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SURGICAL CRAFT
Year : 2019  |  Volume : 35  |  Issue : 3  |  Page : 242-243
 

A safe technique of finger-guided biopsy of the prostate


Resident, Department of Urology, Stanley Medical College, Chennai, Tamil Nadu, India

Date of Submission19-Mar-2019
Date of Acceptance19-May-2019
Date of Web Publication2-Jul-2019

Correspondence Address:
C Danny Darlington
Resident, Department of Urology, Stanley Medical College, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_95_19

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   Abstract 

Prostatic biopsy is the gold standard of diagnosis of prostatic cancer. In the era of transrectal ultrasound-guided biopsy of the prostate, finger-guided prostatic biopsy still has a role in underdeveloped and developing countries. We describe a safer technique of performing a finger-guided prostatic biopsy.



How to cite this article:
Darlington C D. A safe technique of finger-guided biopsy of the prostate. Indian J Urol 2019;35:242-3

How to cite this URL:
Darlington C D. A safe technique of finger-guided biopsy of the prostate. Indian J Urol [serial online] 2019 [cited 2019 Sep 17];35:242-3. Available from: http://www.indianjurol.com/text.asp?2019/35/3/242/261938



   Introduction Top


Although transrectal ultrasound (TRUS)-guided biopsy of the prostate is the standard of care, it is limited by its availability and cost. Systematic finger-guided biopsy (SFGB) of the prostate is a viable option in such situations.[1] Injury to a surgeon's fingers can occur in SFGB as there is no barrier between the biopsy needle and the surgeon's hands apart from the glove. Herein, we describe a technique of SFGB of the prostate, which is economical and mitigates needlestick injury to the surgeon.


   Technique Top


The technique described uses a needle cap as a sheath that protects the surgeon's finger from needlestick injury. A sterile needle cap is cut obliquely so that it forms a bevel, and its length, which is around 4 cm, is equal to the length of distal and middle phalanges of the surgeon's index finger. This custom-made sheath is fixed all along its length to the palmar aspect of index finger of the surgeon's nondominant hand using sterile plasters. The sheath is fixed so that the bevel faces the palmar aspect. The patient is placed in a convenient position – lithotomy, Sims', or modified Sims' position. The surgeon then places his/her left index finger with the custom-made sheath per rectum and injects a local anesthetic using a long intravenous cannula needle passed through the sheath [Figure 1]. The inner needle of an 18-gauge intravenous cannula, which is 7 cm long and 0.8 mm wide, is preferred as this length facilitates injection of the anesthetic deep into the prostate and periprostatic region. A generous amount of anesthetic agent can be injected into and around the prostate to block the nerves as desired. The beveled angle of the sheath does not interfere in accurate palpation of the prostatic nodules while at the same time protecting the surgeon's fingers. After adequate analgesia, the 18-gauge biopsy needle also is passed through the sheath, and the prostatic lobes are systematically sampled for 12 cores of tissues in total [Figure 2]. Suspicious nodules in the prostate can be sampled with reasonable accuracy as the pulp of the surgeon's index finger is free to palpate because of the beveled tip of the sheath. Targeting a nodule is done by placing the pulp of the finger on the upper border of the nodule so that the sheath comes in line with the area to be sampled. The presence of a sheath reduces surgeon's anxiety and aids in better procedural outcome.
Figure 1: Image showing the technique of passing an intravenous cannula needle through the custom made sheath (arrow) for the injection of local anesthetic agent

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Figure 2: Photograph depicting the safe passage of biopsy needle through the custom-made sheath

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This technique has been followed at our center for 80 patients with no needlestick injury and minimal postbiopsy pain and complications. We were able to get a minimum of 12 cores of prostatic tissue in all patients. The visual analog score is ≤3 in 93.75% of patients. The five patients (6.25%) with higher visual analog score were those who underwent repeat biopsies.


   Discussion Top


SFGB of the prostate is still carried out in many parts of India and underdeveloped countries considering the nonavailability of TRUS. SFGB of the prostate can be used along with TRUS-guided biopsy in men with normal prostates on digital rectal examination (DRE). Abrams et al. performed a prospective study comparing SFGB and TRUS-guided biopsy in 145 men with and without suspicious prostate on DRE.[2] The results were equivalent in both groups, probably due to the systematic nature of sampling in both the groups.

Prostatic biopsy is a painful procedure and pain during the procedure can hinder successful systematic biopsy, thereby compromising on diagnostic accuracy. Anesthetic blocks must be administered before the biopsy to alleviate pain.[3] In addition to periprostatic and intraprostatic blocks, perianal block also can be given at 3, 6, 9, and 12 o'clock positions around the anal sphincter. This helps to relax the sphincter and aids in easy passage of the surgeon's finger for biopsy.[4]

The above-described technique is an easier and safer technique for biopsy of the prostate in the setting of limited resources in countries like India.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Chiang IN, Chang SJ, Pu YS, Huang KH, Yu HJ, Huang CY. Diagnostic value of finger-guided prostate nodule biopsy combined with systemic random biopsy. J Formos Med Assoc 2009;108:713-8.  Back to cited text no. 1
    
2.
Abrams M, Belitsky P. Systematic finger guided transrectal needle biopsies of the prostate – Alternative to TRUS guided biopsies in clinical practice. Can J Urol 2001;8:1365-70.  Back to cited text no. 2
    
3.
Şahin A, Ceylan C, Gazel E, Odabaş Ö. Three different anesthesia techniques for a comfortable prostate biopsy. Urol Ann 2015;7:339-44.  Back to cited text no. 3
    
4.
Adegun PT. Caudal and peri-anal nerve block during finger-guided transrectal prostate biopsy: A randomized single blind study. Prostate Biopsy 2017;2:5.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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