Can residents perform transrectal ultrasound-guided prostate biopsy with patient comfort comparable to biopsy performed by attending staff urologists?

Abstract

Transrectal ultrasound (TRUS)-guided prostate biopsy is a critical diagnostic tool in urology. Residents require adequate training but resident education could have a deleterious effect on patient comfort and morbidity. We compared pain associated with prostate biopsy when performed by staff versus resident urologists in order to determine the impact of resident training. Male patients scheduled to undergo prostate biopsy were assigned to either a staff urologist or a resident as the primary surgeon. All residents were directly assisted by the staff surgeon. The patients were given a visual analogue scale (VAS; 0-100 mm) and were asked to assess the pain associated with each component of prostate biopsy, including probe insertion, anesthetic injection and the biopsies themselves. The mean VAS scores for probe insertion, anesthetic injection and biopsies were 31.0, 30.4 and 30.1, respectively, for patients in the staff cohort and 37.1, 28.9 and 33.6, respectively, for those in the resident cohort. There was a statistically significant difference between staff and resident VAS scores, marked by a higher odds of greater pain with ultrasound probe placement (odds ratio (OR) ¼ 1.48, P ¼ 0.012) and the biopsies themselves (OR ¼ 1.52, P ¼ 0.01) in the resident cohort. TRUS biopsy can be performed by adequately trained and supervised resident urologists of all levels, but there is the potential for increased patient pain, particularly with ultrasonic probe insertion and obtaining core biopsies. However, the absolute magnitude of the differences in pain scores between residents and staff was small and may not be clinically meaningful. Such data indicate that urological resident training can be accomplished without compromising patient care and comfort.

Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial

“…When comparing patient-reported comfort in transrectal ultrasound-guided biopsies performed by senior urologist-supervised residents and by attending staff urologists alone, CT Nguyen et al showed that under senior supervision and after a proper amount of training, urology residents can perform the procedure without causing higher levels of discomfort to the patients when compared to those performed by senior urologists [35].…”

The association of level of practical experience in transrectal ultrasonography guided prostate biopsy with its diagnostic outcome

“…There is a clear need for more consistent and standardised training in prostate biopsy techniques, as evidenced by trainee feedback, 5 and the findings of this study and that by Hori et al 13 This need is made more acute by the fact that patients tend to experience more discomfort when biopsied by trainees. 25 Similar to any other surgical procedure, case selection should form an integral part of prostate biopsy training. Our data and those of Hori et al 13 suggest that trainees should focus their practice on patients with serum PSA levels of ≥10ng/ml as diagnostic outcomes for initial extended pattern TRUS guided biopsies in this patient group are similar for novices and experienced operators.…”