Prostate biopsies

PREPARATION FOR THE INTERVENTION

Any surgical intervention requires preparation which may vary depending on each individual. It is essential that you follow the recommendations given to you by your urologist and your anesthesiologist.

If these recommendations are not followed, the intervention could be postponed. In view of the intervention, certain examinations may be prescribed (ultrasound, smear, urodynamic assessment, MRI, etc.) An anesthesia consultation must take place a few days before the intervention. You will be asked to perform a urine analysis a few days before the procedure (ECBU).

In the event of infection, intervention is deferred until the urine is sterilized.

OPERATIVE TECHNIQUE

The procedure is carried out under general anesthesia. It can be performed laparoscopically with or without robotic assistance. In the operating room, you are placed flat on your back. A urinary catheter is placed at the start of the procedure.

USUAL FOLLOW-UP

The time for removal of the urinary catheter is defined by your surgeon. Resumption of intestinal transit (gas) usually occurs within the first 48 hours. However, constipation can bother you for a few days and continue if you are prone to this problem. You may then be prescribed a laxative treatment. The length of hospitalization is usually a few days. A convalescence is expected.

Its duration is adapted to the work you do. You should refrain from exercise, sports, carrying heavy loads, taking baths and having penetrative sex for approximately 1 month. A follow-up consultation with your urologist is planned a few weeks after the procedure. This decides on the possibility of resuming all your activities, particularly sporting activities. You must avoid violent efforts in the 3 months following the procedure.

Sexuality By replacing the descended organs in the correct position, the intervention most often allows you to improve your sexuality. On the other hand, the quality of intercourse can rarely be altered by pain and vaginal lubrication problems. You may be prescribed treatment to improve these local phenomena.

PRECAUTIONS

Healing Laparoscopic surgery involves one or more incisions of varying size. These incisions are not only areas of weakness, but also possible entry points for infection. It is therefore necessary to ensure good local hygiene. If the scar becomes red, hot or if it is raised, it is important to show this scar to your surgeon without urgency: it may be a hematoma or an abscess. The skin heals over several days.

During this period, a little bleeding may occur which can be stopped by compressing it with a compress or a clean cloth. The removal of the wires or staples is carried out by a nurse at home following the medical discharge prescription. Disunion of the skin can sometimes occur. If this opening is superficial, you simply have to wait for it to close; the closing time can reach several weeks (especially in diabetic patients or those on corticosteroid treatment). On the other hand, in the event of a feeling of deep cracking or deep disunity, it is necessary to consult your surgeon quickly. You will be able to resume normal activity but violent efforts and carrying heavy loads (greater than 5 kg) are prohibited for 3 months.

Your usual sporting activities will need to be interrupted for 1 to 3 months depending on the type of sport and its intensity. Cycling and motorcycling is also not recommended for 1 month. You must absolutely avoid constipation so as not to have to strain to have a bowel movement. Transit-facilitating treatment is often necessary for several weeks. You will need to avoid baths, penetrative sex and periodic tampons for six weeks following the procedure. When showering, you can wash the skin incisions with your usual soap. Be sure to dry them by dabbing or hairdrying to avoid any maceration. Tobacco and malnutrition slow down healing.  Post-operative fever The occurrence of a fever after the treatment of genital prolapse

ANATOMIC REMINDER

The prostate is a gland whose growth is dependent on male hormones called androgens. It is located under the bladder and in front of the rectum. It is crossed by the urethra canal, which allows the evacuation of urine.
The prostate has a genital function, it is involved in the production and evacuation of sperm. _ PRINCIPLE OF INTERVENTION
An abnormality in your prostate has been detected by digital rectal exam, MRI or after an abnormal PSA test. Different prostate conditions can explain these abnormalities: infection or inflammation, benign prostatic hypertrophy, prostate cancer, etc.

A microscopic examination of the removed prostate tissue is necessary to make the diagnosis of cancer.

ARE THERE OTHER OPTIONS?

Prostate biopsies represent an essential step with no alternative for the diagnosis of prostate cancer.

PREPARATION FOR INTERVENTION

Any surgical procedure requires preparation which may vary depending on each individual. It is essential that you follow the recommendations given to you by your urologist and your anesthesiologist. If these recommendations are not followed, the intervention could be postponed.

Biopsies are performed in outpatient care or, more rarely, in traditional hospitalization.
They are most often performed under local anesthesia or using an analgesic gas. However, it is possible to perform them under general or loco-regional anesthesia.
It remains customary to eliminate the presence of bacteria in the urine before the examination by a targeted interrogation or bacteriological examination of urine (ECBU). However, when an infection is observed after a biopsy, the bacteria in question exceptionally comes from urine.
It is not necessary to perform a blood coagulation test in the absence of a specific bleeding risk factor.

Digestive preparation, through a rectal enema or a betadine rectal douche, may be requested.
It is not necessary to fast, except when the examination is carried out under regional or general anesthesia.
Certain information must be given to your urologist:

To minimize the risk of infection after biopsies taken through the rectum, it is essential to receive a dose of preventative antibiotic 2 hours before the procedure. These may be tablets or an infusion.

Depending on the information you have given to your urologist, a rectal sample may be taken with culture before taking the biopsies.

OPERATIVE TECHNIQUE

The procedure generally lasts less than an hour.

You are installed lying either on your back or on your side.
The urologist inserts the ultrasound probe through the anus. This is protected, lubricated and equipped with a sighting system. Passing the ultrasound probe generally causes moderate discomfort.
There are two techniques for performing biopsies.

FIRST TECHNIQUE

Punctures are made through the rectum

The urologist can clean the anal canal and rectum using an antiseptic. Then he can inject an anesthetic around the prostate by stinging it through the rectum. The biopsies are then taken with a needle always through the rectum. It is activated by a mechanism producing a sharp clicking sound that may surprise you. The puncture is usually not painful.

SECOND TECHNIQUE

Punctures are made through the skin (perineum)

The urologist cleans the skin of the perineum using an antiseptic. Then he injects an anesthetic under the skin. The biopsies are then taken with a needle still through the skin. It is activated by a mechanism producing a sharp clicking sound that may surprise you. The puncture is usually not painful.
The collected prostate fragments are sent to the pathology laboratory for analysis.
When the series of punctures is finished, you may be advised not to get up suddenly, as this could cause discomfort.

USUAL FOLLOW-UP

Bleeding is typical lasting a few hours to a few days. They occur in the stool, in the urine and through the urethral canal outside of urination. They can also occur in the semen, which often remains dark in color for several weeks. These bleedings are moderate in the vast majority of cases and stop