Cognitive Magnetic Resonance Imaging-Transperineal Ultrasound Fusion Prostate Biopsy with Use of a Urinary Catheter After Abdominoperineal Resection: A Novel Technique and Literature Review.

A standard prostate biopsy can be performed via a transrectal or transperineal approach using a transrectal ultrasound probe, but not in patients without a rectum. These patients pose a diagnostic challenge to urologists in terms of prostate cancer detection. We report use of a novel technique for cognitive magnetic resonance imaging (MRI)-transperineal ultrasound fusion prostate biopsy with a urinary catheter in two patients without a rectum after abdominoperineal resection. In both cases, a urinary catheter was inserted and clamped after injection of 250 mL of sterile saline into the bladder to improve visualization of the prostate. The inflated catheter balloon was placed to the level of the bladder neck to identify the base of the prostate. Cognitive MRI-transperineal ultrasound fusion biopsy was performed on the MRI-defined lesions after confirmation of anatomic landmarks, including the urethra and base of the prostate. Systemic 8-core biopsies were also obtained. In both patients, the targeted lesion was diagnosed as prostate cancer.