Patients' related sexual outcomes in colorectal surgery.

Background: Patients undergoing colorectal surgery (CRS) have an increased risk of developing sexual disorders, attributed to different mechanisms. In this context, sexual function (SF) assessment of patients before and after surgery is essential: to identify risk factors for sexual disorders as well as to minimize their impact on overall quality of life (QoL), allowing them a satisfying relationship and sexual life. Material and methods: Patients over 18 years of age who underwent a CRS in the University Hospital of Geneva, Switzerland, between June 2014 and February 2016 were included. Our main objective was to compare and analyze the evolution of SF, QoL, and marital satisfaction (MS) before and after CRS. Specific and standardized tests were used. Results: A cohort of 72 patients with a median age of 58.73 was analyzed. The majority of CRS was elective (91.5%). A percentage of 52.8% of patients underwent surgery for oncological reasons. There was no statistical difference in SF, sexual QoL, and MS before and after elective or emergency CRS for men. Interestingly, a significant decrease in women's SF (FSFI) as well as their satisfaction within their couple (Locke-Wallace) until 12 months after surgery was found (p = 0.021). However, they showed a steady SF (GRISS) within their couple until 12 months after surgery. Conclusion: Regarding knowledge about difficulties to talk about this intimate topic and gender differences, this general overview raises the question of the necessity to introduce in a long-course follow-up different methods of sexual health assessment with specific stakeholders.

A first look at Android applications in Google Play related to COVID-19.

Due to the convenience of access-on-demand to information and business solutions, mobile apps have become an important asset in the digital world. In the context of the COVID-19 pandemic, app developers have joined the response effort in various ways by releasing apps that target different user bases (e.g., all citizens or journalists), offer different services (e.g., location tracking or diagnostic-aid), provide generic or specialized information, etc. While many apps have raised some concerns by spreading misinformation or even malware, the literature does not yet provide a clear landscape of the different apps that were developed. In this study, we focus on the Android ecosystem and investigate Covid-related Android apps. In a best-effort scenario, we attempt to systematically identify all relevant apps and study their characteristics with the objective to provide a first taxonomy of Covid-related apps, broadening the relevance beyond the implementation of contact tracing. Overall, our study yields a number of empirical insights that contribute to enlarge the knowledge on Covid-related apps: (1) Developer communities contributed rapidly to the COVID-19, with dedicated apps released as early as January 2020; (2) Covid-related apps deliver digital tools to users (e.g., health diaries), serve to broadcast information to users (e.g., spread statistics), and collect data from users (e.g., for tracing); (3) Covid-related apps are less complex than standard apps; (4) they generally do not seem to leak sensitive data; (5) in the majority of cases, Covid-related apps are released by entities with past experience on the market, mostly official government entities or public health organizations.

Differentiating kidney stones from phleboliths in unenhanced low-dose computed tomography using radiomics and machine learning.

OBJECTIVES: Distinguishing between kidney stones and phleboliths can constitute a diagnostic challenge in patients undergoing unenhanced low-dose CT (LDCT) for acute flank pain. We sought to investigate the accuracy of radiomics and a machine-learning classifier in differentiating between kidney stones and phleboliths on LDCT. METHODS: Radiomics features were extracted following a semi-automatic segmentation of kidney stones and phleboliths for two independent consecutive cohorts of patients undergoing LDCT for acute flank pain. Radiomics features from the first cohort of patients (n = 369) were ultimately used to train a machine-learning model designed to distinguish kidney stones (n = 211) from phleboliths (n = 201). Classification performance was assessed on the second independent cohort (i.e., testing set) (kidney stones n = 24; phleboliths n = 23) using positive and negative predictive values (PPV and NPV), area under the receiver operating curves (AUC), and permutation testing. RESULTS: Our machine-learning classification model trained on radiomics features achieved an overall accuracy of 85.1% on the independent testing set, with an AUC of 0.902, PPV of 81.5%, and NPV of 90.0%. Classification accuracy was significantly better than chance on permutation testing (p < 0.05, permutation p value). CONCLUSION: Radiomics and machine learning enable accurate differentiation between kidney stones and phleboliths on LDCT in patients presenting with acute flank pain. KEY POINTS: • Combining a machine-learning algorithm with radiomics features extracted for abdominopelvic calcification on LDCT offers a highly accurate method for discriminating phleboliths from kidney stones. • Our radiomics and machine-learning model proved robust for CT acquisition and reconstruction protocol when tested in comparison with an external independent cohort of patients with acute flank pain. • The high performance of the radiomics-based automatic classification model in differentiating phleboliths from kidney stones indicates its potential as a future diagnostic tool for equivocal abdominopelvic calcifications in the setting of suspected renal colic.

Digital Biologically Plausible Implementation of Binarized Neural Networks With Differential Hafnium Oxide Resistive Memory Arrays.

The brain performs intelligent tasks with extremely low energy consumption. This work takes its inspiration from two strategies used by the brain to achieve this energy efficiency: the absence of separation between computing and memory functions and reliance on low-precision computation. The emergence of resistive memory technologies indeed provides an opportunity to tightly co-integrate logic and memory in hardware. In parallel, the recently proposed concept of a Binarized Neural Network, where multiplications are replaced by exclusive NOR (XNOR) logic gates, offers a way to implement artificial intelligence using very low precision computation. In this work, we therefore propose a strategy for implementing low-energy Binarized Neural Networks that employs brain-inspired concepts while retaining the energy benefits of digital electronics. We design, fabricate, and test a memory array, including periphery and sensing circuits, that is optimized for this in-memory computing scheme. Our circuit employs hafnium oxide resistive memory integrated in the back end of line of a 130-nm CMOS process, in a two-transistor, two-resistor cell, which allows the exclusive NOR operations of the neural network to be performed directly within the sense amplifiers. We show, based on extensive electrical measurements, that our design allows a reduction in the number of bit errors on the synaptic weights without the use of formal error-correcting codes. We design a whole system using this memory array. We show on standard machine learning tasks (MNIST, CIFAR-10, ImageNet, and an ECG task) that the system has inherent resilience to bit errors. We evidence that its energy consumption is attractive compared to more standard approaches and that it can use memory devices in regimes where they exhibit particularly low programming energy and high endurance. We conclude the work by discussing how it associates biologically plausible ideas with more traditional digital electronics concepts.

[Diagnosis and management of small solid renal masses]. / Diagnostic et prise en charge des lésions tissulaires rénales de petite taille.

Discovery of small solid renal masses via echography, CT-scan or MRI is common in current medical practice, with more than 70 % found incidentally. Although they include benign lesions, most are renal cell carcinomas. A radiological assessment, associated if necessary with a percutaneous renal biopsy, leads to their diagnosis in the vast majority of cases. Minimally invasive partial nephrectomy has become the standard surgical technique in specialized centers. Ablative therapies (radiofrequency and cryotherapy) and active surveillance are other possible therapeutic approaches. A benefit-risk assessment of these treatments considering patient age, kidney function and comorbidities, is key in the management of these small solid renal masses.

La mise en évidence de petites lésions tissulaires rénales par échographie, scanner ou IRM, est fréquente dans la pratique médicale actuelle, avec plus de 70 % de découvertes fortuites. Bien qu'elles comprennent des lésions bénignes, la plupart sont des carcinomes à cellules rénales. Un bilan radiologique, associé si nécessaire à une biopsie rénale percutanée, permet de déterminer leur diagnostic dans la majorité des cas. La néphrectomie partielle mini-invasive est devenue la technique chirurgicale de référence dans les centres spécialisés. Les traitements ablatifs (radiofréquence et cryothérapie) et la surveillance active sont d'autres approches thérapeutiques envisageables. Une balance des risques et bénéfices de ces traitements, pondérée avec l'âge, la fonction rénale et les comorbidités du patient, est essentielle dans la prise en charge de ces lésions rénales.

[Preservation of sexual function : a challenge for the colorectal surgeon]. / Préservation de la fonction sexuelle : un défi pour le chirurgien colorectal.

Patients with rectal cancer have an increased risk of developing sexual disorders. These dysfunctions are caused by the disease itself (negative psychological impact, nerve compression in the pelvis), as well as by the treatments (radiotherapy, chemotherapy and surgery). Most sexual disorders are due to the surgery and can be attributed to injuries of the retroperitoneal nerves. Sexuality assessment of patients before and after treatment, a precise knowledge of the pelvic anatomy by the surgeon, and an appropriate care by specialists (gynaecologists, urologists and sexologists) are essential to reduce the risk of sexual disorders and to minimize their impact on overall quality of life.

Les patients atteints d'un cancer du rectum présentent un risque accru de développer ou d'aggraver des troubles de la sexualité. Ces dysfonctions sont causées par la maladie (impact psychologique négatif, compression nerveuse dans le petit bassin) d'une part, et par les traitements (radio, chimiothérapie et chirurgie) d'autre part. Parmi ceux-ci, la chirurgie est responsable de la plupart des troubles sexuels, par lésion des plexus neurovégétatifs. Une évaluation de la sexualité des patients avant et après traitement, une connaissance précise de l'anatomie du petit bassin par le chirurgien ainsi qu'une prise en charge adaptée par des spécialistes (gynécologues, urologues, sexologues) constituent les étapes essentielles afin de diminuer le risque de survenue de troubles sexuels et leur impact sur la qualité de vie globale des patients.

80-W GreenLight Laser Vaporization Versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Obstruction: 5-Year Outcomes of a Single-center Prospective Randomized Trial.

OBJECTIVE: To assess long term functional and safety follow-up data after 80-W GreenLight photoselective vaporization (GL PV) of the prostate and transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Prospective randomized trial at a single tertiary referral center (Geneva, Switzerland). Patients were recruited in the outpatient clinic if they met the criteria for surgical treatment of benign prostatic obstruction. At baseline, 238 patients were treated either with the 80-W GL PV or monopolar TURP. After 5 years, data were available from 105 patients: 44 GL PV patients and 61 TURP patients. The primary outcome measure was the International Prostate Symptom Score (IPSS). Secondary outcome measures included maximum urinary flow rate (Qmax), postvoidal residual (PVR) and reoperation rate. Statistical analyses were performed using Stata 14 (StataCorp). RESULTS: After 5 years of follow-up, mean improvements in International Prostate Symptom Score, postvoidal residual and maximum urinary flow rate were similar in both groups. The re-treatment rate was 14.3% in the GL PV group vs 11.9% in the TURP group (P = .9). CONCLUSION: Noninferiority of the GL PV to TURP was confirmed in all functional and safety outcomes at 5-year follow-up. GL-PV could be a safe surgical alternative for patients suffering from benign prostatic obstruction.

Post-kidney Transplant Robot-assisted Laparoscopic Ureteral (Donor-receiver) Anastomosis for Kidney Graft Reflux or Stricture Disease.

OBJECTIVE: To report our experience with robot-assisted ureteral anastomosis for kidney graft. Kidney graft complex ureteral strictures or symptomatic vesicoureteral reflux may require complex reconstruction. This is classically done through an open surgical access, which adds to the morbidity of kidney transplantation. The da Vinci robot enables performance of complex laparoscopic procedures and may hence be used for such reconstructions. PATIENTS AND METHODS: We retrospectively reviewed all patients undergoing robotic surgical revision for stricture or reflux disease over a 3-year period. Contemporary patients who underwent open surgery were used as a control group. RESULTS: Ten patients underwent a robotic attempt, of whom 4 needed conversion to open surgery. Seven patients underwent an open surgery. Preoperative demographics were similar in both groups. The median operative time was 293 minutes, with a shorter operative time in the open group. The group of patients who could be completed robotically had a significantly lower postoperative length of stay (5 vs 9 days), quicker return to normal food intake (postoperative day 1 vs 3), and quicker control of pain without opiates (postoperative day 1 vs 4) than the converted or open group. Morbidity was comparable with 1 late Clavien IIIb complication in each subgroup (open, converted, and robotic group). After a median follow-up of 43 months, renal function was stable and there were no recurrent graft infections. CONCLUSION: Robotic ureteral reconstruction for kidney graft patients is feasible and efficient, and offers the classical advantages of minimally invasive surgery with outcomes comparable with open series.

Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques.

INTRODUCTION: The study aimed to evaluate 3 different modalities of transrectal ultrasound (TRUS)-guided prostate biopsies (PBs; 2D-, 3D- and targeted 3D-TRUS with fusion to MRI - T3D). Primary end point was the detection rate of prostate cancer (PC). Secondary end point was the detection rate of insignificant PC according to the Epstein criteria. PATIENTS AND METHODS: Inclusion of 284 subsequent patients who underwent 2D-, 3D- or T3D PB from 2011 to 2015. All patients having PB for initial PC detection with a serum prostate-specific antigen value ≤20 ng/ml were included. Patients with T4 and/or clinical and/or radiological metastatic disease, so as these under active surveillance were excluded. RESULTS: Patients with T3D PB had a significantly higher detection rate of PC (58 vs. 19% for 2D and 38% for 3D biopsies; p = 0.001), with no difference in Gleason score distribution (p = 0.644), as well as detection rate of low-risk cancers (p = 0.914). Main predictive factor for positive biopsies was the technique used, with respectively a 3- and 8-fold higher detection rate in the 3D- and T3D group. For T3D-PB, there was a significant correlation between radiological cancer suspicion (Prostate Imaging Reporting and Data System Score) and cancer detection rate (p = 0.02). CONCLUSIONS: T3D PB should be preferred over 2D PB and 3D PB in patients with suspected PC as it improves the cancer detection rate.

Physical Realization of a Supervised Learning System Built with Organic Memristive Synapses.

Multiple modern applications of electronics call for inexpensive chips that can perform complex operations on natural data with limited energy. A vision for accomplishing this is implementing hardware neural networks, which fuse computation and memory, with low cost organic electronics. A challenge, however, is the implementation of synapses (analog memories) composed of such materials. In this work, we introduce robust, fastly programmable, nonvolatile organic memristive nanodevices based on electrografted redox complexes that implement synapses thanks to a wide range of accessible intermediate conductivity states. We demonstrate experimentally an elementary neural network, capable of learning functions, which combines four pairs of organic memristors as synapses and conventional electronics as neurons. Our architecture is highly resilient to issues caused by imperfect devices. It tolerates inter-device variability and an adaptable learning rule offers immunity against asymmetries in device switching. Highly compliant with conventional fabrication processes, the system can be extended to larger computing systems capable of complex cognitive tasks, as demonstrated in complementary simulations.

All Spin Artificial Neural Networks Based on Compound Spintronic Synapse and Neuron.

Artificial synaptic devices implemented by emerging post-CMOS non-volatile memory technologies such as Resistive RAM (RRAM) have made great progress recently. However, it is still a big challenge to fabricate stable and controllable multilevel RRAM. Benefitting from the control of electron spin instead of electron charge, spintronic devices, e.g., magnetic tunnel junction (MTJ) as a binary device, have been explored for neuromorphic computing with low power dissipation. In this paper, a compound spintronic device consisting of multiple vertically stacked MTJs is proposed to jointly behave as a synaptic device, termed as compound spintronic synapse (CSS). Based on our theoretical and experimental work, it has been demonstrated that the proposed compound spintronic device can achieve designable and stable multiple resistance states by interfacial and materials engineering of its components. Additionally, a compound spintronic neuron (CSN) circuit based on the proposed compound spintronic device is presented, enabling a multi-step transfer function. Then, an All Spin Artificial Neural Network (ASANN) is constructed with the CSS and CSN circuit. By conducting system-level simulations on the MNIST database for handwritten digital recognition, the performance of such ASANN has been investigated. Moreover, the impact of the resolution of both the CSS and CSN and device variation on the system performance are discussed in this work.

[Frequent uro-geriatric symptoms : helpful tools for general practitioners]. / L'urogériatrie du médecin généraliste.

Each developed country faces an aging population. Increase of age rises the risk to develop urologic pathology especially in men. Routine investigation and diagnostic of urologic pathology important, however must take into account the patient in his globality (including age, comorbidities, drug medication as well as sociocultural environment). The aim of this article is to help the general practitioner in taking decisions with frequent uro-geriatric symptoms. Bladder catheterization remains an invasive treatment and indication should be regularly re-evaluated. Urinary infections must be distinguished from bacterial colonisations, with some exceptions, don't need any specific treatment. We will resume two algorithms on the management of hematuria and the management of prostate cancer suitable for the elderly.

Tout pays développé voit vieillir sa population et le risque de développer une pathologie urologique augmente avec l'âge, notamment chez les hommes. La prise en charge d'un symptôme urologique doit prendre en compte la personne âgée dans sa globalité. Cet article rappelle les éléments principaux de la gestion initiale d'un prostatisme : dépister les symptômes, débuter un traitement et surtout l'adapter au quotidien du patient. La sonde urinaire est un traitement invasif dont l'indication doit être remise en cause. Les infections urinaires sont à différencier des colonisations bactériennes qu'il ne faut pas traiter, sauf dans certaines situations. Nous reprendrons deux arbres décisionnels sur la prise en charge de l'hématurie et d'un cancer prostatique adaptés à la personne âgée.

Failure Analysis in Magnetic Tunnel Junction Nanopillar with Interfacial Perpendicular Magnetic Anisotropy.

Magnetic tunnel junction nanopillar with interfacial perpendicular magnetic anisotropy (PMA-MTJ) becomes a promising candidate to build up spin transfer torque magnetic random access memory (STT-MRAM) for the next generation of non-volatile memory as it features low spin transfer switching current, fast speed, high scalability, and easy integration into conventional complementary metal oxide semiconductor (CMOS) circuits. However, this device suffers from a number of failure issues, such as large process variation and tunneling barrier breakdown. The large process variation is an intrinsic issue for PMA-MTJ as it is based on the interfacial effects between ultra-thin films with few layers of atoms; the tunneling barrier breakdown is due to the requirement of an ultra-thin tunneling barrier (e.g., <1 nm) to reduce the resistance area for the spin transfer torque switching in the nanopillar. These failure issues limit the research and development of STT-MRAM to widely achieve commercial products. In this paper, we give a full analysis of failure mechanisms for PMA-MTJ and present some eventual solutions from device fabrication to system level integration to optimize the failure issues.

Current-limiting challenges for all-spin logic devices.

All-spin logic device (ASLD) has attracted increasing interests as one of the most promising post-CMOS device candidates, thanks to its low power, non-volatility and logic-in-memory structure. Here we investigate the key current-limiting factors and develop a physics-based model of ASLD through nano-magnet switching, the spin transport properties and the breakdown characteristic of channel. First, ASLD with perpendicular magnetic anisotropy (PMA) nano-magnet is proposed to reduce the critical current (Ic0). Most important, the spin transport efficiency can be enhanced by analyzing the device structure, dimension, contact resistance as well as material parameters. Furthermore, breakdown current density (JBR) of spin channel is studied for the upper current limitation. As a result, we can deduce current-limiting conditions and estimate energy dissipation. Based on the model, we demonstrate ASLD with different structures and channel materials (graphene and copper). Asymmetric structure is found to be the optimal option for current limitations. Copper channel outperforms graphene in term of energy but seriously suffers from breakdown current limit. By exploring the current limit and performance tradeoffs, the optimization of ASLD is also discussed. This benchmarking model of ASLD opens up new prospects for design and implementation of future spintronics applications.

Spin-transfer torque magnetic memory as a stochastic memristive synapse for neuromorphic systems.

Spin-transfer torque magnetic memory (STT-MRAM) is currently under intense academic and industrial development, since it features non-volatility, high write and read speed and high endurance. In this work, we show that when used in a non-conventional regime, it can additionally act as a stochastic memristive device, appropriate to implement a "synaptic" function. We introduce basic concepts relating to spin-transfer torque magnetic tunnel junction (STT-MTJ, the STT-MRAM cell) behavior and its possible use to implement learning-capable synapses. Three programming regimes (low, intermediate and high current) are identified and compared. System-level simulations on a task of vehicle counting highlight the potential of the technology for learning systems. Monte Carlo simulations show its robustness to device variations. The simulations also allow comparing system operation when the different programming regimes of STT-MTJs are used. In comparison to the high and low current regimes, the intermediate current regime allows minimization of energy consumption, while retaining a high robustness to device variations. These results open the way for unexplored applications of STT-MTJs in robust, low power, cognitive-type systems.

[How to manage a pyelocalyceal dilatation?]. / Que faire face à une dilatation pyélocalicielle?

Due to its length and its small diameter, the ureter is exposed to a high obstructive risk which may be ascribed to extremely variable pathologies. Because of a remarkably active peristalsis, the clinical consequence is acute if the obstacle suddenly settles. The radiological sign of appeal is the pyelocalyceal dilatation, which is widely listed in the Western medical system, in consideration of the abundance of the practiced imaging. From the acute situation to the fortuitous discovery, its understanding must be further investigated because of the immediate symptomatic potential impact such as renal colic, which can be associated with sepsis, as well as possible long-term sequelae on renal function. This article aims to help the primary care physician to initiate its diagnosis and treatment.

Histologic confirmation of a biochemical recurrence after radical prostatectomy by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance imaging.

OBJECTIVE: To obtain a histologic confirmation of biochemical recurrence after radical prostatectomy, which still remains a challenge. Historically, biopsy protocols have been designed but have provided rather unsatisfactory results. We report the first case of histologic confirmation of a biochemical recurrence in the prostatectomy bed by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance images. MATERIALS AND METHODS: A 66-year-old man who underwent laparoscopic prostatectomy for a localized prostate cancer of Gleason sum 3+3=6 and preoperative prostate-specific antigen (PSA) level of 8.9 ng/L was followed up yearly. Postoperative serum PSA value was <0.04 ng/L. Nine years later, the patient developed a biochemical recurrence with an elevation of serum PSA level to 1.27 ng/mL. A 3-T endorectal positron emission tomography-magnetic resonance imaging (MRI) scan showed a 5 × 3 mm nodule in the prostatectomy bed in contact with the vesicourethral anastomosis without hypermetabolism. Two biopsies of this nodule were performed by using a 3-dimensional endorectal ultrasonography probe connected to the Koelis navigation system (Urostation; Koelis, Grenoble, France) with fusion to MRI images. RESULTS: Histologic findings confirmed the presence of a recurrence of the prostate cancer of Gleason sum 4+3=7 in both biopsies, and the patient was addressed to the radio-oncologist for salvage therapy. CONCLUSION: The use of a transrectal approach with 3-dimensional guidance and MRI fusion allows correct sampling of prostate cancer recurrence nodules in the prostate bed. This procedure is easily performed in the outpatient clinic but still has to be validated in a larger series.

Neuromorphic function learning with carbon nanotube based synapses.

The principle of using nanoscale memory devices as artificial synapses in neuromorphic circuits is recognized as a promising way to build ground-breaking circuit architectures tolerant to defects and variability. Yet, actual experimental demonstrations of the neural network type of circuits based on non-conventional/non-CMOS memory devices and displaying function learning capabilities remain very scarce. We show here that carbon-nanotube-based memory elements can be used as artificial synapses, combined with conventional neurons and trained to perform functions through the application of a supervised learning algorithm. The same ensemble of eight devices can notably be trained multiple times to code successively any three-input linearly separable Boolean logic function despite device-to-device variability. This work thus represents one of the very few demonstrations of actual function learning with synapses based on nanoscale building blocks. The potential of such an approach for the parallel learning of multiple and more complex functions is also evaluated.

Assessment of sexual function and conjugal satisfaction prior to and after liver transplantation.

BACKGROUND: The aims of this study were to assess sexual function and conjugal satisfaction in patients prior to and after liver transplantation, and in comparison to healthy individuals. MATERIAL AND METHODS: A cross-sectional cohort questionnaire assessment was performed in adult liver recipients, including the International Index of Erectile Function (IIEF) for men or the Female Sexual Function Index (FSFI) for women. Conjugal satisfaction was assessed with the Locke-Wallace Marital Adjustment Test. Waitlist candidates and age-matched healthy individuals were used as controls. RESULTS: Questionnaires of 136 patients were assessed (45 women/91 men, mean age: 57 ± 11 years). Overall, sexual function improved after transplantation (male: p=0.065 and female: p=0.072), but remained lower than in aged-matched healthy individuals. The post-transplant level of conjugal satisfaction was stable and similar to healthy controls in men, but improved significantly in women (p=0.008), with higher levels than in healthy subjects (p=0.05). CONCLUSIONS: The present study shows that sexual function improves after transplantation, yet not to the level of healthy controls. It also demonstrates, for the first time, that post-transplant conjugal satisfaction is at least similar to the one of healthy controls.

[3D ultrasound guidance for prostate biopsy with MRI-image fusion]. / Biopsies de la prostate sous guidage échographique 3D avec fusion à l'IRM.

Endorectal prostate biopsies by using 2D ultrasound guidance remain the gold standard for diagnosing prostate cancer. However this technique is limited by a low yield knowing that only 20-30% of all prostate biopsies detect prostate cancer. Since a few years it is possible to do these biopsies by using 3D endorectal ultrasound guidance with fusion to MRI images in order to increase the yield. This new technique permits to visualize the exact localization of all biopsies and gives the certitude of a good mapping of the prostate tissue increasing the yield up to 40%. By fusioning images of the MRI with the 3D ultrasound, it is even possible to target suspect lesions visualized on the MRI, which permits to increase the yield up to 100% in favorable cases.