Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications
Abstract Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-11-01
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| Series: | BJUI Compass |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/bco2.106 |
| _version_ | 1830285057345978368 |
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| author | Donnacha Hogan Abbie Kanagarajah Henry H. Yao David Wetherell Brendan Dias Phil Dundee Kevin Chu Homayoun Zargar Helen E. O'Connell |
| author_facet | Donnacha Hogan Abbie Kanagarajah Henry H. Yao David Wetherell Brendan Dias Phil Dundee Kevin Chu Homayoun Zargar Helen E. O'Connell |
| author_sort | Donnacha Hogan |
| collection | DOAJ |
| description | Abstract Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001). Conclusion This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study. |
| first_indexed | 2024-12-19T03:33:37Z |
| format | Article |
| id | doaj.art-02ac6dd22abb487185debdf182f78d5e |
| institution | Directory Open Access Journal |
| issn | 2688-4526 |
| language | English |
| last_indexed | 2024-12-19T03:33:37Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj.art-02ac6dd22abb487185debdf182f78d5e2022-12-21T20:37:27ZengWileyBJUI Compass2688-45262021-11-012642843510.1002/bco2.106Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complicationsDonnacha Hogan0Abbie Kanagarajah1Henry H. Yao2David Wetherell3Brendan Dias4Phil Dundee5Kevin Chu6Homayoun Zargar7Helen E. O'Connell8Department of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaDepartment of Urology Western Health Melbourne Victoria AustraliaAbstract Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001). Conclusion This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study.https://doi.org/10.1002/bco2.106cancer detectioncomplicationslocal anaesthesiaprostate cancertolerabilitytransperineal biopsy |
| spellingShingle | Donnacha Hogan Abbie Kanagarajah Henry H. Yao David Wetherell Brendan Dias Phil Dundee Kevin Chu Homayoun Zargar Helen E. O'Connell Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications BJUI Compass cancer detection complications local anaesthesia prostate cancer tolerability transperineal biopsy |
| title | Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications |
| title_full | Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications |
| title_fullStr | Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications |
| title_full_unstemmed | Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications |
| title_short | Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications |
| title_sort | local versus general anesthesia transperineal prostate biopsy tolerability cancer detection and complications |
| topic | cancer detection complications local anaesthesia prostate cancer tolerability transperineal biopsy |
| url | https://doi.org/10.1002/bco2.106 |
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