Can Residents Perform Transrectal Ultrasound-Guided Prostate Biopsy With Patient Comfort Comparable To Biopsy Performed By Attending Staff Urologists?

Main Category: Urology / Nephrology
Also Included In: Medical Students / Training;  Prostate / Prostate Cancer
Article Date: 30 Nov 2009 - 8:00 PDT

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UroToday.com - Urology residents are involved with performing transrectal-ultrasound (TRUS) guided prostate biopsies during their training. Satisfactory accomplishment of this skill is a competency necessary for urologic practice. A group from the Glickman Institute at the Cleveland Clinic evaluated whether with proper training and supervision, resident urologists are able to perform TRUS biopsy with comparable proficiency to staff urologists.

The study was prospectively performed on 865 patients between 2006 and 2008. Fourteen staff urologists and residents in their second, third and fifth years of training participated. Patients had their procedure performed in its entirety by either a staff or resident urologist with staff present. The default mode was for the resident to perform these procedures. TRUS biopsy was performed in a standard fashion and a lidocaine nerve block was used. Immediately following the procedure, patients completed a 100-mm visual analogue scale (VAS) and completed a separate pain score for each component of the procedure; probe insertion, peri-prostate block (PPB) and core biopsies. The effect of resident versus staff performance was analyzed in the context of other potential confounders to include patient age, block site, probe type and anesthesia usage.

Patients undergoing TRUS biopsy by residents reported increased VAS pain scores during probe insertion (37.1 vs. 31) and the core biopsies (33.6 vs. 30.1) compared with those in the staff group. However, there was no difference in the pain scores for the performance of the PPB. Regarding confounders, patient age was similar between resident and staff treated patients. Residents more often administered an apical PPB, which is considered more effective than a basilar PPB. There was some difference in probe types used, but this was primarily dictated by the machine types at different clinics. Logistical regression analysis found that resident treated patients had 1.48-fold greater odds of experiencing more pain during probe insertion. Biopsy pain was 1.523-fold greater when a resident was performing the procedure. PPB demonstrated no difference.

There was a non-significant trend for higher level residents to induce more pain during the procedure compared with junior residents.

Nguyen CT, Gao T, Hernandez AV, Jones JS

Prostate Cancer Prostatic Dis. 2009 Sep 22. Epub ahead of print.
doi:10.1038/pcan.2009.36

Written by UroToday.com
Contributing Editor Christopher P. Evans, MD, FACS

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