Department of Urology, University of Michigan, Ann Arbor, MI.
Department of Urology, E-Da Hospital, Kaoshiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Urology. 2024 Sep;191:12-18. doi: 10.1016/j.urology.2024.04.019. Epub 2024 Apr 26.
To assess perceptions, practice patterns, and barriers to adoption of transperineal prostate biopsy (TPBx) under local anesthesia.
Providers from Michigan urological surgery improvement collaborative (MUSIC) and Pennsylvania urologic regional collaborative (PURC) were administered an online survey to assess beliefs and educational needs regarding TPBx. Providers were divided into those who performed or did not perform TPBx. The MUSIC and PURC registries were queried to assess TPBx utilization. Descriptive analytics and bivariate analysis determined associations between provider/practice demographics and attitudes.
Since 2019, TPBx adoption has increased more than 2-fold to 7.0% and 16% across MUSIC and PURC practices, respectively. Of 350 urologists invited to participate in a survey, a total of 91 complete responses were obtained with 21 respondents (23%) reported performing TPBx. Participants estimated the learning curve was <10 procedure for TPBx performers and non-performers. No significant association was observed between learning curve and provider age/practice setting. The major perceived benefits of TPBx were decreased risk of sepsis, improved cancer detection rate and antibiotic stewardship. The most commonly cited challenges to implementation included access to equipment and patient experience. Urologists performing TPBx reported learning curve as an additional barrier, while those not performing TPBx reported duration of procedure.
Access to equipment and patient experience concerns remain substantial barriers to adoption of TPBx. Dissemination of techniques utilizing existing equipment and optimization of local anesthetic protocols for TPBx may help facilitate the continued adoption of TPBx.
评估在局部麻醉下进行经会阴前列腺活检（TPBx）的认知、实践模式和采用障碍。
密歇根州泌尿外科手术改进合作组织（MUSIC）和宾夕法尼亚州泌尿科区域合作组织（PURC）的医生接受了一项在线调查，以评估他们对 TPBx 的看法和教育需求。医生分为进行 TPBx 和不进行 TPBx 的医生。查询 MUSIC 和 PURC 登记册以评估 TPBx 的使用率。描述性分析和双变量分析确定了提供者/实践特征与态度之间的关联。
自 2019 年以来，MUSIC 和 PURC 实践中 TPBx 的采用率分别增加了两倍以上，达到 7.0%和 16%。在邀请参加调查的 350 名泌尿科医生中，共收到 91 份完整回复，其中 21 名（23%）报告进行了 TPBx。参与者估计 TPBx 表演者和非表演者的学习曲线不到 10 例。未观察到学习曲线与提供者年龄/实践环境之间存在显著关联。TPBx 的主要益处是降低败血症风险、提高癌症检出率和抗生素管理。实施的主要障碍包括设备获取和患者体验。进行 TPBx 的泌尿科医生报告说学习曲线是一个额外的障碍，而不进行 TPBx 的医生则报告了手术持续时间。
设备获取和患者体验问题仍然是采用 TPBx 的重大障碍。传播利用现有设备的技术并优化 TPBx 的局部麻醉方案可能有助于促进 TPBx 的持续采用。
