Introduction of free-hand MRI-guided transperineal prostate biopsies as an outpatient procedure.

INTRODUCTION: Direct biopsy of the prostate is used for diagnosing prostate cancer and most prostate biopsies are performed transrectally with ultrasonic guidance (TRUS-BX). The transrectal approach carries a risk of sepsis as bacteria may transfer directly into the prostate from the rectum. Approximately 6% of the patients will be hospitalised within seven days after TRUX-BX. Increasing antibiotic resistance has spurred a renewed interest in the transperineal approach (TP-BX). Aseptic TP-BX may be performed, significantly reducing the risk of infection. We described the first Danish experience with multiparametric MRI-guided freehand TP-BX. METHODS: Men scheduled for TP-BX were included. Patient age, prostate-specific antigen level, previous biopsy history, weight and height were recorded. We employed a visual analogue scale (VAS) for the various procedure parts and the patients rated their satisfaction. Complications and International Society of Urological Pathology scores were recorded and cancer detection rates calculated. RESULTS: A total of 143 men had TP-BX performed in a consecutive series. The cancer detection rate was 81.8% (95% confidence interval: 74.5-87.8%). The procedure was well tolerated with a median VAS of 2 (range: 0-7), and patients expressed a high degree of satisfaction with the procedure. One patient was hospitalised due to infection. CONCLUSION: TP-BX is well tolerated and feasible as an outpatient procedure performed in local anaesthesia. Transperineal biopsies have a low risk of infection. FUNDING: none. TRIAL REGISTRATION: not relevant.

Transperineal biopsy of the prostate.

Prostate needle biopsies are an essential step in the diagnostic evaluation of prostate cancer. The conventional ultrasound-guided transrectal needle biopsy entails a significant risk of infection, which with increasing antibiotic resistance is thought to increase in the future. This has sparked a renewed interest in transperineal prostate biopsies, as this approach avoids the multiple passages of the rectal mucosa, thus reducing the risk of infection significantly. This review describes the devolvement, technical aspects, and current recommendations of transperineal biopsies.

Implementation of sacral neuromodulation for urinary indications. A Danish prospective study during the initial 15 months of a new service in a tertiary referral hospital.

OBJECTIVE: Sacral neuromodulation (SNM) is a well-established treatment modality for idiopathic overactive bladder and urgency incontinence, idiopathic fecal incontinence and non-obstructive urinary retention. This study describes the start-up phase of establishing the SNM service. Primary objective: To investigate the patient-reported outcome measures of SNM on lower urinary tract dysfunction symptoms. Secondary objectives: To investigate bowel function, sexual satisfaction and to monitor SNM safety. MATERIALS AND METHODS: Twenty-two patients with refractory idiopathic and neurogenic lower urinary tract dysfunction were offered a two-stage test-phase procedure and SNM device implantation. On completing the study, the patients rated their satisfaction with the treatment using a five-point Likert scale and a bother score of urinary, bowel and sexual symptoms on a scale of 1-10 (the worst). Their complications were assessed. RESULTS: Nineteen patients (86%) were responders during the test phase and had the pulse generator implanted. Seventeen patients were very satisfied/satisfied. A statistically significant change in urinary symptoms bother score was observed in the idiopathic and neurogenic patients, a reduction from 10 to 4 (p = .0057) and 10 to 3 (p = .014), respectively. Eleven patients (58%) had symptoms from two or three pelvic compartments. Nine patients (47%) had complications. All but one event was resolved. CONCLUSIONS: SNM is safe in this heterogeneous group of patients with refractory lower urinary tract dysfunction of various etiologies. A substantial improvement was observed in the pelvic organ dysfunction, demanding a multidisciplinary approach. More studies are required to standardize the evaluation of the subjective and objective outcomes of SNM.

A prospective study of a urine and plasma biomarker test for the prediction of gleason ≥3 + 4 prostate cancer in a mixed cohort.

Purpose: Definitive diagnosis of prostate cancer is based on biopsies, a procedure associated with side-effects. The use of biomarkers in blood and urine could potentially help clinicians select patients for whom biopsies are needed. The aim of the study was to test a new urine and plasma biomarker test in detecting medium and high grade prostate cancer.Materials and methods: Blood and urine samples were prospectively collected from 41 patients prior to prostate biopsy or TUR-P and again after 3 months. The cohort included patients with suspicion of prostate cancer and patients with prior prostate cancer diagnosis. The mRNA expression of ten selected genes measured by PCR were used together with clinical data in multiple algorithms for prediction of medium-high grade prostate cancer in prostate biopsies. The testing was originally developed and validated in the USA. The method was transferred to a local Danish laboratory. Medium and high grade cancer was defined as Gleason score ≥ 3 + 4.Results: Using the biomarker test, prior to any prostate procedures, the sensitivity for detecting medium-high grade prostate cancer was 100% and the specificity was 56% and 63%, depending on the cut-off point used. When using the biomarker test, following biopsy or TUR-P, the sensitivity and specificity were reduced to 89% and 28-34% respectively. When comparing results, there was a significant difference (p < 0.05), favoring the test performed prior to the procedures.Conclusions: We were able to predict the presence of medium-high grade prostate cancer, thereby confirming earlier findings of the biomarker test.

Single-centre experience with intradetrusor injection of onabotulinumtoxinA: a retrospective study of the years 2003-2012 in a Danish population.

OBJECTIVE: This study aimed to evaluate the efficacy of treatment for incontinence due to neurogenic detrusor overactivity (NDO) and idiopathic detrusor overactivity (IDO) with onabotulinumtoxinA (BoNT-A) at Aarhus University Hospital, Skejby, Denmark. MATERIALS AND METHODS: The data were collected retrospectively by systematic review of the patient records from March 2003 to May 2012. Patients treated with BoNT-A over the age of 18 years were included. Treatment indication, diagnosis, adverse events, treatment interval, duration of effect and effect grade were registered. Follow-up data were collected by a telephone interview 4 weeks after treatment. RESULTS: The study identified 219 patients, who received a total of 657 treatments during the period. Full effect of the treatment was experienced in 71%, intermediate effect was seen in 16% and low effect in 3%. There was no difference in effect duration between the IDO and NDO groups. The most common adverse event was the need to perform clean intermittent self-catheterization; 27% of all patients experienced this. Urinary tract infections were reported in 5% of procedures and significant haematuria in 1%. These findings correspond with the results of other published studies. CONCLUSION: BoNT-A is a safe and effective treatment for incontinence in IDO and NDO.