Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 22 • CUTTING EDGE - UROLOGY The skin located between the testicles and the anus is shaved and disinfected. The entry point of the needle is located 1.5 cm above the anus. At this level, it injects a few ml of local anesthetic with a needle thin and short. In point prior anesthesia, a thin needle of greater length that allows the injection of the local anesthetic around the prostat is then introduced. A thin metal channel cable is introduced along the path anesthetized until reaching the sus- pected area. This system will make it easy and not annoying for the patient because of the repeated passage of the needle biopsy. The ultrasound probe allows the patient to see at any time the areas that are reached by the needle biopsy. When the procedure is performed, a mild compression dressing is performed with the entry of the needle. Transperineal prostate biopsy has come to the foreground as a result of lower incidence of sepsis, better detection rate for anterior prostate cancer (PCa), and the opportunity to perform the template-guided prostate biopsy [15, 16]. Transrectal and transperineal prostate biopsy pro- cedures require different techniques and are recommended with the same level of evidence [17]. Candidates f or transperineal biops y should be studied with coagulation blood tests and receive antibiotic pro phylaxis; if sedatio n is required (saturation or template-guided biopsy), both blood tests and cardiol ogic evalua tion are recommended. Transperineal biopsy needs multifrequency linear or biplanar p robe s to show perineal passage of the needle; this approach is recommend- ed for patients that have been previously subjected to abdominoperineal amputation or that are affected by severe disease of the rectum (Figs. 6 and 7). Transperineal and transrectal prostate biopsy provides similar detection rates for prostate cancer (PCa) both for first procedure (34–40%) and for repeat procedure (22–43%) performing at least 12 (extended biopsy) vs. >20 (saturation biopsy) cores, respectively [18–31]. Transperineal Fig. 5: Transrectal biopsy in the peripheral right area. Cutting EDGE_Urology(SUN)_final.indd 22 27-Mar-18 10:00:29 AM