Prostate Biopsy: Difference between revisions

Line 126:

**Lithotomy position is also preferred for brachytherapy treatment planning or placement of fiducial gold markers for external-beam therapy

*~~Anesthesia~~

*Perform a DRE to the procedure to detect any nodularity.

*Insert the lubricated ultrasound probe slowly and with pressure to dilate the anal sphincter.

*Measure the prostate size.

**Measuring the prostate size is recommended prior to infiltration of local anaesthesia[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354294/]

*'''Inject local anesthetic'''

** Typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe

** '''TRUS-~~guided~~ periprostatic ~~infiltration~~ of local anesthetic ~~injection bilaterally~~ in the angle between the prostate and the seminal vesicles, near the bladder base (near the nerve bundles)[https://pubmed.ncbi.nlm.nih.gov/24725491/]'''

** '''Use TRUS-guidance for bilateral periprostatic injection of local anesthetic in the angle between the prostate and the seminal vesicles, near the bladder base (near the nerve bundles)[https://pubmed.ncbi.nlm.nih.gov/24725491/]'''

*** '''Can be easily identified as a hypoechoic (dark) area on TRUS'''

***5 ml of 1% lidocaine without epinephrine per side, is sufficient to provide pain relief'''[https://pubmed.ncbi.nlm.nih.gov/24725491/]'''

Line 139:

Line 143:

* See [https://www.youtube.com/watch?v=_DTbRREJsSk&list=PLmlqgyiBVx1EvCpovdviVhpHLlWhov98i&index=57 video]

*Position: usually lithotomy

**~~Anesthesia~~

*Perform a DRE to the procedure to detect any nodularity.

***Typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe

*Insert the lubricated ultrasound probe slowly and with pressure to dilate the anal sphincter.

***Local anesthetic injection: 1% Lidocaine without epinephrine mixed with 8.4% sodium bicarbonate injected bilaterally into the perineal skin and peri-prostatic space to a depth of 10 mm as well as into the pelvic floor musculature, for a total of 20-30 cc[https://pubmed.ncbi.nlm.nih.gov/34048827/]

*Measure the prostate size.

***'''Direct infiltration into the prostate (intraprostatic injection) can augment the anesthetic benefit seen with periprostatic injection'''

**Measuring the prostate size is recommended prior to infiltration of local anaesthesia[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354294/]

*'''Inject local anesthetic'''

**Typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe

**Local anesthetic injection: 1% Lidocaine without epinephrine mixed with 8.4% sodium bicarbonate injected bilaterally into the perineal skin and peri-prostatic space to a depth of 10 mm as well as into the pelvic floor musculature, for a total of 20-30 cc[https://pubmed.ncbi.nlm.nih.gov/34048827/]

**'''Direct infiltration into the prostate (intraprostatic injection) can augment the anesthetic benefit seen with periprostatic injection'''

== Complications[https://pubmed.ncbi.nlm.nih.gov/28363690/] ==

@@ Line 126: / Line 126: @@
 **Lithotomy position is also preferred for brachytherapy treatment planning or placement of fiducial gold markers for external-beam therapy
-*Anesthesia
+*Perform a DRE to the procedure to detect any nodularity.
+*Insert the lubricated ultrasound probe slowly and with pressure to dilate the anal sphincter.
+*Measure the prostate size.
+**Measuring the prostate size is recommended prior to infiltration of local anaesthesia[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354294/]
+*'''Inject local anesthetic'''
 ** Typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe
-** '''TRUS-guided periprostatic infiltration of local anesthetic injection bilaterally in the angle between the prostate and the seminal vesicles, near the bladder base (near the nerve bundles)[https://pubmed.ncbi.nlm.nih.gov/24725491/]'''
+** '''Use TRUS-guidance for bilateral periprostatic injection of local anesthetic in the angle between the prostate and the seminal vesicles, near the bladder base (near the nerve bundles)[https://pubmed.ncbi.nlm.nih.gov/24725491/]'''
 *** '''Can be easily identified as a hypoechoic (dark) area on TRUS'''
 ***5 ml of 1% lidocaine without epinephrine per side, is sufficient to provide pain relief'''[https://pubmed.ncbi.nlm.nih.gov/24725491/]'''
@@ Line 139: / Line 143: @@
 * See [https://www.youtube.com/watch?v=_DTbRREJsSk&list=PLmlqgyiBVx1EvCpovdviVhpHLlWhov98i&index=57 video]
 *Position: usually lithotomy
-**Anesthesia
+*Perform a DRE to the procedure to detect any nodularity.
-***Typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe
+*Insert the lubricated ultrasound probe slowly and with pressure to dilate the anal sphincter.
-***Local anesthetic injection: 1% Lidocaine without epinephrine mixed with 8.4% sodium bicarbonate injected bilaterally into the perineal skin and peri-prostatic space to a depth of 10 mm as well as into the pelvic floor musculature, for a total of 20-30 cc[https://pubmed.ncbi.nlm.nih.gov/34048827/]
+*Measure the prostate size.
-***'''Direct infiltration into the prostate (intraprostatic injection) can augment the anesthetic benefit seen with periprostatic injection'''
+**Measuring the prostate size is recommended prior to infiltration of local anaesthesia[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354294/]
+*'''Inject local anesthetic'''
+**Typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe
+**Local anesthetic injection: 1% Lidocaine without epinephrine mixed with 8.4% sodium bicarbonate injected bilaterally into the perineal skin and peri-prostatic space to a depth of 10 mm as well as into the pelvic floor musculature, for a total of 20-30 cc[https://pubmed.ncbi.nlm.nih.gov/34048827/]
+**'''Direct infiltration into the prostate (intraprostatic injection) can augment the anesthetic benefit seen with periprostatic injection'''
 == Complications[https://pubmed.ncbi.nlm.nih.gov/28363690/] ==