The authors acknowledge the Carefusion Foundation for support via a clinical excellence grant of this work titled &#8220;Prospective evaluation of procedural povidone iodine rectal preparation to reduce infectious complications following ultrasound guided prostate needle biopsy.&#8221;

This patient related study was approved by the institutional review board (IRB) for human research.
1. Patient Preparation and Positioning
<ol>
	<li>Bring the patient to the procedure suite and place them on their right or left side with knees flexed to the chest.</li>
	<li>Perform a surgical timeout whereby the patient, surgical procedure, and indication are reviewed and confirmed.</li>
	<li>When indicated, administer intravenous sedation via the anesthesia service.</li>
</ol>
2. Perform a Digital Rectal Examination (DRE)
<ol>
	<li>Place size appropriate gloves onto both hands.</li>
	<li>Insert gloved finger after lubrication into rectal vault and examine prostate to feel for potential suspicious areas in need of focused attention during transrectal ultrasonography.10</li>
</ol>
3. Creation of Povidone Iodine Rectal Preparation (PIRP)
<ol>
	<li>Pour 15 ml&#160;of a 10% commercially available povidone iodine solution into a sterile basin.</li>
	<li>Add 5 ml&#160;of a commercially available 1% lidocaine gel to this basin.</li>
	<li>Mix the contents for 15 sec&#160;to create a povidone iodine slurry.</li>
</ol>
4. Primary Administration of PIRP
<ol>
	<li>Use a sterile rectal swab to culture the rectal vault.</li>
	<li>Open up a 4 cm x 4 cm sterile gauze, soak in the povidone iodine slurry, and then insert into the rectal vault. Only a small tail of gauze is left emanating from the anus.</li>
	<li>Leave the gauze in place for 2 min&#160;after which it is removed and discarded.</li>
</ol>
5. Secondary Administration of PIRP
<ol>
	<li>Use a disposable gynecologic swab to paint the perianal area with the PIRP solution.</li>
	<li>Insert this gynecologic swab into the rectal vault to a distance of 3 cm from the anus.</li>
	<li>To further maximize the exposure of the rectal mucosa to PIRP, swab the rectal vault in a similar manner at least three times.</li>
	<li>Allow the povidone iodine solution to dry for 2 - 3 min&#160;prior to proceeding with standard transrectal ultrasonography and subsequent biopsy.11 This is essential as the bactericidal effects of the PIRP require the solution to dry on the exposed mucosa.</li>
	<li>Use a sterile rectal swab to culture the rectal vault.</li>
</ol>
6. Transrectal Ultrasonography and Biopsy
<ol>
	<li>Insert the ultrasound probe via the rectum.</li>
	<li>Perform measurements of the prostate and subsequent biopsy in the standard manner consistent with all urologic practices.11,12</li>
</ol>

<ol><li>American Cancer Society. , Available from: <a target="_blank" href="http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics">http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics</a> (2015).</li>
<li>Nam, R. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Increasing+hospital+admission+rates+for+complications+after+transrectal+ultrasound+guided+prostate+biopsy%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Increasing hospital admission rates for complications after transrectal ultrasound guided prostate biopsy.</a> J Urol. 189, Suppl 1. S12-S17 (2013).</li>
<li>Feliciano, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+incidence+of+fluoroquinolone+resistant+infections+after+prostate+biopsy+are+fluoroquinolones+still+effective+prophylaxis%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">The incidence of fluoroquinolone resistant infections after prostate biopsy are fluoroquinolones still effective prophylaxis.</a> J Urol. 179 (3), 952-955 (2008).</li>
<li>Kehinde, O., Al-Maghrebi, M., Sheikh, M., Anim, J. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Combined+ciprofloxacin+and+amikacin+prophylaxis+in+the+prevention+of+septicemia+after+transrectal+ultrasound+guided+biopsy+of+the+prostate%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate.</a> J Urol. 189 (3), 911-915 (2013).</li>
<li>Taylor, A. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Targeted+antimicrobial+prophylaxis+using+rectal+swab+cultures+in+men+undergoing+transrectal+ultrasound+guided+prostate+biopsy+is+associated+with+reduced+incidence+of+postoperative+infectious+complications+and+cost+of+care%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.</a> J Urol. 187 (4), 1275-1279 (2012).</li>
<li>Gyorfi, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Peri+procedural+povidone+iodine+rectal+preparation+reduces+microorganism+counts+and+infectious+complications+following+ultrasound-guided+needle+biopsy+of+the+prostate%5BTitle%5D)+AND+%22World+J+Urol%22%5BJournal%5D)">Peri procedural povidone iodine rectal preparation reduces microorganism counts and infectious complications following ultrasound-guided needle biopsy of the prostate.</a> World J Urol. 32 (4), 905-909 (2014).</li>
<li>Park, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Control+of+infective+complications+of+transrectal+prostate+biopsy%5BTitle%5D)+AND+%22Surg+Infect+Larchmt%22%5BJournal%5D)">Control of infective complications of transrectal prostate biopsy.</a> Surg Infect Larchmt. 15 (4), 431-436 (2014).</li>
<li>Park, D. S., Oh, J. J., Lee, J. H., Jang, W. K., Hong, Y. K., Hong, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Simple+use+of+the+suppository+type+povidone+iodine+can+prevent+infectious+complications+in+transrectal+ultrasound+guided+prostate+biopsy%5BTitle%5D)+AND+%22Adv+Urol%22%5BJournal%5D)">Simple use of the suppository type povidone iodine can prevent infectious complications in transrectal ultrasound guided prostate biopsy.</a> Adv Urol. , (2009).</li>
<li>AbuGhosh, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+prospective+randomized+trial+of+povidone+iodine+prophylactic+cleansing+of+the+rectum+before+transrectal+ultrasound+guided+prostate+biopsy%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">A prospective randomized trial of povidone iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy.</a> J Urol. 189 (4), 1326-1331 (2013).</li>
<li>Gerber, G. S., Brendler, C. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+the+Urological+Patient%3A+History%2C+Physical+Exam%2C+and+Urinalysis%5BTitle%5D)+AND+%22Campbell+Walsh+Urology%22%5BJournal%5D)">Evaluation of the Urological Patient: History, Physical Exam, and Urinalysis.</a> Campbell Walsh Urology. , 10th ed, Available from: 
 <a target="_blank" href="http://www.campbellsurology.com">http://www.campbellsurology.com</a> (2015).</li>
<li>Hodge, K. K., McNeal, J. E., Terris, M. K., Stamey, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Random+systematic+versus+directed+ultrasound+guided+transrectal+core+biopsies+of+the+prostate%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate.</a> J Urol. 142 (1), 71-74 (1989).</li>
<li>Donoghue, P. M., McSweeney, S. E., Jhaveri, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Genitourinary+imaging%3A+current+and+emerging+applications%5BTitle%5D)+AND+%22J+Postgrad+Med%22%5BJournal%5D)">Genitourinary imaging: current and emerging applications.</a> J Postgrad Med. 56 (2), 131-139 (2010).</li>
</ol>

The authors have nothing to disclose.

Infections following TRUS PNB are secondary to translocation of rectal vault bacteria into the highly vascular prostate. Based on this principle, we have explored the simple method of using a topic antiseptic such as povidone iodine to reduce microorganism colony counts prior to prostate needle biopsy. Our experience highlights a reduction from 4.3% to 0.6% (p=0.02) with use of this PIRP regimen at time of biopsy. Furthermore, we hypothesize that the 97% reduction in rectal vault microorganisms is the principle factor underlying this decrease in systemic infections.
Our results with topical povidone are similar to that presented by other groups. Specifically, Park et al.7 evaluated 121 patients who received antibiotic prophylaxis consisting of a single intravenous injection of a 3rd generation cephalosporin and 5 days of cefixime 100 mg BID versus 360 patients who received the same antibiotic regimen in addition to a povidone iodine suppository just prior to biopsy. This study noted an infectious complication in 8 patients (6.6%) in the control group compared to 1 (0.3%) in their study cohort. Recently, AbuGhosh et al. prospectively randomized 865 men receiving oral ciprofloxacin therapy to rectal cleaning with povidone iodine or no rectal cleaning before TRUS PNB.8 This study observed infectious complications in 11 (2.6%) of the rectal preparation group and in 20 (4.5%) of the control group, and sepsis was seen in 4 (1.0%) of the treated group and in 7 (1.6%) of the control group.
The novelty and attractiveness of our PIRP technique as presented in this video is several fold. First, the PIRP requires no additional preparation or systemic antibiotic therapy beyond the standard oral prophylaxis agent. Second, the PIRP technique is cheap with minimal associated cost for practices to purchase commercially available povidone iodine. Third, the PIRP is simple with the ability of any urologist to perform within current office infrastructure while adding only 5 min to a biopsy procedure. Finally, the side effect profile of PIRP therapy is low with no patients in our current series presenting with adverse events.
There are several key steps in this protocol that warrant further discussion. It is important to first insert the povidone iodine soaked gauze into the rectal vault for 2 min&#160;and then remove it allowing for the solution to dry. This process is essential as the bactericidal effect of povidone iodine is predicated on the solution drying on a mucosal surface. A second key protocol step involves painting the perianal area with povidone iodine thereby preventing translocation of bacteria in the perianal area into the rectal vault at the time of biopsy.
The protocol typically does not require modifications owing to its simplicity in delivery. Certain scenarios such as those patients with rectal fissures or exposed hemorrhoids may experience local discomfort and irritation from the povidone iodine solution. Therefore, this therapy is withheld in such patients. Additionally, patients with an iodine or shellfish allergy are at risk for an allergic reaction (rarely anaphylaxis) and therapy should not be used in such patients. Finally, approximately 10% of prostate biopsies at our institution are done in an office setting while the remaining cases are completed under intravenous sedation. Patients undergoing local anesthesia experienced no adverse reactions to the PIRP although larger studies are necessary to validate these observations.
Limitations of this approach involve the delivery system of the iodine into the rectal vault. While the current rectal vault counts following PIRP are 97% below baseline, there still remain some organisms that are persistent which could theoretically be a source of infection. Therefore, the potential exists to improve the delivery system of the PIRP to further reduce rectal microorganism counts. Additionally, the data presented within this study are done in the context of a prospective, albeit non-randomized design. We acknowledge that randomization of patients would have provided the most objective means to assess treatment efficacy.

Prostate cancer is the most common cancer in men and the second leading cause of cancer-related mortality. In 2014, approximately 233,000 cases will be diagnosed in the United States with almost 30,000 men succumbing to this malignancy.1 While the prostate specific antigen (PSA) blood test and digital rectal examination (DRE) play an essential role in prostate cancer screening, transrectal ultrasound guided prostate needle biopsy (TRUS PNB) is the most common means to obtain a histologic tissue diagnosis.
TRUS PNB involves inserting an ultrasound probe into the patient&#8217;s rectum and then generally obtaining 12-14 biopsies of the peripheral zone of the prostate located just anteriorly. Each needle biopsy requires passage of an 18 G needle through the rectal wall into the highly vascular prostate. Therefore, the theoretical risk of bleeding and infection due to bacterial translocation exists following the procedure. Nonetheless, the actuarial complication rate post-procedure has historically remained low.
Antibiotic prophylaxis prior to TRUS PNB is routinely prescribed with quinolone-based antibiotics being the most frequently used agents. Despite adequate prophylaxis, contemporary research implicates an increase in infectious complications post-biopsy.2 Furthermore, studies have attributed this rise in infectious complications following TRUS PNB to the emergence of quinolone resistant microorganisms particularly E. coli.3
This rising rate of quinolone resistance suggests the need for alternate prophylaxis regimens for TRUS PNB procedures. To this end, several different avenues are under investigation. One approach involves administration of an intravenous or intramuscular antibiotic at time of biopsy in conjunction with an oral quinolone.4 While this strategy can reduce sepsis events following TRUS PNB, a principal limitation of this approach is the potential for further developing resistant organisms to this antibiotic family. Another recently investigated methodology incorporates use of a pre-biopsy rectal swab to screen patients colonized with quinolone-resistant rectal flora.5 If such organisms are detected, a &#8220;targeted&#8221; antibiotic regimen could be employed based on the sensitivity profile of the identified resistant bacterial strain. While the methodology is elegant, the actual process of obtaining such swabs, selectively culturing on a quinolone selective medium, and tailoring antibiotics thereafter requires a clinical and laboratory infrastructure that may be lacking in many clinical practices.
Administration of a topic antiseptic to reduce rectal vault microorganism colony counts prior to biopsy may present an alternative strategy to limit TRUS PNB infections. Povidone iodone is an inexpensive, readily available agent that is documented to reduced bacterial counts when applied to surgical sites. Applications in both colorectal and gynecologic surgeries are well known. Therefore, use of povidine iodine as a rectal preparation would present a producible, simple, and cost-effective method to reduced TRUS PNB infections without need for additional preparation prior to biopsy. With respect to the urologic literature, previously work has noted a reduction in clinical infections following TRUS PNB.6-9 This video demonstrates the technique of PIRP to highlight the ease and simplicity to integrate into clinical practices.
All patients undergoing TRUS PNB were initially seen in a specialty urology clinic for referral or initial evaluation for prostate cancer screening. This evaluation entailed a review of the patient&#8217;s serum prostate specific antigen (PSA) and performance of a digital rectal examination (DRE). Abnormality of either the PSA or DRE prompted recommendation of a TRUS PNB.
The TRUS PNB procedure was discussed with all patients and associated risks including infection, bleeding, and urinary retention were clarified. All patients received three days of oral antibiotic prophylaxis with either a quinolone-based medication (i.e., Ciprofloxacin) or trimethoprim-sulfamethoxazole (Bactrim) prior to biopsy.

<table><tbody><tr><td>Povidone Iodine Solution, 10% Topical Microbicide Antiseptic, 8 fl oz.</td><td>Equate</td><td>4067979</td><td></td></tr><tr><td>4 x 4 sterile gauze pads, white</td><td>Dukal Corporation</td><td>DKL1412</td><td></td></tr><tr><td>disposable gynecologic swab&amp;nbsp;</td><td>numerous vendors</td><td></td><td></td></tr><tr><td>1% lidocaine gel&amp;nbsp;</td><td>numerous vendors</td><td></td><td></td></tr></tbody></table>

povidone iodine rectal preparation at time of prostate needle biopsy is a simple and reproducible means to reduce risk of procedural infection

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB.
All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml&#160;of a 10% solution of commercially available povidone iodine is mixed with 5 ml&#160;of 1% lidocaine jelly to create slurry. A 4 cm x 4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2 - 3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy.
This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p = 0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

This PIRP technique has been in practice since January of 2012 (until present) with 165 patients having been enrolled in this quality improvement measure. In this time, only one patient (0.6%) has experienced an infectious complication in the form of systemic sepsis. This patient was colonized with a multi-drug resistant E. coli strain. Rectal swabs following administration of PIRP in this patient noted that the rectal vault was still colonized with 2.1 x 105 CFU/ml&#160;bacteria thereby questioning whether the PIRP adequately treated the rectal vault.
A contemporary population undergoing TRUS PNB between January 2008 and January 2012 who only received oral antibiotic therapy served as a comparative control population. This cohort experienced a 4.3% infection rate (22 of 515 patients) including 17 patients with urinary tract infections (UTI) and 5 with clinical sepsis defined as fever with positive blood culture. All 5 patients with sepsis had multi-drug resistant E. coli whilst the UTI cases were attributable to several different organisms.
Overall, integration of the PIRP technique into clinical practice was associated with a reduction in post-biopsy infections from 4.3% to 0.6% (p = 0.02); Figure 1.
Rectal cultures were performed in the 165 patients before and after PIRP to document changes in rectal vault microorganism colony count attributable to the treatment. Briefly, cultures were obtained by use of sterile culture swabs. The swabs were then immersed in PBS, vortexed to release the bacteria, and serially diluted on Mueller-Hinton agar plates. Bacteria were allowed to grow for 36 - 48 hr and counted. All morphological varieties of bacterial colonies arising on the plate were included to provide a total count. Overall, a 97.2% reduction in microorganism colonies was noted after PIRP administration (mean 2.3 x 105 CFU/ml&#160;vs. 5.8 x 103 CFU/ml, p &#60; 0.001)
No adverse effects of the PIRP were reported by patients either at time of administration or 7-days post-procedure.
<img alt="Figure 1" src="/files/ftp_upload/52670/52670fig1.jpg" /> 
Figure 1.&#160;Urinary Tract Infection (UTI) and Sepsis Events Occurring in the Povidone Iodine Rectal Preparation (PIRP) and Standard Cohort.

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Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy ...

povidone-iodine-rectal-preparation-at-time-prostate-needle-biopsy-is

Universidad San Sebastian

Research

JoVE Journal

Medicine

32.1K Views.  Penn State Milton S. Hershey Medical Center. Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Video: Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Protocol for Prostatectomy Specimen Mapping and Dissection

Enhancing Prostate Tumor Biobanking Reliability with Improved Sampling Technique and Histological Characterization

Acquiring fresh and well-characterized tumor tissue samples is critical for conducting high-quality &#34;omics&#34; studies. However, it can be particularly challenging in the context of prostate cancer (PC) due to the unique nature of this organ and the high heterogeneity associated with this tumor. On the other hand, histopathologically characterizing samples before their storage without causing significant tissue alterations is also an intriguing challenge. In this context, we present a new method for acquiring, mapping, characterizing, and micro-dissecting resected prostate tissue based on anatomopathological criteria.
Unlike previously published protocols, this method reduces the time required for histopathological analysis of the prostate specimen without compromising its structure, which is crucial for assessing surgical margins. Furthermore, it enables the delineation and micro-macro dissection of fresh prostate tissue samples, with a focus on histological tumor areas defined by pathological criteria such as Gleason score, precursor lesions (high-grade prostatic intraepithelial neoplasia - PIN), and inflammatory lesions (prostatitis). These samples are then stored in a Biobank for subsequent research analyses.

Author Spotlight: Advancing Prostate Cancer Research Through Improved Tissue Sampling and Biobanking

This protocol describes a method for facilitating the collection of samples from radical prostatectomy specimens. The goal is to map, characterize, and micro-macro dissect tissue samples from the specimens based on anatomopathological criteria before storing them in a Biobank.

Acquiring fresh and well-characterized tumor tissue samples is critical for conducting high-quality &#34;omics&#34; studies. However, it can be ...

Cancer Research

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real time images with a 15 &#181;m axial resolution at an effective tissue penetration of 2-3 mm. Within the OCT images the loss of signal intensity per millimeter of tissue penetration, the attenuation coefficient, is calculated. The attenuation coefficient is a tissue specific property, providing a quantitative parameter for tissue differentiation. 
Until now, renal mass treatment decisions have been made primarily on the basis of MRI and CT imaging characteristics, age and comorbidity. However these parameters and diagnostic methods lack the finesse to truly detect the malignant potential of a renal mass. A successful core biopsy or fine needle aspiration provides objective tumor differentiation with both sensitivity and specificity in the range of 95-100%. However, a non-diagnostic rate of 10-20% overall, and even up to 30% in SRMs, is to be expected, delaying the diagnostic process due to the frequent necessity for additional biopsy procedures. 
We aim to develop OCT into an optical biopsy, providing real-time imaging combined with on-the-spot tumor differentiation. This publication provides a detailed step-by-step approach for percutaneous, needle based, OCT of renal masses.

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is a high resolution imaging technique that allows analysis of tissue specific optical properties providing the means for tissue differentiation. We developed needle based OCT, providing real-time imaging combined with on-the-spot tumor differentiation. This publication describes a method for percutaneous, needle based OCT of renal masses.

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real ...

Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser

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Here we present a protocol to perform Photoselective Vaporesection of the Prostate (PVRP) for benign prostatic hyperplasia (BPH) treatment.

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging ...

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Presented herein is a protocol to perform targeted biopsy of the prostate using an MRI-ultrasound fusion system.

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Use of Magnetic Resonance Imaging and Biopsy Data to Guide Sampling Procedures for Prostate Cancer Biobanking

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In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer.

This article presents and describes an outpatient treatment for prostate cancer using focal laser ablation. Laser catheter placement is guided by MRI-ultrasound fusion imaging in a fashion similar to prostate needle biopsy. Treatment is monitored in real-time with a thermal probe, placed adjacent to the laser fiber.

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

This manuscript outlines the steps for performing a micro-ultrasound-guided transperineal prostate biopsy under local anesthesia.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound ...

Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is guided by traditional Chinese medicine (TCM) syndrome differentiation theory and employs acupoint stimulation and heat to alleviate pain. Although prior research has shown that these are dependable methods for pain relief, the combined effect of the two techniques has not been described. In our research, we found that compared to using diclofenac sodium enteric-coated capsules alone, adding acupoint needle-embedding combined with ironing therapy was more effective for reducing pain levels at different stages after hemorrhoid surgery. Although this technique is efficient and commonly used in clinics, due to its invasive practice, acupoint needle embedding still carries risks relating to hospital-acquired infections and broken needles. Ironing therapy, on the other hand, can result in burns and connective tissue injuries. Therefore, there is an urgent need to develop a standardized protocol for medical staff. Our protocol refines the traditional techniques and provides detailed instructions on patient preparation, operation techniques, and postoperative care to ensure the therapy is carried out safely and efficiently. By standardizing this therapy, this technique is expected to become an important complementary therapy for postoperative pain relief&#160;in hemorrhoids, which will significantly improve patients &#39;life quality after anal surgery.

The high incidence of pain after anal surgery is due to the physiological structure and pathological status of the anus. At present, the use of painkillers cannot provide satisfactory pain relief, which makes complementary therapy important. This paper proposes acupoint needle-embedding combined with ironing therapy to relieve postoperative pain.

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is ...

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound

Traditional transrectal ultrasound (TRUS)-guided prostate biopsy has limited sensitivity and specificity, particularly for detecting early-stage prostate cancer, due to a lack of precise lesion targeting. An improved cognitive fusion-guided prostate biopsy method has been developed to enhance lesion targeting by integrating three parameters of prostate multiparametric MR (mpMRI) images into TRUS images. Prostate mpMRI measurement is initially performed to obtain three key parameters: the rotation angle (&#945;), the distance from the rectal wall (X), and the distance from the prostate apex (Y). These parameters are then cognitively applied in real-time, TRUS-guided prostate needle biopsy to detect target lesions. This improved transperineal cognitive fusion biopsy method enhances diagnostic accuracy, improves reproducibility, and reduces reliance on operator experience. Clinical application in 423 patients demonstrated a prostate cancer detection rate of 73.5%, with 62.9% classified as clinically significant cancers. Compared with equipment-intensive methods such as MRI-ultrasound fusion biopsy, this approach is cost-effective, practical, and well-suited for broader clinical adoption. Additionally, the method&#39;s flexibility supports integration with other imaging techniques, such as 68Ga-PSMA PET/CT, further improving detection rates for patients with high-risk prostate cancer.

Prostate biopsy is the gold standard diagnostic method for prostate cancer. Cognitive fusion-guided prostate biopsy, which combines transrectal ultrasound with pre-measured MRI parameters, improves biopsy accuracy and enhances the detection rate of clinically significant prostate cancer.

Traditional transrectal ultrasound (TRUS)-guided prostate biopsy has limited sensitivity and specificity, particularly for detecting early-stage prostate ...

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

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