Korean J Radiol.  2020 Apr;21(4):422-430. 10.3348/kjr.2019.0576.

Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management

Affiliations
  • 1Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. mmhoan@gmail.com
  • 2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea.
  • 4Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Abstract

The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.

Keyword

Prostate biopsy; Standard technique; Anticoagulant; Antiplatelet; Enema; Antimicrobial prophylaxis; Local anesthesia; Periprostatic neurovascular bundle block; Intrarectal lidocaine gel application; Opioid; Biopsy core; Biopsy needle

MeSH Terms

Analgesics, Opioid
Anesthesia, Local
Anti-Bacterial Agents
Antibiotic Prophylaxis
Anticoagulants
Biopsy*
Cephalosporins
Consensus*
Enema
Glycerol
Humans
Lidocaine
Methods
Needles
Pain Management*
Platelet Aggregation Inhibitors
Postal Service
Prostate*
Surveys and Questionnaires
Analgesics, Opioid
Anti-Bacterial Agents
Anticoagulants
Cephalosporins
Glycerol
Lidocaine
Platelet Aggregation Inhibitors
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