Name: povidone iodine rectal preparation at time of prostate needle biopsy is a simple and reproducible means to reduce risk of procedural infection
Uploaded: 2015-09-21T14:00:00.000+00:00
Duration: 5 min 32 s
Description: Watch this Scientific Journal Video about Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection at JoVE.com

The authors acknowledge the Carefusion Foundation for support via a clinical excellence grant of this work titled &#8220;Prospective evaluation of procedural povidone iodine rectal preparation to reduce infectious complications following ultrasound guided prostate needle biopsy.&#8221;

Diese patientenbezogenen Studie wurde von der Ethikkommission (IRB) für den menschlichen Forschungs genehmigt. 1. Patientenvorbereitung und Positionierung <ol><li> Bringen Sie den Patienten in die Verfahren suite und legen Sie sie auf ihren rechten oder linken Seite mit gebeugten Knien auf der Brust. </li><li> Führen Sie eine OP-Timeout, wobei die Patienten, chirurgische Verfahren, und Angabe, werden überprüft und bestätigt. </li><li> Wenn angegeben, zu verwalten intravenöser Sedierung über die Anästhesie-Service. </li></ol> 2. Führen Sie eine digitale rektale Untersuchung (DRE) <ol><li> Platz Größe geeignete Handschuhe auf beiden Händen. </li><li> Legen behandschuhten Finger nach der Schmierung in rektalen Gewölbe und prüfen, Prostata, um mögliche verdächtige Bereiche, in denen konzentrierte Aufmerksamkeit während der transrektalen Sonographie fühlen. 10 </li></ol> 3. Erstellung von Povidon-Iod Rectal Vorbereitung (PIRP) <ol><li> Pour 15 ml einer 10%im Handel erhältlich Povidoniod Lösung in ein steriles Becken. </li><li> 5 ml eines handelsüblichen 1% Lidocain-Gel auf diesem Becken. </li><li> Mischen Sie den Inhalt für 15 Sekunden, um eine Povidoniod Brei zu erstellen. </li></ol> 4. Grundschulverwaltung der PIRP <ol><li> Verwenden Sie eine sterile rektale Tupfer zur Kultur der rektalen Gewölbe. </li><li> Eröffnen eine 4 cm x 4 cm steriler Gaze, genießen in der Povidoniod Brei, und dann in den rektalen Gewölbe einfügen. Nur ein kleiner Schwanz aus Gaze wird links vom Anus ausgeht. </li><li> Lassen die Gaze in statt für 2 min, wonach es entfernt und verworfen. </li></ol> 5. Sekundäre Administration of PIRP <ol><li> Verwenden Sie eine Einweg-gynäkologischen Abstrichtupfer, um den perianalen Bereich mit dem PIRP Lösung zu malen. </li><li> Fügen Sie diesen gynäkologischen Tupfer in der rektalen Gewölbe zu einem Abstand von 3 cm von dem Anus. </li><li> Um die Exposition der rektalen Schleimhaut PIRP weiter zu maximieren, Tupfer die rektale vauLT in ähnlicher Weise mindestens dreimal. </li><li> Lassen Sie das Povidon-Iod-Lösung für 2 trocknen - 3 Min. Vor der Anwendung mit Standard-transrektale Sonographie und anschließende Biopsie fortfahren 11 Dies ist wichtig, da die bakterizide Wirkung des PIRP erfordern die Lösung auf der exponierten Schleimhäute trocknen. </li><li> Verwenden Sie eine sterile rektale Tupfer zur Kultur der rektalen Gewölbe. </li></ol> 6. Transrektale Sonographie und Biopsie <ol><li> Legen Sie die Ultraschallsonde über den Enddarm. </li><li> Führen Sie Messungen der Prostata und anschließende Biopsie in der Standard-Weise, die mit allen urologischen Praxis. 11,12 </li></ol>

<ol>
	<li>Nam, R. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increasing+hospital+admission+rates+for+complications+after+transrectal+ultrasound+guided+prostate+biopsy.">Increasing hospital admission rates for complications after transrectal ultrasound guided prostate biopsy.</a> J Urol. 189, S12-S17 (2013).</li><li>Feliciano, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+of+fluoroquinolone+resistant+infections+after+prostate+biopsy+are+fluoroquinolones+still+effective+prophylaxis.">The incidence of fluoroquinolone resistant infections after prostate biopsy are fluoroquinolones still effective prophylaxis.</a> J Urol. 179 (3), 952-955 (2008).</li><li>Kehinde, O., Al-Maghrebi, M., Sheikh, M., Anim, J. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+ciprofloxacin+and+amikacin+prophylaxis+in+the+prevention+of+septicemia+after+transrectal+ultrasound+guided+biopsy+of+the+prostate.">Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate.</a> J Urol. 189 (3), 911-915 (2013).</li><li>Taylor, A. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Targeted+antimicrobial+prophylaxis+using+rectal+swab+cultures+in+men+undergoing+transrectal+ultrasound+guided+prostate+biopsy+is+associated+with+reduced+incidence+of+postoperative+infectious+complications+and+cost+of+care.">Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.</a> J Urol. 187 (4), 1275-1279 (2012).</li><li>Gyorfi, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Peri+procedural+povidone+iodine+rectal+preparation+reduces+microorganism+counts+and+infectious+complications+following+ultrasound-guided+needle+biopsy+of+the+prostate.">Peri procedural povidone iodine rectal preparation reduces microorganism counts and infectious complications following ultrasound-guided needle biopsy of the prostate.</a> World J Urol. 32 (4), 905-909 (2014).</li><li>Park, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Control+of+infective+complications+of+transrectal+prostate+biopsy.">Control of infective complications of transrectal prostate biopsy.</a> Surg Infect Larchmt. 15 (4), 431-436 (2014).</li><li>Park, D. S., Oh, J. J., Lee, J. H., Jang, W. K., Hong, Y. K., Hong, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simple+use+of+the+suppository+type+povidone+iodine+can+prevent+infectious+complications+in+transrectal+ultrasound+guided+prostate+biopsy.">Simple use of the suppository type povidone iodine can prevent infectious complications in transrectal ultrasound guided prostate biopsy.</a> Adv Urol. , (2009).</li><li>AbuGhosh, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+randomized+trial+of+povidone+iodine+prophylactic+cleansing+of+the+rectum+before+transrectal+ultrasound+guided+prostate+biopsy.">A prospective randomized trial of povidone iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy.</a> J Urol. 189 (4), 1326-1331 (2013).</li><li>Gerber, G. S., Brendler, C. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+Urological+Patient:+History,+Physical+Exam,+and+Urinalysis.">Evaluation of the Urological Patient: History, Physical Exam, and Urinalysis.</a> Campbell Walsh Urology. , (2015).</li><li>Hodge, K. K., McNeal, J. E., Terris, M. K., Stamey, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Random+systematic+versus+directed+ultrasound+guided+transrectal+core+biopsies+of+the+prostate.">Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate.</a> J Urol. 142 (1), 71-74 (1989).</li><li>Donoghue, P. M., McSweeney, S. E., Jhaveri, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genitourinary+imaging:+current+and+emerging+applications.">Genitourinary imaging: current and emerging applications.</a> J Postgrad Med. 56 (2), 131-139 (2010).</li></ol>

The authors have nothing to disclose.

Infektionen nach TRUS PNB sind sekundär zu Translokation von rektalen Gewölbe Bakterien in die gefäß Prostata. Auf diesem Prinzip basierende, haben wir das einfache Verfahren der Verwendung eines Thema Antiseptikum, wie Povidon-Iod Mikroorganismenkoloniezählungen vor Prostatabiopsie reduzieren erforscht. Unsere Erfahrung hebt eine Reduzierung von 4,3% auf 0,6% (p = 0,02) mit der Nutzung dieser PIRP Regime zum Zeitpunkt der Biopsie. Darüber hinaus stellen wir die Hypothese, dass die 97% ige Reduktion der rektalen G...

Prostatakrebs ist die häufigste Krebserkrankung bei Männern und die zweithäufigste Ursache der durch Krebs verursachten Sterblichkeit. Im Jahr 2014 werden rund 233.000 Fälle in den Vereinigten Staaten mit fast 30.000 Mann zu erliegen dieser Malignität diagnostiziert werden. 1. Während die Prostata-spezifischen Antigens (PSA) Blutuntersuchung und digitale rektale Untersuchung (DRE) spielen eine wesentliche Rolle bei der Früherkennung von Prostatakrebs, transrektale Ultraschall-geführte Prostatabiopsie (TRUS PNB) ist die häufigste Mittel, um eine histologische Gewebediagnose zu erhalten. TRUS PNB beinhaltet das Einfügen einer Ultraschallsonde in das Rektum des Patienten und dann allgemein üblichen 12-14 Biopsien der Umfangszone der Prostata befindet sich nur nach vorne. Jedes Nadelbiopsie erfordert Durchgang einer 18 G Nadel durch die Mastdarmwand in die gefäß Prostata. Daher wird die theoretische Gefahr von Blutungen und Infektionen durch bakterielle Translokation vorliegt Befolgen des Verfahrens. KeineDestotrotz hat sich die versicherungsmathematischen Komplikationsrate nach dem Eingriff historisch niedrig blieben. Antibiotika-Prophylaxe vor der TRUS PNB wird routinemäßig mit Chinolon-basierte Antibiotika als die am häufigsten verwendeten Mittel verschrieben. Trotz adäquater Prophylaxe, impliziert zeitgenössische Forschung einen Anstieg der infektiösen Komplikationen nach der Biopsie. 2 Darüber hinaus Studien zurückzuführen diesen Anstieg der infektiösen Komplikationen folgenden TRUS PNB zur Entstehung von Chinolon resistenten Mikroorganismen besonders E. coli. 3 Diese steigende Rate von Chinolonresistenz legt nahe, die Notwendigkeit für alternative Prophylaxe-Schemata für TRUS PNB Verfahren. Zu diesem Zweck sind mehrere verschiedene Wege untersucht. Ein Ansatz umfasst die Verabreichung einer intravenösen oder intramuskulären Antibiotikum zum Zeitpunkt der Biopsie in Verbindung mit einer oralen Chinolon. 4 Diese Strategie ist Sepsis Ereignissen nach TRUS PNB reduzieren,ein Haupt Einschränkung dieses Ansatzes ist das Potenzial für die weitere Entwicklung resistenter Organismen gegen dieses Antibiotikum Familie. Weiteres suchten kürzlich Methodik beinhaltet die Verwendung eines vor der Biopsie rektaler Abstrich, um Patienten zu screenen mit Chinolon-resistenten rektale Flora besiedelt. 5 Falls solche Organismen erkannt werden, könnte ein &quot;targeted&quot; Antibiotika-Therapie auf der Basis des Empfindlichkeitsprofils des identifizierten resistenten Bakterien eingesetzt werden Belastung. Während die Methodik ist elegant, der eigentliche Prozess der Erlangung solcher Tupfer, selektiven Züchten auf einem Chinolon selektiven Medium, und Schneiderei Antibiotika erfordert danach eine klinische und Laborinfrastruktur, die in vielen klinischen Praxis fehlen könnten. Die Verabreichung einer antiseptischen Thema zu rektalen Gewölbe Mikrokoloniezahlen vor der Biopsie kann eine alternative Strategie, um TRUS PNB Infektionen begrenzen präsentieren zu reduzieren. Povidon iodone ist eine kostengünstige, leicht verfügbaren Mittel, das istreduziert Bakterienzahlen dokumentiert, wann Operationsstellen aufgetragen. Anwendungen in beiden kolorektalen und gynäkologischen Operationen sind gut bekannt. Daher wird der Einsatz Povidin Jod als rektale Zubereitung würde eine herstellbare, einfache und kostengünstige Methode reduziert TRUS PNB Infektionen ohne zusätzliche Vorbereitung vor der Biopsie zu präsentieren. In Bezug auf den urologischen Literatur, zuvor Arbeit hat eine Verringerung der klinischen Infektionen nach TRUS PNB festgestellt. 6-9 Dieses Video demonstriert die Technik der PIRP, um die Leichtigkeit und Einfachheit hervorheben, um in die klinische Praxis zu integrieren. Alle Patienten, die TRUS PNB wurden in einem Spezialklinik für Urologie Weisung oder erste Bewertung für Prostata-Krebs-Screening zu sehen. Diese Auswertung brachte eine Überprüfung des Patienten Serum Prostata-spezifischen Antigens (PSA) und die Leistung eines digitalen rektalen Untersuchung (DRU). Anomalie entweder der PSA oder DRE aufgefordert Empfehlungeine TRUS PNB. Die TRUS PNB Verfahren wurde bei allen Patienten und die damit verbundenen Risiken, einschließlich Infektionen, Blutungen diskutiert und Harnverhalt wurden geklärt. Alle Patienten erhielten drei Tage der oralen Antibiotika-Prophylaxe entweder mit einem Chinolon-basierte Medikamente (zB Ciprofloxacin) oder Trimethoprim-Sulfamethoxazol (Bactrim) vor der Biopsie.

<table><tbody><tr><td>Povidone Iodine Solution, 10% Topical Microbicide Antiseptic, 8 fl oz.</td><td>Equate</td><td>4067979</td><td></td></tr><tr><td>4 x 4 sterile gauze pads, white</td><td>Dukal Corporation</td><td>DKL1412</td><td></td></tr><tr><td>disposable gynecologic swab&amp;nbsp;</td><td>numerous vendors</td><td></td><td></td></tr><tr><td>1% lidocaine gel&amp;nbsp;</td><td>numerous vendors</td><td></td><td></td></tr></tbody></table>

povidone iodine rectal preparation at time of prostate needle biopsy is a simple and reproducible means to reduce risk of procedural infection

Einzelinstitut und bevölkerungsbezogenen Studien zeigen, dass infektiöse Komplikationen nach transrektalen Ultraschall geführte Prostatabiopsie (TRUS PNB) steigen. Solche Infektionen sind vor allem auf resistente Keime, die die rektale Gewölbe besiedeln und in den Blutstrom während der Biopsie transloziert Chinolon. Eine Povidon-Iod-rektale Zubereitung (PIRP) zum Zeitpunkt der Biopsie ist ein einfaches, reproduzierbares Verfahren zur rektalen Mikrokoloniezahlen und damit resultierenden Infektionen nach TRUS PNB reduzieren. Alle Patienten werden vor der Biopsie verabreicht drei Tagen der oralen Antibiotika-Therapie. Die PIRP Technik beinhaltet zunächst Positionierung des Patienten in der üblichen Weise für eine TRUS PNB. Folgende digitale rektale Untersuchung werden 15 ml einer 10% igen Lösung von im Handel erhältlichen Povidoniod mit 5 ml 1% Lidocain Gelee gemischt, um eine Aufschlämmung zu schaffen. Ein 4 cm x 4 cm steriler Gaze ist soain dieser Aufschlämmung KED und dann in den rektalen Gewölbe für 2 min, wonach es entfernt eingesetzt wird. Danach wird ein Einweg-Baumwolle gynäkologischen Abstrichtupfer verwendet, um sowohl den perianalen Bereich und der rektalen Gewölbe zu einer Entfernung von 3 cm vom Anus zu malen. 3 min vor der Verwendung mit Standard transrektale Sonographie und nachfolgende Biopsie hend - das Povidon-Iod-Lösung wird dann für 2 trocknen. Diese PIRP Technik hat sich in der Praxis an unserer Hochschule seit März von 2012 mit einem zugeordneten Verringerung der post-Biopsie-Infektionen von 4,3% auf 0,6% (p = 0,02) war. Der Hauptvorteil dieser Prophylaxe Regime ist seine Einfachheit und Reproduzierbarkeit bei Verwendung eines leicht erhältlichen, kostengünstigen Mittels an Infektionen. Darüber hinaus vermeidet die Technik Aussetzen Patienten zusätzliche systemische Antibiotika mit potenziellen weiteren Ausbreitung der multiresistenten Organismen. Die Verwendung von PIRP bei TRUS PNB ist jedoch nicht für Patienten mit Jod oder Schalentiere einllergies.

Diese PIRP Technik hat sich in der Praxis seit Januar 2012 (bis heute) mit 165 Patienten, die in dieser Qualität Verbesserungsmaßnahme eingeschrieben gewesen. In dieser Zeit wurde nur bei einem Patienten (0,6%) eine infektiöse Komplikation in Form systemischer Sepsis erlebt. Dieser Patient wurde mit einer Multidrug-resistenten E. kolonisiert coli-Stamm. Rektalabstrichen nach der Verabreichung von PIRP bei dieser Patientin beachten, dass der rektalen Gewölbe war noch mit 2,1 x 10 5 KBE / ...

Watch this Scientific Journal Video about Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection at JoVE.com

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Povidoniod Rectal Vorbereitung bei der Prostata-Nadelbiopsie ist eine einfache und reproduzierbare Mittel zur Gefahr der Verfahrens Infektion zu verringern

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy ...

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Research

JoVE Journal

Medicine

32.0K Aufrufe.  Penn State Milton S. Hershey Medical Center. Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Serie: Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

PRP as a New Approach to Prevent Infection: Preparation and In vitro Antimicrobial Properties of PRP

Implant-associated infection is becoming more and more challenging to the healthcare industry worldwide due to increasing antibiotic resistance, transmission of antibiotic resistant bacteria between animals and humans, and the high cost of treating infections.
In this study, we disclose a new strategy that may be effective in preventing implant-associated infection based on the potential antimicrobial properties of platelet-rich plasma (PRP). Due to its well-studied properties for promoting healing, PRP (a biological product) has been increasingly used for clinical applications including orthopaedic surgeries, periodontal and oral surgeries, maxillofacial surgeries, plastic surgeries, sports medicine, etc.
PRP could be an advanced alternative to conventional antibiotic treatments in preventing implant-associated infections. The use of PRP may be advantageous compared to conventional antibiotic treatments since PRP is less likely to induce antibiotic resistance and PRP's antimicrobial and healing-promoting properties may have a synergistic effect on infection prevention. It is well known that pathogens and human cells are racing for implant surfaces, and PRP's properties of promoting healing could improve human cell attachment thereby reducing the odds for infection. In addition, PRP is inherently biocompatible, and safe and free from the risk of transmissible diseases.
For our study, we have selected several clinical bacterial strains that are commonly found in orthopaedic infections and examined whether PRP has in vitro antimicrobial properties against these bacteria. We have prepared PRP using a twice centrifugation approach which allows the same platelet concentration to be obtained for all samples. We have achieved consistent antimicrobial findings and found that PRP has strong in vitro antimicrobial properties against bacteria like methicillin-sensitive and methicillin-resistant Staphylococcus aureus, Group A Streptococcus, and Neisseria gonorrhoeae. Therefore, the use of PRP may have the potential to prevent infection and to reduce the need for costly post-operative treatment of implant-associated infections.

PRP as a New Approach to Prevent Infection: Preparation and In vitro Antimicrobial Properties of PRP

Implant-associated infection is a significant clinical complication. This study describes an approach using platelet-rich plasma (PRP) to prevent implant-associated infections, presents the protocol for preparing PRP with constant platelet concentration, and reports the newly identified antimicrobial properties of PRP and related protocols for examining such antimicrobial properties in vitro.

PRP als neuer Ansatz, um eine Infektion zu verhindern: Vorbereitung und<em&gt; In-vitro-</em&gt; Antimikrobielle Eigenschaften von PRP

Implant-associated infection is becoming more and more challenging to the healthcare industry worldwide due to increasing antibiotic resistance, ...

Forschung

Immunologie und Infektion

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real time images with a 15 &#181;m axial resolution at an effective tissue penetration of 2-3 mm. Within the OCT images the loss of signal intensity per millimeter of tissue penetration, the attenuation coefficient, is calculated. The attenuation coefficient is a tissue specific property, providing a quantitative parameter for tissue differentiation. 
Until now, renal mass treatment decisions have been made primarily on the basis of MRI and CT imaging characteristics, age and comorbidity. However these parameters and diagnostic methods lack the finesse to truly detect the malignant potential of a renal mass. A successful core biopsy or fine needle aspiration provides objective tumor differentiation with both sensitivity and specificity in the range of 95-100%. However, a non-diagnostic rate of 10-20% overall, and even up to 30% in SRMs, is to be expected, delaying the diagnostic process due to the frequent necessity for additional biopsy procedures. 
We aim to develop OCT into an optical biopsy, providing real-time imaging combined with on-the-spot tumor differentiation. This publication provides a detailed step-by-step approach for percutaneous, needle based, OCT of renal masses.

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is a high resolution imaging technique that allows analysis of tissue specific optical properties providing the means for tissue differentiation. We developed needle based OCT, providing real-time imaging combined with on-the-spot tumor differentiation. This publication describes a method for percutaneous, needle based OCT of renal masses.

In Vivo, perkutane, Nadel Based, Optical Coherence Tomography von Nierentumoren

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real ...

Medizin

Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging male population. Although it is not a life-threatening disease, BPH causes problems that seriously impact the quality of life. Here, we introduce a new technique called photoselective vaporesection of the prostate (PVRP) in treating BPH, which can be seen as a variation of photoselective vaporization of the prostate (PVP). This procedure presents several advantages compared to the PVP technique including less laser energy loss, less intraoperative complications as well as more tissue resection rate.

Here we present a protocol to perform Photoselective Vaporesection of the Prostate (PVRP) for benign prostatic hyperplasia (BPH) treatment.

Photoselektiven Vaporesection der Prostata mittels einer Ende-Firing Lithium Triborate Kristall Laser

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging ...

Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has traditionally been diagnosed via transrectal ultrasound (TRUS) biopsy. Though considered the gold standard, TRUS is unable to visualize most prostate cancer lesions and therefore requires sampling of the entire prostate. This biopsy method often undergrades prostate cancer and fails to detect up to 35% of cancers on initial biopsy. Prostate MRI has been shown to have excellent sensitivity in the detection of cancerous lesions, and advancements in MRI technology during the last decade have led to the development of targeted biopsy. In targeted biopsy, a software platform overlays MRI data onto live TRUS images to create a fused MRI/US three-dimensional model of the prostate. Regions suspicious for malignancy on MRI are contoured by a radiologist, uploaded into the fusion system, and then displayed within the live MRI/US fused model. The urologist is then able to directly biopsy these targets. When compared to conventional TRUS biopsy, MRI/US fusion technology has been demonstrated to improve the detection of clinically significant cancer while reducing insignificant cancer detection. This technology, therefore, has the potential to diagnose prostate cancer primarily in men who would benefit from treatment.

Presented herein is a protocol to perform targeted biopsy of the prostate using an MRI-ultrasound fusion system.

Verwendung von MRI-Ultraschall-Fusion, gezielte Prostatabiopsie zu erreichen

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has ...

Use of Magnetic Resonance Imaging and Biopsy Data to Guide Sampling Procedures for Prostate Cancer Biobanking

Previous methods for biobanking prostate tissue, following radical prostatectomy, generally involved random sampling. In order to increase efficiency, and enable a greater range of downstream applications, a more targeted method of sampling prostate tissue was developed. Here we use both magnetic resonance imaging (MRI) and biopsy data to target specific areas of the organ for sampling. The method involves use of a previously published prostate slicing device which removes a 5 mm transverse slice from a predetermined region of the prostate, followed by the removal of 6 mm punch biopsies from predetermined areas of this slice. These samples can be stored frozen or fixed for biobanking purposes, or used fresh immediately with 70% confidence of tumor content, as compared with 10% confidence from the random sampling approach. This enables the use of all standard downstream techniques such as genomics, proteomics or histological work, but also work that requires fresh tissue such as live tissue imaging or ex vivo culture.

This method involves utilization of clinical diagnostic data for prostate cancer patients in order to guide sampling procedures, when biobanking tissue following radical prostatectomy. This overcomes issues with previously published methods around efficiency and availability of fresh tissue for a wider range of downstream applications.

Verwendung von Magnetresonanztomographie- und Biopsiedaten zur Anleitung von Probenahmeverfahren für Prostatakrebs Biobanking

Previous methods for biobanking prostate tissue, following radical prostatectomy, generally involved random sampling. In order to increase efficiency, and ...

Focal Laser Ablation of Prostate Cancer: An Office Procedure

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer.

This article presents and describes an outpatient treatment for prostate cancer using focal laser ablation. Laser catheter placement is guided by MRI-ultrasound fusion imaging in a fashion similar to prostate needle biopsy. Treatment is monitored in real-time with a thermal probe, placed adjacent to the laser fiber.

Fokale Laserablation von Prostatakrebs: Ein Büroverfahren

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

This manuscript outlines the steps for performing a micro-ultrasound-guided transperineal prostate biopsy under local anesthesia.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound ...

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound

Traditional transrectal ultrasound (TRUS)-guided prostate biopsy has limited sensitivity and specificity, particularly for detecting early-stage prostate cancer, due to a lack of precise lesion targeting. An improved cognitive fusion-guided prostate biopsy method has been developed to enhance lesion targeting by integrating three parameters of prostate multiparametric MR (mpMRI) images into TRUS images. Prostate mpMRI measurement is initially performed to obtain three key parameters: the rotation angle (&#945;), the distance from the rectal wall (X), and the distance from the prostate apex (Y). These parameters are then cognitively applied in real-time, TRUS-guided prostate needle biopsy to detect target lesions. This improved transperineal cognitive fusion biopsy method enhances diagnostic accuracy, improves reproducibility, and reduces reliance on operator experience. Clinical application in 423 patients demonstrated a prostate cancer detection rate of 73.5%, with 62.9% classified as clinically significant cancers. Compared with equipment-intensive methods such as MRI-ultrasound fusion biopsy, this approach is cost-effective, practical, and well-suited for broader clinical adoption. Additionally, the method&#39;s flexibility supports integration with other imaging techniques, such as 68Ga-PSMA PET/CT, further improving detection rates for patients with high-risk prostate cancer.

Prostate biopsy is the gold standard diagnostic method for prostate cancer. Cognitive fusion-guided prostate biopsy, which combines transrectal ultrasound with pre-measured MRI parameters, improves biopsy accuracy and enhances the detection rate of clinically significant prostate cancer.

Eine kognitive Fusions-gesteuerte Prostatabiopsie mittels multiparametrischer Magnetresonanztomographie und transrektalem Ultraschall

Traditional transrectal ultrasound (TRUS)-guided prostate biopsy has limited sensitivity and specificity, particularly for detecting early-stage prostate ...

Peripheral Intravenous Catheter Insertion

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
The purpose of peripheral intravenous catheter (PIV) insertion is to infuse medications, perform intravenous (IV) fluid therapy, or inject radioactive tracers for special examination procedures. Placing a PIV is an invasive procedure and requires the use of an aseptic, no-touch technique. 
Common IV venipuncture sites are the arms and hands in adults and the feet in children. According to the Intravenous Nurses Society (INS), the feet should be avoided in the adult population because of the risk of thrombophlebitis. Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident (CVA), dialysis fistulas, or a mastectomy on the same side. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. The cephalic vein has been associated with nerve damage when used for IV placements. The most distal site available on the hand or arm is preferred so that future venipuncture sites may be used if infiltration or extravasation occurs.
This video will demonstrate the insertion of a PIV, including the preparation and attachment of an IV extension set. Although a PIV securement device is used here to stabilize the IV catheter, according to INS recommendations, some facilities may not elect to purchase these devices, and the alternate chevron or U-shaped taping method may also be used.

Peripheral Intravenous Catheter Insertion: No Touch Technique

Anlegen eines peripheren intravenösen Katheters

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
The purpose of peripheral intravenous catheter ...

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Hand hygiene

Asepsis is the practice of preventing or breaking the chain of infection. The nurse employs aseptic techniques to prevent the spread of microorganisms and reduce the risk of diseases. Hand hygiene is the cornerstone of aseptic techniques and is classified into medical and surgical asepsis. Medical asepsis includes hand hygiene and the use of gloves. Surgical asepsis, or the sterile technique, refers to practices that render and keep objects and areas free of microorganisms.
Hand washing consists of a fast, vigorous rubbing motion across all parts of the hands, with lathered surfaces, followed by 15 seconds of washing under water. Handwashing works by mechanically removing microorganisms from the hands and rinsing them with water. Microorganisms are not killed by handwashing. There are three techniques of hand washing.
Hand washing 
By performing hand hygiene at the right moments and using appropriate techniques, hands become clean and safe as infectious organisms are not transmitted to yourself or others. Using handwashing products that contain an antimicrobial or antibacterial ingredient is recommended in any setting where the risk for infection is high, such as:
<ul>
	<li>&#8226; When hands are visibly soiled with blood and body fluids</li>
	<li>&#8226;&#160;Before eating and after toileting</li>
	<li>&#8226;&#160;When exposed to spore-forming microorganisms.</li>
</ul>
Antiseptic hand wash
An antiseptic hand rub is used to decrease the number of microorganisms present on hand surfaces by applying an antiseptic hand rub. Ethanol-based hand antiseptics containing 70% to 90% alcohol appear to be the most effective against common pathogens found on the hands.
All healthcare workers must practice proper hand hygiene at all times, including:
<ul>
	<li>&#8226;&#160;Just before touching a patient</li>
	<li>&#8226;&#160;Before performing an aseptic task or working with invasive devices</li>
	<li>&#8226;&#160;Before switching from a soiled to a clean body site on a patient</li>
	<li>&#8226;&#160;After contacting a patient or their immediate surroundings</li>
	<li>&#8226;&#160;Following exposure to blood, bodily fluids, or contaminated surfaces (with or without glove use)</li>
	<li>&#8226;&#160;Immediately following glove removal</li>
</ul>
Antiseptic hand rub or surgical hand antisepsis 
Surgical hand antisepsis is an antiseptic hand wash or hand-rub technique that is an integral part of the preparation for surgery by surgical personnel. Its purpose is to eliminate transient microorganisms and reduce resident hand flora. The most currently used antiseptics are chlorhexidine (CHG) and povidone-iodine (PVI). These agents are applied with a sponge and brush. This technique involves coating the elbow to the fingers and can take up to three minutes, depending on hospital protocol.

Handhygiene

Asepsis is the practice of preventing or breaking the chain of infection. The nurse employs aseptic techniques to prevent the spread of microorganisms and ...

Povidoniod Rectal Vorbereitung bei der Prostata-Nadelbiopsie ist eine einfache und reproduzierbare Mittel zur Gefahr der Verfahrens Infektion zu verringern

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