Urological Procedures (Part Two)

Prostate Biopsy

The prostate is a small gland, only in males, in the shape of a chestnut that produces a fluid which is a part of semen.

A prostate biopsy is a procedure through which small parts of material from the prostate are taken and sent to the laboratory for examination. The prostate biopsy can be performed in several ways:

• Taking material through the rectum (end of the large intestine). This is called a transrectal biopsy and is performed under the guidance of ultrasound and is the most used method.
• Taking material through the urine channel (urethra). This is called a transurethral biopsy and is performed with a thin tube, equipped with a camera and a biopsy needle that is inserted into the urethra to the level of the prostate.
• Taking material by penetrating the prostate through the skin in the area between the rectum and the scrotum.

Why a prostate biopsy is performed

The prostate biopsy is mainly performed to detect prostate cancer. The doctor recommends it if:

• PSA is higher than the normal indicator for the respective age,
• the doctor feels any suspicious formation during the rectal examination,
• a previous biopsy was normal, but PSA continues to be high,

Risks

The possible risks during the transrectal prostate biopsy are rare:

• Infection. The most common risk encountered during this procedure is infection.
• Bleeding at the biopsy site. Blood-thinning medication should not be started without the doctor's recommendation.
• Blood in semen. The coloring of semen with red color is a common phenomenon after the prostate biopsy. This may continue for a short time but is not a problem.
• Difficulty in urinating may be temporarily noticed in some cases and passes without needing any intervention.

Preparation

The transrectal prostate biopsy is a procedure that is routinely performed in outpatient conditions in clinics or hospitals. This means that the patient is able to go home after the procedure.

The patient does not need any special preparation. He can eat and drink normally one day before. The bowels should be cleaned the night before using micro enemas or suitable medications for this task.

If the patient uses anticoagulant medications, he must stop them a few days before the procedure but after consulting with the doctor who prescribed the medication to see the benefits and risks of this interruption.

The patient is recommended to use antibiotics before the biopsy, and to continue them for several days after it to prevent any possible infection.

What happens during the biopsy procedure

The patient needs to be undressed in the lower part of the body. He lies on his left side with his knees pulled close to his chest.

After cleaning the area and applying lubricating gel, the doctor inserts a thin ultrasound probe into the rectum. Transrectal ultrasound is used to take images from the prostate by determining the place where anesthesia will be done, and also guides the needle to the places where the biopsy will be taken. Usually, an injection for numbing is applied to avoid the discomfort caused by the biopsy. For this, a numbing substance is injected into different points of the prostate through the needle.

With the help of the biopsy device, which is equipped with a spring and a special needle, material in the form of a very thin cylinder is taken. This procedure causes a slight discomfort feeling for a very short time every time the spring with the needle takes material. The material is taken in the place where the ultrasound shows a suspicious image or 10 or 12 samples are taken throughout the prostate.

The entire procedure lasts about 15 minutes. The material is sent to the laboratory for microscopic examination.

The patient should stay in the clinic for about 30 minutes after the procedure and needs to urinate before leaving home. The doctor gives a prescription for antibiotics for a few days. The patient should not drive immediately after.

After the procedure

The patient may experience mild pain and a little blood from the rectum. Also, blood in urine or slightly colored semen as a result of a few blood drops in it may be noticed. The above concerns are rare but if they occur, they generally pass by themselves after a few days.

Bladder Biopsy

A bladder biopsy is a procedure through which a small piece of tissue from the bladder is taken to be examined in the laboratory under a microscope.

How is the test performed?

A prostate biopsy can be part of a cystoscopy (internal examination of the bladder). A small piece from the suspicious area is taken and sent to the laboratory for examination.

When a bladder biopsy is required

• when bladder cancer is suspected
• when there is blood in the urine
• when there is an anomaly in the bladder such as; infection, ulcers
• when there is frequent urination

This procedure does not cure the problem but helps in making an accurate diagnosis.

Preparation before the procedure

The patient should have urinated a short time before the procedure. He also should have taken antibiotics before the procedure as per the doctor's orders. Aspirin should not be used one week before the procedure. Instead, paracetamol can be used in case of pain.

What does the patient feel

There may be a slight discomfort as the cystoscope passes through the urethra into the bladder. The patient feels an urgent need to urinate when the bladder is filled with liquid.

During the biopsy, there may be a feeling of pinching. Also, there may be a burning sensation at the moment when a small blood vessel is cauterized if there is bleeding.

After the removal of the cystoscope, there may be a slight burning during urination which may continue for one or two days.