Presented by: Omer Sadeh MD
Department of Urology, Rambam Health Care Campus, Haifa, Israel

Introduction

Trans-perineal (TP) ultrasound (US) of the prostate and pelvis may provide a non-invasive, non-painful, office-based method to visualize, evaluate and measure the prostate, and diagnose various conditions. It may also allow live imaging guidance for procedures and treatments presently performed using trans-rectal (TR) or trans-urethral approaches.

This pilot study was designed to assess the feasibility of visualization and evaluation of the prostate via TPUS.

Materials

Twenty subjects scheduled for TRUS-guided prostate biopsy in two medical centers in Israel during 2022 underwent TPUS evaluation of the prostate and pelvic organs using an abdominal curvilinear probe with the BK FlexFocus 500/800 machines. Patients were positioned in the lithotomy position. Examinations were performed by two urologists with extensive experience in conventional prostate US.  Investigators noted adequate visualization of various pelvic organs and anatomical landmarks in the sagittal and coronal views (n=20). Prostate diameters were measured in the base-apex (length) and anterior-posterior (height) aspects. In six patients right-left (width) measurement was also available, thus allowing calculation of prostate volume. Measurements were later compared to those taken by TRUS (n=11).

Results

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Using the TPUS approach, the prostate and bladder were clearly identified in all subjects. Bladder neck and seminal vesicles were viewed in 95% of examinees, pubic bone & rectum in 85%, and the urethra in 80%.

Prostate landmark identification rates are depicted in table 1.

Prostate diameters measured by TPUS and TRUS were compared using Wilcoxon Signed Ranks Test. No statistically significant differences were found between the two methods for length (p=0.248), width (p=0.917) or volume (p=0.075).

Conclusion

TPUS of the prostate requires operator experience in performing and interpreting. An operator learning curve is expected. According to this preliminary study, prostate TPUS may offer a feasible, accurate and simple alternative to some examinations and procedures currently performed using TRUS. Future applications under development include TP high-intensity focused US treatment of benign prostatic hyperplasia & localized prostate cancer and TPUS-enhanced “video” urodynamics.

Funding

NINA Medical

Co-Authors

Shir Tiger, MD
Department of Urology, Kaplan Medical Center, Rehovot, Israel

Dan Leibowitz, MD
Department of Urology, Kaplan Medical Center, Rehovot, Israel

Gilad Amiel, MD
Department of Urology, Rambam Health Care Campus, Haifa, Israel