Die Probenentnahme von Gewebe aus der Prostata
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Please check your Internet connection and reload this page. If the problem continues, please let us know and we'll try to help. An unexpected error occurred. Issue doi: Raman, J. Single institution and population-based studies highlight that infectious Nadelbiopsie der Prostata following transrectal ultrasound guided prostate needle biopsy TRUS PNB are increasing.
Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. All patients are administered three days of oral antibiotic therapy Nadelbiopsie der Prostata to biopsy.
A 4 cm x 4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic Nadelbiopsie der Prostata is used to paint both the perianal area and the rectal vault to a distance of 3 Nadelbiopsie der Prostata from the anus.
The povidone iodine solution is then allowed to dry for 2 Nadelbiopsie der Prostata 3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of with an associated reduction of post-biopsy infections from 4.
The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections.
Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Prostate cancer is the most common cancer in men and the second leading cause of cancer-related mortality. Inapproximatelycases will be diagnosed in the United States with almost 30, men succumbing to this malignancy. Each Nadelbiopsie der Prostata biopsy requires passage of an 18 G needle through the rectal wall into the highly vascular prostate.
Therefore, the theoretical risk of bleeding and infection due to bacterial Nadelbiopsie der Prostata exists following the procedure. Nonetheless, the actuarial complication rate post-procedure has historically remained low. Antibiotic prophylaxis prior to TRUS PNB Nadelbiopsie der Prostata routinely prescribed with quinolone-based antibiotics being the Nadelbiopsie der Prostata frequently used agents.
Despite adequate prophylaxis, contemporary research implicates an increase in infectious complications post-biopsy. To this end, several different avenues are under investigation. One approach involves administration of an intravenous or intramuscular antibiotic at time of biopsy in conjunction with an oral quinolone.
Another recently investigated methodology incorporates use of a pre-biopsy rectal Nadelbiopsie der Prostata to screen patients colonized with quinolone-resistant rectal flora.
While the methodology is elegant, the actual process of obtaining such swabs, selectively culturing on a quinolone selective medium, and tailoring antibiotics thereafter requires a clinical and laboratory infrastructure that may be lacking in many clinical Nadelbiopsie der Prostata. Administration of a topic antiseptic to reduce rectal vault microorganism colony counts prior to biopsy may present an alternative strategy to limit TRUS PNB infections.
Povidone iodone is an inexpensive, readily available agent that is documented to reduced bacterial counts when applied to surgical sites.
Applications in both colorectal and gynecologic surgeries are well known. Therefore, use of povidine iodine as a Nadelbiopsie der Prostata preparation would present a producible, simple, and cost-effective method to reduced TRUS PNB infections without need for Nadelbiopsie der Prostata preparation prior to biopsy.
All patients undergoing TRUS PNB were initially seen in a specialty urology clinic for referral or initial evaluation for prostate cancer Nadelbiopsie der Prostata. The TRUS PNB procedure was discussed with all patients and associated risks including infection, bleeding, and urinary retention were clarified. All patients received three days of oral antibiotic prophylaxis with either a quinolone-based medication i.
Subscription Required. Please recommend JoVE to Nadelbiopsie der Prostata librarian. This patient related study was approved by the institutional review board IRB for human research. This PIRP technique has been in practice since January of until present with patients having been enrolled in this quality improvement measure.
In this time, only one patient Nadelbiopsie der Prostata. This patient was colonized with a multi-drug resistant E. Rectal swabs following administration of PIRP in this patient noted that the rectal vault was still colonized with 2.
Nadelbiopsie der Prostata contemporary population undergoing TRUS PNB between January and January who only received oral antibiotic therapy served as a comparative control population. This cohort experienced a 4. All 5 patients with sepsis had multi-drug resistant E. Overall, integration of the PIRP technique into clinical practice was associated with a Nadelbiopsie der Prostata in post-biopsy infections from 4. Nadelbiopsie der Prostata cultures were performed in the patients before and after PIRP to document changes in rectal vault microorganism colony count attributable to the treatment.
Briefly, cultures were obtained by use of sterile culture swabs. The swabs were then immersed in PBS, vortexed to release the bacteria, and serially diluted on Mueller-Hinton agar plates. Bacteria were allowed to grow for 36 - 48 hr and counted. All morphological varieties of bacterial colonies arising on the plate were included to provide a total count. Overall, a No adverse effects of the PIRP were reported by patients either at time of administration or 7-days post-procedure.
Figure 1. Based on this principle, we have explored the simple method of using a topic antiseptic such as povidone iodine to reduce microorganism colony counts prior to prostate needle biopsy. Our experience highlights a reduction from 4.
Our results with topical povidone are similar to that presented by other groups. Specifically, Park et al. This study noted an infectious complication in 8 patients 6. Recently, AbuGhosh et al. The novelty and attractiveness of our PIRP technique as presented in this video is several fold.
First, the PIRP requires no additional preparation or systemic antibiotic therapy beyond the standard oral prophylaxis agent. Second, the PIRP technique is cheap with minimal associated cost for practices to purchase commercially available povidone iodine.
Nadelbiopsie der Prostata, the Nadelbiopsie der Prostata is simple Nadelbiopsie der Prostata the ability of any urologist to perform within current office infrastructure while adding only 5 min to a biopsy procedure. Finally, the side effect profile of PIRP therapy is low with no patients in our current series presenting with adverse events.
There are several key steps in this protocol that warrant further discussion. This process is essential as the bactericidal effect of povidone iodine is predicated on the solution drying on a mucosal surface.
A second key protocol step involves painting the perianal area with povidone iodine thereby preventing translocation of bacteria in the perianal area into the rectal vault at the time of biopsy. The protocol typically does not require modifications owing to its simplicity in delivery.
Certain scenarios such as those patients with rectal fissures or exposed hemorrhoids may experience local discomfort and irritation from the povidone iodine solution. Therefore, this therapy is withheld in such patients. Additionally, patients with an iodine or shellfish allergy are at risk for an allergic reaction rarely anaphylaxis and therapy should not be used in such patients.
Patients undergoing local anesthesia experienced no adverse reactions to the PIRP although larger studies are necessary to validate Nadelbiopsie der Prostata observations. Limitations of this approach involve the delivery system of the iodine into the rectal vault. Therefore, the Nadelbiopsie der Prostata exists to improve the delivery system of Nadelbiopsie der Prostata PIRP to further reduce rectal microorganism counts.
Additionally, the data presented within this study are done in the context of a prospective, albeit non-randomized design. We acknowledge that randomization of Nadelbiopsie der Prostata would have provided the most objective means to Nadelbiopsie der Prostata treatment efficacy. You must be signed in to post a comment.
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Patient Preparation and Positioning Bring the patient to the procedure suite and place them on their right or left side with knees flexed to the chest. Perform a surgical timeout whereby the patient, surgical procedure, and indication are Nadelbiopsie der Prostata and confirmed. When indicated, administer intravenous sedation via the anesthesia service. Insert gloved finger after lubrication into rectal vault and examine prostate to feel for potential suspicious areas in need of focused attention during transrectal ultrasonography.
Open up a 4 cm x 4 cm sterile gauze, soak in the povidone iodine slurry, and then insert into the rectal vault. Only a small tail of gauze is left emanating from the anus. Insert this gynecologic swab into the rectal vault to a distance of 3 cm from the anus.
To further maximize the exposure of the rectal mucosa to PIRP, swab the rectal vault in a similar manner at least three times.
Nadelbiopsie der Prostata a sterile rectal swab to culture the rectal vault.