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BACKGROUND: Male infertility is a widespread issue that many couples are dealing with. Medical practitioners have begun to use modern diagnostic methods such as transrectal ultrasonography (TRUS) and scrotal ultrasound (US) to better understand the reasons and potential remedies for this disease. With the aid of these imaging tools, the male reproductive system can be thoroughly examined to assess structural abnormalities and other acquired illnesses that may be contributing factors to infertility. AIM/OBJECTIVE: To identify the underlying causes of male infertility through the use of transrectal ultrasound (TRUS) and scrotal ultrasound, with a focus on emphasizing their diagnostic role. RESULTS: In our study encompassing 127 male participants aged between 22 and 70 years (mean age 38.11), 121 individuals presented with primary infertility, while 6 exhibited secondary infertility. Transrectal Ultrasound (TRUS) findings indicated a range of abnormalities, 20 unilateral seminal vesicle agenesis, 5 unilateral atrophic seminal vesicle, 5 bilateral seminal vesicle agenesis, 1 bilateral atrophic seminal vesicles, 4 seminal vesicle calculi, 2 vas deferens calculi, 2 testicular microlithiasis, 14 ejaculatory duct calculi, 1 ejaculatory duct stricture, 1 epidydymal head cyst, 16 prostatic cysts, 6 prostatitis and 57 normal studies. Among the 121 patients, 51 underwent scrotal ultrasound which revealed 13 normal, 24 varicoceles, 2 hydroceles, 1 spermatocele, 9 epidydymal cysts, 5 epidydymitis, 4 atrophic testis, 1 epidydymo-orchitis and 1 undescended testis. CONCLUSION: Ultrasounds of the scrotum and transrectum are crucial for identifying anomalies in male infertility that can be corrected. The likelihood of becoming a parent is increased by these imaging modalities, which also improve clinical assessments and guide treatment plans. [ABSTRACT FROM AUTHOR] more...

Abstract Background Despite the fact that prostate abscess (PA) is a serious condition, no standardized guidelines are available on the best methods for its drainage. The goal of the current study is to compare the outcomes of the three modalities of prostate abscess (PA) drainage: transrectal ultrasound (TRUS) guided aspiration (TRA), transperineal aspiration (TPA), and transurethral de-roofing (TUD). Methods The records of 66 patients diagnosed with PAs were collected between 2015 and 2022 and divided into 3 groups according to the technique of abscess drainage that was used. Group A included 26 patients treated by TRA; Group B included 28 patients treated by TUD; and Group C included 12 patients treated by TPA. The three groups were compared based on demographic data, drainage success, recurrence, complications, and hospital stay. Results The mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Central abscesses were detected in 35 patients (53%), peripheral in 21 patients (31.8%), and both central and peripheral in 10 patients (15.2%). The most common clinical presentation was lower urinary tract symptoms (LUTS) in 45 patients (68.18%), followed by fever in 40 patients (60.6%). The mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Recurrence of the abscess occurred in three (11.5%), one (3.6%), and one (8.3%) patients in groups A, B, and C, respectively (p = 0.496). The mean hospital stay was 4.8 ± 1.7, 5 ± 1.8, and 4.5 ± 1.3 days in groups A, B, and C, respectively (p = 0.763). When compared to the other two groups, the TUD group had a higher rate of complications (32.1%). Conclusion A TRUS-guided transrectal and transperineal aspiration of PA were comparable to TUD technique regarding the recurrence rate and hospitalization period; however, the safety profile was in favor of the aspiration groups. more...

Objective/background: Benign prostatic hyperplasia (BPH) is increasing substantial burden on health care systems. Men with high body mass index (BMI) have bigger prostate volumes (PV) with subsequent increase in lower urinary tract symptoms (LUTS) than men with normal BMI. The purpose of this research was to investigate the correlation between Obesity and PV in patients with BPH. Method: The study included 560 patients (50–80 years) with BPH. Weight and height measured to calculate BMI. TRUS was used to measure PV. Patient demographics such as IPSS score and prostate specific antigen (PSA) were also noted. Results: Patients in the study had a mean age of 65.3 ± 9.45 years and the mean BMI was 23.97 ± 4.89 kg/m2. The mean PV of each BMI group were 37.45 ± 0.81, 57.89 ± 1.52 and 77.94 ± 2.17 (ml) for normal, overweight and obese groups, respectively, and the average PV score was 57.76 ± 1.50 ml. The mean PSA score was 3.26 ± 0.94 (ng/dl) with a range of 0.6–10.4. There was significant correlation between BMI and PV (p = 0.001) as well as between BMI with PSA and IPSS (p = 0.02, 0.001, respectively). Conclusion: The results showing strong correlation between BMI and PV also BMI with PSA and IPSS. Therefore reducing weight may lead to a lower prostate volume in the elderly stage, making LUTS less noticeable and improving quality of life. [ABSTRACT FROM AUTHOR] more...

Objective: This study aimed to prospectively assess the visibility of interstitial needles on transrectal ultrasound (TRUS) in cervical cancer brachytherapy patients and evaluate its impact on implant and treatment plan quality. Material and methods: TRUS was utilized during and after applicator insertion, with each needle's visibility documented through axial images at the high-risk clinical target volume's largest diameter. Needle visibility on TRUS was scored from 0 (no visibility) to 3 (excellent discrimination, margins distinct). Quantitative assessment involved measuring the distance between tandem and each needle on TRUS and comparing it to respective magnetic resonance imaging (MRI) measurements. Expected treatment plan quality based on TRUS images was rated from 1 (meeting all planning objectives) to 4 (violation of High-risk clinical target volume (CTVHR) and/or organ at risk (OAR) hard constraints) and compared to the final MRI-based plan. Results: Analysis included 23 patients with local FIGO stage IB2-IVA, comprising 41 applications with a total of 230 needles. A high visibility rate of 99.1% (228/230 needles) was observed, with a mean visibility score of 2.5 ± 0.7 for visible needles. The maximum and mean difference between MRI and TRUS measurements were 8 mm and –0.1 ± 1.6 mm, respectively, with > 3 mm discrepancies in 3.5% of needles. Expected treatment plan quality after TRUS assessment exactly aligned with the final MRI plan in 28 out of 41 applications with only minor deviations in all other cases. Conclusion: Real-time TRUS-guided interstitial needle placement yielded high-quality implants, thanks to excellent needle visibility during insertion. This supports the potential of TRUS-guided brachytherapy as a promising modality for gynecological indications. [ABSTRACT FROM AUTHOR] more...

Copyright of Studies in Law: Research Papers / Studia Prawnicze. Rozprawy i Materialy is the property of Andrzej Frycz Modrzewski Krakow University, AFM Publishing Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...

Introduction Transrectal ultrasound (TRUS) is a valuable imaging technique used to diagnose abscesses and fistulas in the anorectal region. It provides detailed visualization of soft tissues and anatomical structures, making it a crucial tool for assessing conditions that are often challenging to diagnose with other methods. Our work explores the anatomy relevant to TRUS and outlines the methodology of the examination, emphasizing its importance in the accurate detection and treatment planning of anorectal disorders. Aim of the study To evaluate the effectiveness of transrectal ultrasound (TRUS) as a diagnostic tool for identifying and assessing abscesses and fistulas in the anorectal region. Methods and materials This review was conducted based on available data published in the PubMed database, using the following phrases: "TRUS”, „abscess", „diagnosis of fistulas”, and ”anorectal disorders”. Conclusion Transrectal ultrasound (TRUS) has proven to be a highly effective diagnostic tool for the detection and evaluation of abscesses and fistulas in the anorectal region. Its ability to provide clear visualization of soft tissues and complex anatomical structures enhances diagnostic accuracy, facilitating more precise treatment planning. By outlining the anatomical context and proper methodology for TRUS, this study highlights the technique’s value in improving clinical outcomes for patients with anorectal disorders. Further research and refinement of TRUS protocols may continue to optimize its diagnostic potential. more...

Abstract Objectives In this narrative review, we aim to present two cases of transperineal drainage of prostate abscesses with a good clinical outcome. Furthermore, we reviewed the literature on this treatment approach and aim to propose a minimally invasive protocol for managing this rare condition. Patients and Methods Our patients are 33‐ and 61‐year‐old males who both underwent uncomplicated transperineal drainage of prostate abscess with the use of a Precision Point device with rapid clinical improvement and complete resolution of the abscess within the follow‐up period. We used PubMed to conduct a literature search and included and evaluated 16 relevant case reports and case series in which the authors utilized transperineal drainage techniques for prostatic abscesses. Results Our first patient was young and very unwell with sepsis and a pulmonary embolism. He had a complex abscess extending through the prostate to the left pelvic side wall. Trans‐gluteal drainage of the pelvic side‐wall collection was required in addition to transperineal drainage of the prostate abscess. After drainage and a prolonged course of antibiotics, he achieved resolution of the abscess by 7 weeks with ejaculatory function intact. Our second patient who was very keen on the preservation of ejaculatory function had multiple small abscesses and underwent transperineal drainage. He had significant interval improvement of his abscess burden at the 4‐week follow‐up and complete resolution at the 6‐month follow‐up. The total number of cases in the literature on our review is 22, with considerable variability in how the authors managed the prostate abscesses that underwent transperineal drainage, including variability in their follow‐up time frame, choice of imaging modality, duration of antibiotic treatment, drain placement, and use of irrigation solutions (including antibiotics) into the abscess cavity. Furthermore, the sizes of the prostate abscesses were not consistently reported. Given the small sample size and variability in management from different authors, it was not possible to draw any statistical analysis. Conclusion Transperineal prostate abscess drainage combined with prolonged antibiotic therapy provides a less invasive alternative to treating prostate abscesses for those who which to preserve ejaculatory function and avoid the other adverse events of transurethral de‐roofing. In itself, it can achieve complete resolution of abscess. It provides the benefit of drainage under real‐time imaging; for percutaneous drain placement; prevents urethral injury; retrograde ejaculation; and can be done under local anaesthetic which is preferable for the unstable patient. The utility of the procedure may be limited by the complexity of the abscess or whether it has extended beyond the prostate. The patient should always be informed that further drainage via percutaneous methods or transurethral methods may be necessary if their clinical condition does not improve. We recommend this procedure be offered as an alternative to transurethral methods in younger patients and those who would like to preserve ejaculatory function. Furthermore, we highly encourage a prolonged course of antibiotic therapy and interval follow‐up with clinical review of symptoms and imaging to confirm resolution. more...

Prostate cancer is one of the most common male malignancies worldwide. It affects middle-aged men (45–60 years) and is the leading cause of cancer-related mortality in Western countries. The TRUS (trans rectal ultrasound)-guided prostate biopsy has been a standard procedure in prostate cancer detection for more than thirty years, and it is recommended in male patients with an abnormal PSA (prostate-specific antigens) or abnormalities found during digital rectal examinations. During this procedure, urologists might encounter difficulties which may cause subsequent complications. This manuscript aims to present both the complications and the technical difficulties that may occur during TRUS-guided prostate biopsy, along with resolutions and solutions found in the specialized literature. The conclusions of this manuscript will note that the TRUS-guided prostate biopsy remains a solid, cost-efficient, and safe procedure with which to diagnose prostate cancer. The complications are usually self-limiting and do not require additional medical assistance. The difficulties posed by the procedure can be safely overcome if there are no other available alternatives. Open communication with the patients improves both pre- and post-procedure compliance. [ABSTRACT FROM AUTHOR] more...

Abstract Background Multi-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3–5 and PI-RADS 4–5 as a threshold for targeted prostatic biopsy. Methods This is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3–4 versus PI-RADS 4–5 lesion by mpMRI for prostate cancer detection in biopsy-naive men. Results The overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3–5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4–5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value more...

Background: Premature ejaculation (PE) seems to be the most common sexual complaint in men. Prostatic inflammation is a known cause of PE. Transrectal ultrasonography (TRUS) is widely used to help in the management of both benign and malignant diseases of the prostate. This study aimed To discuss TRUS findings in cases of PE. Method: A case control study carried out on 24 married adult male patients with age ranged from 25 to 53 years, diagnosed with PE, attending our outpatient clinic at the Department of Urology, Faculty of Medicine, Zagazig University Hospital for the first time from October 2018 to June 2019. Full medical history was taken from all patients. All patients underwent a complete andrological and physical examination. Evaluation of prostate and seminal vesicles was done via transrectal ultrasound scanning methods. Results: The TRUS findings of prostate showed that the volume of prostate among the studied cases ranged from 13.2 to 39.2 ml with mean 27.65 ml. 20.8% had calcification, 37.5% had inhomogeneous prostatic texture and only 4.2% had utricular cyst. The TRUS findings of seminal vesicle (SV) among the studied cases showed that total volume ranged from 4 to 9.5 ml with mean 6.55 ml. Conclusion: The TRUS of SV must be considered in the clinical assessment of patients with PE. SVs ultrasound changes and its surgical or endoscopic management in future might be of a valuable goal for the management of patients with PE. [ABSTRACT FROM AUTHOR] more...

Background: Multi-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3–5 and PI-RADS 4–5 as a threshold for targeted prostatic biopsy. Methods: This is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3–4 versus PI-RADS 4–5 lesion by mpMRI for prostate cancer detection in biopsy-naive men. Results: The overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3–5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4–5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value < 0.0001 and P value = 0.004, respectively). Conclusions: Limiting the TBs to PI-RADS 4–5 lesions improves the performance of mp-MRI in the detection of prostate cancer especially aggressive tumors. [ABSTRACT FROM AUTHOR] more...

Purpose: Prostate cancer (PCa) imaging has been revolutionized by the introduction of multi-parametric Magnetic Resonance Imaging (mpMRI). Transrectal ultrasound (TRUS) has always been considered a low-performance modality. To overcome this, a computerized artificial neural network analysis (ANNA/C–TRUS) of the TRUS based on an artificial intelligence (AI) analysis has been proposed. Our aim was to evaluate the diagnostic performance of the ANNA/C-TRUS system and its ability to improve conventional TRUS in PCa diagnosis. Methods: We retrospectively analyzed data from 64 patients with PCa and scheduled for radical prostatectomy who underwent TRUS followed by ANNA/C-TRUS analysis before the procedure. The results of ANNA/C-TRUS analysis with whole mount sections from final pathology. Results: On a per-sectors analysis, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy were 62%, 81%, 80%, 64% and 78% respectively. The values for the detection of clinically significant prostate cancer were 69%, 77%, 88%, 50% and 75%. The diagnostic values for high grade tumours were 70%, 74%, 91%, 41% and 74%, respectively. Cancer volume (≤ 0.5 or greater) did not influence the diagnostic performance of the ANNA/C-TRUS system. Conclusions: ANNA/C-TRUS represents a promising diagnostic tool and application of AI for PCa diagnosis. It improves the ability of conventional TRUS to diagnose prostate cancer, preserving its simplicity and availability. Since it is an AI system, it does not hold the inter-observer variability nor a learning curve. Multicenter biopsy-based studies with the inclusion of an adequate number of patients are needed to confirm these results. [ABSTRACT FROM AUTHOR] more...

Introduction: Journal clubs are a strategy that allows students to be exposed to critical appraisal of articles from the early stages of their training. Its long-term impact on the formation of competencies is debated. Objetive: To evaluate if the sessions of a Journal Club increase the confidence that Dentistry students have in their abilities to critically appraise a clinical trial. Material and Methods: A prospective cohort study that involved 21 students from the Faculty of Dentistry of the Universidad Nacional Mayor de San Marcos (Lima, Peru) who participated in six Journal Club monthly sessions. The sessions involved the analysis and discussion of clinical trials. Confidence to critically appraise an article before and after was assessed using a self-administered scale. Final and baseline scores were analyzed using a Wilcoxon test. Results: Nineteen students finished all the sessions. Scores before the sessions were on average 2.09±1.17, while after the sixth session an average of 3.53±0.26 was obtained (p more...

In prostate cancer, fusion biopsy, which couples magnetic resonance imaging (MRI) with transrectal ultrasound (TRUS), poses the basis for targeted biopsy by allowing the comparison of information coming from both imaging modalities at the same time. Compared with the standard clinical procedure, it provides a less invasive option for the patients and increases the likelihood of sampling cancerous tissue regions for the subsequent pathology analyses. As a prerequisite to image fusion, segmentation must be achieved from both MRI and TRUS domains. The automatic contour delineation of the prostate gland from TRUS images is a challenging task due to several factors including unclear boundaries, speckle noise, and the variety of prostate anatomical shapes. Automatic methodologies, such as those based on deep learning, require a huge quantity of training data to achieve satisfactory results. In this paper, the authors propose a novel optimization formulation to find the best superellipse, a deformable model that can accurately represent the prostate shape. The advantage of the proposed approach is that it does not require extensive annotations, and can be used independently of the specific transducer employed during prostate biopsies. Moreover, in order to show the clinical applicability of the method, this study also presents a module for the automatic segmentation of the prostate gland from MRI, exploiting the nnU-Net framework. Lastly, segmented contours from both imaging domains are fused with a customized registration algorithm in order to create a tool that can help the physician to perform a targeted prostate biopsy by interacting with the graphical user interface. [ABSTRACT FROM AUTHOR] more...

The use of mobile devices such as smartphones and tablets, which is increasingly widespread throughout the world, is currently at an all-time high. This technological disruption makes mobile e-commerce or mcommerce a business channel that is considered more convenient and efficient for today's lifestyle compared to e-commerce or offline stores. This study aims to determine the effect of perceived risk, satisfaction and price image on repurchase intention using m-commerce among the people of Sungai Penuh City, with trust and price sensitivity as moderating. This study uses the Smart PLS software data analysis method. Research This research was conducted in the urban area of Sungai Penuh City in 2021. The population in this study was the Sungai Penuh City Community who had shopped through m-commerce at least once. The results of this study state that perceived risk has no significant effect on repurchase intentions using m-commerce. Price image also has a positive and significant effect on repurchase intention using mcommerce. Whether consumer confidence in m-commerce is higher or lower, the perceived risk still has no impact on repurchase intentions using m-commerce. The second moderating effect of this study is the Pengaruh Persepsian Risiko, Kepuasan dan Citra Harga Terhadap Niat Membeli Ulang Menggunakan M-Commerce di Kalangan Masyarakat Kota Sungai Penuh, dengan Kepercayaan dan Sensitivitas Harga Sebagai Moderasi. [ABSTRACT FROM AUTHOR] more...

Ultrasound (US) imaging for medical purposes has been increasing in popularity over the years. The US technology has some valuable strengths, such as it is harmless, very cheap, and can provide real-time feedback. At the same time, it has also some drawbacks that the research in this field is trying to mitigate, such as the high level of noise and the low quality of the images. This survey aims at presenting the advances in the techniques used for US medical imaging. It describes the studies on the different organs that the US uses the most and tries to categorize the research in this field into three groups, i.e., segmentation, classification, and miscellaneous. This latter group includes the works that either provide aid during surgical operations or try to enhance the quality of the acquired US images/volumes. To the best of our knowledge, this is the first review that analyzes the different techniques exploited on a large selection of body locations (i.e., brain, thyroid, heart, breast, fetal, and prostate) in the three sub-fields of research. [ABSTRACT FROM AUTHOR] more...

Background: We aimed to assess the safety and effectiveness of TRUS guided betamethasone injections in refractory cases of chronic nonbacterial prostatitis., Patients and Methods: Forty-five patients with refractory CNP were included in a prospective cohort clinical trial. Six injections of betamethasone sodium sulfate were guided by TRUS. After injection: assessment of NIH-CPSI, IPSS, IIEF, GRA and VAS were performed 1, 4, and 12 weeks after injection. Prostatitis symptoms were measured by NIH-CPSI. We considered the minimal clinically important difference (MCID) as a 25% decrease or a six-point reduction from baseline. We considered the MCID of the IIEF to be at least an increase of 4 points. We considered the MCID of the IPSS score to be three points and the MCID for the VAS score to be a 25%-35% change of the initial score. Regarding the global response assessment (GRA), scores 5-7 means significant success rate of perceived treatment., Results: According to total NIH CPSI score, the success rate of injected cases was 71% after 1 week, dropping to 55.6% after 4 weeks and 44.4% after 12 weeks. According to IPSS questionnaire, the MD (mean difference) is -4.09 ± 3.5, -3.8 ± 3.83 and -3.47 ± 3.92. According to the IIEF questionnaire, the success rate was 22% and 26.7% after 4 and 12 weeks respectively. According to GRA, successful pain control was reported in 82%, 71% and 64.4% after 1, 4 and 12 weeks, respectively., Conclusion: Intraprostatic betamethasone injection is a simple, safe, and feasible procedure in refractory cases with CNP with predominant pain and urinary symptoms., (© 2024 Wiley Periodicals LLC.) more...

While brachytherapy is an effective treatment for localized prostate cancer, there has been a noticeable decline in its use. Training opportunity for prostate brachytherapy has been in steady decline, with some residents receiving little to no hands-on training. This work was developed to design a training environment that uses a phantom-based simulator to teach the process of TRUS-based prostate brachytherapy A prostate phantom was fabricated from a representative prostate patient TRUS scan. Three materials were used: gelatin powder, graphite powder, and water. The prostate was developed using 9% gelatin and 0.3% graphite per 100 ml water. Five radiation oncologists were asked to qualitatively score the phantom according to image quality, haptic feedback, needle insertion quality, and its compatibility with operative tools. The contrast-to-noise ratio (CNR) was estimated using different concentrations of graphite. The elasticity of the phantom was evaluated based on ultrasound elastography measurements The prostate phantom had an average CNR of 3.94 ± 1.09 compared to real prostate images with a CNR of 2 ± 1.8. The average Young's modulus was computed to be 58.03 ± 6.24 kPa compared to real prostate tissue (58.8 ± 8.2 kPa). Oncologists ranked the phantom as "very good" for overall quality of the phantom. They reported that needle insertion quality was "very good" during a simulated brachytherapy procedure. We have developed a 3D printing prostate phantom to be used for training purposes during prostate brachytherapy. The phantom has been evaluated for image quality and elasticity. The reconstructed phantom could be used as an anthropomorphic surrogate to train residents on prostate brachytherapy procedures. [ABSTRACT FROM AUTHOR] more...

Abstract Background Ultrasound (US) imaging has been proved as an excellent diagnostic tool in gynecology and, due to its wide availability and limited cost, is under intense investigation as base for dose adaptation in cervical cancer brachytherapy. Purpose of this work is to test inter/intra-observer uncertainties between magnetic resonance (MR) and trans-rectal ultrasound (TRUS) imaging in defining maximum tumor width before first brachytherapy (BT) application in a prospective cohort of cervical cancer patients undergoing image-guided adaptive brachytherapy (IGABT). Methods One hundred ten consecutive cervical cancer patients treated between 2013 and 2016 were included. Before the first BT implant patients underwent MR and TRUS scan with no applicator in place. Images were independently analyzed by three examiners, blinded to the other’s results. With clinical information at hand, maximum tumor width was measured on preBT TRUS and MR. Quantitative agreement analysis was undertaken. Intra-class correlation coefficient (ICC), Passing-Bablok and Bland Altman plots were used to evaluate the intra/inter-observers measurement agreement. Results Average difference between tumor width measured on MR (HRCTVMR) and TRUS (HRCTVTRUS) was 1.3 ± 3.2 mm (p more...

BACKGROUND: Tissue Doppler imaging (TDI) uses the Doppler principle to quantify the movement of biological tissues. OBJECTIVE: To investigate the contribution of TDI parameters derived during magnetic resonance imaging and ultrasound (MRI/US) fusion-guided biopsy for prostate cancer (PCa) discrimination. METHODS: From March 2016 to Dec. 2018, 75 men with suspected PCa prospectively underwent fusion-guided prostate biopsy. TDI overlaid on predefined target lesion were compared to the confirmed contralateral tumor-free area of the prostate gland (using Image J). Diagnostic value of TDI parameters was assessed using histopathology as standard of reference. RESULTS: Thirty-seven patients were diagnosed with PCa (49.3%), among them 27 with clinically significant PCa (Gleason score > 3 + 3 = 6 (ISUP 1). The LES/REF ratio was lower in confirmed PCa patients compared to patients without PCa (0.42, IQR, 0.22–0.59 vs. 0.52, IQR, 0.40–0.72, p = 0.017). TDI parameters allowed differentiation of low-risk from high-to-intermediate-risk PCa (ISUP 2 versus ISUP 3) based on lower pixel counts within the target ROI (1340, IQR 596–2430 vs. 2687, IQR 2453–3216, p = 0.004), lower pixel percentage (16.4 IQR 11.4–29.5 vs. 27.3, IQR 22.1–39.5; p = 0.005), and lower LES/REF ratios (0.29, IQR 0.19–0.51 vs. 0.52, IQR 0.47–0.74, p = 0.001). CONCLUSION: TDI of prostate lesions prelocated by MRI discriminates between cancerous and noncancerous lesions and further seems to enable characterization of PCa aggressiveness. This widely available US technique may improve confidence in target lesion localization for tissue sampling. [ABSTRACT FROM AUTHOR] more...

Ultrasound is a widely used method for examination of the prostate. This retrospective study compared the prostate volume obtained using transabdominal (TA) ultrasound to the volume of transrectal (TRUS) ultrasound. Over a three year period 42 patients had the volume of the prostate measured using both TA and TRUS methods. Sixteen different sonographers performed the TA measurements and three radiologists the TRUS measurement. Sixty‐six percentage of TRUS and 78% of TA measurements were classed as grade 3 prostatomegaly according to the volume obtained. TA measurements were larger than the TRUS measurement in 57% of cases. The findings in this study suggest that TA and TRUS cannot be used interchangeably. [ABSTRACT FROM AUTHOR] more...

A fifty-nine year-old male was hospitalized for exacerbation of chronic pancreatitis. As a gigantic cyst of the pancreatic tail was identified, it was fused with the jejunal loop. Due to persistent fever and severe symptoms in the storage and voiding phases, the patient was referred to a urologist. Because transrectal ultrasound examination revealed a fluid collection resembling the left seminal vesicle filled with purulent material, a transrectal puncture procedure was performed. The analysis of computed tomography scans led to the diagnosis of duplicated collecting system of the left kidney with the enormous ureter of the upper moiety that entered the prostate gland. In order to permanently decompress the hydronephrosed upper moiety of the left kidney, the patient was deemed eligible for endoscopic treatment. A transurethral incision through the bladder wall and the adjacent segment of the ectopic ureter was made with holmium laser under transrectal ultrasonography guidance, thus creating a neo-orifice of this ureter. more...

Objectives: The aim of the study was to sonological evaluation of male infertility at pre-testicular, testicular and post-testicular levels. Material and methods: This study was conducted in the department of obstetrics and gynecology in collaboration with the department of radiodiagnosis. All the patients are evaluated with history, clinical examination, and appropriate basic investigations like semen analysis. Patients are classified into pre-testicular, testicular, post-testicular and idiopathic groups. Trans scrotal ultrasound (TSU) and doppler, trans rectal ultrasound (TRUS) were done. The observations are tabulated and analyzed. Results: The TRUS findings in the testicular group 2 numbers of patients had calcification of prostrate. In post testicular group 82.3% (n=14) had seminal vesicle enlargement, 47% (n=8) had ejaculatory duct enlargement. In the idiopathic group 60% (n=3) had seminal vesicle cyst, 20% (n=1) had enlarged prostate and 20% (n=1) had seminal vesicle calcification. The TSU findings in the testicular group 66.6% (n=14) had small testis, 33.33% (n=7) patients had calcification, 30.0% (n=8) had varicocele of testis. In post testicular group epididymal cyst seen in 50% (n=8), epididymal calcification in 31.2% (n=5). In idiopathic group epididymal cyst seen in 22.2% (n=2), epididymal calcification in 22.2% (n=2). Conclusion: Imaging modalities are adjuvant to conventional evaluation of male infertility whereas the imaging modalities evaluate the anatomical integrity and normalcy of male reproductive system. more...

The purpose of this study was to compare low-dose-rate prostate brachytherapy treatment plans created using three retrospectively applied planning techniques with plans delivered to patients. Treatment plans were created retrospectively on transrectal ultrasound (TRUS) scans for 26 patients. The technique dubbed 4D Brachytherapy was applied, using TRUS and MRI to obtain prostatic measurements required for the associated webBXT online nomogram. Using a patient's MRI scan to create a treatment plan involving loose seeds was also explored. Plans delivered to patients were made using an intraoperative loose seed TRUS-based planning technique. Prostate V 100 (%), prostate V 150 (%), prostate D 90 (Gy), rectum D 0.1cc (Gy), rectum D 2cc (Gy), urethra D 10 (%), urethra D 30 (%), and prostate volumes were measured for each patient. Statistical analysis was used to assess and compare plans. Prostate volumes measured by TRUS and MRI were significantly different. Prostate volumes calculated by the webBXT online nomogram using TRUS- and MRI-based measurements were not significantly different. Compared with delivered plans, TRUS-based 4D Brachytherapy plans showed significantly lower rectum D 0.1cc (Gy) values, MRI-based 4D Brachytherapy plans showed significantly higher prostate V 100 (%) values and significantly lower rectum D 0.1cc (Gy), urethra D 10 (%), and urethra D 30 (%) values, and loose seed MRI-based plans showed significantly lower prostate V 100 (%), prostate D 90 (Gy), rectum D 0.1cc (Gy), rectum D 2cc (Gy), urethra D 10 (%), and urethra D 30 (%) values. TRUS-based 4D Brachytherapy plans showed similar dosimetry to delivered plans; rectal dosimetry was superior. MRI can be integrated into the 4D Brachytherapy workflow. The webBXT online nomogram overestimates the required number of seeds. [ABSTRACT FROM AUTHOR] more...

Identifying dominant intraprostatic lesions (DILs) on transrectal ultrasound (TRUS) images during prostate high-dose-rate brachytherapy treatment planning remains a significant challenge. Multiparametric MRI (mpMRI) is the tool of choice for DIL identification; however, the geometry of the prostate on mpMRI and on the TRUS may differ significantly, requiring image registration. This study assesses the dosimetric impact attributed to differences in DIL contours generated using commonly available MRI to TRUS automated registration: rigid, semi-rigid, and deformable image registration, respectively. Ten patients, each with mpMRI and TRUS data sets, were included in this study. Five radiation oncologists with expertise in TRUS-based high-dose-rate brachytherapy were asked cognitively to transfer the DIL from the mpMRI images of each patient to the TRUS image. The contours were analyzed for concordance using simultaneous truth and performance level estimation (STAPLE) algorithm. The impact of DIL contour differences due to registration variability was evaluated by comparing the STAPLE-DIL dosimetry from the reference (STAPLE) plan with that from the evaluation plans (manual and automated registration) for each patient. The dosimetric impact of the automatic registration approach was also validated using a margin expansion that normalizes the volume of the autoregistered DILs to the volumes of the STAPLE-DILs. Dose metrics including D 90 , D mean , V 150 , and V 200 to the prostate and DIL were reported. For urethra and rectum, D 10 and V 80 were reported. Significant differences in DIL coverage between reference and evaluation plans were found regardless of the algorithm methodology. No statistical difference was reported in STAPLE-DIL dosimetry when manual registration was used. A margin of 1.5 ± 0.8 mm, 1.1 ± 0.8 mm, and 2.5 ± 1.6 mm was required to be added for rigid, semi-rigid, and deformable registration, respectively, to mitigate the difference in STAPLE-DIL coverage between the evaluation and reference plans. The dosimetric impact of integrating an MRI-delineated DIL into a TRUS-based brachytherapy workflow has been validated in this study. The results show that rigid, semi-rigid, and deformable registration algorithms lead to a significant undercoverage of the DIL D 90 and D mean. A margin of at least 1.5 ± 0.8 mm, 1.1 ± 0.8 mm, and 2.5 ± 1.6 mm is required to be added to the rigid, semi-rigid, and deformable DIL registration to be suitable for DIL-boosting during prostate brachytherapy. [ABSTRACT FROM AUTHOR] more...

The purpose of this research is to exploit a weak and semi-supervised deep learning framework to segment prostate cancer in TRUS images, alleviating the time-consuming work of radiologists to draw the boundary of the lesions and training the neural network on the data that do not have complete annotations. A histologic-proven benchmarking dataset of 102 case images was built and 22 images were randomly selected for evaluation. Some portion of the training images were strong supervised, annotated pixel by pixel. Using the strong supervised images, a deep learning neural network was trained. The rest of the training images with only weak supervision, which is just the location of the lesion, were fed to the trained network to produce the intermediate pixelwise labels for the weak supervised images. Then, we retrained the neural network on the all training images with the original labels and the intermediate labels and fed the training images to the retrained network to produce the refined labels. Comparing the distance of the center of mass of the refined labels and the intermediate labels to the weak supervision location, the closer one replaced the previous label, which could be considered as the label updates. After the label updates, test set images were fed to the retrained network for evaluation. The proposed method shows better result with weak and semi-supervised data than the method using only small portion of strong supervised data, although the improvement may not be as much as when the fully strong supervised dataset is used. In terms of mean intersection over union (mIoU), the proposed method reached about 0.6 when the ratio of the strong supervised data was 40%, about 2% decreased performance compared to that of 100% strong supervised case. The proposed method seems to be able to help to alleviate the time-consuming work of radiologists to draw the boundary of the lesions, and to train the neural network on the data that do not have complete annotations. [ABSTRACT FROM AUTHOR] more...

Purpose: This report presents our early experience at Cleveland Clinic replacing conventional ultrasound with a novel 29 MHz high-resolution micro-ultrasound system for both systematic sampling and real-time targeting of suspicious regions during prostate biopsy. The added value of micro-ultrasound and MRI over systematic biopsy is presented. Methods: Sixty-seven consecutive subjects (January–August 2018) from our prospective database who underwent prostate biopsy using the micro-ultrasound system were included. 19/67 had prostate MRI imaging available. MRI targets were sampled using the UroNav fusion system. Patients had a median PSA of 5.37 ng/mL (IQR 4.13–8.74). Results: 38/67 (56.7%) subjects were positive for prostate cancer. In six of these cases, systematic biopsy was negative with only micro-ultrasound targeted samples detecting cancer. In two other cases, patients were upgraded from Grade Group 1 to Grade Groups 4 and 2 based on micro-ultrasound targets. Micro-ultrasound targets detected cancer in two subjects where MRI was negative (Grade Groups 3 and 2). MRI targets alone did not change the overall diagnosis of any subjects. Switching biopsy guidance to real-time micro-ultrasound increased detection rate on prostate biopsy from 44.8% (30/67) to 56.7% (38/67), a relative increase of 26.7%. Conclusion: High-resolution micro-ultrasound identified clinically significant cancer that would have, otherwise, been missed by both MRI fusion and systematic biopsy and was useful in both biopsy naïve and repeat negative patients. Early results from this small, single-center cohort are promising, particularly given the ease with which micro-ultrasound can replace the conventional ultrasound in standard prostate biopsy procedures. [ABSTRACT FROM AUTHOR] more...

Background: To identify the predictor factors, such as prostate-specific antigen (PSA), age, prostate volume (PV), and PSA density (PSAD) as indications to perform transrectal ultrasonography (TRUS)-guided prostate biopsy in reducing unnecessary biopsies and improving detection rate. Methods: A total of 1232 samples were obtained from the medical records of patients underwent prostate biopsy from January 2008 to December 2013 in Cipto Mangunkusumo Hospital Jakarta. Pre-biopsy data including age, PSA, prostate volume, and PSAD were obtained. The Mann-Whitney U-test and unpaired t-test were conducted on the quantitative variables; a chi-square test was used for qualitative variables. This study also conducted receiver operating characteristic (ROC) curve analysis to determine the cut-off point and the optimum specificity and sensitivity for each variable. Results: Among 1232 patients, 33.5% had a positive biopsy result. The median age and PSA (68 years and 57.45 ng/ml) in the positive biopsy group was higher than in the negative group (65 years and 11.69 ng/ml), p Conclusion: The incidence of PCa increased with higher PSA level, older age and lower PV. Utilization of PSAD 0.17 ng/ml/ml as a cut-off point in patients with PSA level between 4-10 ng/ml is recommended to improve PCa detection in Indonesian men. more...

Ksharasutra (parasurgical procedure using a thread treated by alkalies) is being practiced in Indian system of medicine since ancient time for management of ano-rectal disorders; particularly for Bhagandara, (fistula in ano), and generally difficult to treat. In this case series, standard Ksharasutra was prepared as per the Ayurvedic Pharmacopeia of India and used to treat the different cases of Bhagandara. In this case series total 6 patients of Bhagandara were treated with Ksharasutra and partial fistulectomy. The average Unit Cutting Time and healing (UCTH) was observed 7.86 days/cm. During treatment Panchawalkala Kwatha (decoction of five medicinal plant's bark), Shatdhautaghrita, Jatyaditaila and Erandabhrishtaharitaki Churna were used as adjuvant drugs. To generate quality evidence Transrectal Ultra Sonography (TRUS) was used in pre as well as post-treatment and showed remarkable tool to assess effect of treatment. Substantial clinical result was observed at the end of treatment and all the patients were free of fistula. No recurrence was observed in any case during the 12 follow up of 12 months. The treatment was reported safe and well tolerated in all the patients. more...

We present a robot-assisted approach for transrectal ultrasound (TRUS) guided prostate biopsy. The robot is a hands-free probe manipulator that moves the probe with the same 4 DoF that are used manually. Software was developed for three-dimensional (3-D) imaging, biopsy planning, robot control, and navigation. Methods to minimize the deformation of the prostate caused by the probe at 3-D imaging and needle targeting were developed to reduce biopsy targeting errors. We also present a prostate coordinate system (PCS). The PCS helps defining a systematic biopsy plan without the need for prostate segmentation. Comprehensive tests were performed, including two bench tests, one imaging test, two in vitro targeting tests, and an IRB-approved clinical trial on five patients. Preclinical tests showed that image-based needle targeting can be accomplished with accuracy on the order of 1 mm. Prostate biopsy can be accomplished with minimal TRUS pressure on the gland and submillimetric prostate deformations. All five clinical cases were successful with an average procedure time of 13 min and millimeter targeting accuracy. Hands-free TRUS operation, transrectal TRUS guided prostate biopsy with minimal prostate deformations, and the PCS-based biopsy plan are novel methods. Robot-assisted prostate biopsy is safe and feasible. Accurate needle targeting has the potential to increase the detection of clinically significant prostate cancer. [ABSTRACT FROM AUTHOR] more...

Purpose: The greater soft tissue contrast of magnetic resonance imaging (MRI) allows improved accuracy in prostate contouring compared to transrectal ultrasound (TRUS) and helps in identifying specific regions within the prostate. This study attempts to evaluate the potential benefit of MRI-TRUS fusion in treatment planning for more accurate prostate contouring and tumor dose escalation. Material and methods: 14 patients with previous MRI-guided prostate biopsy and an low-dose-rate (LDR) permanent prostate seed implant have been selected. The prostate and tumor (5 patients) were contoured on the MRI images by a radiologist. The prostate was also contoured on TRUS images during LDR procedure together by a urologist and radiation oncologist. MRI and TRUS images were rigidly fused to compare prostate contours in MRI and TRUS. Prostate was then re-contoured by the radiation oncologist using this fusion. Moreover, V100, V150, and D90 differences were evaluated for localized tumor compared to prostate with negative values indicating cold tumor regions. These cases were re-planned to simulate dose escalation. Results: The prostate volume was contoured 8 ±10% smaller in TRUS images, compared to MRI images. The mean percent difference in tumor (compared to prostate) V100 was 0.3 ±–0.4%, V150 was –0.7 ±–24.8%, and D90 was 0.2 ±–12.1%. For the posteriorly located tumors (2 cases), V100 was 0.0 ±–0.3%, D90 was 9.5 ±–3.0%, and V150 was 26.1 ±–5.4%. For anteriorly located tumors (3 cases), V100 was 0.4 ±–0.4%, D90 was –6.0 ±–11.9%, and V150 was –18.5 ±–14.4% (became 15.6 ±14.6% after re-plan). Conclusions: The MRI-TRUS image fusion is a feasible tool for the visualization of the prostate gland, particularly at the apex and base of the gland. Tumor identification presents the potential for dose escalation using fusion, especially for anteriorly located tumors. [ABSTRACT FROM AUTHOR] more...

Purpose: Transrectal ultrasound images are routinely acquired for low dose rate (LDR) prostate brachytherapy dosimetric preplanning (pTRUS), although diagnostic multiparametric magnetic resonance imaging (mpMRI) may serve this purpose as well. We compared the predictive abilities of TRUS vs MRI relative to intraoperative TRUS (iTRUS) to assess the role of mpMRI in brachytherapy preplanning. Materials and methods: Retrospective analysis was performed on 32 patients who underwent iTRUS‐guided prostate LDR brachytherapy as either mono‐ or combination therapy. 56.3% had pTRUS‐only volume studies and 43.7% had both 3T‐mpMRI and pTRUS preplanning. MRI was used for preplanning and its image fusion with iTRUS was also used for intraoperative guidance of seed placement. Differences in gland volume, seed number, and activity and procedure time were examined, as well as the identification of lesions suspicious for tumor foci. Pearson correlation coefficient and Fisher's Z test were used to estimate associations between continuous measures. Results: There was good correlation of planning volumes between iTRUS and either pTRUS or MRI (r = 0.89, r = 0.77), not impacted by the addition of hormonal therapy (P = 0.65, P = 0.33). Both consistently predicted intraoperative seed number (r = 0.87, r = 0.86). MRI/TRUS fusion did not significantly increase surgical or anesthesia time (P = 0.10, P = 0.46). mpMRI revealed suspicious focal lesions in 11 of 14 cases not visible on pTRUS, that when correlated with histopathology, were incorporated into the plan. Conclusions: Relative to pTRUS, MRI yielded reliable preplanning measures, supporting the role of MRI‐only LDR treatment planning. mpMRI carries numerous diagnostic, staging and preplanning advantages that facilitate better patient selection and delivery of novel dose escalation and targeted therapy, with no additional surgical or anesthesia time. Prospective studies assessing its impact on treatment planning and delivery can serve to establish mpMRI as the standard of care in LDR prostate brachytherapy planning. [ABSTRACT FROM AUTHOR] more...

Background: Screening for colorectal cancer in Denmark has resulted in more patients being diagnosed with benign adenomas and early-stage rectal cancer. In general, TRUS is accepted as a good modality for evaluating the above mentioned before deciding on surgery. Objective: To investigate the accuracy of TRUS in a clinical setting at the Region Hospital in Herning, Denmark. Study design: Retrospective cohort study from January 2016 to June 2018. Methods: Quantitative method. The cohort (117 patients) was recruited by searching for specific procedure codes. Data were collected by going through the electronic patient files. Results: TRUS predicted T0, T1, T2 and T3 with an accuracy of 91%, 35%, 43% and 20% respectively and an overall accuracy of 68%. A weighted Cohens kappa value of 0.30 (p .05). TRUS differentiated between T0/T1 with a sensitivity of 70%, specificity of 85% and an accuracy of 85% and kappa value of 0.44 (p .05). Conclusion: TRUS can with great precision establish whether the tumor is benign so correct local treatment can be instituted. [ABSTRACT FROM AUTHOR] more...