Crossing the perineum: history of transperineal prostate biopsy
BAUS ePoster online library. Connor M. Jun 25, 2019; 259562; P6-8 Disclosure(s): MJC is funded by the Wellcome Trust
Mr. Martin J. Connor
Mr. Martin J. Connor
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Abstract
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INTRODUCTION: Prostate biopsy focus has shifted from a transrectal to transperineal approach following recent high level evidence supporting favourable diagnostic yield and lower infection rate. Historically, the move across the perineum has not been a one-way affair with transperineal biopsies (TPB) predating popular transrectal ultrasound guided biopsy (TRUS). We chart the history of TPB, reflecting upon key urologists involved in TPB development.

Materials and Methods: Non-systematic search of the literature of electronic journals and books was performed relating to the history of TPB.

RESULTS:
(1) Young's invasive open TPB was documented in 1926 using a transverse incision between the ischial tuberosities, 2 cm above the anus. Ischiorectal fossa was opened and dissected to prostatic capsule. Diagnosis was confirmed by fresh section, with many patients proceeding to prostatectomy. High rates of urinary incontinence (UI) and long post-operative stay limited uptake. (2) Barringer described a less invasive, but inaccurate (50%), punch TPB using a screw tip needle technique in 1922. (3) Fearguson modified this using repeated aspiration via an 18-gauge needle. Unfortunately, tissue was often limited and plagued by loss of architecture (4) Kaufman successfully described TPB under digital-guidance in 1954. Introducing a needle 1 cm above the anus over site of disease, following the point to the prostatic nodule. Digital-needle control improved accuracy (73%), reduced UI and rectal injury. Introducing permanently fixed prostate tissue and repeated TPB for the first-time.

Conclusion: The history of TPB underpins modern prostate biopsy practice, which is further enhanced by real-time rectal ultrasound and MRI-fusion imaging.
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