A Technical Modification to Reduce Potential Contamination in Transperineal Prostate Fusion Biopsy

Özet

Objective: Prostate fusion biopsy could be performed either transrectal or transperineal route. Interestingly, the risk of infective complications after transperineal approach does not seem fewer than transrectal approach. Even when transperineal approach is chosen surgeons may have to deal with fecal contents during the biopsy procedure. We have developed a simple modification to minimize perineal contamination during transperineal prostate fusion biopsy. In this study, the results of patients who underwent transperineal fusion biopsy by using our novel technique were presented. Materials and Methods: Targeted prostate fusion biopsy was performed in 91 patients who underwent mutliparametric magnetic resonance imaging (Philips İntera 3.0 T) and had Prostate Imaging Reporting and Data System 3 or higher lesions, under general anesthesia, with the guide of transrectal ultrasonography (SmartUS, Telemed), with the help of transperineal stepper (CIVCO, EX3) by using MIM Symphony (MIM Software, Cleveland) software between May 2016 and May 2019 with a suspicion of prostate cancer. In the first 24 patients, both targeted fusion biopsy and systematic biopsy were taken only by transperineal approach, while in the 67 patients who were followed up, fusion biopsy was taken by transperineal method and systematic biopsy was taken by transrectal method. In the original technique, a condom filled with 120 mL saline was placed into the rectum; whereas in our modified technique, initially an empty condom was placed into the rectum and filled with 100 mL ultrasound gel and then fixed to the anus by using a standard ileostomy adapter. Results: We performed only transperineal biopsy in 24 patients and both transperineal and transrectal biopsies in 67 patients. A total of 139 lesions with an average size of 9.6-4.4 mm (4-25) were sampled by transperineal route in 91 patients. The mean number of core biopsies was 5.2-1.7 (2-13) for each of 139 lesions. Pathological examination revealed prostate adenocarcinoma in 33 lesions (23.7%) out of 139 lesions. None of the patients had fever or urosepsis after transperineal approach however, only 1 (p=0.43) patient who underwent transperineal and transrectal biopsies developed urosepsis symptoms and treated with intravenous antibiotic in the hospital. Conclusion: Our novel and simple technique to reduce infective complications after transperineal biopsies seems feasible and safe. Further comparative studies with larger number of patients are needed to demonstrate its clinical benefit.