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Published in: World Journal of Urology 9/2019

01-09-2019 | Original Article

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

Authors: Guglielmo Mantica, Andrea Pacchetti, Roberta Aimar, Mattia Cerasuolo, Federico Dotta, Alberto Olivero, Giovannalberto Pini, Giovanni Passaretti, Massimo Maffezzini, Carlo Terrone

Published in: World Journal of Urology | Issue 9/2019

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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.
Literature
1.
go back to reference 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):55–59CrossRefPubMed 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):55–59CrossRefPubMed
2.
go back to reference Fabiani A, Principi E, Filosa A, Servi L (2017) The eternal enigma in prostatic biopsy access route. Arch Ital Urol Androl 89(3):245–246CrossRefPubMed Fabiani A, Principi E, Filosa A, Servi L (2017) The eternal enigma in prostatic biopsy access route. Arch Ital Urol Androl 89(3):245–246CrossRefPubMed
3.
go back to reference Chang DT, Challacombe B, Lawrentschuk N (2013) Transperineal biopsy of the prostate—is this the future? Nat Rev Urol 10(12):690–702CrossRefPubMed Chang DT, Challacombe B, Lawrentschuk N (2013) Transperineal biopsy of the prostate—is this the future? Nat Rev Urol 10(12):690–702CrossRefPubMed
4.
go back to reference 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):719–724CrossRefPubMed 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):719–724CrossRefPubMed
5.
go back to reference Ficarra V, Novella G, Galfano A, Artibani W (2007) Transperineal TRUS-guided prostate biopsy. Urologia 74(1):1–7CrossRefPubMed Ficarra V, Novella G, Galfano A, Artibani W (2007) Transperineal TRUS-guided prostate biopsy. Urologia 74(1):1–7CrossRefPubMed
6.
go back to reference 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):1736–1742CrossRefPubMed 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):1736–1742CrossRefPubMed
7.
go back to reference 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):205–213CrossRefPubMedPubMedCentral 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):205–213CrossRefPubMedPubMedCentral
9.
go back to reference 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):713–718CrossRefPubMed 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):713–718CrossRefPubMed
10.
go back to reference 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):693–698CrossRefPubMed 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):693–698CrossRefPubMed
11.
go back to reference 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):761–768CrossRefPubMed 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):761–768CrossRefPubMed
13.
go back to reference 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):617–621CrossRefPubMed 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):617–621CrossRefPubMed
14.
go back to reference 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):961–966CrossRefPubMed 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):961–966CrossRefPubMed
15.
go back to reference Miller J, Perumalla C, Heap G (2005) Complications of transrectal versus transperineal prostate biopsy. ANZ J Surg 75(1–2):48–50CrossRefPubMed Miller J, Perumalla C, Heap G (2005) Complications of transrectal versus transperineal prostate biopsy. ANZ J Surg 75(1–2):48–50CrossRefPubMed
16.
go back to reference 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):27–34CrossRefPubMed 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):27–34CrossRefPubMed
17.
go back to reference 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):302–308CrossRefPubMed 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):302–308CrossRefPubMed
18.
go back to reference 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):247–252CrossRefPubMedPubMedCentral 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):247–252CrossRefPubMedPubMedCentral
19.
go back to reference 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 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
20.
go back to reference 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):673–683PubMed 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):673–683PubMed
21.
go back to reference 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):15–20CrossRefPubMed 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):15–20CrossRefPubMed
22.
go back to reference 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):331–335CrossRefPubMedPubMedCentral 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):331–335CrossRefPubMedPubMedCentral
23.
go back to reference 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):7959–7964PubMed 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):7959–7964PubMed
24.
go back to reference 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):424–429CrossRefPubMed 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):424–429CrossRefPubMed
25.
go back to reference 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):735–739CrossRefPubMed 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):735–739CrossRefPubMed
26.
go back to reference 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):845–850CrossRefPubMed 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):845–850CrossRefPubMed
27.
go back to reference 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):76–81CrossRefPubMed 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):76–81CrossRefPubMed
28.
go back to reference 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):e9CrossRefPubMedPubMedCentral 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):e9CrossRefPubMedPubMedCentral
30.
go back to reference 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):1686–1693CrossRefPubMed 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):1686–1693CrossRefPubMed
Metadata
Title
Developing a five-step training model for transperineal prostate biopsies in a naïve residents’ group: a prospective observational randomised study of two different techniques
Authors
Guglielmo Mantica
Andrea Pacchetti
Roberta Aimar
Mattia Cerasuolo
Federico Dotta
Alberto Olivero
Giovannalberto Pini
Giovanni Passaretti
Massimo Maffezzini
Carlo Terrone
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 9/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-018-2599-6

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