BackTable / Urology / Podcast / Episode #96
Transperineal Prostate Biopsy: A Practical Startup Guide
with Dr. Matthew Allaway and Dr. Juan Javier-DesLoges
On this episode of BackTable Urology, Dr. Aditya Bagrodia, Dr. Matt Allaway (Perineologic Biopsy), and Dr. Juan Javier-DesLoges (UC San Diego) discuss benefits and procedural tips for the transperineal prostate biopsy.
BackTable, LLC (Producer). (2023, May 3). Ep. 96 – Transperineal Prostate Biopsy: A Practical Startup Guide [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Matthew Allaway
Dr. Matthew Allaway is a practicing urologist at Urology Associates in Cumberland and the founder and CEO of Perineologic.
Dr. Juan Javier-DesLoges
Dr. Juan Javier-DesLoges is a urologic oncologist at UC San Diego in California.
Dr. Aditya Bagrodia
Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.
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.
[Dr. Aditya Bagrodia]
Hey, thanks for spending some time with us this afternoon. As I was preparing for this podcast, I was thinking to myself, I grew up on transrectal and fire biopsies, my blocks worked, my clinically significant cancer detection rates for zones three, four, and five were 30%, 60%, and 90%. Every year or so there was a patient who got a bout of sepsis from his biopsy. Why rock the boat? Why do I need to change anything?
[Dr. Matt Halloway]
That is the question and there are two answers to the question. Obviously, the first is complications, which span from rectal bleeding, to infections, to sepsis. In fact, in Norway, they've essentially banned the transrectal biopsy because in that smaller country, they had a handful, five to eight, of deaths a year from a prostate biopsy. We've got complications on one side and then we have cancer detection on the other. There's definitely a building body of data that's showing that the transperineal approach offers the trajectory in order to really sample the prostate properly.
To understand the prostate you've got to understand that these zones are all pancaked within each other and it's not shaped like a rectangle or a box. It's a complicated sphere and we know now where the cancers are hiding and we know just by simple logic of geometrical vectors that going transrectal is not doing the best job of capturing the disease. Those I think are the two issues that in my life pushed me to dedicate the last eight years of research and work in industry to try to change that.
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