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What is Transrectal Ultrasonography?
Transrectal ultrasonongraphy (TRUS) of the prostate has revolutionized doctors’ ability to examine this organ. It thus extends the possibilities of the physical examination. The most common application for this technology is to evaluate a man for prostate carcinoma (cancer).
When and why is TRUS performed?
TRUS is most commonly performed in conjunction with prostatic needle biopsy (a small tissue sample examined under a microscope). This rapid and generally well-tolerated procedure has produced impressive changes in the ability to determine the manner and stage presentation of men with prostate carcinoma. With advances of the blood test (PSA) and ultrasound guided biopsy, urologists can diagnosis tumors earlier. Over the last 10 to 15 years, they have been able to decrease the death rate from prostate carcinoma with appropriate early treatment.
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Why should I have a TRUS?
Generally the indications for prostate ultrasound and biopsy are either an abnormal digital rectal exam (DRE) or an elevation in the serum PSA level. Occasionally, men undergo TRUS because of symptoms of bladder outlet obstruction, such as difficulty urinating, or constitutional symptoms that suggest metastatic prostate carcinoma, i.e., spread of the disease to other parts of the body. TRUS has many other indications. These include: evaluation of complicated urinary tract infections, work-up of certain types of infertility, and evaluation of men with unusual pelvic symptoms. TRUS provides excellent visualization of the prostate. These indications and the ability to precisely direct a biopsy needle into regions of interest (or to provide uniformed consistent separation in the area sampled by the biopsy) have made the taking of prostate biopsies under ultrasound guidance a routine practice. Indeed, in many settings this has become the standard of care.
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How do I prepare for the procedure?
Prior to your prostate biopsy, you will be given prophylactic antibiotic tablet(s) with which to prevent infection. One dose of the antibiotic should be taken the night before your procedure. An additional antibiotic dose, if given, should be taken the morning of your biopsy. You may be given additional antibiotics to take after your procedure. Please take the medication as the physician or his nurse has instructed you. If this medication is being mailed to you, please contact your physician’s nurse if the tablets either arrived crushed or are not enclosed with these instructions.
On the day of, or the evening prior to the examination, you will need to give yourself an enema. This can be purchased at any pharmacy or grocery in the laxative section of the store. We recommend the brand FLEETS enema. Please follow the directions on the side of the FLEETS enema box, and please give yourself the enema 2 to 4 hours before your appointment.
If you have any questions concerning your examination or the procedure, you may call us at: (214) 648-3070.
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Can I take aspirin before the procedure?
If you are taking aspirin daily to thin your blood or for pain relief, please discontinue taking it at least 5 days before your biopsy or surgery. You should ask the physician when you to resume taking this medication after your procedure.
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EXAMPLES OF MEDICATIONS CONTAINING ASPIRIN:
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® Alka-Seltzer
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® Bufferin
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® Ecotrin
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® Emperin
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® Pepto-Bismol
If you are uncertain if any of your current medications contain aspirin, please call on the Urology Nurses at the Seay Biomedical Building at (214)645-UROL (8765).
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How is TRUS done?
Informed consent (your written permission) is obtained before the procedure. In most cases, a DRE will be performed before inserting the transrectal ultrasound probe. No anesthetic is required, even when biopsies are taken. Lidocaine Jelly or injection of Lidocaine may be used in the office to lessen the discomfort associated with this procedure. For purely diagnostic purposes, ultrasound requires little preparation. In general, though, a cleansing enema removes feces and gas from the rectum that might mechanically interfere with the study.
Antibiotics are essential if biopsy is to be performed. Most urologists will recommend or prescribe an oral fluroquinolon-type antibiotic for the day before and the morning of the procedure. This oral antibiotic is continued for 24 to 48 hours after the prostate biopsy.
In most incidences, urologists prefer patients to lay on their left side during the procedure. This posture allows the rectal probe to be easily inserted while also allowing the patient to relax. This knee/chest position also helps the prostate to be visualized. Generally, the rectal probe will be inserted, and the urologist will take pictures of the prostate in different areas: the base, the mid and apex, and the right and left side. Also, size measurements will be made of the prostate, which will be compared to the serum PSA findings.
These biopsies are not painful, but patients do feel and hear the biopsy gun firing.
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What areas are the biopsies taken from?
During the procedure, biopsies are taken from the base, mid-gland, and apex of both sides of the prostate. Sometimes additional biopsies are taken on the far lateral portions of the prostate or the “transition zone.” Thus, generally 5 to 6 and up to 15 to 16 biopsies can be taken in the area of the prostate. These biopsies are placed in a special medium and brought to the pathologist who read them to determine if the prostate is normal or if there are signs of carcinoma or benign prostatic hyperplasia.
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What can I expect after the procedure?
After the procedure, the ultrasound probe is removed, and the patient is free to dress in his normal clothes. Patients should remain in the waiting room until they can urinate without difficulty at least once on their own.
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Are there risks or complications?
There is a possibility of blood in the urine or bleeding in the rectum. Typically, this is mild, self-limiting, and resolves over a 1- to 2-day period. Occasionally (less than 1% of men), bleeding from the rectum or urine will need some type of intervention or therapy. The antibiotics should be taken as directed because they will prevent infection from occurring as a result of normal bacteria from the colon getting into the prostate.
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What do I do after the procedure?
The patient will be given a checklist of dos and don’ts. He should make sure he understands these and should call if he develops any questions or concerns once he leaves the clinic.
Biopsy results take at least 5 to 7 days. Usually, either the urology staff physician or his nurse will call the patient directly with the results. Often, if the biopsy is positive for cancer, repeat office visits are needed to discuss the various treatment options.
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