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Year : 2022  |  Volume : 38  |  Issue : 1  |  Page : 34-41

Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience

Department of Urology, Uro-Oncology and Robotic Surgery, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India

Correspondence Address:
Ananthakrishnan Sivaraman
Department of Urology, Uro-Oncology and Robotic Surgery, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iju.iju_222_21

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Introduction: With the emergence of multidrug-resistant organisms causing urosepsis after transrectal biopsy of prostate, the need for an alternative approach has increased. We assessed the safety and feasibility of transrectal ultrasound (TRUS) guided free-hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer. Materials and Methods: This prospective study was conducted from July 2019 to December 2020 in which patients with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination underwent magnetic resonance imaging-TRUS cognitive fusion transperineal prostate biopsy (target and systematic) using coaxial needle. Demographic, perioperative, and outcome data of 50 consecutive patients were analyzed. Results: The mean age of the patients was 69.6 ± 7.61 years, median PSA 13.55 ng/mL (4.17–672) and prostate size 45cc (16–520). Prostate Imaging–Reporting and Data System (PIRADS) 2, 3, 4, and 5 lesions were found in 2, 12, 12, and 24 patients, respectively. Average procedure duration was 20 min (15-40 min) and number of cores ranged from 12 to 38 (median 20). Forty out of fifty (40/50) patients experienced only mild pain with visual analog scale ≤2. Histopathological examination showed adenocarcinoma, benign prostatic hyperplasia, and chronic prostatitis in 41, 5, and 4 patients respectively with 82% cancer detection rate (CDR). Over 95% of cases showed clinically significant cancer (International Society of Urological Pathology class ≥ 2) and 91.7% of patients with PIRADS score 4/5 and 66.7% with PIRADS score 3 had malignancy. Three patients developed complications (two hematuria, one urinary retention), both were managed conservatively and none had urosepsis. Conclusions: Free-hand transperineal prostate biopsy by coaxial needle technique under LA is safe and feasible with good tolerability, high CDR, and minimal complications particularly reduced urosepsis.

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