Transrectal Ultrasound-guided Biopsy Of The Prostate Research Articles

Impact of a Switch From Ciprofloxacin to Ceftriaxone Prophylaxis on Infectious Complications After Transrectal Ultrasound-Guided Biopsy of the Prostate.

In a 12-year single-center quasi-experimental study, a switch from ciprofloxacin to ceftriaxone prophylaxis for transrectal ultrasound-guided prostate biopsy procedures was associated with a significant reduction in 30-day postprocedure urinary tract infection, urinary tract infection-related hospitalizations, antibiotic prescriptions, and isolation of fluoroquinolone-resistant organisms from urine or blood cultures.

Antimicrobial prophylaxis protocol based on rectal swab culture before prostate biopsy to prevent infectious complications: a prospective randomized comparative study.

To evaluate the benefit of targeted antibiotic prophylaxis (TAP) based on rectal swab culture in comparison with standard empiric antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided needle biopsy of the prostate (TRUS-BP), as well as to assess rate of fecal carriage of Fluoroquinolone-resistant Enterobacterales FQRE. We prospectively analyzed data that randomized 157 patients within two groups: (G1) TAP according to rectal swab performed 10days before PB; (G2): empirical antibiotic prophylaxis with ciprofloxacin. Prevalence of FQRE digestive carriage and risk factors were investigated. Incidence of infectious complications after (TRUS-BP) in each group was compared. G2 included 80 patients versus 77 in G1. There was no difference between the two groups regarding age, diabetes, prostate volume, PSA, number of biopsy cores, and risk factors for FQRE. In G2, the prevalence of FQRE digestive carriage was 56.3% all related to E. coli species. In the case of digestive carriage of FQRE, TAP according to the rectal swab culture with third-generation cephalosporins was performed in 73.3%. Patients with FQRE had history of FQ use within the last 6months in 17.8% (p = 0.03). Rate of febrile urinary tract infection after PB was 13% in G1 and 3.8% in G2 (p = 0.02). Incidence of FQ resistance in the intestinal flora of our local population was prevalent. Risk factor for resistance was the use of FQ within the last 6months. TAP adapted to rectal swab, mainly with third-generation cephalosporins, significantly reduced the rate of infectious complications after (TRUS-BP).

1207. Impact of a switch from ciprofloxacin to ceftriaxone on infectious complications after transrectal ultrasound-guided biopsy of the prostate

Abstract Background Transrectal ultrasound-guided biopsy of the prostate (TRUBP), first described in the 1980s, remains a commonly performed procedure. Since approximately 2010, increasing infection rates due to fluoroquinolone-resistant E. coli have been reported. These data prompted a change in our recommended antibiotic prophylaxis in March 2014 from ciprofloxacin to ceftriaxone. Limited data are available on whether this strategy leads to improved outcomes or contributes to emergence of infections due to ceftriaxone-resistant organisms. Methods We conducted a retrospective, single-center cohort study comparing patients who received ciprofloxacin monotherapy from 1/1/2011 through 2/28/2014 and patients who received ceftriaxone monotherapy from 3/1/2014 through 12/31/2022 as prophylaxis for TRUBP. The primary outcomes were the percentage of procedures with positive blood cultures within 30 days after the procedure and the percentage of urinary tract infections (UTI), defined as a positive urine culture, within 30 days after the procedure. Secondary outcomes included the percentage of procedures with UTI due to specific organisms, including E. coli, fluoroquinolone-resistant E. coli, and extended-spectrum beta-lactamase producing (ESBL) E. coli within 30 days after the procedure. Results Of 2,910 total TRUBP procedures, ciprofloxacin was used for prophylaxis in 653 procedures in 578 patients, and ceftriaxone was used for 2,257 procedures in 1,794 patients. As shown in Table 1, patients receiving ceftriaxone prophylaxis had significantly fewer positive blood and urine cultures in the 30 days after the procedure and significant reductions in positive urine cultures with E. coli, fluoroquinolone-resistant E. coli, and non-E. coli Enterobacteriaceae. Conclusion Our findings suggest that in the setting of increasing rates of fluoroquinolone resistance in E. coli, switching from ciprofloxacin to ceftriaxone for TRUBP prophylaxis may result in fewer infectious complications without increasing the risk for emergence of infections due to ceftriaxone-resistant organisms. Disclosures All Authors: No reported disclosures

Change from transrectal to transperineal ultrasound-guided prostate biopsy under local anaesthetic eliminates sepsis as a complication

Transrectal ultrasound-guided (TRUS) biopsy of the prostate is associated with increased risk of post-procedural sepsis with associated morbidity, mortality, re-admission to hospital, and increased healthcare costs. In the study institution, active surveillance of post-procedural infection complications is performed by clinical nurse specialists for prostate cancer under the guidance of the infection prevention and control team. To protect hospital services for acute medical admissions related to the coronavirus disease 2019 (COVID-19) pandemic, TRUS biopsy services were reduced nationally, with exceptions only for those patients at high risk of prostate cancer. In the study institution, this change prompted a complete move to transperineal (TP) prostate biopsy performed in outpatients under local anaesthetic. TP biopsies eliminated the risk of post-procedural sepsis and, consequently, sepsis-related admission while maintaining a service for prostate cancer diagnosis during the COVID-19 pandemic.

V14-12 PATIENT TOLERABILITY WITH OFFICE TRANSPERINEAL BIOPSY USING A REUSABLE NEEDLE GUIDE

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-12 PATIENT TOLERABILITY WITH OFFICE TRANSPERINEAL BIOPSY USING A REUSABLE NEEDLE GUIDE Stephen Wertheimer, Sara Perkins, Alex Borchert, Jeff Budzyn, Craig Rogers, and Amit Patel Stephen WertheimerStephen Wertheimer More articles by this author , Sara PerkinsSara Perkins More articles by this author , Alex BorchertAlex Borchert More articles by this author , Jeff BudzynJeff Budzyn More articles by this author , Craig RogersCraig Rogers More articles by this author , and Amit PatelAmit Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One of the most common urologic procedures is transrectal ultrasound-guided (TRUS) biopsy of the prostate. It is associated with a 1-5% risk of severe sepsis, despite the use of prophylactic antibiotics. Additionally, infectious complications appear to be increasing due to fluoroquinolone resistance. Recent studies have demonstrated the feasibility of transperineal (TP) prostate biopsy in the outpatient setting under local anesthetic (LA). We demonstrate the safety, efficacy, and tolerability our technique for performing TP biopsy under LA in the clinic setting using a reusable needle guide. METHODS: For biopsies, a biplanar ultrasound probe with an attached adjustable, reusable needle guide is used. A 17 gauge x 10 cm coaxial needle is attached to the needle guide. The skin is infiltrated, bilaterally, approximately 2 cm anterolateral to the anal verge with 1% lidocaine using a 25 gauge needle. A deeper prostatic block is then performed using a 20 gauge spinal needle, inserting it through the coaxial sheath. Administration of the anesthetic is delivered to the musculature of the pelvic floor, superficial-to-deep. Prostate samples are obtained using an 18 gauge x 25cm biopsy gun. All biopsies on a side can be obtained utilizing a single perineal skin puncture site. Patients who underwent office TP biopsy after May 2019 also completed a 10-item patient experience questionnaire regarding pain or discomfort experienced during the procedure. RESULTS: Our approach to office TP biopsy with reusable needle guide had a significantly lower utilization of prophylactic antibiotics compared to TRUS biopsy: 33.8% vs 99.5% (p<0.001), yet there were no admissions or infections, compared to 6 admissions (1.1%) for TRUS biopsy (p=0.01), of which 4 (0.7%) were for UTI or sepsis (p=0.04). The mean VAS score±SD for pain or discomfort caused by the overall office TP biopsy was 3.68±1.96. CONCLUSIONS: We demonstrate that office TP biopsy under LA with a reusable needle guide can be safely introduced with equivalent cancer detection rates whilst nearly eliminating the risk of urinary sepsis. This was achieved while also significantly reducing the use of prophylactic antibiotics. The procedure was well tolerated, with the most common complaint being local infiltration of anesthetic. We believe that office TP biopsy under LA can be performed with good patient tolerability, as almost 94% of patients were willing to undergo the procedure again. There is also the potential for reduction in overall cost with the use of a reusable needle guide. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1169-e1169 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Wertheimer More articles by this author Sara Perkins More articles by this author Alex Borchert More articles by this author Jeff Budzyn More articles by this author Craig Rogers More articles by this author Amit Patel More articles by this author Expand All Advertisement Loading ...

Contemporary practice of prostate biopsy in Nigeria: Differences in technique and prophylactic measures among urologist

Objectives: Prostate cancer is the most common cancer affecting men in Nigeria. Trans-rectal ultrasound-guided biopsy of the prostate is routinely performed to diagnose prostate cancer. Though safe, prostate biopsy may be associated with some complications. In Nigeria, there are scanty national guidelines on prophylactic measures and techniques in prostate biopsy. The aim of the study was to assess the pre-biopsy prophylactic measures and biopsy protocols employed by Nigerian Urologists. Material and Methods: A survey questionnaire was distributed during the 2019 Annual General Meeting of the Nigerian Association of Urologic Surgeons and information collected on the biopsy route, use of anesthesia, antibiotic prophylaxis, number of samples taken, and possible complications. Results: A total of 72 urologists participated in the study. Bowel preparation was performed by 10 (13.9%) participants for a duration of 1–3 days. All urologists used the transrectal route and anesthesia was given by all. Prophylactic antibiotics were given by all participants. Our participants administered antibiotic prophylaxis for a period of 1, 3, 5, or 7 days (4.2%, 23.6%, 43.1%, and 22.2%, respectively). Ciprofloxacin/metronidazole combination was most commonly prescribed (70.8%). Most urologists (69.4%) commonly take between 8 and 12 core tissues per biopsy session. The most common complication was hemorrhage (43.1%), followed by perineal pain (40.3%). Conclusion: There is a lack of evenness in pre-biopsy prophylactic measures and biopsy protocol among Nigerian Urologists. There is a need for a Nigerian guideline to elucidate the most appropriate antibiotic(s), route of administration and duration of treatment, the preferred anesthesia type, and the number of core-tissues that are appropriate.

Effect of Prolonged Duration of Transrectal Ultrasound-Guided Biopsy of the Prostate and Pre-Procedure Anxiety on Pain in Patients without Anesthesia.

ObjectiveTo evaluate factors correlated with pain during prostate biopsy and willingness to undergo transrectal ultrasound-guided prostate biopsy (TR-PBx) again without anesthesia in patients undergoing TR-PBx without anesthesia.MethodsThis retrospective, single-center study evaluated 624 patients who underwent TR-PBx without anesthesia. Based on a nomogram using patient age and prostate volume, 6–12 core biopsy samples were allocated. Anxiety was evaluated using the Faces Anxiety Scale before the TR-PBx. Pain was evaluated using the Faces Pain Scale at each puncture and immediately after confirmation of cessation of bleeding from the rectum after the transrectal probe was pulled out. The question “If this operation must be repeated, would you agree to undergo it again under same conditions?” was asked after the procedure was completed. The change in pain at each puncture and factors correlated with post-procedural pain were calculated using multiple regression analysis, and factors predicting an answer of “yes” to the question using binary logistic analysis were evaluated.ResultsScores on the Faces Pain Scale significantly increased from the first core sample to last as the number of samples increased. However, the number of samples did not show significant correlation with pain evaluated after the procedure was complete. Time during the biopsy and the anxiety score had a significant correlation with the pain scale score for the completed procedure. Short duration of TR-biopsy and a low anxiety score predicted a reply of “Yes” to the question.ConclusionA long operative time during the TR-PBx procedure and strong pre-procedure anxiety can increase pain for patients undergoing the procedure without anesthesia and cause patients to be unwilling to undergo TR-PBx again without anesthesia.

The diagnostic value of a new formula combining age and prostate volume in prostate cancer

Background and objective: This study combined two clinical indicators (age and prostate volume (PV)) to generate age to PV (AVR) ratio, whose diagnostic value for prostate cancer (PCa) was examined based on prostate specific antigen (PSA) in the range of 4--20.0 ng/mL. Methods: The medical records of patients who underwent transrectal ultrasound-guided biopsy of the prostate in our hospital from June 2015 to June 2019 were examined retrospectively. According to the pathological results of the biopsy, the patients were divided into the PCa and benign prostatic hyperplasia (BPH) groups. Receiver operating characteristic (ROC) curves for TPSA, PSAD, PV, (F/T)PSA, AVR, and PSA-AV were plotted with SPSS 26.0 and GraphPad Prism 5.0, and areas under the ROC curves (AUROCs) were determined and compared by Delong test. A log-linear model was used to compare AVR and other parameters with similar high sensitivities, for specificity. Results: The AUROC for AVR was significantly different from those of TPSA (p &lt; 0.001), PV (p = 0.004),(F/T)PSA (p &lt; 0.001), and PSA-AV (p = 0.006), and similar to that of PSAD (p = 0.064). With the same high sensitivity (90.0%), log-linear model analysis showed that the specificity of AVR was significantly higher than those of TPSA and (F/T)PSA (p &lt; 0.01), while there were no significant differences among AVR and PSAD, PV and PSA-AV. Conclusion: With PSA in the range of 4--20.0 ng/mL, AVR may be useful in sparing an invasive intervention for a number of patients.

Use of colour Doppler to eliminate rectal bleeding from trans-rectal ultrasound-guided biopsy of the prostate

Bleeding is one of the complications of trans-rectal ultrasound (TRUS)-guided biopsy of the prostate. Urethral bleeding could be prevented by avoiding the trajectory on the urethra. However, rectal bleeding is difficult to predict because the peri-prostatic, intra-prostatic and rectal vessels cannot be seen on an ordinary ultrasound scan. Use of colour Doppler to map out the vessels cognitively before injection of local anaesthesia prevents puncture of the vessels, which is a key cause of rectal bleeding. Level of evidence: Not applicable.

Patterns of infection following transrectal ultrasound‐guided biopsy of the prostate in a regional New South Wales Centre

To determine the rates, severity and patterns of resistance in patients presenting with post-transrectal ultrasound infection in a regional centre in New South Wales, Australia. A single-centre retrospective review from August 2013 until August 2017. Murrumbidgee Local Health District, New South Wales. All patients who underwent transrectal ultrasonography biopsy of the prostate in the public health system. Rate of infection and sepsis following biopsy of the prostate requiring readmission to hospital within 30days from the procedure. A total of 317 men underwent transrectal ultrasound-guided biopsy of the prostate over the study period. Nineteen (6%) patients presented with clinical signs of post-transrectal ultrasound infection, of which 18 (5.7%) required readmission for intravenous antibiotics. Median time to readmission was 2days (0-7), and the average length of hospital stay was 5days (1-15). Three (0.3%) patients required admission to intensive care for inotropic support. Thirteen patients (68%) had positive blood cultures, and all were positive for Escherichia coli. Four of these patients (21%) had extended spectrum beta-lactamase producing isolates resistant to their preoperative antibiotics. Prostate cancer is common in the elderly community with worse outcomes in regional settings. Infective complications from transrectal ultrasound biopsy were 6% in this regional setting with high rates of multi-resistant organisms. Awareness of this is important for rural health practitioners who are likely to be exposed to this patient population.

Are Inflammatory Markers Useful in Predicting Urinary Tract Infection After Transrectal Ultrasound-Guided Biopsy of the Prostate?

Background: Sepsis is a serious and life-threatening complication after transrectal ultrasound (TRUS)-guided prostate biopsy. It is critical to predict its occurrence prior to conducting the biopsy. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte (PLR) have been proven to be promising diagnostic indicators of infectious complications after various surgical procedures. The aim of this study was to determine whether inflammatory markers, NLR and PLR ratios, are useful surrogates to predict sepsis after TRUS biopsy. Methods: A total of 378 patients underwent TRUS-guided prostate biopsy with no clinical evidence of prostatitis from December 2009 to May 2013 in American University of Beirut Medical Center. Data collected included age, smoking status, prostate size, post-void residual, prostate-specific antigen (PSA) value, blood culture, urine culture, Gleason score, pathology results, neutrophils, leukocyte count and platelet counts. Also, NLR and PLR were calculated. The primary outcome collected was sepsis. All data were entered and analyzed by Statistical Package for Social Sciences. Results: Of the 378 patients who underwent TRUS biopsy, 31 patients developed sepsis. Septic patients were younger (63.7 ± 6.2 years) than non-septic patients (65.5 ± 8.0 years). No association between sepsis and NLR or PLR was observed; however, a significant association between sepsis and pre-biopsy urine analysis and pre-biopsy PSA (P = 0.011) was noted. Conclusion: In this study, none of the pre-procedure NLR and PLR studied was found to predict sepsis after TRUS biopsy. Future efforts should be directed to investigate this relationship in prospective studies. World J Nephrol Urol. 2020;9(1):11-14 doi: https://doi.org/10.14740/wjnu398

Phenotypic screening for quinolone resistance in Escherichia coli

Recent studies show that rectal colonization with low-level ciprofloxacin-resistant Escherichia coli (ciprofloxacin minimal inhibitory concentration (MIC) above the epidemiological cutoff point, but below the clinical breakpoint for resistance), i.e., in the range > 0.06–0.5 mg/L is an independent risk factor for febrile urinary tract infection after transrectal ultrasound-guided biopsy (TRUS-B) of the prostate, adding to the other risk posed by established ciprofloxacin resistance in E. coli (MIC > 0.5 mg/L) as currently defined. We aimed to identify the quinolone that by disk diffusion best discriminates phenotypic wild-type isolates (ciprofloxacin MIC ≤ 0.06 mg/L) of E. coli from isolates with acquired resistance, and to determine the resistance genotype of each isolate. The susceptibility of 108 E. coli isolates was evaluated by ciprofloxacin, levofloxacin, moxifloxacin, nalidixic acid, and pefloxacin disk diffusion and correlated to ciprofloxacin MIC (broth microdilution) using EUCAST methodology. Genotypic resistance was identified by PCR and DNA sequencing. The specificity was 100% for all quinolone disks. Sensitivity varied substantially, as follows: ciprofloxacin 59%, levofloxacin 46%, moxifloxacin 59%, nalidixic acid 97%, and pefloxacin 97%. We suggest that in situations where low-level quinolone resistance might be of importance, such as when screening for quinolone resistance in fecal samples pre-TRUS-B, a pefloxacin (S ≥ 24 mm) or nalidixic acid (S ≥ 19 mm) disk, or a combination of the two, should be used. In a setting where plasmid-mediated resistance is prevalent, pefloxacin might perform better than nalidixic acid.

Impact of prostate needle biopsy on erectile function: A prospective study.

Needle biopsy of the prostate is a diagnostic method for prostate cancer which is a relatively safe method with low risk of serious complications. The evidences regarding the occurrence of erectile dysfunction following prostate biopsy are controversial. Herein, we aimed at determining the rate of erectile dysfunction in those undergoing transrectal ultrasound-guided prostate biopsy. All candidates for prostate biopsy were enrolled. The International Index of Erectile Function-5 was completed 1 m before and 1, 3, and 6 months after ultrasound-guided prostate biopsy by each patient for erectile dysfunction. Patients with a previous history of erectile dysfunction which due to a positive pathology had received any type of treatment were excluded from the study. Eighty patients with the mean age of 64.8 years, the mean prostate-specific antigen level of 11.64 ng/dL, and the mean prostate volume of 62.43 cc were included. The prostate biopsy result was positive in 38.8% of the cases. No significant relationship was found between erectile dysfunction and prostate-specific antigen level, prostate volume, and the pathology result (P = 0.320, 0.509, and 0.131). The mean questionnaire score 1 month before and after the biopsy was 23 and 18, respectively; it demonstrated a significant difference (P < 0.001). The same score was 17 and 14.5 three and six months after biopsy. The mean score 1 m before and 3 m after biopsy also revealed a significant difference (P < 0.001). Transrectal ultrasound-guided needle biopsy of the prostate causes progressive erectile dysfunction in these patients. This relationship is not affected by the biopsy result, prostate volume, or the prostate-specific antigen level.

Efficacy of combined prophylactic use of levofloxacin and isepamicin for transrectal prostate needle biopsy: A retrospective single-center study

PurposeTo assess the efficacy of a combined regimen of levofloxacin (LVFX) plus isepamicin (ISP) as prophylaxis for transrectal ultrasound-guided needle biopsy of the prostate (TRUSP-Bx). Materials and methodsOverall, 562 patients undergoing TRUSP-Bx were included in the present study. All patients were administered a single-dose of oral LVFX (500 mg) in the morning and intravenous ISP (400 mg) 60 min before biopsy. All biopsies were performed via TRUSP-Bx with an 18-gauge needle, and 12-core specimens were routinely obtained. Before initiating antibiotic treatment, urine and blood bacterial cultures were tested to determine the causative microorganisms in the patients with acute bacterial prostatitis. ResultsAcute bacterial prostatitis developed in three (0.53%) participants. The incidence rates of acute bacterial prostatitis in the low- and high-risk groups were 0.79% and 0.46%, respectively. These patients showed clinical symptoms of acute bacterial prostatitis 12–24 h after their biopsy. Escherichia coli (E. coli) was isolated in the urine or bladder cultures of all of patients. All three isolates were determined to be LVFX-resistant E. coli, although they had good sensitivity to aminoglycosides, cephalosporins, and carbapenems. All patients were administered antibiotic treatment (cephalosporin or carbapenem) immediately and were treated successfully with no evidence of further disease progression. ConclusionAntibiotic prophylaxis with LVFX plus ISP was effective, resulting in a lower incidence of acute bacterial prostatitis after TRUSP-Bx in both low- and high-risk patients.

Mean Platelet Volume as an Inflammation Marker, Possible Biomarker of Tumor Detection in Prostate Biopsy

Background: In the diagnosis of prostatic diseases, the need for markers other than prostate specific antigen (PSA) has been increasing in recent years. So, we aimed to determine the predictive value, the neutrophil lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume before prostate biopsy in predicting the results of pathology. Transrectal ultrasound-guided biopsy of the prostate was performed because of high PSA values and compared values of these parameters to predict of pathology results. Methods: 2715 patients who underwent 10 - 12 quadrant transrectal ultrasound-guided prostate biopsies between January 2008 and January 2018 have been evaluated retrospectively. Patients were divided into groups according to the biopsy pathology results by benign (group 1), atypical small acinar proliferation (ASAP) (group 2) and prostate cancer (group 3). A total of 204 patients who were benign prostate hyperplasia in 71 patients (34.8%), atypical small acinar proliferation in 80 (39.21%) and prostate adenocarcinoma (PCa) in 53 patients (25.98%) were included in the study by systematic sampling. Before the biopsy total PSA (tPSA), free PSA (fPSA), rate of percentage of free to total prostate specific antigen (f/tPSA) rate, PSA density (PSA-D), white blood cell (WBC) count, blood neutrophil count (NC), blood lymphocyte count (LC), neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV), platelet count (PLT) and platelet-to-lymphocyte ratio (PLR) were measured and compared in all groups. Differences in continuous variables were assessed using the ANOVA. Logistic regression was used to analyze the linear relationship between predictive variables and pathology results. P Results: NLR and PLR values were lower in group 1 than group 2 and were found statistically significant between in group 1 and group 2 (p: 0.03 and p: 0.02, respectively). MPV value was found 1.7 times higher in patients who were diagnosed with ASAP pathology than those with benign pathologies. Although there was statistically significant increase in MPV values in logistic regression results, no statistically significant diagnostic value was found. In addition MPV value was found 0.5 times higher in patients who were diagnosed patients with ASAP than prostate cancer group. ROC analysis showed that the optimal threshold was 7.65 femtoliter (sensitivity: 51%; specificity: 30%) and was found to be a statistically significant diagnostic value to distinguish groups 2 and 3. The lowest value of MPV was found in group 3. Conclusions: In cases where the PSA value is insufficient in predicting the pathology result, the effect of NLR, PLR and MPV on differential diagnosis can be kept in mind. While NLR and PLR are more useful in the diagnosis of ASAP, MPV is more effective in the diagnosis of malignancy.

A safe technique of finger-guided biopsy of the prostate.

Prostatic biopsy is the gold standard of diagnosis of prostatic cancer. In the era of transrectal ultrasound-guided biopsy of the prostate, finger-guided prostatic biopsy still has a role in underdeveloped and developing countries. We describe a safer technique of performing a finger-guided prostatic biopsy.

1179. Incidence of Bacteremia and Bacteriuria With Antibiotic-Resistant Enterobacteriaceae After Transrectal Ultrasound-Guided Biopsy of the Prostate (TRUSBP)

BackgroundInfection with Escherichia coli after TRUSBP is common, but other Enterobacteriaceae also occur. In the absence of microbiological data, prophylaxis with co-trimoxazole (TMP-SMX) or fluoroquinolones (FQ) is usually prescribed. We estimated the incidence of bacteremia and bacteriuria after TRUSBP with distinct species of Enterobacteriaceae and their rate of resistance to common antibiotics.MethodsUsing Veterans Healthcare Administration (VHA) databases, we identified patients undergoing TRUSBP between January 1, 2013 and December 31, 2017. We determined the incidence of Enterobacteriaceae isolated from urine and blood cultures obtained within 30 days of TRUSBP. Using microbiology data from VHA, we determined rates of resistance to TMP-SMX, FQ (ciprofloxacin as marker), ESC (ceftriaxone as marker), and carbapenems (Carb) (ertapenem as marker).ResultsOverall, 377 (0.3%) and 1,739 (1.4%) of 126,761 TRUSBPs were complicated by bacteremia or bacteriuria with Enterobacteriaceae, respectively. E. coli was predominant (91% of blood and 81% in urine). Rates of FQ resistance were low in Klebsiellaand Enterobacter but exceeded 60% in E. coli. In general, TMP-SMX resistance exceeded 30%. Of note, 16.6% of blood and 11% of urine Enterobacteriacaea were resistant to ESC, while Carb-resistance was rare.ConclusionFQ and ESC-resistant Enterobacteriaceae are prevalent in bacteremia and bacteriuria after TRUSBP. Antibiotics used for prophylaxis and empirical treatment are likely to be ineffective. The prevention and management of TRUSBP-related infections should include microbiology-guided approaches.TotalESC-ResistantCarb-ResistantFQ ResistantTMP-SMX Resistant Enterobacteriaceae Blood3776116.4%20.5%23562.3%12934.2%Urine173919211.0%201.2%98656.7%60734.9%CitrobacterBlood31%0–1–1–Urine22522.7%29.1%836.4%731.8%EnterobacterBlood40000Urine46817.4%24.3%36.5%12.2% Escherichia coli Blood3445716.6%00.0%23267.4%12335.8%Urine141515711.1%20.1%93466.0%55639.3% Klebsiella Blood24312.5%14.2%28.3%416.7%Urine196147.1%63.1%157.7%2211.2% Morganella Blood21101Urine13215.4%538.5%538.5%861.5%Proteus33618.2%39.1%1751.5%1133.3%Providencia200–1–0–Serratia110021Shigella10011Disclosures All authors: No reported disclosures.

YouTube as a source of patient information for transrectal ultrasound-guided biopsy of the prostate

To assess the quality of YouTube videos explaining transrectal ultrasound (TRUS)-guided biopsies of the prostate. A search of YouTube was made for the terms "TRUS", "TRUS biopsy", "transrectal ultrasound", and "prostate biopsy". Videos were selected from the first 10 pages of results and reviewed by three authors against criteria based on written information from the British Association of Urological Surgeons. They were given a qualitative rating based on how well they provided information on factors such as preparation for the procedure, mechanism of the procedure and possible side effects. Data were also collected on view count, country of origin, likes, and dislikes. A total of 41 videos were reviewed, with no videos achieving an "excellent" rating, 32 being rated as "very poor", and only one rated as "good". Despite the poor-quality information, 39 of the videos were from healthcare organisations or individual surgeons. Videos often lacked specific information, or were targeted at healthcare professionals instead of patients. The information about TRUS-guided prostate biopsies on YouTube was not of a sufficiently high standard to allow patients to make informed decisions. Healthcare professionals hence have a duty to point patients towards adequate sources of reputable information online. Furthermore, there remains an opportunity to produce high-quality, informative, patient-focussed medical YouTube videos.

Editorial Comment

Prostate biopsy is one of the most common procedures performed by urologists with an estimated >2 million performed in the United States and Europe every year, 1 Borghesi M. Ahmed H. Nam R. et al. Complications after systematic, random, and image-guided prostate biopsy. Eur Urol. 2017; 71: 353-365 Abstract Full Text Full Text PDF PubMed Scopus (180) Google Scholar , 2 Loeb S. Carter H.B. Berndt S.I. et al. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011; 186: 1830-1834 Abstract Full Text Full Text PDF PubMed Scopus (451) Google Scholar and is the gold standard for the diagnosis of prostate cancer. The majority of prostate biopsies in the United States are done in the office setting using the ultrasound probe through a transrectal approach. The proximity of the posterior prostate to the anterior rectal wall provides easy access the peripheral zone which is known to harbor >70% of malignancies. 3 McNeal J.E. Normal histology of the prostate. Am J Surg Pathol. 1988; 12: 619-633 Crossref PubMed Scopus (421) Google Scholar However, this approach is associated with a significant risk of infectious complications, with rates ranging from 1 to 17.5% in the literature. Furthermore, the risk of serious infectious complications requiring hospitalization has been shown to be increasing over time, 4 Anastasiadis E. van der Meulen J. Emberton M. Hospital admissions after transrectal ultrasound-guided biopsy of the prostate in men diagnosed with prostate cancer: a database analysis in England. Int J Urol. 2015; 22: 181-186 Crossref PubMed Scopus (35) Google Scholar likely as a result of the increased prevalence of fluoroquinolone-resistant Escherichia coli. 5 Tukenmez Tigen E. Tandogdu Z. Ergonul O. et al. Outcomes of fecal carriage of extended-spectrum beta-lactamase after transrectal ultrasound-guided biopsy of the prostate. Urology. 2014; 84: 1008-1015 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Partly in response to this, several centers are increasingly using the transperineal (TP) approach to prostate biopsy. Rather than using broad-spectrum prophylaxis, which contributes to antibiotic resistance, TP biopsies are often performed after a single prophylactic dose of first generation cephalosporin. Large series using this approach have reported sepsis rates approaching zero. 1 Borghesi M. Ahmed H. Nam R. et al. Complications after systematic, random, and image-guided prostate biopsy. Eur Urol. 2017; 71: 353-365 Abstract Full Text Full Text PDF PubMed Scopus (180) Google Scholar To date, TP biopsy has been mostly performed under general anesthesia, having important implications on health care resources, cost and time. Although the TP approach has been more widely adopted in other countries, in the United States it has been mostly reserved for special situations where the transrectal approach is either not possible or is unsafe. In recent years, several devices have been developed allowing TP prostate biopsies to be performed in the office, under local anesthesia, without the need for bulky, cumbersome, expensive equipment. The authors of this manuscript present their initial experience using 1 such device, and demonstrate the safety and feasibility of office TP prostate biopsy in a small number of men. What is now needed are studies in larger cohorts of patients demonstrating safety on a large scale using standardized reporting, patient tolerability using validated pain questionnaires and confirmation of the diagnostic accuracy for prostate cancer. Advances in prostate imaging (eg magnetic resonance imaging) aim to decrease the overuse of prostate biopsy, similarly modifications of the approach and instrumentation for prostate biopsy aim to decrease the morbidity of the procedure. These efforts will continue to shift the balance in favor of screening and diagnosis of prostate cancer, and will thus benefit the population on a large scale.

Which is better for pain reduction during transrectal ultrasound-guided biopsy of the prostate: Intravenous diazepam, local periprostatic nerve block, or combination? controlled randomized study.

Background:Transrectal ultrasound-guided prostate biopsy (TRUSPB) is considered the procedure of choice for the diagnosis of prostate cancer. Men undergoing this biopsy experience high psychological stress. Different studies recommend techniques as sedation, lidocaine gel intrarectally, periprostatic nerve block alone, or nitrous oxide inhalation as effective methods of analgesia during procedural-related pain or discomfort. We evaluated three techniques for pain relief during TRUSPB and evaluated if there was any increase in the incidence of complications when employing either technique.Setting:Assiut University Hospital, Assiut, Egypt.Methods:Three hundred patients of age 43–92-year-old underwent TRUSPBs. Patients were allocated randomly into three equal groups to receive intravenous (IV) diazepam 5 mg slowly (Group I), bilateral periprostatic nerve block by 10 ml of 1% lidocaine solution injected under ultrasound guidance (Group II), or combined IV diazepam and the periprostatic nerve block (Group III).Results:The mean pain score was 4.95 for patients in Group I, 4.15 for patients in Group II, and 2.18 for patients in Group III with statistically significant findings (F = 120.27, P < 0.001). TRUSPB under combined IV sedation and local anesthesia had no significant increase in the incidence of complications.Conclusions:Patients should have analgesia during TRUSPB to decrease the procedure pain and to improve tolerance permitting proper aiming for biopsy cores without increasing the patient distress. The combined IV sedation and local periprostatic nerve block are efficient in controlling and limiting pain better than employing each technique alone with no significant increase in complications incidence.