Background:Transrectal(TR)and transperineal(TP)biopsies are commonly used methods for diagnosing prostate cancer.However,their comparative effectiveness in conjunction with machine learning(ML)techniques remains under...Background:Transrectal(TR)and transperineal(TP)biopsies are commonly used methods for diagnosing prostate cancer.However,their comparative effectiveness in conjunction with machine learning(ML)techniques remains underexplored.This study aimed to evaluate the predictive accuracy of ML algorithms in detecting prostate cancer using data derived from TR and TP biopsies.Methods:The clinical records of patients who underwent prostate biopsy at King Saud University Medical City and King Faisal Specialist Hospital and Research Centerin Riyadh,Saudi Arabia,between 2018 and 2025 were analyzed.Data were used to train and testMLmodels,including eXtreme Gradient Boosting(XGBoost),Decision Tree,Random Forest,and Extra Trees.Results:The two datasets are comparable.The models demonstrated exceptional performance,achieving accuracies of up to 96.49%and 95.56%on TP and TR biopsy datasets,respectively.The area under the curve(AUC)values were also high,reaching 0.9988 for TP and 0.9903 for TR biopsy predictions.Conclusion:These findings highlight the potential of MLto enhance the diagnostic accuracy of prostate cancer detection irrespective of the biopsy method.However,TP biopsy data showed marginally higher accuracy,possibly because of the lower risk of contamination.While ML holds great promise for transforming prostate cancer care,further research is needed to address limitations.Collaboration between clinicians,data scientists,and researchers is crucial to ensure the clinical relevance and interpretability of ML models.展开更多
Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the C...Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone.Two hundred and twenty-two patients who underwent transrectal prostate biopsy(TRB)and 216 patients who underwent transperineal prostate biopsy(TPB)between June 2016 and September 2022 were reviewed in this study.In addition,110 patients who received additional targeted biopsies following the systematic TPB were identified.Clinical parameters,including age,PSA derivative,prostate volume(PV),and needle core count,were recorded.The data were fitted via propensity score matching(PSM),adjusting for potential confounders.TPB outperformed TRB in terms of the CDR(49.6%vs 28.3%,P=0.001).The clinically significant prostate cancer(csPCa)detection rate was not significantly different between TPB and TRB(78.6%vs 68.8%,P=0.306).In stratified analysis,TPB outperformed TRB in CDR when the age of patients was 65–75 years(59.0%vs 22.0%,P<0.001),when PV was 25.00–50.00 ml(63.2%vs 28.3%,P<0.001),and when needle core count was no more than 12(58.5%vs 31.5%,P=0.005).The CDR(P=0.712)and detection rate of csPCa(P=0.993)did not significantly differ among the systematic,targeted,and combined biopsies.TPB outperformed TRB in CDR for patients with gray-zone PSA.Moreover,performing target biopsy after systematic TPB provided no additional benefits in CDR.展开更多
Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (...Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.展开更多
This systematic review was performed to compare the efficacy and complications of transperineal （TP） vs. transrectal （TR） prostate biopsy. A systematic research of PUBM ED, EMBASE and the Cochrane Library was perf...This systematic review was performed to compare the efficacy and complications of transperineal （TP） vs. transrectal （TR） prostate biopsy. A systematic research of PUBM ED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer （PCa） detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen （PSA） levels and digital rectal examination （DRE） findings. The Cochrane Collaboration＇s RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials （RCTs） and four casecontrol studies （CCS）, met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups （risk difference （RD）, -0.02; 95% confidence interval （CI）, -0.08-0.03; P=0.34）. Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group （RD, -0.01; 95% CI, -0.05-0.04; P=0.81）. There was no significant difference in PCa detection rate between the saturation TR and TP approaches （31.4% vs. 25.7%, respectively;P=0.3）. There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.展开更多
This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy(TSV)guided by rea卜time transrectal ultrasonography(TRUS)in managing persistent...This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy(TSV)guided by rea卜time transrectal ultrasonography(TRUS)in managing persistent hematospermia.A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center,prospective,observational study.The median follow-up period was 36.5(range:8.0-97.5)months.TSV was successfully performed in 272(96.8%)patients.The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum.Seven(2.6%),74(27.2%),64(23.5%),and 127(46.7%)patients had Types I(through the ejaculatory duct in the urethra),II(through the ejaculatory duct in the prostatic utricle),III(transutricular fenestration through a thin membrane),and IV(real-time transrectal ultrasound-guided transutricular fenestration)approach,respectively.In patients who successfully underwent surgery,bleeding occurred in the seminal vesicle in 249(91.5%)patients.Seminal vesiculitis,calculus in the prostatic utricle,calculus in the ejaculatory duct,calculus in the seminal vesicle,prostatic utricle cysts,and seminal vesicle cysts were observed in 213(78.3%),96(35.3%),22(8.1%),81(29.8%),25(9.2%),and 11(4.0%)patients,respectively.Hematospermia was alleviated or disappeared in 244(89.7%)patients 12 months after surgery.Fifteen patients had recurrent hematospermia,and the median time to recurrence was 7.5(range:2.0-18.5)months.TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.展开更多
Obstructive azoospermia （OA） is one of the most common causes of male infertility. Transrectal ultrasound （TRUS） has been used to diagnose OA for many years. From 2009 to 2013, we evaluated a prospective cohort of...Obstructive azoospermia （OA） is one of the most common causes of male infertility. Transrectal ultrasound （TRUS） has been used to diagnose OA for many years. From 2009 to 2013, we evaluated a prospective cohort of 1249 patients with suspected OA using TRUS. It was found that dilation of the ejaculatory duct （ED） （29.9%, 374/1249） was the most common cause of OA, followed by seminal vesicle （SV） abnormalities （28.5%, 356/1249）. A total of 237 patients were diagnosed with congenital defects （agenesis and/or hypoplasia） of the SV, constituting more than half of the cases of SV disease in OA （19.0%, 237/1249）. In contrast to ED, congenital defects of the SV could not be corrected with surgical treatment. Therefore, it is meaningful to compare TRUS and magnetic resonance imaging （MRI） for accurate diagnosis of SV defects. Among our patients, 30 with agenesis or/and hypoplasia of the SV on TRUS were further evaluated using pelvic MRI within 2 years, with the objective of verifying the TRUS results. The concordance rate for diagnosing congenital defects of the SV was 73.3% （22/30）. We concluded that TRUS is a reliable and convenient method for diagnosing agenesis or hypoplasia of the SV in OA patients with a high concordance with MRI while MRI is useful in patients with inconclusive TRUS findings.展开更多
The aim of this study is to evaluate the ability of the random forest algorithm that combines data on transrectal ultrasound findings, age, and serum levels of prostate-specific antigen to predict prostate carcinoma. ...The aim of this study is to evaluate the ability of the random forest algorithm that combines data on transrectal ultrasound findings, age, and serum levels of prostate-specific antigen to predict prostate carcinoma. Clinico-demographic data were analyzed for 941 patients with prostate diseases treated at our hospital, including age, serum prostate-specific antigen levels, transrectal ultrasound findings, and pathology diagnosis based on ultrasound-guided needle biopsy of the prostate. These data were compared between patients with and without prostate cancer using the Chi-square test, and then entered into the random forest model to predict diagnosis. Patients with and without prostate cancer differed significantly in age and serum prostate-specific antigen levels （P 〈 0.001）, as well as in all transrectal ultrasound characteristics （P 〈 0.05） except uneven echo （P = 0.609）. The random forest model based on age, prostate-specific antigen and ultrasound predicted prostate cancer with an accuracy of 83.10%, sensitivity of 65.64%, and specificity of 93.83%. Positive predictive value was 86.72%, and negative predictive value was 81.64%. By integrating age, prostate-specific antigen levels and transrectal ultrasound findings, the random forest algorithm shows better diagnostic performance for prostate cancer than either diagnostic indicator on its own. This algorithm may help improve diagnosis of the disease by identifying patients at high risk for biopsy.展开更多
Chronic prostatitis can affect the sperm＇s quality. Previous studies have shown that transrectal microwave thermotherapy （TRMT） results in symptomatic relief in patients with chronic prostatitis, but the effects on...Chronic prostatitis can affect the sperm＇s quality. Previous studies have shown that transrectal microwave thermotherapy （TRMT） results in symptomatic relief in patients with chronic prostatitis, but the effects on sperm have not been carefully investigated. This study evaluates the impact of TRMT on the relief or decrease of symptoms and quality of sperm when used to treat patients with chronic nonbacterial prostatitis. Sixty patients were enrolled in the study. TRMT treatment was administered over 5 days, 1 h per day. Semen examination was carried out pretreatment and immediately at the conclusion of the 5-day treatment. Also, it was repeated 1 month, 3 months, and 6 months later. The treatment＇s symptom relief efficacy was evaluated using the National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI）. After the treatment, the overall NIH-CPSI scores were lower compared to those of pretreatment. In addition, the white blood cells and lecithin in expressed prostatic secretion were normal after the treatment. The sperm count was decreased by 23.8% 3 months after the treatment, sperm motility was reduced by 10.3% immediately after treatment, and sperm deformity was increased by 17.2%. The sperm volume and PH were not affected. However, the sperm quality recovered after treatment and the malformation rate was also lower at 6 months after treatment. TRMT is a favorable and safe treatment option for patients with nonbacterial chronic prostatitis. It could relieve the patient＇s symptoms and impact on sperm quality in the short-term.展开更多
BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of...BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of DAM.The value of ultrasonography in the diagnosis of DAM is still controversial.Through a literature review,we summarized the current state of ultrasonic examination for DAM and reported for the first time the contrast-enhanced ultrasound(CEUS)features of DAM seen using a biplane transrectal probe.CASE SUMMARY A 37-year-old woman presented with a sacrococcygeal mass that had gradually increased in size over the previous 6 mo.MRI and CT examinations failed to allow a definite diagnosis to be made.Transperineal core needle biopsy(CNB)guided by transrectal ultrasound and CEUS was suggested after a multidisciplinary discussion.Grayscale ultrasound of the lesion showed a layered appearance with alternating hyperechoic and hypoechoic patterns.Transrectal CEUS showed a laminated distribution of the contrast agent that was consistent with the layered appearance of the tumor on grayscale ultrasound.We performed transperineal CNB of the enhanced area inside the tumor under transrectal CEUS guidance and finally made a definitive diagnosis of DAM through histopathology.The patient underwent laparoscopic-assisted transabdominal surgery combined with transperineal surgery for large pelvic tumor resection and pelvic floor peritoneal reconstruction.No recurrence or metastasis was found at the ninemonth follow-up.CONCLUSION Transrectal CEUS can show the layered perfusion characteristics of the contrast agent,guiding subsequent transperineal CNB of the enhanced area within the DAM.展开更多
The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data Sy...The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data System(PI-RADS)system for avoiding unnecessary mpMRI-guided targeted biopsy(TB).From January 2018 to October 2019,fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients.The study included 188 suspicious lesions on mpMRI in 156 patients,all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy(SB).Univariate analyses were performed to investigate the relationship between TRUS features and PCa.Then,logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa.The detection rates of PCa based on TB alone,SB alone,and combined SB and TB were 55.9%(105 of 188),52.6%(82 of 156),and 62.8%(98 of 156),respectively.The significant predictors of PCa on TRUS were hypoechogenicity(odds ratio[OR]:9.595,P=0.002),taller-than-wide shape(OR:3.539,P=0.022),asymmetric vascular structures(OR:3.728,P=0.031),close proximity to capsule(OR:3.473,P=0.040),and irregular margins(OR:3.843,P=0.041).We propose subgrouping PI-RADS score 3 into categories 3a,3b,3c,and 3d based on different numbers of TRUS predictors,as the creation of PI-RADS 3a(no suspicious ultrasound features)could avoid 16.7%of mpMRI-guided TBs.Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.展开更多
Introduction: To present the initial experience of 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance by using a toothed oval clamp. Case Presentation: One patient received 3-port...Introduction: To present the initial experience of 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance by using a toothed oval clamp. Case Presentation: One patient received 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance by using a toothed oval clamp. Better direct vision and exposure could be acquired for performing laparoscopic surgical procedure, avoiding additional port inserted. Using this procedure, with strictly adhering to the principles of laparoscopic colectomy and oncological procedure, along with the specimen exteriorized via recta, transacted and a stapled anastomosis performed, no incision can be achieved at the end of an operation. The operative time was 180 minutes. The estimated blood loss in the course of an operation was 80 ml. The patient recovered quickly after surgery, with no post-operative pain and no incision. The patient was dischanged home on the 6th postoperative day. Conclusions: With a transrectal assistance by using a toothed oval clamp, 3-port laparoscopic surgery for rectal cancer could be achieved without no incision at the end of the operation, the same as NOTES. It is enormously advantageous to the patient and suitable for application in developing countries, especially in a rural area.展开更多
Objective: To observe the sonographic and hemodynamic features of hypoechoic hypertrophic lesions and hypoechoic cancer lesions in the hypertrophic prostate inner glands, in order to raise the accuracy of early diagno...Objective: To observe the sonographic and hemodynamic features of hypoechoic hypertrophic lesions and hypoechoic cancer lesions in the hypertrophic prostate inner glands, in order to raise the accuracy of early diagnosis rate for prostate cancer. Methods: 31 cases of hypoechoic hypertrophic lesions and 18 cases of hypoechoic cancer lesions in the hypertrophic prostate inner glands were observed by transrectal ultrasonography and comparatively analyze the shape, edge and the systolic peak velocity (Vs) , resistance index (RI) and pulsatility index (PI) of the lesions. Results: In contrast with hypertrophic group, the cancer group presented irregular shape and unclear edge, and obviously higher Vs, RI and PI. Conclusion: The sonographic appearance and Vs. RI. PI have important value in distinguishing hypoechoic hypertrophic lesions and hypoechoic cancer lesions in the hypertrophic prostate inner glands.展开更多
Objective:The aim of the study was to detect the valuable ultrasonographic features in diagnosing prostate cancer.Methods:The patients who underwent transrectal ultrasound in the period from May 2005 to October 2009 a...Objective:The aim of the study was to detect the valuable ultrasonographic features in diagnosing prostate cancer.Methods:The patients who underwent transrectal ultrasound in the period from May 2005 to October 2009 at the 1st Affiliated Hospital of Dalian Medical University,China,were included,with needle biopsy diagnosis for patients with the prostate cancer and prostatic hyperplasia.Seventy-four cases of prostate cancer were diagnosed as adenocarcinoma,compared with 51 cases diagnosed as prostatic hyperplasia.Retrospective analysis of patients with transrectal ultrasound were done,comparing the difference between the two groups in the echo level (hypoechogenic),outlines (ill-defined margin),posterior acoustic attenuation,periphery halo,microcalcification incidence,the blood supply level,peak systolic velocity (Vs) and resistance index (RI).Results:The ratios of hypoechogenic lesions in the prostate cancer group and prostatic hyperplasia group were 56.76% and 35.90%,respectively (P<0.05),the ratios of irregular outlines were 85.14% and 15.38% respectively (P<0.05),the ratios of microcalcification were 39.19% and 10.26%,respectively (P < 0.05),the ratios of posterior acoustic attenuation were 41.89% and 12.82%,respectively (P<0.05),and the ratios of periphery halo were 35.14% and 38.46% respectively (P>0.05).Vs of the two groups were (44.00 ± 15.30) cm/s and (17.32 ± 4.65) cm/s,respectively (P<0.05).RI of the two groups were 0.76 ± 0.10,and 0.51 ± 0.03 respectively (P<0.05).The significant correlation was designated in the blood supply level between the prostate cancer group and prostatic hyperplasia group (r=-0.388,P<0.01).Higher revascularization grade was seen in the prostate cancer group compared to benign prostatic hyperplasia group.Conclusion:(1) The significant roles for diagnosing prostate cancer are hypoechogenic,irregular outlines,spiculation,microcalcification,high revascularization grade,posterior acoustic attenuation,high Vs and high RI.(2) It could not help in diagnosing prostate cancer with ultrasonographic periphery halo or not.展开更多
Objective:The aim of the study was to observe the characters and differences of the inner and outer parts of prostate gland, the prostatic cancer lesions in inner and outer parts of prostate glands by transrectal cont...Objective:The aim of the study was to observe the characters and differences of the inner and outer parts of prostate gland, the prostatic cancer lesions in inner and outer parts of prostate glands by transrectal contrast enhanced ultrasonography (TRCEUS) in order to provide valuable information for diagnosing of prostatic cancers. Methods: The ultrasound contrast agent was SonoVue (from Bracco Company, Italian). Instrument adopted Esaote Company Technos DU8 (transrectal ultrasonography). We observed the starting and ending times of transrectal contrast enhancement in the normal prostate inner gland group (16 cases), normal prostate outer gland group (16 cases), and the prostatic cancer lesions in inner gland group (8 cases) as well as in outer gland group (11 cases), respectively. Results: There was no significant difference in the starting time of the normal prostate glands between the inner gland and outer gland groups (P>0.05), likewise no significant difference between the cancer lesions in the inner gland and outer gland groups (P>0.05), but starting times of the cancer lesions in both groups were earlier than those of the normal prostate inner and outer glands groups (P<0.01). The ending time of enhancement was no significant difference among all groups (P>0.05). Conclusion: The earlier starting time of contrast enhancement in prostatic cancer lesions by TRCEUS has important value of distinguishing the cancer lesions from normal prostate glands. It is helpful to diagnose the prostatic cancer lesions.展开更多
Objectives—to determine correlation between GSs(Gleason scores)on needle biopsy and RP(radical prostatectomy),evaluating diagnostic tests on biopsy and RP within the last years,between 1984 and 2018.Method—analysis ...Objectives—to determine correlation between GSs(Gleason scores)on needle biopsy and RP(radical prostatectomy),evaluating diagnostic tests on biopsy and RP within the last years,between 1984 and 2018.Method—analysis of 100 patients,diagnosed with PCa(prostate cancer)needle biopsy using 18-gauge needle,who underwent RP with lymphadenectomy and for which preoperative and postoperative GSs were available.GS group analysis used three categorization schemes for differentiation:mild,moderate and poor for the whole group and we determined SE(sensitivity),SP(specificity),PVPR(positive predictive value),negative predictive value and accuracy.Results—we found that 42%of the patients had no changes between GS on biopsy and prostatectomy,while 20%were overgraded and 38%undergraded by needle biopsy.Graduation of+1 point in GS(32%)or-1 point(17%)was the most common.Most patients were classified as moderately differentiated by biopsies(78 and 35%in scheme 1 and 2 or 3,respectively),while 43%of patients received an intermediate differentiation classification.Biopsy accuracy varied from 44 to 76%for the analysis of all three schemes.Conclusion—there are differences in correlation between GS on biopsy and on surgical specimen,and Gleason’s graduation also depends on the experience of the pathologist.We have shown that sextant biopsies using 18-gauge and a same group of pathologists showed acceptable concordance values(42%)between the GS on biopsy and prostatectomy.展开更多
Objective To study the effects of 1% tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound （TRUS）-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided ...Objective To study the effects of 1% tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound （TRUS）-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided prostate biopsy were divided into two groups with 50 in each. In Group 1, patients received liquid paraffin, and in Group 2, patients were given 1% tetracaine hydrochloride jelly before biopsy. Pain score was measured by horizontal visual analogue scales （ VAS ）, and pain and discomfort were compared between the two groups. Results The average pain scores at the time of insertion of the ultrasound probe were 2. 9 ＋_1. 7 and 1. 4 ＋_1. 8 （ P =0. 000） and the average pain scores at the time of performing biopsy were 5. 2 ＋-1. 5 and 3. 1 ＋ 1. 7 （P =0. 000） in Group 1 and Group 2, respectively. There were no significant differences between the two groups in terms of age, serum prostate specific antigen, digital rectal examination, TRUS, and biopsy core number （ P 〉 O. 05 ）. There were no significant differences of complications after biopsy, such as hematuria, acute urinary retention, urinary tract infection, rectum bleeding, and fever （ P 〉0. 05）. Conclusion TRUS-guided prostate biopsy is safe. Use of 1% tetracaine hydrochloride jelly in the rectum and anus before TRUS-guided prostate biopsy is an effective method for relieving TRUS-guided prostate biopsy-induced pain during the procedure.展开更多
Objective: to compare the effect of transperineum and transrectal prostate puncture biopsy guided by rectal ultrasound. Methods: 117 patients who underwent perineal and transrectal prostate puncture biopsy from 2019 t...Objective: to compare the effect of transperineum and transrectal prostate puncture biopsy guided by rectal ultrasound. Methods: 117 patients who underwent perineal and transrectal prostate puncture biopsy from 2019 to 2021, including 58 patients and 59 patients from transrectal prostate puncture biopsy group, were selected to compare the final effect of patients with different puncture biopsies. Results: the effect of perineal biopsy was better than transrectal prostate biopsy, and patients were significantly lower than transrectal prostate biopsy. Conclusion: on the whole, the two rectal biopsy methods differ the actual biopsy results, which can check the disease well, but the related complications of perineal puncture biopsy will be relatively low.展开更多
Medical ultrasound,developed after World War II,emerged from the application of sonar technology originally used for submarine detection during the 1950s.In the early stages of this development,the concept of transrec...Medical ultrasound,developed after World War II,emerged from the application of sonar technology originally used for submarine detection during the 1950s.In the early stages of this development,the concept of transrectal ultrasound(TRUS)was proposed.In 1955,Wild and Reid in the United States developed a basic transrectal scanner,but it could only display the rectal mucosa which lacked diagnostic value.展开更多
Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of pe...Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations.We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques.Materials and Methods:A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019–2022 was performed.Results:We identified 319 patients—174 transrectal and 145 transperineal.8 patients who had transperineal biopsy(5.5%)received peri-operative antibiotics,compared to 100%with transrectal biopsy.35.86%of transperineal patients received a bowel preparation,compared to 100%in the transrectal group.44.14%and 49.43%of patients received a prior prostate biopsy in the transperineal and transrectal groups,respectively.Patients in the transperineal biopsy group had zero infectious complications,1 ER visit,and zero 30-day readmissions.This is compared to 9 infectious complications(5.17%,p=0.005),8 ER visits(4.60%,p=0.036),and 730-day readmissions(4.02%,p=0.015)in the transrectal group.Conclusions:In a single institution series,patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy.Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group,there were zero infectious complications or 30-day readmissions.With greater infectious complications with transrectal biopsy and growing antibiotic resistance,we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.展开更多
Hematospermia is a rare condition, but often causes frustration. The reason for this frustration is that theexact incidence of hematospermia remains unknown and its cause is difficult to determine.^1 Many reports in t...Hematospermia is a rare condition, but often causes frustration. The reason for this frustration is that theexact incidence of hematospermia remains unknown and its cause is difficult to determine.^1 Many reports in the past decades have focused on the etiology of hematospermia.^2 Hematospermia is treated initially by administration of antibiotics, coagulants, and sex steroid hormones. However, some cases may prove resistant to this therapy and the condition may continue. For some intractable and agnogenic cases, the therapeutic strategy mentioned above is not very effective. Recently, we treated 63 such nonresponsive patients by direct continuous antibiotic irrigation into the bilateral seminal vesicles through puncture under transrectal ultrasonography （TRUS） guidance.展开更多
文摘Background:Transrectal(TR)and transperineal(TP)biopsies are commonly used methods for diagnosing prostate cancer.However,their comparative effectiveness in conjunction with machine learning(ML)techniques remains underexplored.This study aimed to evaluate the predictive accuracy of ML algorithms in detecting prostate cancer using data derived from TR and TP biopsies.Methods:The clinical records of patients who underwent prostate biopsy at King Saud University Medical City and King Faisal Specialist Hospital and Research Centerin Riyadh,Saudi Arabia,between 2018 and 2025 were analyzed.Data were used to train and testMLmodels,including eXtreme Gradient Boosting(XGBoost),Decision Tree,Random Forest,and Extra Trees.Results:The two datasets are comparable.The models demonstrated exceptional performance,achieving accuracies of up to 96.49%and 95.56%on TP and TR biopsy datasets,respectively.The area under the curve(AUC)values were also high,reaching 0.9988 for TP and 0.9903 for TR biopsy predictions.Conclusion:These findings highlight the potential of MLto enhance the diagnostic accuracy of prostate cancer detection irrespective of the biopsy method.However,TP biopsy data showed marginally higher accuracy,possibly because of the lower risk of contamination.While ML holds great promise for transforming prostate cancer care,further research is needed to address limitations.Collaboration between clinicians,data scientists,and researchers is crucial to ensure the clinical relevance and interpretability of ML models.
文摘Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone.Two hundred and twenty-two patients who underwent transrectal prostate biopsy(TRB)and 216 patients who underwent transperineal prostate biopsy(TPB)between June 2016 and September 2022 were reviewed in this study.In addition,110 patients who received additional targeted biopsies following the systematic TPB were identified.Clinical parameters,including age,PSA derivative,prostate volume(PV),and needle core count,were recorded.The data were fitted via propensity score matching(PSM),adjusting for potential confounders.TPB outperformed TRB in terms of the CDR(49.6%vs 28.3%,P=0.001).The clinically significant prostate cancer(csPCa)detection rate was not significantly different between TPB and TRB(78.6%vs 68.8%,P=0.306).In stratified analysis,TPB outperformed TRB in CDR when the age of patients was 65–75 years(59.0%vs 22.0%,P<0.001),when PV was 25.00–50.00 ml(63.2%vs 28.3%,P<0.001),and when needle core count was no more than 12(58.5%vs 31.5%,P=0.005).The CDR(P=0.712)and detection rate of csPCa(P=0.993)did not significantly differ among the systematic,targeted,and combined biopsies.TPB outperformed TRB in CDR for patients with gray-zone PSA.Moreover,performing target biopsy after systematic TPB provided no additional benefits in CDR.
文摘Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.
基金This review was supported by Nationnal Natural Science Foundation of China （NSFC 81172439）.
文摘This systematic review was performed to compare the efficacy and complications of transperineal （TP） vs. transrectal （TR） prostate biopsy. A systematic research of PUBM ED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer （PCa） detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen （PSA） levels and digital rectal examination （DRE） findings. The Cochrane Collaboration＇s RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials （RCTs） and four casecontrol studies （CCS）, met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups （risk difference （RD）, -0.02; 95% confidence interval （CI）, -0.08-0.03; P=0.34）. Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group （RD, -0.01; 95% CI, -0.05-0.04; P=0.81）. There was no significant difference in PCa detection rate between the saturation TR and TP approaches （31.4% vs. 25.7%, respectively;P=0.3）. There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.
基金the National Nature Science Foundation of China(Grant No.81670625)Shandong Province Natural Science Foundation-Doctoral Fund(No.ZR2017BH104)Shandong Province Natural Science Foundation-Surface Project(No.ZR2018MH006).
文摘This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy(TSV)guided by rea卜time transrectal ultrasonography(TRUS)in managing persistent hematospermia.A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center,prospective,observational study.The median follow-up period was 36.5(range:8.0-97.5)months.TSV was successfully performed in 272(96.8%)patients.The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum.Seven(2.6%),74(27.2%),64(23.5%),and 127(46.7%)patients had Types I(through the ejaculatory duct in the urethra),II(through the ejaculatory duct in the prostatic utricle),III(transutricular fenestration through a thin membrane),and IV(real-time transrectal ultrasound-guided transutricular fenestration)approach,respectively.In patients who successfully underwent surgery,bleeding occurred in the seminal vesicle in 249(91.5%)patients.Seminal vesiculitis,calculus in the prostatic utricle,calculus in the ejaculatory duct,calculus in the seminal vesicle,prostatic utricle cysts,and seminal vesicle cysts were observed in 213(78.3%),96(35.3%),22(8.1%),81(29.8%),25(9.2%),and 11(4.0%)patients,respectively.Hematospermia was alleviated or disappeared in 244(89.7%)patients 12 months after surgery.Fifteen patients had recurrent hematospermia,and the median time to recurrence was 7.5(range:2.0-18.5)months.TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.
文摘Obstructive azoospermia （OA） is one of the most common causes of male infertility. Transrectal ultrasound （TRUS） has been used to diagnose OA for many years. From 2009 to 2013, we evaluated a prospective cohort of 1249 patients with suspected OA using TRUS. It was found that dilation of the ejaculatory duct （ED） （29.9%, 374/1249） was the most common cause of OA, followed by seminal vesicle （SV） abnormalities （28.5%, 356/1249）. A total of 237 patients were diagnosed with congenital defects （agenesis and/or hypoplasia） of the SV, constituting more than half of the cases of SV disease in OA （19.0%, 237/1249）. In contrast to ED, congenital defects of the SV could not be corrected with surgical treatment. Therefore, it is meaningful to compare TRUS and magnetic resonance imaging （MRI） for accurate diagnosis of SV defects. Among our patients, 30 with agenesis or/and hypoplasia of the SV on TRUS were further evaluated using pelvic MRI within 2 years, with the objective of verifying the TRUS results. The concordance rate for diagnosing congenital defects of the SV was 73.3% （22/30）. We concluded that TRUS is a reliable and convenient method for diagnosing agenesis or hypoplasia of the SV in OA patients with a high concordance with MRI while MRI is useful in patients with inconclusive TRUS findings.
文摘The aim of this study is to evaluate the ability of the random forest algorithm that combines data on transrectal ultrasound findings, age, and serum levels of prostate-specific antigen to predict prostate carcinoma. Clinico-demographic data were analyzed for 941 patients with prostate diseases treated at our hospital, including age, serum prostate-specific antigen levels, transrectal ultrasound findings, and pathology diagnosis based on ultrasound-guided needle biopsy of the prostate. These data were compared between patients with and without prostate cancer using the Chi-square test, and then entered into the random forest model to predict diagnosis. Patients with and without prostate cancer differed significantly in age and serum prostate-specific antigen levels （P 〈 0.001）, as well as in all transrectal ultrasound characteristics （P 〈 0.05） except uneven echo （P = 0.609）. The random forest model based on age, prostate-specific antigen and ultrasound predicted prostate cancer with an accuracy of 83.10%, sensitivity of 65.64%, and specificity of 93.83%. Positive predictive value was 86.72%, and negative predictive value was 81.64%. By integrating age, prostate-specific antigen levels and transrectal ultrasound findings, the random forest algorithm shows better diagnostic performance for prostate cancer than either diagnostic indicator on its own. This algorithm may help improve diagnosis of the disease by identifying patients at high risk for biopsy.
文摘Chronic prostatitis can affect the sperm＇s quality. Previous studies have shown that transrectal microwave thermotherapy （TRMT） results in symptomatic relief in patients with chronic prostatitis, but the effects on sperm have not been carefully investigated. This study evaluates the impact of TRMT on the relief or decrease of symptoms and quality of sperm when used to treat patients with chronic nonbacterial prostatitis. Sixty patients were enrolled in the study. TRMT treatment was administered over 5 days, 1 h per day. Semen examination was carried out pretreatment and immediately at the conclusion of the 5-day treatment. Also, it was repeated 1 month, 3 months, and 6 months later. The treatment＇s symptom relief efficacy was evaluated using the National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI）. After the treatment, the overall NIH-CPSI scores were lower compared to those of pretreatment. In addition, the white blood cells and lecithin in expressed prostatic secretion were normal after the treatment. The sperm count was decreased by 23.8% 3 months after the treatment, sperm motility was reduced by 10.3% immediately after treatment, and sperm deformity was increased by 17.2%. The sperm volume and PH were not affected. However, the sperm quality recovered after treatment and the malformation rate was also lower at 6 months after treatment. TRMT is a favorable and safe treatment option for patients with nonbacterial chronic prostatitis. It could relieve the patient＇s symptoms and impact on sperm quality in the short-term.
文摘BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of DAM.The value of ultrasonography in the diagnosis of DAM is still controversial.Through a literature review,we summarized the current state of ultrasonic examination for DAM and reported for the first time the contrast-enhanced ultrasound(CEUS)features of DAM seen using a biplane transrectal probe.CASE SUMMARY A 37-year-old woman presented with a sacrococcygeal mass that had gradually increased in size over the previous 6 mo.MRI and CT examinations failed to allow a definite diagnosis to be made.Transperineal core needle biopsy(CNB)guided by transrectal ultrasound and CEUS was suggested after a multidisciplinary discussion.Grayscale ultrasound of the lesion showed a layered appearance with alternating hyperechoic and hypoechoic patterns.Transrectal CEUS showed a laminated distribution of the contrast agent that was consistent with the layered appearance of the tumor on grayscale ultrasound.We performed transperineal CNB of the enhanced area inside the tumor under transrectal CEUS guidance and finally made a definitive diagnosis of DAM through histopathology.The patient underwent laparoscopic-assisted transabdominal surgery combined with transperineal surgery for large pelvic tumor resection and pelvic floor peritoneal reconstruction.No recurrence or metastasis was found at the ninemonth follow-up.CONCLUSION Transrectal CEUS can show the layered perfusion characteristics of the contrast agent,guiding subsequent transperineal CNB of the enhanced area within the DAM.
基金This work was supported in part by the National Natural Science Foundation of China(No.81671695,81725008,81801700 and 81927801)Fundamental Research Funds for the Central Universities(No.22120190213)+1 种基金Shanghai Municipal Health Commission(No.2019LJ21 and SHSLCZDZK03502)the Science and Technology Commission of Shanghai Municipality(No.19DZ2251100 and 19441903200).
文摘The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data System(PI-RADS)system for avoiding unnecessary mpMRI-guided targeted biopsy(TB).From January 2018 to October 2019,fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients.The study included 188 suspicious lesions on mpMRI in 156 patients,all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy(SB).Univariate analyses were performed to investigate the relationship between TRUS features and PCa.Then,logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa.The detection rates of PCa based on TB alone,SB alone,and combined SB and TB were 55.9%(105 of 188),52.6%(82 of 156),and 62.8%(98 of 156),respectively.The significant predictors of PCa on TRUS were hypoechogenicity(odds ratio[OR]:9.595,P=0.002),taller-than-wide shape(OR:3.539,P=0.022),asymmetric vascular structures(OR:3.728,P=0.031),close proximity to capsule(OR:3.473,P=0.040),and irregular margins(OR:3.843,P=0.041).We propose subgrouping PI-RADS score 3 into categories 3a,3b,3c,and 3d based on different numbers of TRUS predictors,as the creation of PI-RADS 3a(no suspicious ultrasound features)could avoid 16.7%of mpMRI-guided TBs.Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.
文摘Introduction: To present the initial experience of 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance by using a toothed oval clamp. Case Presentation: One patient received 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance by using a toothed oval clamp. Better direct vision and exposure could be acquired for performing laparoscopic surgical procedure, avoiding additional port inserted. Using this procedure, with strictly adhering to the principles of laparoscopic colectomy and oncological procedure, along with the specimen exteriorized via recta, transacted and a stapled anastomosis performed, no incision can be achieved at the end of an operation. The operative time was 180 minutes. The estimated blood loss in the course of an operation was 80 ml. The patient recovered quickly after surgery, with no post-operative pain and no incision. The patient was dischanged home on the 6th postoperative day. Conclusions: With a transrectal assistance by using a toothed oval clamp, 3-port laparoscopic surgery for rectal cancer could be achieved without no incision at the end of the operation, the same as NOTES. It is enormously advantageous to the patient and suitable for application in developing countries, especially in a rural area.
文摘Objective: To observe the sonographic and hemodynamic features of hypoechoic hypertrophic lesions and hypoechoic cancer lesions in the hypertrophic prostate inner glands, in order to raise the accuracy of early diagnosis rate for prostate cancer. Methods: 31 cases of hypoechoic hypertrophic lesions and 18 cases of hypoechoic cancer lesions in the hypertrophic prostate inner glands were observed by transrectal ultrasonography and comparatively analyze the shape, edge and the systolic peak velocity (Vs) , resistance index (RI) and pulsatility index (PI) of the lesions. Results: In contrast with hypertrophic group, the cancer group presented irregular shape and unclear edge, and obviously higher Vs, RI and PI. Conclusion: The sonographic appearance and Vs. RI. PI have important value in distinguishing hypoechoic hypertrophic lesions and hypoechoic cancer lesions in the hypertrophic prostate inner glands.
文摘Objective:The aim of the study was to detect the valuable ultrasonographic features in diagnosing prostate cancer.Methods:The patients who underwent transrectal ultrasound in the period from May 2005 to October 2009 at the 1st Affiliated Hospital of Dalian Medical University,China,were included,with needle biopsy diagnosis for patients with the prostate cancer and prostatic hyperplasia.Seventy-four cases of prostate cancer were diagnosed as adenocarcinoma,compared with 51 cases diagnosed as prostatic hyperplasia.Retrospective analysis of patients with transrectal ultrasound were done,comparing the difference between the two groups in the echo level (hypoechogenic),outlines (ill-defined margin),posterior acoustic attenuation,periphery halo,microcalcification incidence,the blood supply level,peak systolic velocity (Vs) and resistance index (RI).Results:The ratios of hypoechogenic lesions in the prostate cancer group and prostatic hyperplasia group were 56.76% and 35.90%,respectively (P<0.05),the ratios of irregular outlines were 85.14% and 15.38% respectively (P<0.05),the ratios of microcalcification were 39.19% and 10.26%,respectively (P < 0.05),the ratios of posterior acoustic attenuation were 41.89% and 12.82%,respectively (P<0.05),and the ratios of periphery halo were 35.14% and 38.46% respectively (P>0.05).Vs of the two groups were (44.00 ± 15.30) cm/s and (17.32 ± 4.65) cm/s,respectively (P<0.05).RI of the two groups were 0.76 ± 0.10,and 0.51 ± 0.03 respectively (P<0.05).The significant correlation was designated in the blood supply level between the prostate cancer group and prostatic hyperplasia group (r=-0.388,P<0.01).Higher revascularization grade was seen in the prostate cancer group compared to benign prostatic hyperplasia group.Conclusion:(1) The significant roles for diagnosing prostate cancer are hypoechogenic,irregular outlines,spiculation,microcalcification,high revascularization grade,posterior acoustic attenuation,high Vs and high RI.(2) It could not help in diagnosing prostate cancer with ultrasonographic periphery halo or not.
文摘Objective:The aim of the study was to observe the characters and differences of the inner and outer parts of prostate gland, the prostatic cancer lesions in inner and outer parts of prostate glands by transrectal contrast enhanced ultrasonography (TRCEUS) in order to provide valuable information for diagnosing of prostatic cancers. Methods: The ultrasound contrast agent was SonoVue (from Bracco Company, Italian). Instrument adopted Esaote Company Technos DU8 (transrectal ultrasonography). We observed the starting and ending times of transrectal contrast enhancement in the normal prostate inner gland group (16 cases), normal prostate outer gland group (16 cases), and the prostatic cancer lesions in inner gland group (8 cases) as well as in outer gland group (11 cases), respectively. Results: There was no significant difference in the starting time of the normal prostate glands between the inner gland and outer gland groups (P>0.05), likewise no significant difference between the cancer lesions in the inner gland and outer gland groups (P>0.05), but starting times of the cancer lesions in both groups were earlier than those of the normal prostate inner and outer glands groups (P<0.01). The ending time of enhancement was no significant difference among all groups (P>0.05). Conclusion: The earlier starting time of contrast enhancement in prostatic cancer lesions by TRCEUS has important value of distinguishing the cancer lesions from normal prostate glands. It is helpful to diagnose the prostatic cancer lesions.
文摘Objectives—to determine correlation between GSs(Gleason scores)on needle biopsy and RP(radical prostatectomy),evaluating diagnostic tests on biopsy and RP within the last years,between 1984 and 2018.Method—analysis of 100 patients,diagnosed with PCa(prostate cancer)needle biopsy using 18-gauge needle,who underwent RP with lymphadenectomy and for which preoperative and postoperative GSs were available.GS group analysis used three categorization schemes for differentiation:mild,moderate and poor for the whole group and we determined SE(sensitivity),SP(specificity),PVPR(positive predictive value),negative predictive value and accuracy.Results—we found that 42%of the patients had no changes between GS on biopsy and prostatectomy,while 20%were overgraded and 38%undergraded by needle biopsy.Graduation of+1 point in GS(32%)or-1 point(17%)was the most common.Most patients were classified as moderately differentiated by biopsies(78 and 35%in scheme 1 and 2 or 3,respectively),while 43%of patients received an intermediate differentiation classification.Biopsy accuracy varied from 44 to 76%for the analysis of all three schemes.Conclusion—there are differences in correlation between GS on biopsy and on surgical specimen,and Gleason’s graduation also depends on the experience of the pathologist.We have shown that sextant biopsies using 18-gauge and a same group of pathologists showed acceptable concordance values(42%)between the GS on biopsy and prostatectomy.
文摘Objective To study the effects of 1% tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound （TRUS）-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided prostate biopsy were divided into two groups with 50 in each. In Group 1, patients received liquid paraffin, and in Group 2, patients were given 1% tetracaine hydrochloride jelly before biopsy. Pain score was measured by horizontal visual analogue scales （ VAS ）, and pain and discomfort were compared between the two groups. Results The average pain scores at the time of insertion of the ultrasound probe were 2. 9 ＋_1. 7 and 1. 4 ＋_1. 8 （ P =0. 000） and the average pain scores at the time of performing biopsy were 5. 2 ＋-1. 5 and 3. 1 ＋ 1. 7 （P =0. 000） in Group 1 and Group 2, respectively. There were no significant differences between the two groups in terms of age, serum prostate specific antigen, digital rectal examination, TRUS, and biopsy core number （ P 〉 O. 05 ）. There were no significant differences of complications after biopsy, such as hematuria, acute urinary retention, urinary tract infection, rectum bleeding, and fever （ P 〉0. 05）. Conclusion TRUS-guided prostate biopsy is safe. Use of 1% tetracaine hydrochloride jelly in the rectum and anus before TRUS-guided prostate biopsy is an effective method for relieving TRUS-guided prostate biopsy-induced pain during the procedure.
文摘Objective: to compare the effect of transperineum and transrectal prostate puncture biopsy guided by rectal ultrasound. Methods: 117 patients who underwent perineal and transrectal prostate puncture biopsy from 2019 to 2021, including 58 patients and 59 patients from transrectal prostate puncture biopsy group, were selected to compare the final effect of patients with different puncture biopsies. Results: the effect of perineal biopsy was better than transrectal prostate biopsy, and patients were significantly lower than transrectal prostate biopsy. Conclusion: on the whole, the two rectal biopsy methods differ the actual biopsy results, which can check the disease well, but the related complications of perineal puncture biopsy will be relatively low.
文摘Medical ultrasound,developed after World War II,emerged from the application of sonar technology originally used for submarine detection during the 1950s.In the early stages of this development,the concept of transrectal ultrasound(TRUS)was proposed.In 1955,Wild and Reid in the United States developed a basic transrectal scanner,but it could only display the rectal mucosa which lacked diagnostic value.
基金the Cancer Institute of New Jersey is supported by a grant from the National Cancer Institute:P30CA072720Arnav Srivastava is supported by a training grant from the National Cancer Institute:T32CA180984.
文摘Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations.We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques.Materials and Methods:A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019–2022 was performed.Results:We identified 319 patients—174 transrectal and 145 transperineal.8 patients who had transperineal biopsy(5.5%)received peri-operative antibiotics,compared to 100%with transrectal biopsy.35.86%of transperineal patients received a bowel preparation,compared to 100%in the transrectal group.44.14%and 49.43%of patients received a prior prostate biopsy in the transperineal and transrectal groups,respectively.Patients in the transperineal biopsy group had zero infectious complications,1 ER visit,and zero 30-day readmissions.This is compared to 9 infectious complications(5.17%,p=0.005),8 ER visits(4.60%,p=0.036),and 730-day readmissions(4.02%,p=0.015)in the transrectal group.Conclusions:In a single institution series,patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy.Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group,there were zero infectious complications or 30-day readmissions.With greater infectious complications with transrectal biopsy and growing antibiotic resistance,we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.
文摘Hematospermia is a rare condition, but often causes frustration. The reason for this frustration is that theexact incidence of hematospermia remains unknown and its cause is difficult to determine.^1 Many reports in the past decades have focused on the etiology of hematospermia.^2 Hematospermia is treated initially by administration of antibiotics, coagulants, and sex steroid hormones. However, some cases may prove resistant to this therapy and the condition may continue. For some intractable and agnogenic cases, the therapeutic strategy mentioned above is not very effective. Recently, we treated 63 such nonresponsive patients by direct continuous antibiotic irrigation into the bilateral seminal vesicles through puncture under transrectal ultrasonography （TRUS） guidance.
