Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co INTERVENTIONAL ULTRASOUND: TRANSPERINEAL AND TRANSRECTAL PROSTATIC BIOPSY • 21  The biopsy needle may reach the prostate through the rectum (transrectal approach) or the skin of the area located between the testicles and anus (transperineal approach). Both of these methods have proved particularly effective and safe. The choice essentially depends on the opera- tor’s preference. Transrectal Approach The procedure can be performed both in the lateral decubitus position (lying on your side and with your legs bent) (Fig. 1) and in gynecological position. Before any operation is practiced, rectal examination to rule out the presence of concomitant abnormalities of the rectal wall should be performed. Transrectal biopsy is performed under local anesthesia. The ultrasound probe introduced into the rectum is provided with a channel for the passage of fine needles. So with an 18 gauge 25 cm needle, it is possible to reach every part of the prostate (Figs. 3, 4, and 5). Only patients with high comorbidity may require the procedure in the operating room under sedation or anesthesia. Local Anesthesia Prior to Biopsy Ultrasound-guided periprostatic block is state of the art [13] (Video 26.1). It is not important whether the depot is apical or basal. Intrarectal instillation of local anesthesia is inferior to periprostatic infiltration [14]. Transperineal Approach The procedure is performed in gynecological position. The doctor performs a rectal examination to rule out the presence of concomitant abnormalities of the rectal wall. The patient is asked to raise a hand with the testicles, or claims are with gauze fixed with patches to “hammock” groin. Fig. 3: Transrectal biopsy in the peripheral rear area. Fig. 4: Transrectal biopsy in the apex. Cutting EDGE_Urology(SUN)_final.indd 21 27-Mar-18 10:00:29 AM