Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality

Purpose: To compare 5 different rectal preparation strategies for prostate MRI. Methods: This 5-arm quality-assurance study evaluated 56 patients per arm (280 patients) including: no preparation, clear-fluids diet (CFD) beginning at 00:00 hours on the day of MRI, Fleet®-enema, enema + CFD, enema + CFD + IV-antispasmodic agent. The study was powered to 0.80 with alpha-error of 0.05. Three blinded radiologists independently evaluated T2-Weighted (T2W) and Diffusion Weighed Imaging (DWI) for: rectal diameter (maximal AP diameter), rectal content (stool, fluid, gas), rectal motion, T2W/DWI image quality, T2W image sharpness and DWI susceptibility artifact using 5-point Likert scales. Overall comparisons were performed using analysis of variance (ANOVA) and Kruskal-Wallis, with pair-wise comparisons using paired t-tests and Wilcoxon sign-rank tests. Results: Rectal diameter and amount of gas were lower in enema compared to non-enema groups (p < 0.001), with smallest diameter and least gas in the enema + CFD + IV-antispasmodic group (p = 0.022-<0.001). T2W image quality and sharpness were highest in the enema + CFD groups (p < 0.001) with no difference comparing enema + CFD with/without IV-antispasmodic (p = 0.064, 0.084). Motion artifact was least in enema + CFD + IV-antispasmodic group compared to all other groups (p < 0.001), followed by the enema + CFD group (p = 0.008-<0.001). DWI image quality was highest (p < 0.001) and DWI susceptibility artifact lowest (p < 0.001) in the enema + CFD groups (p < 0.001) and did not differ comparing enema + CFD with/without anti-spasmodic (p = 0.058-0.202). Conclusions: Use of enema + clear-fluids diet before prostate MRI yields the highest T2W and DWI image quality with the least DWI artifact. IV-antispasmodic use reduces motion on T2W but does not improve image quality on T2W or DWI, or lessen DWI artifact compared to enema + clear-fluids diet.

Randomized clinical trial on the use of a colon-occlusion device to assist rectal washout

Background Transrectal Natural Orifice Transluminal Endoscopic Surgery is currently limited by the inherent risk of surgical site infection due to peritoneal contamination after rectotomy. Coloshield has been developed as a temporary colon occlusion device to facilitate rectal washout. However, effectiveness and safety has not been evaluated in humans. Methods Twenty-two patients have been randomly assigned to undergo proctological intervention with a rectal washout with and without the use of Coloshield. Patients and assessors were blinded. Boston Bowel Preparation Scale (BBPS) has been determined 30 min as well as immediately after rectal washout. Feasibility, pain, intra- and postoperative morbidity as well as bowel function and continence 6 weeks after surgery were assessed. Results BBPS 30 min after rectal washout with and without Coloshield was in mean 2.42 ± 1.02 and 2.12 ± 0.89 (p = 0.042). Mean BBPS immediately after rectal washout was 2.39 ± 1.02 and 2.24 ± 0.66 (p = 0.269). Mean BBPS immediately after rectal washout and 30 min thereafter did not differ (p = 0.711). Coloshield application was feasible without any complications. The median (interquartile range) numeric rating scale for pain 4 h after surgery was 1 (0–1) and 3 (0–4) (p = 0.212). Six weeks after surgery 0/11 and 1/11 patients suffered from evacuation difficulties (p = 1.0) and the median Vaizey–Wexner score was 1 (0–3) and 1 (0–2) (p = 0.360). Conclusions Coloshield application in humans is feasible and safe. Slight benefits in rectal preparation by washout are found when Coloshield is used. Colon occlusion by Coloshield for transrectal NOTES should be evaluated within clinical studies. Trial registration Clinicaltrials.gov NCT02579330

Biópsia Prostática Transretal Após Preparação Profilática do Recto com Iodo-Povidona: Estudo Prospectivo Randomizado

Introduction: Transrectal ultrasound guided prostate biopsy (TRUS-Bx), according to the literature, can lead to urinary tract infections in up to 11% and sepsis in up to 2% of patients. We evaluate whether an original way to apply povidone-iodine rectal preparation just prior to TRUS-Bx can reduce infectious complications. Material and Methods: Between January 2014 and September 2016, 94 men in private office were prospectively randomized to two groups, before TRUS-Bx: • Rectal cleansing (an original transrectal “prostate massage” for about half a minute with 2.5 mL of betadine dermic solution 100 mg/mL) (n=47) or • No cleansing (n=47). All of the patients received prophylactic antibiotics: levofloxacin 500 mg PO for 7 days, beginning the day before procedure. Patients completed a telephone interview 4 days after undergoing the biopsy and went to the office 2 weeks after biopsy. The primary end point was the rate of infectious complications. An infectious complication when one or more of the following events occurred: 1) fever greater than 38.0Cº, 2) urinary tract infection or 3) sepsis (standardized definition). Student t test and multivariate regression analysis were used for data analysis. Results: Infectious complications developed in 6 cases (12.7%) in the non-rectal preparation group: five patients had fever without sepsis (11%) and one had sepsis (2%). In the povidone-iodine rectal preparation group there were no infectious complications (0.0%). Multivariate analysis did not identify any patient subgroups at significantly higher risk of infection after prostate biopsy. Of the 94 men who underwent TRUS-Bx 45 (47.9%) were diagnosed with prostate cancer and 3 (3.2%) had ASAP in the result. The hospital admission rate for urological complications within 30 days of the procedure was 1%, and only for infection related reasons (sepsis). Conclusion: The administration of quinolone-based prophylactic antibiotics and the simple use of 2.5 mL of povidone-iodine dermic solution in a transrectal prostate massage for Introduction: Transrectal ultrasound guided prostate biopsy (TRUS-Bx), according to the literature, can lead to urinary tract infections in up to 11% and sepsis in up to 2% of patients. We evaluate whether an original way to apply povidone-iodine rectal preparation just prior to TRUS-Bx can reduce infectious complications. Material and Methods: Between January 2014 and September 2016, 94 men in private office were prospectively randomized to two groups, before TRUS-Bx: • Rectal cleansing (an original transrectal “prostate massage” for about half a minute with 2.5 mL of betadine dermic solution 100 mg/mL) (n=47) or • No cleansing (n=47). All of the patients received prophylactic antibiotics: levofloxacin 500 mg PO for 7 days, beginning the day before procedure. Patients completed a telephone interview 4 days after undergoing the biopsy and went to the office 2 weeks after biopsy. The primary end point was the rate of infectious complications. An infectious complication when one or more of the following events occurred: 1) fever greater than 38.0Cº, 2) urinary tract infection or 3) sepsis (standardized definition). Student t test and multivariate regression analysis were used for data analysis. Results: Infectious complications developed in 6 cases (12.7%) in the non-rectal preparation group: five patients had fever without sepsis (11%) and one had sepsis (2%). In the povidone-iodine rectal preparation group there were no infectious complications (0.0%). Multivariate analysis did not identify any patient subgroups at significantly higher risk of infection after prostate biopsy. Of the 94 men who underwent TRUS-Bx 45 (47.9%) were diagnosed with prostate cancer and 3 (3.2%) had ASAP in the result. The hospital admission rate for urological complications within 30 days of the procedure was 1%, and only for infection related reasons (sepsis). Conclusion: The administration of quinolone-based prophylactic antibiotics and the simple use of 2.5 mL of povidone-iodine dermic solution in a transrectal prostate massage for

A feasibility study for the introduction of micro-enema to improve organ consistency in patients receiving radiotherapy for urinary bladder cancer

AimsThe aim of the study was to assess the effect on rectal consistency, of introducing a micro-enema in the preparation of patients receiving radiotherapy treatment of urinary bladder cancer.Materials and methodsThe treatment cone beam computed tomography (CBCT) images from patients receiving radiotherapy for bladder cancer were retrospectively assessed. CBCT datasets from nine patients treated without rectal preparation (97 CBCT), and 13 patients (134 CBCT) treated following micro-enema use before planning and treatment were evaluated. CBCT were compared with the planning computed tomography for rectal status, rectal diameter and presence of gas.ResultsReproducibility of an empty rectum was achieved in 70% of treatment fractions delivered using an enema protocol compared with 33% of fractions delivered without preparation. In total, 10% of fractions were delivered with the presence of faeces or faeces and gas, compared with 46% of fractions for the non-intervention group. Enemas did not affect the proportion of fractions delivered with gas, however, where gas was present, 65% of CBCT fractions had <5% gas for patients using enemas compared with 32% without.FindingsThe use of a micro-enema before planning scan and each fraction was well tolerated and proved effective in managing and reducing inter-fraction variations in rectal volume and contents.