Wednesday, October 3, 2012

Prostate biopsy ( transrectal US-guided and Transgluteal CT-guided prostate biopsy) part 4

CT-guided transgluteal prostate biopsy
 The patient needs to fast for 6 h before the procedure.
 Antibiotic prophylaxis is not routinely used.
 Intravenous conscious sedation is used with midazolam and fentanyl. Oxygen saturation,
blood pressure, and heart rate and rhythm are monitored throughout the procedure.
 The patient is placed prone on the CT table.
 Lidocaine infiltration of the skin and soft tissues is performed. Peri-prostatic lidocaine
is not necessary in this scenario.
 Under CT guidance and using a transgluteal approach, two 17-gauge coaxial systems
are advanced to the near surface of the peripheral zone of the prostate on each side. The
17-gauge needle is manipulated to guide the core caudally, cranially, medially and laterally
in the prostate and biopsies are taken at the apex, midway between the apex and
base and at the base. Twelve 18-gauge cores are obtained.
 A post-procedure CT is performed to rule out any immediate complication.

Immediate Post-Procure Care CT-guided Transgluteal Prostate Biopsy
 The patient may be discharged 3 h after the procedure, if stable.

 Infections: Febrile urinary tract infection, bacteremia or acute prostatitis. Rare cases of
fatal septicemia have been reported. Treatment is achieved with oral or intravenous antibiotics depending on the severity of the infection.
 Bleeding: Rectal bleeding, hematuria or hematospermia. Usually bleeding is self-limiting
and should resolve within 1 week. More significant rectal bleeding may require
anoscopic intervention.
 Acute urinary retention has been described, especially in patients with significant BPH.

Alternative Procedures/Future Directions
 Contrast-enhanced transrectal ultrasound: Infusion of intravenous microbubble ultrasound
contrast agents can amplify flow signals within the microvasculature of prostate
tumors, thus making them more conspicuous and allowing for more accurate biopsy
sampling of the prostate.

Key pointsey Points
›› Antibiotic prophylaxis is needed for transrectal US-guided prostate biopsy.
›› Extended biopsy schemes should be performed with five peripheral and one
central core on either side of the prostate, with additional cores for any
hypoechoic lesions detected.
›› Transgluteal CT-guided prostate biopsy can be performed in patients lacking a
›› Most common complications include infections and bleeding (rectal, hematuria,
 IInterventional Radiology Procedures in Biopsy and Drainage,
DOI: 10.1007/978-1-84800-899-1_12, © Springer-Verlag London Limited 2011



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