Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 20 • CUTTING EDGE - UROLOGY To minimize the risk of infections, it is appropriate to take an antibiotic before the examina- tion; oral or intravenous antibiotics are state of the art. Quinolones are the drugs of choice, with ciprofloxacin being superior to ofloxacin [6]; prophylaxis should be made taking into account the proportion of bacterial resistance in the region where biopsy is performed, and then the patient choose the antibiotic accordingly. In addition, the patient should be questioned about previous urinary infections and if he/she has taken antibiotics for 3 months prior to biopsy. If this occurs, he/she should choose an antibiotic different from the previous. Increased quinolone resistance [7] is associated with a rise in severe post-biopsy infection [8]. In cases of doubt, and if there has already been a prostatitis, the resistance of the intestinal germs by culture obtained by rectal swab should be tested [9–12]. Furthermore, to reduce the risk of infections, the preparation involves running the morning of an enema to clear the rectum [5]. How to Do the Biopsy? Biopsy without complications does not require hospitalization. The overall duration of the proce- dure is less than 30 min. Based on the operator’s preferences, the patient is encouraged to take the following positions: the side (Fig. 1), gynecological, and knee-chest positions. The first two position are the most frequently used. In Fig. 2, the instruments needed are biopsy gun, syringe with anesthetic, 18 cm needle, and sterile container for the samples. The next stage involves the introduction of an ultrasound probe in the rectum. This tool will allow the operator to view the loggia, the prostate, and the bladder. In particular, the operator will proceed to the measurement of the volume of the prostate. The most important function of the ultrasound probe is to provide an image of the area and to drive accurately the operator in the selection of the different areas in which to execute withdrawal prostate. A biopsy gun with a hook cutting edge (crypt) is able to take small frustules of suspicious tissue. The quick-snap mechanism with which the needle is pushed and withdrawn from the pros- tate minimizes the feeling of discomfort. Fig. 1: Patient in positions on the side ready for transrectal biopsy. Fig. 2: Instruments: biopsy gun 25 cm 18 gauge needle, syringe with anesthetic with a 25 cm 22 gauge echogenic needle tip, and the sterile cassettes for the samples. Cutting EDGE_Urology(SUN)_final.indd 20 27-Mar-18 10:00:28 AM