancer for PSA (p=0.01), MSMB (p=0.016) p63 (p<0.0001), AMACR (p<0.0001) and PSMA (p<0.0001). Expression also correlates with Likert score for PSMA (p=0.009), p63 (p=0.023) and AMACR (p<0.0001). CONCLUSIONS This new method of constructing TMA blocks is effective at utilising interesting regions of biopsy tissue. It allows multiple biomarkers to be assessed quickly from large cohort studies that accurately represent the tissue routinely used for diagnosis. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1270 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jonathan OLIVIER More articles by this author Jonathan Kay More articles by this author Vasili Stravinides More articles by this author Freeman Alex More articles by this author Hashim Ahmed More articles by this author Caroline Moore More articles by this author Emberton Mark More articles by this author Whitaker Hayley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Effect of Prostate Biopsy on Erectile Functions

Prostate cancer (PCa) is the most common malignancy among men in the United States of America (USA). Tissue samples should be taken from different parts of prostate by transrectal ultrasound guided prostate needle biopsy (TPND) and these samples should be examined histopathologically for the diagnosis of PCa. In recent years, the serum prostate specific antigen (PSA) measurement and number of prostate biopsies performed have become more frequent. Re-biopsy should be considered in the patients with persistent high serum prostate specific antigen level and/or abnormal digital rectal examination without malignancy in first biopsy, the patients with multiple high grade prostatic intraepithelial neoplasia (PIN) and/or atypical small acinar proliferation (ASAP) in first biopsy, the patients on active surveillance (AS). TNPB is not a fully innocent method. ED has been always neglected as a complication following TPNB. There is an increasing tendency towards relationship between ED after TPNB. The studies including relationship between ED after TNPD are evaluated in this review. The possible etiological factors of permanent erectile dysfunction (ED) after prostate needle biopsy are pyschological and organic factors. Temporary inflammatory and neurovascular damage are likely important, possibly combined with the impact of TPNB. Furthermore increased anxiety at the time of screening, biopsy, and immediately following biopsy. Also other possible etiological factors are number of needle cores, use of periprostatic nerve block, disease involving neurovascular bundles. In light of literature, there is a strong relationship between ED after TPNB but the exact etiology is stil conflicting.

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

Intrarectal Lidocaine-Diltiazem-Meperidine Gel for Transrectal Ultrasound Guided Prostate Biopsy.

Background:TRUS-guided needle biopsy of the prostate gland is the current standard method used for diagnosis of prostate cancer. Pain control during this procedure is through the use of i.v. sedation or local anaesthetic (LA), depending on clinician preference.Objectives:The aim of this study was to evaluate the effectiveness of intrarectal lidocaine, lidocaine-diltiazem and lidocaine-meperidine-diltiazem gel for anesthetizing transrectal ultrasound guided prostate biopsy.Patients and Methods:In a randomized double-blind clinical trial, 100 consecutive patients were divided into three groups. The patients received one of the gels before transrectal ultrasound guided prostate needle biopsy: group A, intrarectal and perianal lidocaine, gel 1 g; group B, intrarectal lidocaine gel, 1 g, + perianal diltiazem, 1 g; group C, intrarectal lidocaine gel, 1 g, + meperidine, 25 mg, and perianal diltiazem, 1 g. Visual analog pain scale was used to estimate pain during probe insertion and biopsy. Heart rate and blood pressure during probe insertion and biopsy were recorded too.Results:The mean of visual analog pain scale was 4.5 in group A, 3.5 in group B, and 2.0 in group C during probe insertion (P value = 0.01). The mean of visual analog pain scale was 5.1 in group A, 3.5 group B, and 2.5 in group C during biopsy (P value = 0.001). The groups were comparable for patients' age, weight, serum prostate-specific antigen (PSA), and prostate size (P > 0.05). No side effects of meperidine and lidocaine including drowsiness, dizziness, tinnitus and light-headedness or requiring assistance for activity were noted.Conclusions:Lidocaine-meperidine-diltiazem gel provides significantly better pain control than lidocaine-diltiazem gel and lidocaine gel alone during transrectal ultrasound guided prostate biopsy and probe insertion. This mixture gel is safe, easy to administer and well accepted by patients.

The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies.

IntroductionTransrectal ultrasonography (TRUS) guided prostate needle biopsy has been performed to diagnose and stage prostate cancer for many years. There are many different bowel preparation protocols to diminish the infectious complications, but there is no standardized consensus among urologists. Therefore, we aimed to assess two different bowel preparation methods on the rate of infectious complications in patients who underwent TRUS–guided prostate biopsy.Material and methodsA total of 387 cases of TRUS–guided prostate biopsy were included in this retrospective study. All patients received antibiotic prophylaxis with ciprofloxacin (500 mg) twice a day orally for 7 days starting on the day before the biopsy. The patients were divided into two groups according to the bowel preparation method used. Patients (Group 1, n = 164) only received self–administrated phosphate enema) on the morning of the prostate biopsy. Other patients (Group 2, n = 223) received sennasoid a–b laxatives the night before the prostate biopsy. Infectious complications were classified as sepsis, fever (greater than 38°C) without sepsis, and other clinical infections.ResultsMajor complications developed in 14 cases (3.8%), including 3 cases (0.8%) of urinary retention, and 11 (3%) infectious complications, all of which were sepsis. There were 3 and 8 cases of urosepsis in Group 1 and Group 2, respectively. There were no statistically significant differences between both Groups regarding to the rates of urosepsis (p = 0.358).ConclusionsDespite both methods of bowel preparation, sodium phosphate enema or sennasoid a–b calcium laxatives, before TRUS–guided prostate biopsy have similar effect on the rate of urosepsis, so both methods of bowel preparation can be safely used.

A single 80 mg intravenous gentamicin dose prior to prostate needle biopsy does not reduce procedural infectious complications.

IntroductionRates of infectious complications continue to increase following transrectal ultrasound guided prostate needle biopsy (TRUS PNB). Administration of a parenteral antibiotic at time of procedure represents one potential prophylaxis strategy. The efficacy of this practice remains incompletely defined.Material and methodsOur institutional TRUS PNB database was reviewed to identify consecutive men undergoing a biopsy over a 48-month period. The peri-operative intravenous antibiotic regimen (when used) included gentamicin 80 mg administered intravenously (IV) 30 minutes prior to biopsy. The incidence of infections post-biopsy was compared between patients receiving oral alone versus IV plus oral antibiotic prophylaxis.Results182 of 522 men (34.9%) included in this study received peri-procedural IV gentamicin at time of TRUS PNB, with a significant increase in utilization during the study time period (p <0.001). In total, 39 patients (7.5%) developed an infectious complication post-biopsy. No differences in infection rates were observed between patients receiving only oral prophylaxis (27 of 340, 7.9%) versus those receiving oral with IV gentamicin (12 of 182, 6.6%) (p = 0.73).ConclusionsIn this 4-year cohort analysis, a single peri-procedural dose of 80 mg of intravenous gentamicin failed to confer a reduction in infectious complications following prostate needle biopsy. Such data underscore the need to better understand the dose, route, and type of antimicrobial therapy to limit procedural infections.

The Impact of Multiple Prostate Needle Biopsies on Long-Term Erectile Dysfunction

IntroductionThe impact of transrectal ultrasound guided prostate needle biopsy on erectile dysfunction remains uncertain. We examined whether transrectal ultrasound guided prostate needle biopsy contributes to the development or worsening of erectile dysfunction as assessed by IIEF-5 scores in patients who underwent multiple prostate needle biopsies. MethodsThe study population consisted of 826 men who underwent transrectal ultrasound guided 10 to 12-core prostate needle biopsy for suspicion or surveillance of prostate cancer. Men were evaluated for erectile dysfunction using the IIEF-5 questionnaire. Erectile dysfunction was modeled as a categorical variable, defined as any (0 to 20), mild (16 to 20), mild to moderate (11 to 15), moderate (6 to 10) or severe (0 to 5). The impact of multiple prostate needle biopsies was also evaluated. ResultsOf 826 men who underwent prostate needle biopsy 240 (29%) had undergone 1 or more and 168 (20%) had undergone 2 or more biopsies. Mean patient age was 63 years and mean IIEF-5 score was 16. On univariate analysis age (OR 1.11, 95% CI 1.09–1.14, p <0.001), and 1 (OR 1.79, 95% CI 1.06–3.03, p=0.03) or 2 (OR 1.80, 95% CI 1.02–3.17, p=0.04) prior prostate needle biopsies were associated with erectile dysfunction. On multivariate analysis age alone was predictive of severe erectile dysfunction (OR 1.09, 95% CI 1.05–1.12, p=0.002). A repeat prostate needle biopsy within 12 months was associated with worse erectile dysfunction (OR 1.55, 95% CI 1.08–2.93, p=0.02). When long-term erectile function was evaluated, prostate needle biopsy was not significant after adjustment for covariates. ConclusionsIn the short term prostate needle biopsy may be important in predicting transient (less than 1 year) erectile dysfunction. However, in the long term prostate needle biopsy does not predict erectile dysfunction in aging men.

Epidural Abscess on the Lumbosacral Area after Transrectal Ultrasonography Guided Prostate Needle Biopsy

Transrectal ultrasonography guided prostate needle biopsy (PNB) is a useful tool for diagnosis of prostate cancer when the patient has positive findings, such as elevated prostate specific antigen, or a nodule on a digital rectal exam. Because PNB can be performed through the rectum, infection and hemorrhage are the most frequent complications after PNB. Many physicians have reported on their studies, including antibiotic therapy, for decreasing these complications, and some of these treatment modalities have been applied to patients who have undergone PNB. We report on a case of epidural abscess on the lumbosacral area after PNB.

Towards ultrasound probe positioning optimization during prostate needle biopsy using pressure feedback

Accurate Transrectal Ultrasound (TRUS)-guided prostate needle biopsy requires registering preoperative 3D TRUS or MR image, in which tumors and other suspicious areas are visible, to intraoperative 2D TRUS images. Such image registration is time-consuming while its real-time implementation is yet to be developed. To bypass this registration step, robotic needle biopsy systems can be used to place the US probe at the same position relative to the prostate during the 3D and 2D image acquisition to ensure similar prostate deformation. To have such similar deformation, only visual feedback is not sufficient as such feedback can be used to only guarantee that the whole prostate is within the field of view irrespective of the probe's orientation. As such, contact pressure feedback can be utilized to ensure consistent minimum contact between the probe and prostate. A robotic system is proposed where a TRUS probe with pressure sensor array is used. The contact pressure can be measured during imaging and used to provide feedback in conjunction with an optimization algorithm for consistent probe positioning. The robotic system is driven by the feedback to position the probe such that pressure pattern of the sensors during 2D image acquisition is similar to the pressure pattern during 3D image acquisition. The proposed method takes into account the patient's body movement expected during image acquisition. In this study, an in silico phantom is used where the simulated contact pressure distribution required in the optimization algorithm is obtained using a prostate finite element model. Starting from an arbitrary position where the probe contacts the phantom, this position was varied systematically until a position corresponding to maximum pressure pattern similarity between contact pressure patterns corresponding to the 2D and 3D imaging was achieved successfully. Results obtained from the in silico phantom study indicate that the proposed technique is capable of ensuring having only minimal relative prostate deformation between preoperative image acquisition and intraoperative imaging used for guiding needle biopsy, paving the way for faster and more accurate registration.

Editorial Comment

No AccessJournal of UrologyOncology: Prostate/Testis/Penis/Urethra1 Jan 2013Editorial Comment Janet Colli Janet ColliJanet Colli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.11.055AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 189(1S), pp. S17–S18 References 1 : Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol2001; 166: 856. Link, Google Scholar Department of Urology, University of Alabama, Birmingham, Alabama© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 1SJanuary 2013Page: S17-S18 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Janet Colli More articles by this author Expand All Advertisement PDF downloadLoading ...

Reduction in Hospital Admission Rates Due to Post-Prostate Biopsy Infections After Augmenting Standard Antibiotic Prophylaxis

We evaluated the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy, comparing an augmented regimen of antibiotic prophylaxis to the standard regimen, and established cost-effectiveness at our center. Our standard antibiotic prophylaxis regimen consisted of 3 days of ciprofloxacin or Bactrim™ DS in the perioperative period. An increase in hospital admissions related to infection after transrectal ultrasound guided biopsy from January 2010 through December 2010 led us to initiate an augmented regimen of 3 days of ciprofloxacin or Bactrim DS in addition to 1 dose of intramuscular gentamicin before biopsy from January 2011 to December 2011. Urine and blood cultures along with bacterial susceptibilities were obtained at admission and compared between the 2 groups. Cost analysis was done to determine the cost-effectiveness of standard and augmented regimens. The rate of hospitalization due to post-biopsy infections was 3.8% (11 patients among 290 biopsies) in 2010, which decreased to 0.6% (2 patients among 310 biopsies) in 2011 (p <0.001). Of the admitted patients who received standard prophylaxis, 73% had fluoroquinolone resistant Escherichia coli urinary infection and/or bacteremia and only 9% had strains resistant to gentamicin. Multivariate analysis showed that the standard regimen was significantly associated with hospital admission due to post-biopsy infection (HR 2.078 ± 0.84, p = 0.013). The augmented regimen resulted in a cost savings of $15,700 per 100 patients compared to the standard regimen. The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.

Increasing Risk of Infectious Complications After Transrectal Ultrasound–Guided Prostate Biopsies: Time to Reassess Antimicrobial Prophylaxis?

BackgroundAn increasing risk of infectious complications following transrectal ultrasound–guided prostate needle biopsy (PNB) has been observed recently in some centers. ObjectiveTo delineate the risk factors associated with post-PNB bacteremia and/or urinary tract infection (UTI) and determine why this risk has risen over time. Design, setting, and participantsA case–control study in a Canadian tertiary-care center. Cases were all patients who developed bacteremia and/or UTIs after PNB between 2002 and 2011; controls were randomly selected among patients who underwent a PNB without such complications. Outcome measurements and statistical analysisCrude and adjusted odds ratios and their 95% confidence intervals were calculated using logistic regression. Results and limitationsA total of 5798 PNBs were performed during the study period, following which there were 48 cases of urinary sepsis (42% with bacteremia). The incidence increased from 0.52 infections per 100 biopsies in 2002–2009 to 2.15 infections per 100 biopsies in 2010–2011 (p<0.001). Escherichia coli was the predominant pathogen (75% of cases). Among 42 patients whose post-PNB infection was caused by aerobic or facultative Gram-negative rods, 22 patients (52%) were infected by pathogens resistant to ciprofloxacin. Independent risk factors for post-PNB infection were diabetes, hospitalization during the preceding month, chronic obstructive pulmonary disease, and performance of the biopsy in 2010–2011. In 2010–2011, the minimal inhibitory concentrations for ciprofloxacin increased compared with 2002–2009 (p<0.03). The major limitation of the study was its retrospective hospital-based nature, which hampered data collection on outpatient antibiotic prescriptions. ConclusionsIn the past 2 yr, ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center. Novel antibacterial prophylaxis approaches need to be evaluated.