To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability. Patients and methodsObservational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint TM TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs). ResultsSome 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'. ConclusionOur data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.

SummaryThirty cases offemoral sub-capitalfractures. Garden grades [1][2][3][4]

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Objectives: A retrospective study was conducted to examine the feasibility and safety of performing trans-urethral resection of bladder tumour (TURBT) in newly diagnosed patients as a day case operation. Patients and methods: All patients who underwent a primary TURBT over a 12 month period were included. Data were collected on patient demographics, tumour characteristics, day case vs. inpatient admission, indications for inpatient admission, re-admission rates within 28 days, and surrogate markers for quality of resection including recurrence rates. Results: A total of 172 patients were included. TURBT was performed as a day case procedure on 138 patients (80.2%). Rates of re-admission within 28 days were 7.2% and 5.9% in the day case and inpatient cohorts respectively. One hundred and thirty (75.6%) patients had non-muscle invasive bladder cancer (NMIBC). Of these, 84 (64.6%) were found to have detrusor muscle in their specimens, and 86 (66.2%) received peri-operative mitomycin C. Twelve month recurrence rates were 12%, 27% and 33% for low, intermediate and high-risk NMIBC respectively. Conclusion: This study shows that day case surgery for TURBT is feasible in the majority of patients, with a low rate of re-admission. Our data suggest that day case TURBT is suitable as standard practice in our institution and should be considered by others. Level of evidence: 2b.