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365 Local Anaesthetic Transperineal Template Biopsy in the Outpatient Setting: A More Sustainable Option in the NHS? Br J Surg 2022. [DOI: 10.1093/bjs/znac039.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Transperineal prostate (TP) biopsies have traditionally been performed under general anaesthesia using a grid plate, ultrasound probe and access cannula. This requires theatre heavy resources. Novel techniques and equipment allow TP biopsies to be performed under local anaesthetic (LA) and are well tolerated. However, this equipment tends to be single use and disposable.
Our urology department uses the re-usable BK Medical® needle guide and biplanar probe in the outpatient department (OPD). We present outcomes from patients who have undergone LA prostate biopsies using a re-usable system.
Method
Data was collected from 92 patients who had TP biopsies in the OPD from November 2020 – August 2021. Clinical parameters including MRI Prostate Imaging-Reporting and Data System (PI-RADS) score, prostate specific antigen (PSA) level, histopathological outcomes, re-biopsy and post-procedure complications were collated. Patient Reported Outcome Measures were collected prospectively.
Results
Median (range) PSA level was 7 (2.28–59.3)ng/mL. Mean prostate core samples taken were 24(17–40). All procedures were successfully completed under LA. 93% of patients reported a pain score of 3 or less on the visual analogue scale. 93% of patients would recommend this method of biopsy. 44/92(47.8%) had clinically significant prostate cancer (Gleason ≥3+4). Two patients required repeat biopsies, one was benign, the other clinically significant prostate cancer.
Conclusions
TP biopsies with the re-usable BK Medical® needle probe are effective, safe and well tolerated with an overall one-off cost of £1400 per grid versus £200 per single use kit, and an environmental advantage by being re-useable thereby contributing to NHS sustainability goals.
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915 An Unusual Case of Breast Tuberculosis: A Case Report. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Breast Tuberculosis (TB) is a rare form of extra-pulmonary tuberculosis. It can mimic the presentation of many breast diseases including malignancy. We present a case of breast tuberculosis that had negative cultures from breast tissue while positive on lymph node biopsy.
Case presentation
A 36-year-old Libyan British lady presented to the symptomatic breast clinic with a large left breast mass during the first trimester of her fifth pregnancy. She has received antibiotics to treat mastitis but with no improvement. On Examination she had large left upper quadrant mass with skin tethering as well as palpable left axillary lymph nodes. Ultrasound imaging suggested features suspicious for malignancy and hence core biopsies were obtained which showed chronic inflammatory changes only. Ziehl Neelson stain was negative at this stage. A week later she developed low grade fever as well as signs of infection at biopsy site, this was treated with flucloxacillin, pus aspirated from underlying mass and sent for culture and sensitivity. Unfortunately, this lady travelled to Tunisia after her review and was subsequently diagnosed with breast tuberculosis on cultures from lymph node biopsies. On her return to our clinic, she was on appropriate treatment for TB, she had good response to treatment and follow up ultrasound showed stable residual collection.
Conclusions
This case illustrates the challenges in the diagnosis of breast tuberculosis as it is a rare entity of a disease that remains less prevalent in European countries. In most cases full recovery can be expected with anti- tuberculous treatment.
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