|
Bad TRUS view:
|
|
| Stool |
Rectal cleansing |
| Bubbles |
Wait a few minutes |
| Prostate calcifications |
Not reliable |
|
Hydrodissection:
|
|
|
Needle is not advanced:
|
|
| in the midline |
Check relation on TRUS axial view and the D-line/central plane with the urinary catheter |
| to the prostate base |
Palpate with finger to check if rectum wall is free |
| Not performed in the proper plane |
Check on TRUS axial view and perform again |
|
Hydrodissection is not possible due to incorrect position of the needle, e.g. in the rectum wall or in the prostate adhesions or patient anatomy |
Reposition the needle Lowering the probe before starting may help to open the space; if this is not possible, it is recommended to abort the procedure |
|
Dilator:
|
|
| is difficult to insert |
Make a deeper incision |
| is not advanced to the prostate base |
Check on TRUS and reposition |
|
Balloon:
|
|
| cannot be inflated |
Remove the sheath sufficiently |
|
Push the balloon deeper, so it does not interfere with pelvic muscles |
| is partially inflated and accidentally sealed |
Remove RBI or detach it |
| is inflated in a suboptimal position (wrong cleavage) |
Deflate RBI (percutaneous) |
| is sealed and spontaneously deflates |
Completely Deflate RBI, be mindful of perforation |
|
Post-procedure:
|
|
| Infection |
Prophylactic antibiotic pre-procedure |
|
Quick start of antibiotic regimen |
| Bleeding |
Stop antiplatelet therapy in advance |
| Urinary retention |
Urinary catheter |
| Rectal perforation |
Deflate RBI, suture, and post-operative antibiotics |
| Balloon is deflated |
Implant transperineal fiducial markers before RBI implantation |
