INTRODUCTION AND OBJECTIVE: Multiple transperineal prostate (TP) biopsy templates exist but with uncertainty regarding the optimal sampling strategy. Prior work shows that anterior base cores from the transition zone have minimal diagnostic yield. Thus, we aimed to compare the cancer detection rate (CDR) between the 12-core modified Barzell (MB) template with a novel Michigan Urological Surgery Improvement Collaborative (MUSIC) TP biopsy template created to increase peripheral zone sampling where cancer detection is greatest. METHODS: All patients undergoing freehand TP biopsy from June 2017 to November 2020 were included. The MB template was used from June 2017 to January 2019 and modified to develop the MUSIC TP template which was performed from January 2019 onwards. Patient demographic, clinical, and pathological variables were collected. Bivariate and multivariable logistic regression model was performed to compare CDR between MB and MUSIC TP biopsy templates. RESULTS: A total of 283 biopsies were included utilizing the MB (n[139) and MUSIC template (n[144). Overall CDR of the MB and MUSIC TP templates were 38.1% and 47.2%, respectively (p[0.122). CDR of !Gleason Grade group (GG) 2 for the MB and MUSIC TP templates were 21.6% and 25%, respectively, (p[0.497). Controlling for age, race, PSA, digital rectal exam, urologist, prior diagnosis and family history of prostate cancer, no significant difference between the templates in overall CDR (OR[1.11, CI 0.61-2.04, p[0.73) or !GG2 CDR (OR[1.15, CI 0.68-1.94, p[0.59) was observed. A subset of MUSIC TP biopsies (n[103) that had 1-2 additional midline core(s) obtained (apex, base) were identified. The addition of the midline cores only resulted in a single GG1 diagnosis and no cases of higher risk disease not identified with the standard MUSIC template.CONCLUSIONS: There is no significant difference in CDR between the MB and MUSIC TP biopsy templates. The addition of midline peripheral zone cores to the MUSIC TP template does not improve cancer diagnosis and should not be routinely included in sampling. Continued evaluation with greater power may demonstrate a significant difference in CDR between sampling strategies.
the intraoperative results , there were no significant differences in surgical time (109 vs 102 minutes, p[0.52). Laser time was longer for HoLEP-VB (39.2 vs 24.7 minutes, p<0.001). The mean hemoglobin decrease was 1.8 g/L of the cohort and there was no difference in the primary endpoint between the groups. In addition, there were no significant differences in the length of stay, days of use of urinary catheter and incidence of complications, including the need for transfusion and reinterventions (Table 2).CONCLUSIONS: The use of Virtual Basket pulse modulation during HoLEP appears to provide a similar hemostatic control than Thulium-YAG. Patients that underwent HoLEP-VB had similar perioperative outcomes to patients treated with ThuLEP.
Background Urosepsis following transrectal ultrasound guided prostate biopsy (TRUS PB) occurs in 0.3-3.1% of patients. Our center gives ciprofloxacin and ceftriaxone prophylaxis. With rise in urinary pathogens resistant to fluoroquinolones or producing extended spectrum beta lactam (ESBL+), prophylactic regimen might need changing. Studies have highlighted cost effectiveness of rectal screening for ESBL+ organism prior to TRUS PB to determine target antibiotic. We compare our center’s incidence of urosepsis admissions following TRUS PB to the expected rate and calculate cost-effectiveness of pre-procedure screening to prevent urosepsis admissions. Methods All patients with CPT billing code 55700 (biopsy, prostate; needle or punch, single or multiple, any approach) from January 2020 through January 2021 were identified retrospectively. Charts were queried for emergency department or urgent care visits and hospital admissions within two weeks of TRUS PB and admissions reviewed for evidence of urosepsis and ESBL+ cultures. Hospitalization cost was compared to the extrapolated cost of doing pre-procedural rectal swabs. Cost of rectal swab and culture was estimated at $39.02 per swab, and identification and susceptibility at $67 per isolate. Results 33 of 1593 patients presented to our institution within 2 weeks of TRUS PB over a 13 month period. 3 were admitted for urosepsis post TRUS PB (2 with ESBL+ infection, 1 with no growth on culture), 12 had ED visits relating to their TRUS PB without urosepsis, (2 due to UTI with other organisms) and 18 visits were unrelated to TRUS PB. Our urosepsis admission rate was 0.19% (for ESBL+ 0.13%). Cost of the 3 hospitalizations was $37,910.92 ($27,063.76 for 2 ESBL+ infections). Rectal swabs would in theory have prevented 2 admissions. Cost of swab and culture would be $62,158.86. 50% of the swabs would need further testing to identify ESBL+ organism, for an additional cost of $53,365.50. Conclusion Given lower than expected urosepsis admission rates at our institution after TRUS PB, pre-procedure rectal swabs would not be cost effective, especially since some admissions may be unavoidable. The cost analysis is an underestimate as a visit some days prior to procedure would be scheduled and the staff resource utilization to collect the swab is not accounted for. Disclosures All Authors: No reported disclosures.
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