Risk Factors and Contemporary Management Options for Pain and Discomfort Experienced During a Prostate Biopsy.

PURPOSE OF REVIEW: Prostate fusion biopsy, an innovative imaging modality for diagnosing prostate cancer, presents certain challenges for patients including discomfort and emotional distress, leading to nonadherence to treatment and follow-ups. To inform clinicians and offer pain relief alternatives to patients, this review delves into the risk factors for increased pain and modern management options to alleviate pain during prostate biopsy. RECENT FINDINGS: Individual responses to pain vary, and the overall experience of pain during a prostate biopsy has been contributed to numerous factors such as patient age, prostate volume, previous biopsy experience, and more. As a result, several strategies aim to mitigate pain during in-office procedures. Notably, techniques including pharmacological analgesics, hand holding, heating pads, entertainment/virtual reality, and distraction have shown significant efficacy. Existing studies explore risk factors influencing pain intensity during prostate biopsy and effective pain management strategies. This review consolidates available information to guide clinicians in enhancing patient comfort and thus, encourage surveillance adherence.

Association of Crowd-Sourced Assessment of Technical Skills and Outcomes of Robotic-assisted Radical Prostatectomy.

OBJECTIVE: To investigate if use of the Crowd-Sourced Assessment of Technical Skills (CSATS) platform and video peer review with constructive feedback is associated with improvement in technical skill and patient outcomes for robotic-assisted laparoscopic prostatectomy (RALP). METHODS: Five fellowship-trained urologists voluntarily submitted RALP cases for CSATS Global Evaluative Assessment of Robotic Skills (GEARS) scoring and expert narrative review between April 15, 2022-April 30, 2023. Surgeon-selected and randomly selected cases were reviewed. Surgeons underwent local peer review of videos with constructive feedback. Change in GEARS scores and frequency of postoperative outcomes over the 12-month periods before and during the study were analyzed in logistic regression models. Bias was assessed with sensitivity analysis comparing surgeon-selected to randomly selected cases. RESULTS: GEARS scores for randomly selected vs surgeon-selected cases did not differ significantly. Overall GEARS score correlated positively with annual surgical RALP volume (r = 0.39, P = .003) and negatively with years in practice (r = -0.34, P = .01). After adjusting for confounders, there was no significant improvement in overall GEARS Score (0.01 ± 0.02/month, P = .48); but likelihood of sepsis (Odds Ratio 0.07, 95% CI 0.01-1.00, P = .05) and pelvic fluid collection (Odds Ratio 0.09, 95% CI 0.01-0.99, P = .049) were significantly decreased during the intervention period (n = 165) compared to the prior 12months (n = 144). No outcome increased in likelihood (P > .05). CONCLUSION: Integration of CSATS and local video peer review is associated with significant improvement in patient outcomes after RALP, despite no significant change in surgeons' GEARS scores. This is the first study demonstrating improvement in patient RALP outcomes after implementation of such a paradigm in practicing surgeons.