Treatment

Transperineal Ultrasound Guided Prostate Biopsy (TPPB) involves taking multiple cores of prostate tissue via the perineum, the triangle of skin between the scrotum in front, the anus behind and the groin on each side, guided by an ultrasound probe in the rectum.

Intravenous antibiotics are given just prior to the procedure and biopsies are taken through the skin, which can be shaved and prepped with surgical paint. These points of difference compared to other procedures such as the Trans-Rectal Ultrasound Biopsy (TRUS), greatly reduce the risk of infection as compared with the trans-rectal route. Also, the TPPB allows for the entire prostate gland to be biopsied, meaning small areas of cancer are much less likely to be missed using this procedure.

TPPB is a day stay procedure. You will need to starve for at least 6 hours (nil by mouth) before your anaesthetic and ensure you have a driver to take you home. You will need an empty rectum, therefore you will need to self-administer an enema the night before the procedure. Your doctor or nurse will talk you through this at your initial consultation.

Your Consent

We need your permission for your operation to go ahead. Before you sign the consent form it is important that you understand the risks and effects of the operation and anaesthetic. These will be discussed with you by your doctor and the nurse, should you have any questions, your nurse or doctor would be happy to answer these.

About Your Anaesthetic

You will NOT be allowed to eat or drink anything for at least six hours before your surgery. This includes chewing gum and sweets. You will be given general anaesthetic after admission.

• General Anaesthetic: You will be asleep throughout the operation and remember nothing of it.

Feel free to discuss your anaesthetic procedure, and your questions with the anaesthetist.

You must not drive any vehicle or operate any machinery for 24 hours after having an anaesthetic. You will have to arrange for someone to drive you home if you go home within 24 hours of your surgery.

Your Operation

TPPB is a day stay procedure. After admission you will be given a general anaesthetic. Once asleep you will given intravenous antibiotics and your legs will be placed in comfortable rests and your perineum shaved and painted with surgical disinfectant. The ultrasound probe, which is held in a so-called stepper, will be introduced into your rectum allowing visualisation of your prostate. Biopsies are taken in planes 10-12mm apart while the number of biopsies will depend on the size of the gland. 

On completion of the procedure, you will be given a rectal antibiotic in suppository form. A catheter is then introduced into the bladder.

After Surgery

You will return to recovery and after that to the day stay unit where the catheter will be removed once it drains clear urine. It is important that you pass a good volume of urine prior to discharge. Occasionally, if the urine is too blood stained you will be sent home with the catheter and return the next day for its removal.

If you live out of Tauranga, the District Nursing Service will remove it.

Going Home

You will be discharged with a prescription for cipofloxacin 500mg, an antibiotic which you should take twice a day. Although rare, it is possible to get blood poisoning in the first 24-36 hours. Symptoms could include shivering, high temperatures, sweats, nausea and/or vomiting and if they develop you should go to your nearest Emergency Department where you will be given IV antibiotics.

Once Home

Possible side effects include a dull pain in the perineum, local bruising or skin discolouration and passing blood or old blood in the urine or semen. Normally you should be able to return to work or normal activities the next day.

Cancer, if present, cannot be seen with the ultrasound. The tissue samples are sent to the laboratory and stained with various high-tech systems and viewed microscopically. Typically, results take 7-10 working days. If cancer is present you will be seen by a urologist at the earliest opportunity to discuss your options. You will receive an appointment notification for this from our office in due course.

While you are in hospital we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask your nurse who will be more than happy to help.