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Transperineal Ultrasound Guided Prostatic Biopsy (TPUS)

What is a TPUS biopsy?

A Transperineal Ultrasound guided prostate biopsy (TPUS) is an investigation used to diagnose prostate cancer. In general, a TPUS prostate biopsy is performed in men with an abnormal PSA, a palpable abnormality on a digital rectal examination (DRE) or a rapidly increasing PSAlevel. It is slightly different and more complicated than a TRUS (transrectal ultrasound guided) prostate biopsy and requires specialized equipment.

Preoperative preparation

Once you have decided, in consultation with Dr Swindle, to undergo a TPUS biopsy, a date and time will be booked for the procedure. You will need to begin a clear liquid diet (no solid foods) for 24 hours before the operation and take nothing by mouth after midnight the night before. (Examples of clear liquid – clear stock, jelly, black tea, apple juice).

You will need to be accompanied to and from the procedure as you will not be able to drive after the anaesthetic and you should not be alone the night of the procedure. The procedure itself will not take very long but there are several steps to the procedure.

If you have recently travelled to Asia (prior 6 months) please notify Dr Swindle as this may affect the preparation for your procedure.

tpus photo

Medications

You are usually able to continue taking your prescribed medications during the course of your surgical procedure however it may however be necessary to cease some medications. Be sure to bring all medications that you are currently taking with you to the hospital, including inhalers and sprays, in their labelled containers. Please advise Dr Swindle and your anaesthetist who will discuss with you which of these medicines you should take on the day of surgery and which may need to be avoided.

Many medications can thin the blood and cause excessive bleeding during surgical procedures. It is very important that you cease any blood thinning medications 7-10 days prior to some surgical procedures. However, do not cease any of these medications without discussion with Dr Swindle.

Generally, anti-coagulant medications should be ceased 5 days before the surgical procedure (and you may need to start on other medications when you’re not taking these). A blood test should be performed on the morning of the procedure to ensure that the blood is clotting appropriately. The medications should not be resumed until 1-2 weeks after the surgical procedure but Dr Swindle will discuss the exact timing of restarting these medications with you.

You should stop taking all natural therapy preparations as these may interfere with the clotting ability of the blood.

Please ensure Dr Swindle is aware of all drugs, pills and medications that you take, whether on prescription or not, even if they are not on the list of medications to avoid.

Antibiotics

The antibiotic Ciproxin will be given to you on the day of the procedure. The first Ciproxin tablet should be taken½ hour prior to the procedure. The second tablet should be taken on the night of the procedure. The antibiotics are then continued one tablet each morning and evening after your procedure until the course of 6 tablets is completed.

Information about this antibiotic will be given to you at the time of booking the procedure. Please let Dr Swindle know if this antibiotic is unsuitable or if you have any drug allergies. If you cannot take Ciproxin for any reason then you will be given another antibiotic before and after the procedure.

Microlax enema

You are required to self administer a Microlax enema during the morning of your procedure, prior to arriving at the hospital.

Anaesthetic assessment

You will be assessed by the Anaesthetist prior to the procedure. A general anaesthetic is used for the TPUS. The anaesthetist will check your medical history and ensure you have not eaten or taken any fluids orally for the preceding 6 hours.

About the procedure

After you have been reviewed by the anaesthetist you will be taken into theatre. A drip will be placed in your arm and you will be given an anaesthetic. You will be placed in stirrups and Dr Swindle will insert the ultrasound probe and a series of images and measurements will be taken and the volume of the prostate calculated.

Specialised equipment is used for the procedure and a stepper and biopsy template is attached to the ultrasound probe. A fine biopsy needle is then passed through the skin of the perineum and multiple biopsies of the prostate are taken. Using this technique the anterior zone of the prostate is easily targeted and sampled. This area can potentially be difficult to sample using the standard TRUS technique.

Following the procedure you will be taken back to recovery where you will still be in your bed and the nursing staff will monitor very closely your pulse, blood pressure and breathing. You will be monitored here for approximately 20 minutes. When the nursing staff are happy with your recovery you will be dressed and then placed in the lounge area for a further hour or so where you will be offered some refreshments.

When the staff are happy with your recovery you will be allowed to leave.

You will need to be accompanied to and from the procedure as you will not be able to drive after the anaesthetic and you should not be alone the night of the procedure. You should avoid strenuous activity for 24 hours and should not work the following day. You should not make any major decisions or sign any legal documents for 24 hours after the procedure. This is not because of the procedure itself but as a result of undergoing an anaesthetic.

Potential side effects

There are a number of potential complications from the TPUS biopsy procedure. The vast majority of patients have no problems at all but it is important that you understand what may potentially happen.

Urethral bleeding

Most men do pass a small amount of blood in their urine or leak blood from the penis after the procedure. This is an expected occurrence after the procedure. This should settle within 24-48 hours.

Rectal Bleeding

Most men pass a small amount of blood in the first one or two bowel motions after the procedure. This is an expected occurrence after the procedure. This should settle within 24-48 hours.

Haematospermia

Blood in the semen or dark staining of the semen can persist for up to 3 months after the procedure. This is an expected occurrence and nothing to be concerned about. Sexual activity can continue as normal.

Sepsis

This is a severe form of infection and is otherwise known as blood poisoning. This occurs in 1 in 100-200 patients. The symptoms consist of fevers, chills, shaking, lethargy, warm skin, shortness of breath, rapid heartbeat, drowsiness and a general feeling of being unwell.

Urinary retention

Occasionally patients may have difficulty passing urine after the procedure. This usually happens in older men or men with extremely large prostates. The symptoms consist of difficulty urinating, abdominal pain, poor flow or frequent urination.

Urinary tract infection

Infection of the urine, prostate or testicles can occur after the procedure and can cause symptoms of difficulty urinating, burning on urination, frequent urination, swollen testicles or fevers.

Pain

You may experience mild pelvic discomfort within 24 hours of the biopsy. Panadol, Panadeine, or Digesic are usually all that is required. If you are requiring stronger pain relief then you need to contact Dr Swindle.

Erectile difficulties

Rarely patients have described difficulties in gaining erections after a prostate biopsy. This is very rare and usually occurs in men who have a positive diagnosis and is often related to anxiety.

 

When to contact Dr Swindle post surgery

Dr Swindle is available 24 hours a day 7 days a week on 0409 103 333. Never hesitate to call him if you have any concerns or if you feel unwell. He would prefer to be contacted and know if there are any problems. There are certain complications that require emergency medical treatment.

If any of the following complications occur go immediately to the emergency department where the prostate biopsy was performed or your nearest emergency department. Once you have sought emergency treatment then contact Dr Swindle on 0409 103 333 or have the medical staff contact Dr Swindle. If you are unsure whether or not to go to the hospital then contact Dr Swindle.

  • Urinary tract infection – If you have symptoms of a urinary tract infection such as difficulty urinating, burning on urination, frequent urination, swollen testicles or fevers then seek urgent medical advice as instructed above.
  • Severe infection – Sepsis – If you have symptoms of a severe infection such as fevers, chills, shaking, lethargy, warm skin, shortness of breath, rapid heartbeat, drowsiness or a general feeling of being unwell then seek urgent medical advice as instructed above.
  • Urinary retention – If you are have the symptoms of urinary retention such as difficulty urinating, abdominal pain, poor flow or frequent urination then seek urgent medical advice as instructed above.
  • Bleeding – If you are passing a large amount of blood in your urine or bowel motions and are passing blood clots then seek urgent medical advice as instructed above.
Follow up after a biopsy

Dr Swindle will telephone you within 72 hours following the procedure. Should the results be available any earlier from Pathology, Dr Swindle will call you as soon as they are available.

If the biopsy results are positive for cancer you will be required to come back within the next week or so to discuss this diagnosis in more detail and to discuss treatment options. It is recommended that you bring your wife or partner along to this consultation.

If the biopsy results are negative for cancer you will still require a follow up appointment with Dr Swindle however this can be done at a later stage approximately 4-6 weeks after the biopsy.

It is very important that you do return to discuss your biopsy results with Dr Swindle. Even if they are negative, small prostate cancers can be missed with the initial biopsy, although this is rare.

Occasionally Dr Swindle will recommend a second biopsy either straight away or in the future if any of the following are present or occur:

  • A highly suspicious rectal examination.
  • A persistently rising PSA.
  • A low free/total PSA ratio.
  • Presence of large amounts of PIN (prostatic intraepithelial neoplasia) or atypical cells in the pathology report.

If you have any questions regarding the Transperineal Ultrasound guided prostate biopsy procedure, please contact Dr Swindle’s office on 07 3010 3333 or appointments@qprostate.com.

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