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Template Guided Prostate Biopsies

What is the difference between a TRUS and Biopsy and a Template Guided Biopsy using Prostate Mapping?
A TRUS and Biopsy refers to a Trans rectal ultra sound and Trans rectal biopsy of the prostate, in which 6-14 biopsy samples are taken of the prostate in a non-specific pattern. This is performed under a local anaesthetic.

A template guided biopsy is carried out under a general anaesthetic. After the anaesthetic has been administered, an ultra sound probe is gently inserted into the back passage and the prostate gland is scanned. A soft, flexible tube (catheter) is inserted through the water pipe (urethra) and into the bladder to drain the bladder. This is left in place for 6 hours after the procedure. Using a grid (template), which has holes spaced 5mm apart, placed against the perineum, a biopsy needle is inserted through each hole and the prostate is sampled every 5mm. Each biopsy taken is placed in a separate pot for the Consultant Histopathologist to examine separately under the microscope. A report is given telling us whether each biopsy has cancer in it or not. Other information is also given such as whether the tissue looked inflamed or whether there are other features such as precancerous areas within the prostate. Typically between 30-50 biopsy samples are taken and the whole procedure lasts between 20-40 minutes.

At the end of the procedure the template is removed and the perineum is injected with local anaesthetic. A pressure dressing will be placed over the area to help prevent any bruising. The pressure dressing and the catheter are both removed after 6 hours.

What is the preparation for Template guided biopsies?
You will be admitted to the Hospital a few hours prior to your procedure. You will be sent an appointment to attend the preadmission clinic. Starving instructions will be sent direct to your home address from the hospital. After your admission you will be given an enema to ensure the back passage is clear of any faeces, so that the prostate can be scanned by the ultrasound clearly.

You will be seen by Mr Lewi and your Consultant Anaesthetist prior to your procedure, when you will be asked to sign a consent form.

What are the side effects of template guided biopsies?
Template guided biopsies carry no extra risk than a TRUS and biopsy.
Complications of both include:

  • Bruising of the perineum than can spread to the scrotum.
  • Temporary discomfort in the back passage area (most men).
  • Blood in the urine for 1-2 weeks (most men).
  • Blood in the semen for 72 hours for most men (lasting up to 3 months in a few men).
  • Prostatitis (inflammation or infection of the prostate gland) (some men).
  • Retention of urine requiring a temporary catheter (2-10 in 100).
  • Septicaemia requiring admission to hospital (0-1 in 100).
  • A few men experience temporary erectile dysfunction.

What can I expect when I go home?
You will be given a course of antibiotics and Tamsulosin tablets, to take home and if necessary analgesia can also be arranged. You may experience some perineal pain or discomfort after the procedure but Paracetamol or Nurofen should be adequate. You should avoid aspirin or other blood thinning drugs for 24 hours as these may increase the risk of bleeding.

You can expect to see some blood in your urine for 14 days following the biopsies. You may notice some blood in your semen for up to 3 months. If the bleeding becomes excessive, prolonged or if you start to pass blood clots then seek medical attention.

Occasionally swelling may occur in the prostate gland as an inflammatory response to the biopsies being taken. This could lead to difficulty in passing urine and may very occasionally cause the ability to pass urine to stop completely. This is known as urinary retention and you need to then have a urinary catheter reinserted to drain the bladder. If this happens the catheter will be left in place for a few days or you will be instructed into how to perform self intermittent catheterisation.

There is a <1% risk of you developing septicaemia following the biopsies. If you develop flu like symptoms within 24 hours of the biopsies being taken (fever, cold shivers, general aching) you should seek medical assistance immediately.

You should try and increase you fluid intake for the 48 hours following your biopsies.

When can I go back to work?
We advise you to take 48 hours off work after the procedure.

When can I drive?
We advise you not to drive for 48 hours after the procedure but you will need to check with your insurance company. You will need to feel comfortable performing an emergency stop and check that any analgesia you are taking, if any, does not impair your ability to drive.

When will my results be available?
You will receive an appointment to see Mr Lewi for your results through the post. This is usually 7-10 days after your biopsies and the appointment is in the Outpatients Department at Springfield Hospital.
If you have any further questions please do not hesitate to contact the team as detailed below.

Contact Information
Sarah Buttle, Urology Nurse Specialist. 01245 234000 ext 4260.
Ward, 01245 234080.
Esther Kendall, 01245 234087.

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