Transperineal Prostate Biopsy: A Practical Startup Guide

First, the doctors discuss why they invested in learning to perform transperineal biopsy. Dr. Allaway explains that transrectal biopsy can lead to rectal bleeding, infections, and sepsis. He also believes that the perineal approach offers the proper trajectory to sample the prostate appropriately. Next, they discuss the equipment required for transperineal biopsies, such as probes, ultrasounds, grid steppers, and needle sheaths. They weigh the pros and cons of performing the procedure in the office versus in the clinic. Additionally, they discuss different costs and features of different probes.

Next, they discuss their techniques for obtaining the transperineal biopsy, including tips for patient positioning, probe maneuvers, and local anesthetic injections. Dr. Javier-DesLoges uses a local injection of lidocaine, normal saline, and sodium bicarbonate. Dr. Allaway then shares his advice on how to deal with obstacles, such as stool burden and rectal gas. They end the episode by highlighting the importance of collaboration and learning from others’ techniques. Dr. DesLoges strongly recommends the AUA course on transperineal biopsies as an educational resource.