Introduction: Transperineal prostate biopsy provides several advantages over the historical transrectal approach. These include a lower risk of post-biopsy sepsis, reduced risk of rectal bleeding, a lower barrier to cognitive targeting, easier targeting of anterior lesions, and antibiotic stewardship. One of the barriers to adoption among urologists is lack of training and education in this approach. Commercial devices to couple ultrasound(US) probes to biopsy needles have been developed and marketed to urologists. However, these add substantial cost and limit degrees of movement. Here we provide an educational video showing a feasible, cost-neutral office based transperineal prostate biopsy approach.
Methods: In this video we demonstrate our technique for device-free office based transperineal prostate biopsy utilizing a 12 core template and two angiocatheters as access sites. We review positioning, equipment, anesthesia strategies and the biopsy technique.
Results: We begin the video with discussion of table setup and templates used by our practice. We then show our method of angiocatheter insertion following anesthetization of the two biopsy tracts with injection at the periapical triangle. Finally, we demonstrate our biopsy and handoff practices.
Essential to our device-free technique is the ability to direct the US probe and biopsy needle. To do this reliably we hold the biplanar US parallel to the superior-inferior(horizontal) axis of the prostate without moving it off midline, visualizing the urethra in the sagittal plane as the guiding landmark. We then insert the biopsy needle parallel to the probe while simultaneously utilizing shallow twists of the probe in the clockwise-counterclockwise direction. This dynamic scanning assures proper identification of the needle tip and not its more proximal shaft while slightly pivoting the needle to biopsy sites. Throughout this procedure, we take great care to maintain the probe’s alignment in the same horizontal plane to keep proper orientation. This technique also allows for anterior-posterior pivoting without needing to establish additional entry sites.
Conclusions: This video provides education on how to perform an in office transperineal prostate biopsy using readily available equipment in a general urology practice. It highlights key features of transperineal prostate biopsies and provides a framework for urologists looking to learn or adopt this biopsy technique without incurring any additional significant costs over the transrectal approach.
.jpg)
.jpg)