Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management

  • Myoung Seok Lee (Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Min Hoan Moon (Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Chan Kyo Kim (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung Yoon Park (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Moon Hyung Choi (Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital) ;
  • Sung Il Jung (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine)
  • Received : 2019.08.05
  • Accepted : 2019.12.12
  • Published : 2020.04.01
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Abstract

The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.

Keywords

References

  1. Lee G, Attar K, Laniado M, Karim O. Trans-rectal ultrasound guided biopsy of the prostate: nationwide diversity in practice and training in the United Kingdom. Int Urol Nephrol 2007;39:185-188 
  2. Choi SJ, Jeong WK, Jo AJ, Choi JA, Kim MJ, Lee M, et al. Methodology for developing evidence-based clinical imaging guidelines: joint recommendations by Korean Society of Radiology and National Evidence-based Healthcare Collaborating Agency. Korean J Radiol 2017;18:208-216 
  3. Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al.; Guideline Committee for the Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. 2017 Thyroid Radiofrequency Ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2018;19:632-655 
  4. Kang MJ, Kim JH, Kim YK, Lee HJ, Shin KM, Kim JI, et al. 2018 Korean clinical imaging guideline for hemoptysis. Korean J Radiol 2018;19:866-871 
  5. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol 2013;64:876-892 
  6. El-Hakim A, Moussa S. CUA guidelines on prostate biopsy methodology. Can Urol Assoc J 2010;4:89-94 
  7. Jaffe TA, Raiff D, Ho LM, Kim CY. Management of anticoagulant and antiplatelet medications in adults undergoing percutaneous interventions. AJR Am J Roentgenol 2015;205:421-428 
  8. Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al.; Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012;23:727-736 
  9. Maan Z, Cutting CW, Patel U, Kerry S, Pietrzak P, Perry MJ, et al. Morbidity of transrectal ultrasonography-guided prostate biopsies in patients after the continued use of low-dose aspirin. BJU Int 2003;91:798-800 
  10. Herget EJ, Saliken JC, Donnelly BJ, Gray RR, Wiseman D, Brunet G. Transrectal ultrasound-guided biopsy of the prostate: relation between ASA use and bleeding complications. Can Assoc Radiol J 1999;50:173-176 
  11. Ihezue CU, Smart J, Dewbury KC, Mehta R, Burgess L. Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications. Clin Radiol 2005;60:459-463 
  12. Giannarini G, Mogorovich A, Valent F, Morelli G, De Maria M, Manassero F, et al. Continuing or discontinuing low-dose aspirin before transrectal prostate biopsy: results of a prospective randomized trial. Urology 2007;70:501-505 
  13. Lindert KA, Kabalin JN, Terris MK. Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy. J Urol 2000;164:76-80 
  14. Carey JM, Korman HJ. Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? J Urol 2001;166:82-85 
  15. Jeon SS, Woo SH, Hyun JH, Choi HY, Chai SE. Bisacodyl rectal preparation can decrease infectious complications of transrectal ultrasound-guided prostate biopsy. Urology 2003;62:461-466 
  16. Park DS, Oh JJ, Lee JH, Jang WK, Hong YK, Hong SK. Simple use of the suppository type povidone-iodine can prevent infectious complications in transrectal ultrasound-guided prostate biopsy. Adv Urol 2009:750598 
  17. Kam SC, Choi SM, Yoon S, Choi JH, Lee SH, Hwa JS, et al. Complications of transrectal ultrasound-guided prostate biopsy: impact of prebiopsy enema. Korean J Urol 2014;55:732-736 
  18. De Nunzio C, Lombardo R, Presicce F, Bellangino M, Finazzi Agro E, Gambrosier MB, et al. Transrectal-ultrasound prostatic biopsy preparation: rectal enema vs. mechanical bowel preparation. Cent European J Urol 2015;68:223-228 
  19. Zani EL, Clark OA, Rodrigues Netto N Jr. Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev 2011;(5):CD006576 
  20. Yang M, Zhao X, Wu Z, Xiao N, Lu C. Meta-analysis of antibiotic prophylaxis use in transrectal prostatic biopsy. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2009;34:115-123 
  21. Schaeffer AJ, Montorsi F, Scattoni V, Perroncel R, Song J, Haverstock DC, et al. Comparison of a 3-day with a 1-day regimen of an extended-release formulation of ciprofloxacin as antimicrobial prophylaxis for patients undergoing transrectal needle biopsy of the prostate. BJU Int 2007;100:51-57 
  22. Briffaux R, Merlet B, Normand G, Coloby P, Leremboure H, Bruyere F, et al. [Short or long schemes of antibiotic prophylaxis for prostate biopsy. A multicentre prospective randomised study]. Prog Urol 2009;19:39-46 
  23. Jung SI. Infection in patients undergoing transrectal ultrasound guided prostate biopsy. Korean J Urogenit Tract Infect Inflamm 2013;8:20-26 
  24. Nash PA, Bruce JE, Indudhara R, Shinohara K. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol 1996;155:607-609 
  25. Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis 2007;10:127-136 
  26. Hergan L, Kashefi C, Parsons JK. Local anesthetic reduces pain associated with transrectal ultrasound-guided prostate biopsy: a meta-analysis. Urology 2007;69:520-525 
  27. Maccagnano C, Scattoni V, Roscigno M, Raber M, Angiolilli D, Montorsi F, et al. Anaesthesia in transrectal prostate biopsy: which is the most effective technique? Urol Int 2011;87:1-13 
  28. Lee C, Woo HH. Current methods of analgesia for transrectal ultrasonography (TRUS)-guided prostate biopsy -- a systematic review. BJU Int 2014;113:48-56 
  29. Izol V, Soyupak B, Seydaoglu G, Aridogan IA, Tansug Z. Three different techniques for administering analgesia during transrectal ultrasound-guided prostate biopsy: a comparative study. Int Braz J Urol 2012;38:122-128 
  30. Moudouni S, Amine M, Lakmichi A, Dahami Z, Sarf I. UP-02.137. A randomized, controlled trial comparing lidocaine periprostatic nerve block and lidocaine gel intrarectally associated with tramadol per os for transrectal ultrasound guided biopsy of prostate. Urology 2011;78:S307 
  31. Optimal techniques of prostate biopsy and specimen handling. American Urologic Association Web site. http://www.auanet.org/guidelines/prostate-biopsy-and-specimen-handling. Published 2015. Accessed May 25, 2018 
  32. McCormack M, Duclos A, Latour M, McCormack MH, Liberman D, Djahangirian O, et al. Effect of needle size on cancer detection, pain, bleeding and infection in TRUS-guided prostate biopsies: a prospective trial. Can Urol Assoc J 2012;6:97-101 
  33. Obek C, Doganca T, Erdal S, Erdogan S, Durak H. Core length in prostate biopsy: size matters. J Urol 2012;187:2051-2055