Presentation Authors: Luke Stroman*, Anoushka Neale, Oussama El Hage, Paul Cathcart, Ben Challacombe, Ben Namdarian, Tim O'Brien, Rick Popert, London, United Kingdom
Introduction: Trans-rectal (TRUS) prostate biopsy carries a risk of triggering sepsis. This risk is lower with trans-perineal (TP) approaches but logistic issues have limited uptake of TP biopsy by urologists. On 1st September 2017 at Guy's Hospital in London, we declared our intention to move to a prostate biopsy pathway involving only TP approaches. We termed this day, TREXIT, viz, a complete & clean break from trans-rectal prostate biopsy._x000D_
We hypothesised that our strategy might be successful if we could minimise the need for general anaesthetic (GA) and maximise utilisation of freehand TP biopsies performed under local anaesthetic (LA) or IV sedation (IVS).
Methods: All consecutive patients undergoing TP biopsy over a one year time period were analysed. TP Biopsies were done either using a cognitive freehand technique using PrecisionpointTM transperineal access system or stepper with or without MRI fusion technology. A single pre-operative dose of antibiotics was given depending on trust protocol and patient allergies. Approach, anaesthetic methods and complications were gathered retrospectively from electronic patient records, morbidity and mortality meetings and A&E attendances.
Results: 678 men underwent TP biopsy. No men underwent TRUS biopsy. Median age 60.5 (range 44-88). LA biopsy was performed in 395/678 (58%) of which 168/395 (42%) were in the outpatient clinic. Biopsy under GA was completed in 205/678 (30%) & under IVS in 78/678 (11%). Systematic biopsies were completed in 276/678 (41%, median 24 cores), systematic biopsies with additional targets in 269/678 (40%, median 27 cores) and limited targeted biopsies only in 133/678 (19%, median 5 cores). Primary biopsies for new suspected cancer were in 532/678 (78%) and 146/678 (22%) for surveillance. Of the primary biopsies 134/532 (25%) were benign, 74/532 (14%) demonstrated Gleason 6, 243/532, (46%) showed Gleason 7 and 81/532 (15%) demonstrated Gleason 8 or above._x000D_
Complications included: 1/678 (0.16%) sepsis requiring hospital admission and intra-venous antibiotics; 1/678 (0.16%) UTI; 1/678 (0.16%) Haematuria with clot retention; and 4/678 (0.5%) urinary retention. No patients with retention needed surgery. Vasovagal episodes were seen in 7/678 (1%) patients, although 6/395 (1.5%) of these were following LA. There were no complications classified as Clavien 3 or higher.
Conclusions: A switch to a TP only biopsy strategy has proved feasible and has been delivered with low complication rates. Using modern techniques, nearly 60% of these TP biopsies can be delivered under LA.