TRANSRECTAL PROSTATIC CORE BIOPSY: A SIMPLIFIED METHOD K. A. HANASH, M.D.
From the Urology and Impotence McLean, Virginia
Center of Northern Virginia,
The recent use of the Biopty* gun has significantly improved the urologist’s ability to perform an almost painless prostatic biopsy in his office. The simplicity of this technique, employed with or without ultrasonic guidance, helps to accurately obtain several cores of prostatic tissue without the need of analgesia or sedation. However, in certain patients with a tight anal sphincter or with external hemorrhoids, the passage of the flimsy needle over the index finger may be difficult and traumatic. It may result in glove perforation with skin injury, or anal or rectal scraping causing significant patient discomfort and bleeding. Different recent innovative techniques, such as the use of a needle guide with double gloving,’ and the passage of the needle within its shortened sheath,2 have minimized these complications and have facilitated the procedure. In my experience, when the sheath is cut at the tip of the needle with the Biopty gun in cocked position, the firing of the gun thrusts not only the needle but even the tip of the sheath into the prostate. This may result in moderate to marked pain and occasional bleeding. To simplify the procedure and prevent pain and complications, the following technique is proposed. Technique The patient is given oral fluoroquinolones for forty-eight hours before and forty-eight hours after the procedure. A Fleet enema is administered by the patient one hour before the biopsy. The needle is removed from its packaging and *C.R. Bard,
296
Covington,
Georgia.
handled in a sterile manner. The protective plastic sheath is completely removed from the needle. About 4 inches (10 cm) of plastic sheath is cut off and discarded. The patient is placed in a vertical knee-chest position. A digital rectal examination is performed to reconfirm the presence and location of the prostatic lesion. The shortened plastic sheath (without the needle) is placed over the surgeon’s gloved index finger and is introduced into the rectum up to the prostatic lesion. The needle, which has been loaded in the Biopty Gun, is passed through the plastic sheath and advanced to its tip. The plastic sheath is pulled back about 1 inch, exposing the tip of the needle which is guided with the index finger to the prostatic lesion. The finger is withdrawn from the tip of the needle to prevent injury. The needle is pulled back about 5 mm from the prostatic lesion and the gun is fired by the operator or an assistant. The needle is removed and the prostatic tissue scraped out from its tip with a fine needle. The plastic sheath may be left in place if additional cores of tissue are to be removed. This technique, which has been used in over 30 patients, has proved to be simple, nontraumatic, almost painless, and accurate, with very few minor complications. 6845 Elm Street Suite 603 McLean, Virginia 22101 References 1. Chiou RK: Needle biopsy of the prostate, in Marshall FF (Ed): Operative Urology, Philadelphia, WB Saunders, 1991, chap 58, pp 438-443. 2. Marshall S: Prostatic nwdle biopsy: a simple technique for increasing accuracy. J Urol 142: 1023 (1989).
From the Urology and Impotence McLean, Virginia
Center of Northern Virginia,
The recent use of the Biopty* gun has significantly improved the urologist’s ability to perform an almost painless prostatic biopsy in his office. The simplicity of this technique, employed with or without ultrasonic guidance, helps to accurately obtain several cores of prostatic tissue without the need of analgesia or sedation. However, in certain patients with a tight anal sphincter or with external hemorrhoids, the passage of the flimsy needle over the index finger may be difficult and traumatic. It may result in glove perforation with skin injury, or anal or rectal scraping causing significant patient discomfort and bleeding. Different recent innovative techniques, such as the use of a needle guide with double gloving,’ and the passage of the needle within its shortened sheath,2 have minimized these complications and have facilitated the procedure. In my experience, when the sheath is cut at the tip of the needle with the Biopty gun in cocked position, the firing of the gun thrusts not only the needle but even the tip of the sheath into the prostate. This may result in moderate to marked pain and occasional bleeding. To simplify the procedure and prevent pain and complications, the following technique is proposed. Technique The patient is given oral fluoroquinolones for forty-eight hours before and forty-eight hours after the procedure. A Fleet enema is administered by the patient one hour before the biopsy. The needle is removed from its packaging and *C.R. Bard,
296
Covington,
Georgia.
handled in a sterile manner. The protective plastic sheath is completely removed from the needle. About 4 inches (10 cm) of plastic sheath is cut off and discarded. The patient is placed in a vertical knee-chest position. A digital rectal examination is performed to reconfirm the presence and location of the prostatic lesion. The shortened plastic sheath (without the needle) is placed over the surgeon’s gloved index finger and is introduced into the rectum up to the prostatic lesion. The needle, which has been loaded in the Biopty Gun, is passed through the plastic sheath and advanced to its tip. The plastic sheath is pulled back about 1 inch, exposing the tip of the needle which is guided with the index finger to the prostatic lesion. The finger is withdrawn from the tip of the needle to prevent injury. The needle is pulled back about 5 mm from the prostatic lesion and the gun is fired by the operator or an assistant. The needle is removed and the prostatic tissue scraped out from its tip with a fine needle. The plastic sheath may be left in place if additional cores of tissue are to be removed. This technique, which has been used in over 30 patients, has proved to be simple, nontraumatic, almost painless, and accurate, with very few minor complications. 6845 Elm Street Suite 603 McLean, Virginia 22101 References 1. Chiou RK: Needle biopsy of the prostate, in Marshall FF (Ed): Operative Urology, Philadelphia, WB Saunders, 1991, chap 58, pp 438-443. 2. Marshall S: Prostatic nwdle biopsy: a simple technique for increasing accuracy. J Urol 142: 1023 (1989).
