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Developing a five-step training model for transperineal prostate biopsies in a naïve residents’ group: a prospective observational randomised study of two different techniques

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Abstract

Purpose

To evaluate a five-step training model for transperineal prostate biopsies (TPPB) and the differences in terms of the detection rate (DR) and the ease of execution when using either the “fan technique” (FT) or the use of a Free Hand technique (FH).

Methods

A prospective observational randomised study was conducted from September 2015 to November 2017. Six naïve residents, who underwent the same five-steps training model, were randomly subdivided into two different groups of three residents based on the selected TPPB technique: A (FT) and B (FH). Patient characteristics (age, PSA, prostatic volume, DRE, MRI), intraoperative (operative time, number of samples) and postoperative parameters (histologic, pain) were evaluated in the 2 groups. The overall and stratified DR for PSA ranges and prostate volume (PV), operative time and complications were compared.

Results

The overall detection rate was very high in both groups (FT 58.2% vs FH 59.6%) and not statistically different between the two techniques. There were no differences in terms of complication rates and pain. The FH showed a better detection rate in prostates smaller than 40 cc (p = 0.023) and a faster operative time (p = 0.025) compared to FT.

Conclusions

Within the TPPB, FH is associated with a higher detection rate in patients with prostate < 40 cc compared to an FT when performed by inexperienced trainees. Standardised training organised in consecutive steps seems to contribute to the achievement of overall high detection rates with both methods.

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References

  1. Di Franco CA, Jallous H, Porru D, Giliberto GL, Cebrelli T, Tinelli C, Rovereto B (2017) A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer. Arch Ital Urol Androl 89(1):55–59

    Article  PubMed  Google Scholar 

  2. Fabiani A, Principi E, Filosa A, Servi L (2017) The eternal enigma in prostatic biopsy access route. Arch Ital Urol Androl 89(3):245–246

    Article  PubMed  Google Scholar 

  3. Chang DT, Challacombe B, Lawrentschuk N (2013) Transperineal biopsy of the prostate—is this the future? Nat Rev Urol 10(12):690–702

    Article  PubMed  Google Scholar 

  4. Kawakami S, Yamamoto S, Numao N, Ishikawa Y, Kihara K, Fukui I (2007) Direct comparison between transrectal and transperineal extended prostate biopsy for the detection of cancer. Int J Urol 14(8):719–724

    Article  PubMed  Google Scholar 

  5. Ficarra V, Novella G, Galfano A, Artibani W (2007) Transperineal TRUS-guided prostate biopsy. Urologia 74(1):1–7

    Article  CAS  PubMed  Google Scholar 

  6. Babaei Jandaghi A, Habibzadeh H, Falahatkar S, Heidarzadeh A, Pourghorban R (2016) Transperineal prostate core needle biopsy: a comparison of coaxial versus noncoaxial method in a randomised trial. Cardiovasc Intervent Radiol 39(12):1736–1742

    Article  PubMed  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bonkat G, Pickard R, Bartoletti R, et al. (2018) EAU Guidelines on urological infections. European Association of Urology. https://uroweb.org/guideline/urological-infections

  9. Fulgham PF (2018) Multiparametric ultrasound-targeted biopsy compares favorably to multiparametric MRI-transrectal ultrasound fusion-targeted biopsy on initial biopsy of men at risk for prostate cancer. World J Urol 36(5):713–718

    Article  PubMed  Google Scholar 

  10. Xie Y, Tokas T, Grabski B, Loch T (2018) Internal Fusion: exact correlation of transrectal ultrasound images of the prostate by detailed landmarks over time for targeted biopsies or follow-up. World J Urol 36(5):693–698

    Article  PubMed  Google Scholar 

  11. Kaufmann S, Russo GI, Bamberg F, Löwe L, Morgia G, Nikolaou K, Stenzl A, Kruck S, Bedke J (2018) Prostate cancer detection in patients with prior negative biopsy undergoing cognitive-, robotic- or in-bore MRI target biopsy. World J Urol 36(5):761–768

    Article  PubMed  Google Scholar 

  12. Cicione A, De Nunzio C, Manno S, Damiano R, Posti A, Lima E, Tubaro A, Balloni F (2018) An update on prostate biopsy in the era of magnetic resonance imaging. Urol Nefrol 70(3):264–274. https://doi.org/10.23736/S0393-2249.18.03048-5 (Epub 2018 Mar 28)

    Article  Google Scholar 

  13. Vis AN, Boerma MO, Ciatto S, Hoedemaeker RF, Schröder FH, van der Kwast TH (2000) Detection of prostate cancer: a comparative study of the diagnostic efficacy of sextant transrectal versus sextant transperineal biopsy. Urology 56(4):617–621

    Article  CAS  PubMed  Google Scholar 

  14. Emiliozzi P, Corsetti A, Tassi B, Federico G, Martini M, Pansadoro V (2003) Best approach for prostate cancer detection: a prospective study on transperineal versus transrectal six-core prostate biopsy. Urology 61(5):961–966

    Article  CAS  PubMed  Google Scholar 

  15. Miller J, Perumalla C, Heap G (2005) Complications of transrectal versus transperineal prostate biopsy. ANZ J Surg 75(1–2):48–50

    Article  PubMed  Google Scholar 

  16. Hung AJ, Bottyan T, Clifford TG, Serang S, Nakhoda ZK, Shah SH, Yokoi H, Aron M, Gill IS (2017) Structured learning for robotic surgery utilizing a proficiency score: a pilot study. World J Urol 35(1):27–34

    Article  PubMed  Google Scholar 

  17. Ruparel RK, Taylor AS, Patel J, Patel VR, Heckman MG, Rawal B, Leveillee RJ, Thiel DD (2014) Assessment of virtual reality robotic simulation performance by urology resident trainees. J Surg Educ 71(3):302–308

    Article  PubMed  Google Scholar 

  18. Gregorio SA, Rivas JG, Molina SS, Gómez AT, Ledo JC, Sebastián JD, Barthel JJ (2014) Laparoscopic radical prostatectomy training for residents: Hospital Universitario La Paz model. Cent European J Urol 67(3):247–252

    Article  PubMed  PubMed Central  Google Scholar 

  19. Somani BK, Van Cleynenbreugel B, Gozen A, Palou J, Barmoshe S, Biyani S, Gaya JM, Hellawell G, Pini G, Oscar FR, Sanchez Salas R, Macek P, Skolarikos A, Wagner C, Eret V, Haensel S, Siena G, Schmidt M, Klitsch M, Vesely S, Ploumidis A, Proietti S, Kamphuis G, Tokas T, Geraghty R, Veneziano D (2018) The European urology residents education programme hands-on training format: 4 years of hands-on training improvements from the European school of urology. Eur Urol Focus S2405–4569(18):30080–30084

    Google Scholar 

  20. Garde Garcia H, Ortiz Oshiro E, Ciappara Paniagua M, Poma Medrano L, Fuentes Ferrer M, Vera Gonzalez V, Moreno Sierra J (2014) Interest areas for training in endourology, laparoscopy and robotics: results of a multicentric survey among Spanish residents. Arch Esp Urol 67(8):673–683

    PubMed  Google Scholar 

  21. Miernik A, Sevcenco S, Kuehhas FE, Bach C, Buchholz N, Adams F, Wilhelm K, Schoenthaler M (2014) Bringing excellence into urology: How to improve the future training of residents? Arab J Urol 12(1):15–20

    Article  PubMed  Google Scholar 

  22. Blankstein U, Lantz AG, D'A Honey RJ, Pace KT, Ordon M, Lee JY (2015) Simulation-based flexible ureteroscopy training using a novel ureteroscopy part-task trainer. Can Urol Assoc J 9(9–10):331–335

    Article  PubMed  PubMed Central  Google Scholar 

  23. Safir IJ, Shrewsberry AB, Issa IM, Ogan K, Ritenour CW, Sullivan J, Issa MM (2015) Impact of remote monitoring and supervision on resident training using new ACGME milestone criteria. Can J Urol 22(5):7959–7964

    PubMed  Google Scholar 

  24. Mai Z, Yan W, Zhou Y, Zhou Z, Chen J, Xiao Y, Liang Z, Ji Z, Li H (2016) Transperineal template-guided prostate biopsy: 10 years of experience. BJU Int 117(3):424–429

    Article  CAS  PubMed  Google Scholar 

  25. Pinkstaff DM, Igel TC, Petrou SP, Broderick GA, Wehle MJ, Young PR (2005) Systematic transperineal ultrasound-guided template biopsy of the prostate: three-year experience. Urology 65(4):735–739

    Article  PubMed  Google Scholar 

  26. Emiliozzi P, Longhi S, Scarpone P, Pansadoro A, DePaula F, Pansadoro V (2001) The value of a single biopsy with 12 transperineal cores for detecting prostate cancer in patients with elevated prostate specific antigen. J Urol 166(3):845–850

    Article  CAS  PubMed  Google Scholar 

  27. Furuno T, Demura T, Kaneta T, Gotoda H, Muraoka S, Sato T, Nagamori S, Shinohara N, Koyanagi T (2004) Difference of cancer core distribution between first and repeat biopsy: In patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy. Prostate 58(1):76–81

    Article  PubMed  Google Scholar 

  28. Bochenska K, Milad MP, DeLancey JO, Lewicky-Gaupp C (2018) Instructional video and medical student surgical knot-tying proficiency: randomized controlled trial. JMIR Med Educ 4(1):e9

    Article  PubMed  PubMed Central  Google Scholar 

  29. Alameddine MB, Englesbe MJ, Waits SA (2018) A video-based coaching intervention to improve surgical skill in fourth-year medical students. J Surg Educ. https://doi.org/10.1016/j.jsurg.2018.04.003

    Article  PubMed  Google Scholar 

  30. Malas T, Al-Atassi T, Brandys T, Naik V, Lapierre H, Lam BK (2018) Impact of visualization on simulation training for vascular anastomosis. J Thorac Cardiovasc Surg 155(4):1686–1693

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Policlinico San Martino Hospital, University of Genova, Largo Rosanna Benzi 10, 16130, Genova, Italy

    Guglielmo Mantica, Andrea Pacchetti, Mattia Cerasuolo, Federico Dotta, Alberto Olivero, Massimo Maffezzini & Carlo Terrone

  2. Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy

    Guglielmo Mantica, Giovannalberto Pini & Giovanni Passaretti

  3. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy

    Roberta Aimar

Authors
  1. Guglielmo Mantica
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  2. Andrea Pacchetti
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  3. Roberta Aimar
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  4. Mattia Cerasuolo
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  5. Federico Dotta
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  6. Alberto Olivero
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  7. Giovannalberto Pini
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  8. Giovanni Passaretti
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  9. Massimo Maffezzini
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  10. Carlo Terrone
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Contributions

GM Project development, data analysis and manuscript writing. AP Data collection and data analysis. RA Data collection and data analysis. MC Data collection and data analysis. FD Data collection and data analysis. AO Data collection and data analysis. GP Manuscript editing. GP Manuscript editing. MM Manuscript editing. CT Project development and manuscript editing.

Corresponding author

Correspondence to Guglielmo Mantica.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Mantica, G., Pacchetti, A., Aimar, R. et al. Developing a five-step training model for transperineal prostate biopsies in a naïve residents’ group: a prospective observational randomised study of two different techniques. World J Urol 37, 1845–1850 (2019). https://doi.org/10.1007/s00345-018-2599-6

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  • DOI: https://doi.org/10.1007/s00345-018-2599-6

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