Trans Perineal Ultrasound Guided Prostate Biopsies – Minimally Invasive

/0 Comments/in /by

You would have had a 3T MRI study prior to pinpoint any suspicious high-grade lesions. PET PSMA is another means of determining if you have any suspicious areas. Usually, targeted biopsies are taken of the prostate via the skin between scrotum and anus (perineal area).

The 3 possibilities of an elevated PSA is:

  • Benign Prostate Hyperplasia,
  • Prostatitis or
  • Prostate Cancer.
  • (Cyclist can have a higher PSA -saddle irritation)

Why is it done?

  • This is a diagnostic procedure used to make a diagnosis for an elevated PSA.
  • It is done as a day surgery procedure.
  • You are required to remain starved 6-8 hours prior to the procedure.

 

How is it done?

  • This procedure: is done under GA as a day procedure and takes approximately 30min (Incl anesthetic time)
  • Lithotomy position
  • Sterile field preparation
  • Prophylactic antibiotics are essential and is provided with your anaesthetic.
  • Minimally invasive technique with 2 skin puncture sites using: PIVOT-PRO or PRECISION POINT technique
  • This is a transcutaneous access – through the skin between your scrotum and anus.

Complications

Side–effects

  • Hematuria (blood in urine) 2-3days
  • Hematospermia (blood in ejaculate) will become less the more often you ejaculate.
  • Bacteraemia (infection) with low-grade fever and feeling unwell < 0.5%

 

ANY FEVERS REQUIRES URGENT ATTENTION

 

Download Information Sheet

Wes TPUS Biopsy Prostate PIVOT PRO

 

Copyright 2019 Dr Jo Schoeman

Trans Urethral Bladder Neck Resection

/0 Comments/in /by

For those guys with normal sized prostates, but with a prominent bladder neck causing all the irritating symptoms of an enlarged prostate (LUTS).

Why is it done?

  • This procedure is performed when the bladder neck has become stenotic (narrow) and tight, usually after a TURP, can also be found in the young man, with an overactive bladder neck.
  • Usually seen in the younger more anxious men who keeps his finger on the pulse of everything.
  • Symptoms include:
    • a weak stream,
    • nightly urination,
    • frequent urination,
    • inability to urinate,
    • kidney failure due to the weak urination (obstruction),
    • bladder stones,
    • recurrent bladder infections.
  • Medication such as Flomaxtra, Urorec and Minipress etc. should always be given as a trial first.
  • Prostate cancer first needs to be ruled out by doing a PSA and when indicated a 3T MRI scan is required prior to targeted prostate biopsies to exclude a malignancy.

How is it done?

  • Patients will receive a general anesthesia unless otherwise indicated.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigate (fluid).
  • The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
  • And incision of the bladder neck is made until a largely patent bladder neck is present, using bipolar current.
  • Laser can also be utilized and is probably preferred due to lack of bleeding.
  • Prophylactic antibiotics will be given to prevent any infections.

What can go wrong?

  • Any anesthesia has its risks, and the anesthetist will explain this to you.
  • You may in extreme cases experience blood loss, which may require a blood transfusion.
  • You will wake up with a catheter in your urethra and bladder. This will remain in the bladder for 1-3 days depending on the technique used and incidence of post-operative bleeding.
  • You may have a continuous bladder irrigate running in and out of your bladder to prevent clot formation.
  • Lower abdominal discomfort for a few days.
  • NB! Each person is unique and for this reason symptoms vary!

What next?

  • You will spend 1-3 days in hospital.
  • You will a trial without catheter as soon as your urine is clear.
  • You will be discharged as soon as you can completely empty your bladder.
  • You may initially suffer from urge incontinence and will improve within the next 6 weeks.
  • Allow for 6 weeks for stabilization of symptoms.
  • There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks. Should your pathology be worrisome, you will be contacted for an earlier appointment.
  • Don’t hesitate to ask me if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side-effects

  • Retrograde ejaculation in more than 90% of patients. Therefore, if you have not completed your family, this procedure is not for you unless absolutely necessary.
  • Infertility as a result of the retrograde ejaculation.
  • Stress incontinence especially in the elderly and the diabetic patients.
  • Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
  • Urethral structuring in 2-3% of patients, requiring intermittent self-dilatation.
  • Scarring of the bladder neck can occur within 3-5 years requiring a second procedure.
  • NB! Each person is unique and for this reason symptoms vary!

Download Information Sheet

Wes Bladder Neck Incision

Trans Urethral De-Roofing of Prostate Abscess

/0 Comments/in /by

Non invasive opening of an abscess found in the prostate, Very similar to a TURP with the exception that the bladder neck is preserved

Why is it done?

  • This procedure is performed when you have been diagnosed with a prostatic abscess, usually after an MRI investigation.
  • You would have had a history of swinging low to high grade fevers, a history of catheterization or instrumentation.
  • Not improving on antibiotics.
  • You may possibly be very sick with High Dependancy Unit (HDU) admission on intravenous antibiotics.
  • This procedure is done where the abscess or fluid collection in the parenchyma of the prostate is in the transitional zone of the prostate and easily accessible via endoscopic technique.
  • It is done under a general anaesthetic with prophylactic antibiotics in place, or appropriate Antibiotics as per your serum cultures.

How is it done?

  • Patients will receive a general Anaesthesia unless otherwise indicated.
  • A cystoscopy is performed by placing a camera in the urethra with the help of lignocaine gel.
  • The inside of the prostatic urethra and bladder is viewed for pathology and especially signs of the abcess. If any suspicious lesions are seen, a biopsy will be taken.
  • The area of the prostatic urethra above the abcess is resected until the abcess is opened and drained.
  • The bladder neck and urethral sphincter is preserved.
  • Laser can also be utilized and is probably preferred due to lack of bleeding.
  • Prophylactic antibiotics will be given to prevent any infections.

What can go wrong?

  • Any anaesthesia has its risks and the anaethiatist will explain this to you.
  • You will wake up with a catheter in your urethra and bladder. This will remain in the bladder for 1-3 days depending on the technique used and incidence of post-operatve bleeding. And until signs of sepsis have cleared.
  • You may have a continuous bladder irrigate running in and out of your bladder to prevent clot formation until the urine clears.
  • Lower abdominal discomfort for a few days.
  • NB! Each person is unique and for this reason symptoms vary!

What next?

  • You will be hospitalized until all signs of sepsis have cleared.
  • You will a trial without catheter as soon as your urine is clear.
  • You will be discharged as soon as you can completely empty your bladder.
  • You may initially suffer from urge incontinence and will improve within the next 6 weeks.
  • Allow for 6 weeks for stabilization of symptoms.
  • You may have a change in ejaculate volume and could even suffer retrograde ejaculation.
  • There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
  • A follow-up appointment will be scheduled for 6 weeks. Should your pathology be worrisome, you will be contacted for an earlier appointment.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

 

Download Information Sheet

Wes TUR Deroofing of Prostate Abscess

Urolift

/0 Comments/in /by

Minimal invasive management for the relief of LUTS (lower urinary tract symptoms)

Why is it done?

  • This procedure is performed when the prostate gland is causing LUTS and you want an alternative to medication without the complications of a permanent procedure.
  • Symptoms include:
    • a weak stream,
    • nightly urination,
    • frequent urination,
    • inability to urinate,
    • kidney failure due to the obstruction,
    • bladder stones,
    • recurrent bladder infections.
  • Medication such as Flomaxtra, Urorec, Minipress etc.  should always be given as a first resort.
  • This is an alternative to medication, where the ejaculatory function is to be preserved.
  • Prostate cancer first needs to be ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
  • Usually, a trial of alpha-blockers would be attempted
  • Prostate sizes up to 80-100 cc with NO mid lobe.

https://www.youtube.com/watch?v=e20Ak49YD6E

How is it done?

  • Patients will receive general anesthesia.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigate fluid.
  • The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
  • The device is placed through the cystoscopy sheath.
  • Prostate lobes are drawn apart similar to opening a curtain.
  • Occasionally a Bladder Neck Incision may be done if the bladder neck is too narrow.
  • Prophylactic antibiotics will be given to prevent any infections.

 

Complications

Side–effects

  • Ejaculation will not be affected as with medication, TURP and TUVP, therefore no retrograde ejaculation, thus preserving sexual function.
  • Fertility is not guaranteed. If it is an issue, DON’T DO IT!
  • Some urinary urge symptoms especially in the first 6 weeks.
  • May experience a slower stream initially due to swelling
  • Some urgency symptoms.
  • Possible infection due to cystoscopy (<2%)
  • Rare cases of stone formation on clips.
  • Further enlargement of prostate lobes within 3-5 years requiring a definite procedure.
  • NB! Each person is unique and for this reason, symptoms vary!

 

Download Information Sheet

Wes UROLIFT

Copyright 2019 Dr Jo Schoeman