“Prostate management” under MRI-guidance: 7 years of improvements

BACKGROUND: The aim of this retrospective study is to represent our experience in percutaneous MRI-guided prostate procedures (biopsy and cryotherapy), and to discuss the improvement achieved in standardization of these procedures leading to a gain in feasibility and reproducibility of the technique used by urologists while handling MRI-environment. METHODS: From 2009 to 2018, 62 patients required MRI-guided prostate procedures in our institute. Throughout 9 years of experience, we have achieved an improvement of the technique used to protect the rectum and the urethra which increased accuracy and reproducibility. Procedures were performed by both urologists and radiologists under MRI guidance (Magnetom-Espree and Magnetom-Aera; Siemens, Erlangen, Germany) in a dedicated hybrid-room. RESULTS: Utilization of a patient stand and an acrylic needle-guided template created by Noras Company allowed standardization of the technique used and thus allowed an increase in accuracy. In order to protect the rectum, we inject patient’s own blood into the Denonvillier’s fascia which helps to dissect away the prostate from the rectum. In addition, the use of a thermocouple assistance probe placed in the urethral sphincter enabled urethral temperature monitoring during the entire procedure. The aim of temperature monitoring is to protect the urethra from possible thermal injuries. CONCLUSIONS: Improvements achieved in our technique used in MRI guided prostate procedures may allow wide spread use of this technique in both radiological and urological fields and opens opportunities in the development of focal therapy of the prostate using MRI-guidance.