Jane Cho

In vitro comparison of a novel facilitated ultrasound targeting technology vs standard technique for percutaneous renal biopsy.

OBJECTIVE To improve the understanding of the epidemiology of renal cortical neoplasms through pretreatment biopsy, we evaluated a facilitated ultrasound targeting (FUT) technology. The technology allows a needle to be passed through the transducer probe and guided along a virtual dotted line on the monitor. We compared the FUT with standard percutaneous biopsy (PB) technique. MATERIALS AND METHODS Forty-eight participants with various levels of training were recruited. Participants performed ultrasound-guided biopsies on phantom models using FUT and the standard biopsy technique in a randomized sequence. The phantom models consisted of pimento olives embedded in an opaque mold of Metamucil and Knox gelatin. Patients were given up to 10 attempts to achieve 3 complete specimens from the olives. Patients rated each biopsy technique. Results were stratified by level of experience. RESULTS The mean time to obtain 3 complete biopsy specimens was significantly faster for FUT compared with the standard technique (140 seconds vs 246 seconds, P = .0001). The mean number of attempts needed to obtain 3 specimens was significantly less with FUT compared with the standard technique (4.3 vs 5.6 attempts, P = .0007). Patients reported that FUT was significantly easier to use compared with the standard technique (P = .0005). No significant order effect was observed. CONCLUSION In this in vitro comparison, FUT increased the efficiency and efficacy of PB for users of all experience levels. FUT may allow urologists with limited PB experience to perform the procedure reliably and easily. Clinical evaluation of this technology is actively in progress.

Technique for office-based, ultrasonography-guided percutaneous biopsy of renal cortical neoplasms using a novel transducer for facilitated ultrasound targeting.

To help clarify which small renal cortical neoplasms (RCNs) require surgery by using office‐based, ultrasonography‐guided percutaneous renal biopsy.

Severity of Hematuria Effects Resolution in Patients Treated with Hyperbaric Oxygen Therapy for Radiation-Induced Hematuria

Introduction: We investigated the differences between prostate cancer patients with radiation-induced hematuria treated with hyperbaric oxygen (HBO) therapy that did or did not have a resolution of hematuria. Materials and Methods: We performed a retrospective review of prostate cancer patients with radiation-induced hematuria who underwent HBO from April 2000 to March 2010. We performed an analysis of demographic data and severity of hematuria in those who had resolution of or persistent hematuria. Additionally, prostate-specific antigen (PSA) data were also obtained during the study period. Results: Overall, 11/22 men had resolution of hematuria after HBO therapy with a median follow-up of 2.2 (0.35-13.6) years. The Radiation Therapy Oncology Group (RTOG) grade of hematuria is predictive of final hematuria outcome (resolution vs. persistent) after HBO (p = 0.026). No significant PSA changes were noted before and after HBO therapy. Conclusions: The RTOG hematuria grade is associated with the resolution of hematuria after HBO therapy for radiation-induced hematuria in men treated for prostate cancer. This information may be helpful during shared medical decision-making regarding utility of HBO therapy in the context of severity of hematuria.

In Vitro Randomized Comparison of a Standard and Novel Echogenic Needle for Ultrasonography-Guided Renal Targeting

BACKGROUND AND PURPOSE Urologists are becoming increasingly aware of the importance of pretreatment percutaneous renal biopsy of small renal cortical neoplasms. A barrier to the routine performance of ultrasonography-guided percutaneous renal biopsy has been the technical challenges associated with the procedure. We evaluated a new modified needle, which incorporates an echogenic needle tip designed to improve the needle tips visibility under ultrasonographic visualization. We evaluated and compared the ultrasonographic imaging quality of the echogenic needle (EN) and a standard needle (SN). METHODS Forty-eight participants were recruited to perform ultrasonography-guided needle targeting and drainage of a simulated cyst within a phantom model. The simulated cysts were embedded in an opaque gel mold. Each participant was blinded to the type of needle being deployed and was asked to identify and aspirate the simulated cyst with each needle under ultrasonography guidance. Each needle was tested at three ultrasound-aiming angles, (0, 15, and 30 degrees). The quality of needle visibility under ultrasonographic imaging was assessed via a questionnaire, including needle preference and a visibility score (1-10) at each aiming angle. Participants were stratified by level of ultrasound experience. RESULTS For each angle tested, the EN received higher visibility ratings. The mean visibility scores for the EN vs the SN were 6.44 vs 5.52 at 0 degrees (P=0.001), 7.77 vs 6.96 at 15 degrees (P=0.0004) and 8.33 vs 7.54 at 30 degrees (P=0.0001). Participants reported significantly greater comfort using the EN needle compared with the SN (P=0.001). These results held true regardless of the sequence of needle tested first. Also, there was a significant difference in visibility scores by angle (P=0.0001). Larger angles (30>15>0) resulted in higher scores. CONCLUSIONS In this in vitro trial, the application of the EN improved needle visibility for users of all levels of experience. Clinical correlation is pending.

58 TOTAL ILLNESS BURDEN INDEX FOR PROSTATE CANCER (TIBI-CAP) PRIOR TO PROSTATE BIOPSY CAN PREDICT OTHER CAUSE MORBIDITY

INTRODUCTION AND OBJECTIVES: The treatment of prostate cancer is evaluated in the context of a patient’s age and comorbidity. Shifting the assessment of a patient’s health status to a point earlier in the process of disease evaluation and treatment may be useful to identify more suitable candidates to begin this process earlier rather than later. The Total Illness Burden Index for Prostate Cancer (TIBI-CaP) questionnaire is an immediate patient reported measure of comorbidity to guide decision making. We compare it prospectively to the standard physician reported Charlson Comorbidity Index (CCI) in patients undergoing prostate biopsy to predict hospital admissions. METHODS: A prospective observational cohort study was performed of 133 participants prior to obtaining a transrectal ultrasound guided prostate biopsy. Eleven patients had incomplete data or missing follow-up; therefore, a total of 122 (92%) patients were retained for a mean of 21 months (range 4 31 months). The TIBI-CaP and CCI scores were compared between subgroups defined by non-elective hospital admission, elective surgery, non-prostate malignancy and survival status using t-tests. RESULTS: Patients averaged 64.5 years at enrollment. One patient died in the study from a metastatic squamous cell carcinoma. The overall hospital admission rate was 17% (21/122), most commonly from cardiovascular or pulmonary disease. Forty-six men (38%) were diagnosed with cancer on the prostate biopsy. Twenty-three percent (28/122) had elective non-prostate surgery and 5% (6/122) were diagnosed with a non-prostate malignancy. Mean TIBI-CaP scores were higher in men who were admitted to the hospital (5.1 vs. 3.5, p 0.03), had elective surgery (4.8 vs. 3.4, p 0.05) or non-prostate cancers (5.5 vs 3.7, p 0.17) with odds ratios displayed in figure 1. No significant differences were observed in CCI scores. In stepwise logistic regression, a TIBI-CaP score 5.0 was associated with 3.5 times higher risk for hospital admission (95% CI: 1.3-10.0, p 0.02). CONCLUSIONS: The patient-reported measure of comorbidity (TIBI-CaP) identified patients at high risk for non-elective hospital admission over at 20 month average follow up period and may aid medical decision making specifically in the prostate biopsy population better than that of the Charlson Comorbidity Index. Source of Funding: None