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...

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Autores principales:	Donnacha Hogan, Abbie Kanagarajah, Henry H. Yao, David Wetherell, Brendan Dias, Phil Dundee, Kevin Chu, Homayoun Zargar, Helen E. O'Connell
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	cancer detection complications local anaesthesia prostate cancer tolerability transperineal biopsy Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/02ac6dd22abb487185debdf182f78d5e
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spelling	oai:doaj.org-article:02ac6dd22abb487185debdf182f78d5e2021-11-17T16:19:37ZLocal versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications2688-452610.1002/bco2.106https://doaj.org/article/02ac6dd22abb487185debdf182f78d5e2021-11-01T00:00:00Zhttps://doi.org/10.1002/bco2.106https://doaj.org/toc/2688-4526Abstract 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.Donnacha HoganAbbie KanagarajahHenry H. YaoDavid WetherellBrendan DiasPhil DundeeKevin ChuHomayoun ZargarHelen E. O'ConnellWileyarticlecancer detectioncomplicationslocal anaesthesiaprostate cancertolerabilitytransperineal biopsyDiseases of the genitourinary system. UrologyRC870-923ENBJUI Compass, Vol 2, Iss 6, Pp 428-435 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cancer detection complications local anaesthesia prostate cancer tolerability transperineal biopsy Diseases of the genitourinary system. Urology RC870-923
spellingShingle	cancer detection complications local anaesthesia prostate cancer tolerability transperineal biopsy Diseases of the genitourinary system. Urology RC870-923 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
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.
format	article
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
title	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_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_sort	local versus general anesthesia transperineal prostate biopsy: tolerability, cancer detection, and complications
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/02ac6dd22abb487185debdf182f78d5e
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Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

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