Phelps, WI
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Description of Procedure :
He was placed in the supine position and prepped and draped after providing informed consent for cystoscopy. Flexible
cystoscopy showed some mild very short ring strictures in the bulbar urethra that allowed the flexible ureteroscope without
difficulty. Prostatic urethra shows considerable enlargement of the lateral tissue as well as a high bladder neck. No tumors
stones or debris are seen in the bladder. On retroflexion the patient has extreme enlargement of the prostate bulging up into the
base of the bladder especially anteriorly. I am not able to make out the UOs except on retroflexion. Again no tumors were seen
and the scope was removed.
He provided informed consent and was placed in dorsal lithotomy position. Scrotum was elevated and secured to the inner thigh
with tape. The perineum was prepped with Betadine. BK rectal probe was prepared Using a transducer cover, 3 cc of
lubricant were placed into the transducer cover. Air bubbles were pressed out of the lubricant. Ultrasound was placed per
rectum. Prostate exhibited standard heterogeneity with no abnormalities of the outline of the gland. Uronav system was used
Standard imaging prep was performed. Two access points were marked on the perineum skin in standard configuration to the
right and left of midline. A mixture of 1% lidocaine and Sodium Bicarbonate was injected into the skin at each access point
using a 25 gauge needle. 2 cc approximately were injected into each site. Then the access needle was placed into an
appropriate aperture location. The carriage was placed on the rails of the clamp. The carriage was advanced until the access
needle was impressed into the skin at the access point on the patient's right. A 20 gauge spinal needle was placed through the
access needle and advanced through the subcutaneous tissue to the pelvic floor musculature. The muscle was infiltrated with
local anesthetic. Injection of local was made using real-time ultrasound guidance in 3 planes. Another bolus of lidocaine was
deposited just lateral to the apex between the pelvic floor and apical capsule. At this point the access needle was moved to
imprint into the patient's contralateral side at the access point. Spinal needle was advanced through it and local anesthetic was
injected in an identical manner. Approximately 10 cc were injected on each side.
The access needle was perforated through the access point on the side of the biopsies. The biopsy gun was then used through
the access needle and visualized under constant ultrasound guidance advancing through the perineal subcutaneous tissue. Under
real-time ultrasound guidance, biopsy samples were obtained in the prostate as follows:
Left area of interest 4 cores
Right area of interest #1 3 cores
Right area of interest #2 2 cores
2 cores were taken at each of the following sites: Right posterior lateral, right base, left posterior medial, left base, right anterior
medial, right anterior lateral, left anterior lateral.
The aperture was changed as appropriate for anterior and posterior biopsies. At this point with prostate appropriately sampled,
the access needle and ultrasound were removed. The perineum was cleaned and Neosporin ointment applied to the puncture
sites. He was taken to recovery in good condition. There were no complications and he tolerated the procedure well.