Presentation Authors: Masaya Ito*, Madoka Kataoka, Kosuke Takemura, Hiroaki Suzuki, Kazumasa Sakamoto, Yasukazu Nakanishi, Kenichi Tobisu, Fumitaka Koga, Tokyo, Japan
Introduction: Transperineal prostate biopsy (TPB) has reportedly fewer infectious complications and superior detectability for ventral cancer compared with transrectal biopsy. However, TPB is generally considered technically demanding. We have developed a standardized TPB protocol under local anesthesia (Kubo et al. Int. J Urol 2009) to be used by trainee urologists. In this study, we assessed learning curves and outcomes of TPB performed by trainees.
Methods: Trainees were defined as urologists in practice for less than one year. We reviewed the charts of men on whom trainee urologists educated at our hospital had performed TPB between 2015 and 2018, recording procedure time, presence or absence of cancer, and complications. Local anesthesia was ensured using subcutaneous anesthesia for perineal and periapical triangle blocks. Systematic 14-core TPB was performed with magnetic resonance imaging (MRI)-targeted biopsy (four cores per targeted lesion). Men undergoing targeted biopsy alone were excluded from this analysis. We evaluated the learning curves and outcomes of TPB, and compared them with outcomes of TPB performed by senior urologists as controls.
Results: Three trainees performed 115 procedures (50 by MK over 12 months, 34 by KT over 9 months, and 31 by HS over 6 months) and three senior urologists performed 121 procedures. There was no significant difference in age, prostate-specific antigen, or MRI positivity rates between trainees&[prime] and senior urologists&[prime] patients. The median TPB times were 13/9 minutes for trainees/senior urologists (p < 0.01). TPB times of trainees shortened over time to match those of senior urologists during the learning curve (Figure). There was no difference in cancer detection rates between trainees and senior urologists (73% and 68%, respectively, P=0.39). No infectious complications occurred in either group. Urinary retention was observed in two cases in each group (1.7%/1.7%) and vagal reflex was observed in one trainee case.
Conclusions: Trainees achieved procedure times equivalent to those of senior urologists within 30-50 procedures. Cancer detection rates and complication rates were comparable between trainees&[prime] and senior urologists&[prime] cases during the learning curve.