Patient tolerance and complication rates of transperineal prostate biopsy with coaxial technique under local anesthesia: initial experience of a single institution

OBJECTIVE

Due to infectious complications of transrectal prostate biopsy (TRBx), the transperineal prostate biopsy (TPBx) technique is gaining popularity and is the first-line method in many institutions. We share our experience of the first 100 patients with TPBx, performed using the coaxial needle technique under local anesthesia.

PATIENTS AND METHODS

We retrospectively reviewed the records of the first 100 patients who had undergone TPBx between December 2022 and September 2023. Complication rates, cancer detection rates, patient tolerance, and pain response to the TPBx under local anesthesia at different steps of the procedure were collected.

RESULTS

The mean age, total prostate-specific antigen (PSA), prostate volume, and PSA density were 64.5±7.5 years, 8.82±12 ng/mL, 58.4±26.4 mL, and 0.17±0.18 ng/mL2. Prostate cancer (PCa) was detected at histopathological evaluation in 51 patients. The mean positive core number and percentage of cancer involvement per core in patients who have PCa were 5.4±3.2 and 68.5±29.1, respectively. The mean pain score during the entire procedure was 2.85±1.48. When the steps are evaluated separately, the mean pain score during the probe placement step, local anesthetic, and sampling steps were 3.35±1.65, 2.54±1.45, and 0.9±0.82, respectively.

CONCLUSIONS

Transperineal prostate biopsy with coaxial needle technique under local anesthesia is a well-tolerated procedure with feasible complication rates and patient discomfort.

COVID-19 Vaccination Safety Profiles in Patients With Solid Tumour Cancers: A Systematic Review

Vaccination has become an essential means of protection for solid tumour patients against coronavirus disease 2019 (COVID-19). In this systematic review, we sought to identify common safety profiles of the COVID-19 vaccine in patients with solid tumours. A search of Web of Science, PubMed, EMBASE and Cochrane was conducted for studies in English full-text that reported side-effect data experienced by patients with cancer who were at least 12 years old with solid tumours or a recent history of solid tumours after receiving either one or multiple doses of the COVID-19 vaccination. Study quality was assessed with the Newcastle Ottawa Scale criteria. Acceptable study types were retrospective and prospective cohorts, retrospective and prospective observational studies, observational analyses and case series; systematic reviews, meta-analyses and case reports were excluded. Among local/injection site symptoms, the most commonly reported were injection site pain and ipsilateral axillary/clavicular lymphadenopathy, whereas the most commonly reported systemic effects were fatigue/malaise, musculoskeletal symptoms and headache. Most side-effects reported were characterised as mild to moderate. A thorough evaluation of the randomised controlled trials for each featured vaccine led to the conclusion that in the USA and abroad, the safety profile seen in patients with solid tumours is comparable with that seen in the general public.

A98 DEFINING TRANSITION SUCCESS ACCORDING TO YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE

Background

The incidence of childhood-onset inflammatory bowel disease (IBD) diagnoses is increasing in Canada; therefore, more patients will need to transition from pediatric into adult care. The literature on transition in IBD patients has focused mainly on preparation and while transition success is often referenced, it is not clearly defined. Prior research on IBD transition success has only focused on the perspectives of the health care providers. Taking into consideration that transition is a process that greatly relies on patient involvement, patient perspectives should be represented in defining its success.

Aims

The primary aim is to understand patients’ perspectives on the outcomes that characterize a successful transition from pediatric to adult care.

Methods

This study paired a theoretical position of naturalistic inquiry with the method of qualitative description. Purposive sampling was used to recruit patients from IBD clinics at the University of Alberta and the University of Calgary. Inclusion criteria included transition within the last two years, diagnoses with IBD for at least a year prior to transitioning, and absence of comorbidities. Virtual semi-structured interviews were conducted using an established interview guide. Interviews were transcribed verbatim and then analyzed concurrently with data collection by latent content analysis using NVivo computer software. Participant recruitment and data analysis continued until no further themes emerged from the data, which signaled that thematic saturation was achieved.

Results

Thematic saturation was achieved after 17 interviews. Among participants, 58.8% were female; 47% had a diagnosis of Crohn’s, 47% of ulcerative colitis, and one individual was diagnosed with both. The median age at diagnosis was 15 years (IQR, 3.5). The majority (94%) of participants viewed their transition as being successful. Overall, the major themes that emerged from the data were: 1. relationship with one’s adult care team, characterized predominantly as the patient being comfortable with their new team; 2. health outcomes, characterized by disease remaining stable, and medication adherence; 3. independence in one’s care, characterized by making and attending appointments on their own, asking questions and in general having an awareness about your health and disease; 4. care stability, characterized by no drop off in care, and regular contact and follow up by their provider.

Conclusions

Young adults with IBD define pediatric transition success in four themes: relationship with care team, health outcomes, independence in one’s care, and care stability. Through understanding what transition success looks like from the patients’ perspectives, health care providers can help patients achieve success as they define it.

Funding Agencies

None

Okadaic acid attenuates short-term and long-term synaptic plasticity of hippocampal dentate gyrus neurons in rats

Protein phosphorylation states have a pivotal role in regulation of synaptic plasticity and long-term modulation of synaptic transmission. Serine/threonine protein phosphatase 1 (PP1) and 2A (PP2A) have a critical effect on various regulatory mechanisms involved in synaptic plasticity, learning and memory. Okadaic acid (OKA), a potent inhibitor of PP1 and PP2A, reportedly leads to cognitive decline and Alzheimer's disease (AD)-like pathology. The aim of this study was to examine the effect of OKA on electrophysiological characteristics of hippocampal dentate gyrus (DG) neurons in vivo. Male Wistar rats were divided into two control and OKA groups. OKA was injected intracerebroventricularly (i.c.v.) into lateral ventricles and after two weeks the long-term potentiation (LTP) and paired-pulse responses recorded from hippocampal perforant path-DG synapses in order to assess short-term and long-term synaptic plasticity. Results of this study revealed that OKA-induced inhibition of PP1 and PP2A activity drastically attenuates the field excitatory postsynaptic potential (fEPSP) slope and population spike (PS) amplitude following paired pulse and high frequency stimulation (HFS) of hippocampal DG neurons indicating pre- and post-synaptic involvement in electrical activity of these neurons. Administration of OKA impaired the short-term and long-term spatial memories conducted by Y-maze and passive avoidance tests, respectively. OKA-induced attenuation in electrophysiological activity and consequent memory deficits also provide a beneficial tool for studying neurodegenerative disorders such as AD.

Can the effect of adhesion barriers and/or intravesical balloon inflation improve bladder autoaugmentation outcomes in a rabbit model?

INTRODUCTION

Bladder augmentation is used for the treatment of bladder dysfunction in order to minimize intravesical pressure and increase bladder capacity. However, less-invasive procedures, such as autoaugmentation, have been proposed due to several complications that have occurred using bowel and gastric segments. The technique of autoaugmentation involves wide excision of the detrusor by leaving the bladder mucosa intact and has shown increased bladder capacity and compliance. An additional step to keep the achieved surface area of this non-contractible bladder segment and, thus, bladder capacity, was reported by using an intravesical balloon to prevent shrinkage of the surgically achieved diverticulum during autoaugmentation. On the other hand, adhesion barriers (AB) with absorbable hydrogel, which can spare tissue and organ plans, are used to prevent postsurgical adhesions. The efficacy of sprayable AB has been demonstrated in animal models and it is now mostly used in laparoscopic surgeries.

OBJECTIVE

The present study aimed to compare the efficacy of AB and/or intravesical balloon insertion, which might potentially improve the urodynamic and histopathological outcomes of autoaugmentation in a rabbit model.

METHODS

A total of 25 New Zealand rabbits were included in the study. Following the surgical reduction to form a low-capacity bladder model (35-40% of the initial volume), standard detrusorotomy was performed in all groups except the sham group. Group 2 had only autoaugmentation as the control group. The bladders in Group 3 were supported with an intravesical balloon. An Adhesion Barrier System (CUI Tissue Expander) was used for all bladders in Group 4, without balloon inflation. In Group 5, both intravesical balloon inflation and adhesion barrier application were performed following autoaugmentation. Urodynamic evaluations were performed at day 0 before reduction, day 0 after reduction, and the 90th postoperative day. Capacity and compliance measurements were noted. Bladders were histopathologically evaluated. Expression of CD31 (microvessel density) and fibrosis were noted.

RESULTS

Autoaugmentation does not result in a reliable increase in bladder capacity and compliance when compared to a sham group. Urodynamic measurements were similar in balloon-inflated groups (Group 3 and Group 5), showing a statistically significant improvement. Sprayable AB system alone revealed a slight, but not statistically significant, increase (Table). No significant differences between all five groups were detected regarding microvessel density (CD31 expression) and fibrosis.

DISCUSSION

In the present study, the intravesical balloon application (IVBA) efficiency was investigated alone and in combination with AB. The main basis of this study were the previous findings, which demonstrated prevention or decrease in the contraction of diverticula by IVBA. The role of AB alone or within a combination was also evaluated. Adhesion barriers are mostly used in laparoscopic gynecologic and colorectal operations. They decrease the postoperative adhesions by forming a physical barrier. In the present study, it was thought that AB might reduce postoperative adhesions and enhance the outcome of autoaugmentation. One of the most important outcomes was the inconsistency of fibrosis density with final bladder capacity and compliance values; this finding did not support the role of fibrosis prevention with IVBA. The present study had some limitations: the partial cystectomy method, which was used to form a low-compliance bladder, is a different clinical condition to neurogenic bladder, and a rectal catheter was not used during urodynamic evaluation. General anesthesia and muscle relaxant were performed during urodynamy and abdominal contractions were not seen.

CONCLUSION

Bladder autoaugmentation in a rabbit model, followed by intravesical balloon inflation offers improvement in bladder capacity and compliance. The use of sprayable adhesion barrier hydrogel technology may facilitate tissue healing and result in it being easier to maintain the success achieved by surgery when only supported with an intravesical balloon.