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;

Este estudo relacionado paciente foi aprovado pelo conselho de revisão institucional (IRB) para pesquisas com seres humanos. 1. Preparação do paciente e Posicionamento <ol><li> Trazer o paciente para a suíte procedimento e colocá-los em seu lado direito ou esquerdo com os joelhos flexionados ao peito. </li><li> Execute um tempo limite cirúrgico pelo qual o paciente, o procedimento cirúrgico, e indicação são revisados ​​e confirmados. </li><li> Quando indicado, administrar sedação endovenosa através do serviço de anestesia. </li></ol> 2. Execute um exame retal digital (DRE) <ol><li> Lugar tamanho luvas apropriadas em ambas as mãos. </li><li> Insira dedo de luva depois da lubrificação em ampola retal e próstata examinar a sentir por áreas potenciais suspeitos que necessitam de atenção concentrada durante a ultra-sonografia transretal. 10 </li></ol> 3. Criação de iodopovidona retal Preparação (PIRP) <ol><li> Deitar 15 ml de uma solução 10%disponível comercialmente solução de povidona-iodo numa bacia estéril. </li><li> Adicionar 5 ml de um 1% disponível comercialmente gel de lidocaína a esta bacia. </li><li> Misturar os conteúdos durante 15 segundos para criar uma suspensão de iodo povidona. </li></ol> 4. Administração Fundamental de PIRP <ol><li> Utilize um swab retal estéril para a cultura da ampola retal. </li><li> Abra-se a 4 cm x 4 cm de gaze estéril, mergulhar na lama iodopovidona, e depois inserir na ampola retal. Apenas uma pequena cauda de gaze é deixada emanando a partir do ânus. </li><li> Deixar a gaze no lugar durante 2 minutos após o que é removido e deitado fora. </li></ol> 5. Administração Secundária de PIRP <ol><li> Utilize um cotonete ginecológica descartável para pintar a área perianal com a solução PIRP. </li><li> Insira este swab ginecológica na ampola retal para uma distância de 3 cm do ânus. </li><li> Para maximizar ainda mais a exposição da mucosa retal para PIRP, limpe o vau rectallt de um modo semelhante, pelo menos, três vezes. </li><li> Permitir que a solução de povidona-iodo a secar durante 2 -. 3 min antes de prosseguir com ultra-sonografia padrão e biopsia posterior 11 Isto é essencial que os efeitos bactericidas da PIRP requerem que a solução seque sobre a mucosa exposta. </li><li> Utilize um swab retal estéril para a cultura da ampola retal. </li></ol> 6. transretal ultra-sonografia e biópsia <ol><li> Inserir a sonda de ultra-som através do reto. </li><li> Realizar medições da próstata e biópsia posterior da forma padrão consistente com todas as práticas urológicas 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.

Infecções seguintes TRUS PNB são secundárias a translocação de bactérias ampola retal na próstata altamente vascular. Com base neste princípio, temos explorado o método simples de usar um anti-séptico tópico como iodopovidona para reduzir a contagem de microrganismos colônia antes de biópsia por agulha de próstata. A nossa experiência evidencia uma redução de 4,3% a 0,6% (p = 0,02) com a utilização do presente regime PIRP no momento da biopsia. Além disso, a hipótese de que a redução de 97% em mi...

O câncer de próstata é o câncer mais comum em homens ea segunda causa de mortalidade relacionada ao câncer. Em 2014, aproximadamente 233 mil casos serão diagnosticados nos Estados Unidos, com quase 30.000 homens sucumbir a esta doença maligna. 1 Enquanto o antígeno específico da próstata (PSA) exame de sangue e exame de toque retal (DRE) desempenham um papel essencial no rastreio do cancro da próstata, transretal ultra-som de próstata guiada agulha de biópsia (USTR PNB) é o meio mais comum para obter um diagnóstico histológico de tecido. TRUS PNB envolve a inserção de uma sonda de ultra-sons no recto do paciente e, em seguida, geralmente aceite 12-14 biópsias da zona periférica da próstata localizado anteriormente. Cada biópsia de agulha requer passagem de um 18 G agulha através da parede rectal na próstata altamente vascular. Portanto, o risco teórico de sangramento e infecção devido a translocação bacteriana existe o seguinte procedimento. Nenhumobstante, o pós-procedimento taxa de complicação atuarial tem historicamente se manteve baixa. A profilaxia antibiótica antes da TRUS PNB é rotineiramente prescrita com antibióticos à base de quinolona sendo os agentes mais utilizados. Apesar profilaxia adequada, a pesquisa contemporânea implica um aumento de complicações infecciosas pós-biópsia. 2 Além disso, estudos têm atribuído esse aumento de complicações infecciosas seguinte TRUS PNB para o surgimento de microorganismos resistentes quinolonas particularmente E. coli. 3 Este aumento da taxa de resistência às quinolonas sugere a necessidade de esquemas de profilaxia alternativos para procedimentos TRUS PNB. Para este fim, vários caminhos diferentes estão sob investigação. Uma abordagem envolve a administração de um antibiótico intravenosa ou intramuscular no momento da biópsia em conjunto com uma quinolona oral. 4 Embora esta estratégia pode reduzir eventos sepse seguintes TRUS PNB,uma limitação principal desta abordagem é o potencial para o desenvolvimento de organismos resistentes ainda mais a esta família de antibióticos. Outra metodologia recentemente investigada incorpora o uso de uma zaragatoa rectal pré-biópsia para o rastreio de pacientes colonizados com resistentes à quinolona flora rectais. 5 Se forem detectados tais organismos, um regime de antibióticos &quot;alvo&quot; pode ser empregue com base no perfil de sensibilidade das bactérias resistentes identificado estirpe. Embora a metodologia é elegante, o próprio processo de obtenção de tais cotonetes, seletivamente cultura em um meio seletivo quinolonas, antibióticos e adaptando posteriormente requer uma infra-estrutura laboratorial e clínica que pode estar faltando em muitas práticas clínicas. A administração de um anti-séptico tópico para reduzir a ampola retal microorganismo colônia contagens antes da biópsia pode apresentar uma estratégia alternativa para limitar infecções TRUS PNB. Povidone iodone é um barato agente, que é prontamente disponíveldocumentados para contagens de bactérias reduzidas quando aplicada a locais cirúrgicos. Aplicações em ambas as cirurgias colorretais e ginecológicas são bem conhecidos. Portanto, o uso de iodo povidine como uma preparação rectal iria apresentar um método producible, simples e de baixo custo para reduzir infecções TRUS PNB, sem necessidade de preparação adicional antes da biópsia. No que diz respeito à literatura urológica, anteriormente trabalho observou uma redução em infecções clínicas seguintes TRUS PNB. 6-9 Este vídeo demonstra a técnica de PIRP para realçar a simplicidade e facilidade de integrar em práticas clínicas. Todos os pacientes submetidos à TRUS PNB foram inicialmente visto em uma clínica de urologia especialidade para encaminhamento ou avaliação inicial para o rastreamento do câncer de próstata. Essa avaliação envolveu uma avaliação do antígeno do paciente soro específico da próstata (PSA) e realização de um exame de toque retal (DRE). Anormalidade, quer do PSA ou DRE solicitado recomendação deum PNB TRUS. O procedimento TRUS PNB foi discutido com todos os pacientes e os riscos associados, incluindo infecção, sangramento e retenção urinária foram esclarecidas. Todos os pacientes receberam três dias de profilaxia com antibióticos orais ou com um medicamento à base de quinolona (ou seja, Ciprofloxacina) ou sulfametoxazol-trimetoprim (Bactrim) antes da biópsia.

<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

Instituição única e estudos de base populacional destacar que as complicações infecciosas seguintes biópsia transretal ultra-som guiada agulha de próstata (USTR PNB) estão aumentando. Essas infecções são em grande parte atribuível a quinolonas microrganismos resistentes que colonizam a ampola retal e são translocados para a corrente sanguínea durante o procedimento de biópsia. A preparação iodopovidona rectal (PIRP) no momento da biópsia é um método simples e reprodutível para reduzir a contagem de colônias de microorganismos e infecções retais, portanto, resultantes seguintes TRUS PNB. Todos os pacientes são administrados três dias de terapia com antibiótico oral antes da biópsia. A técnica envolve inicialmente PIRP posicionar o paciente da maneira padrão para um TRUS PNB. Após o exame digital rectal, 15 ml de uma solução a 10% de iodo disponível comercialmente povidona é misturada com 5 ml de lidocaína a 1% geleia para criar pasta. A 4 cm x 4 cm gaze estéril é soaked nesta pasta e, em seguida, inserido no cofre rectal durante 2 min, após o que é removido. Depois disso, um descartável ginecológica cotonete de algodão é usada para pintar, tanto a região perianal e a abóbada rectal para uma distância de 3 cm do ânus. A solução de povidona-iodo é então deixado a secar durante 2 - 3 minutos antes de prosseguir com ultra-sonografia padrão e biópsia subsequente. Esta técnica PIRP tem sido na prática em nossa instituição desde março de 2012, com uma redução associada de infecções pós-biópsia de 4,3% para 0,6% (p = 0,02). A principal vantagem deste esquema profilaxia é a sua simplicidade e reprodutibilidade com o uso de uma forma facilmente disponível, barato agente para reduzir infecções. Além disso, a técnica evita expor os pacientes a antibióticos sistémicos adicionais com potencial de propagação adicional de organismos multi-resistentes a drogas. Uso de PIRP em TRUS PNB, no entanto, não é aplicável a pacientes com iodo ou um mariscollergies.

Esta técnica PIRP tem sido na prática desde janeiro de 2012 (até o presente) com 165 pacientes terem sido incluídos neste medida de melhoria da qualidade. Neste momento, apenas um paciente (0,6%) sofreu uma complicação infecciosa na forma de sepse sistêmica. Este paciente foi colonizado com E. multi-resistente estirpe de E. coli. Swab retal após a administração de PIRP neste paciente observou que a ampola retal ainda foi colonizada com bactérias 2.1 x 10 5 UFC / mL questionando, a...

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.

Iodopovidona retal Preparação no momento da próstata agulha de biópsia é um simples e reprodutível meios para reduzir o risco de infecção Processual

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

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Medicine

31.9K visualizações.  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.

Vídeo: 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 como uma nova abordagem para prevenir a infecção: Preparação e<em&gt; In vitro</em&gt; Propriedades antimicrobianas do PRP

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

Imunologia e Infecção

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.

Na Vivo, percutânea, Agulha Based, Tomografia de Coerência Óptica de massas renais

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

Medicina

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.

Photoselective Vaporesection da próstata através de um acionamento do fim de lítio Triborate cristal 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.

Uso da fusão de MRI-ultra-som para atingir o alvo biópsia de próstata

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.

Uso da imagem latente de ressonância magnética e dados da biópsia para guiar procedimentos da amostragem para o cancro da próstata 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.

Ablação focal a laser do câncer de próstata: um procedimento de escritório

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.

Uma biópsia de próstata guiada por fusão cognitiva usando ressonância magnética multiparamétrica e ultrassom transretal

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

Inserção de Cateter Intravenoso Periférico

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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Assessing and Flushing a Peripheral Intravenous Line

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
After peripheral intravenous (IV) access is initiated, it is important to assess and maintain the IV catheter according to institutional policies and nursing standards of practice. The regular assessment of the insertion site and the surrounding areas for signs of complications is necessary to prevent IV catheter complications, including infiltration, phlebitis, infection, extravasation, or catheter dislodgement. Routine IV maintenance is equally important to preserve line patency and to reduce the risk of occlusion, thrombosis, and thrombophlebitis. According to the CDC, peripheral IV catheters (PIV) may be kept in place for as long as 96 h, with proper care and maintenance. In addition, according to the Infusion Nurses Society (INS), a pediatric patient IV catheter may be kept in place until the IV line is no longer patent or it demonstrates complications. Routine rotation every 96 h is not indicated in the pediatric population due to increased anxiety caused by needle sticks. 
This video demonstrates the assessment and maintenance of peripheral IV lines, including general considerations before initiating the procedure, assessing the injection site for associated complications, and maintaining catheter patency by flushing it with the normal saline solution.

Avaliação e Lavagem uma Linha Intravenosa Periférica

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
After peripheral intravenous (IV) access is ...