This podcast is created by Coelis.
We have to be actors in the changing of the practice and we have to change it now because it's a better way,
because it's the way of the future.
So the sooner we do it,
the better we're going to be in the future.
Hello Prostatol community,
welcome back to another exciting episode where we explore the frontiers of urology.
I'm Thomas,
your host,
and today's episode holds a special place in my heart because recently
I had the incredible opportunity to step into the operating room alongside the brilliant Dr.
Julien Ragt from Hôpital Cochon.
Together,
we were on a mission to witness and understand the transpareneal biopsies approach.
As we transition in today's conversation,
I'm eager to pick Dr.
Anrac Brain on the logistical intricacies of implementing the Transparenal approach.
From the meticulous planning to the live execution,
we'll unravel the behind-the-scenes magic that makes this procedure both revolutionary and essential in the realm of urology.
Without further ado,
let's welcome back Dr.
Julien Ract.
Thank you for joining us again,
and get ready for an episode that goes behind theory,
taking you on a journey into the real-world application of Transparenal Biopsies.
Bonjour,
Dr.
Enract.
Hello,
Thomas.
We are really pleased to welcome you for this podcast.
Comment ça va aujourd'hui?
I'm fine.
I'm really happy to be here.
It's always a pleasure to hear your really nice introduction.
Thank you so much.
I'm blushing now.
Before to start,
could you please introduce yourself for our listeners?
Yes,
my name is Julien Enract.
I live in Paris.
I work in the Hôpital Cochin since four years.
I'm a urologist.
I did my med school in Paris Descartes Université.
I worked on the prostatic biopsies,
and I also work in the research unit in
Necker Enfant Malade.
We do basic science about prostatic disease in general.
Thank you for this presentation.
For those of you who want to learn more about Dr.
Enracht and his practice,
feel free to listen to our first episode about transperineal prostate biopsy.
Could you tell us if you now regret switching to transperineal prostate biopsy?
No,
we don't regret the transperineal biopsy.
It's been now two or three years that we do only transperineal prostate biopsy.
We practice the biopsy in the ambulatory operating room.
So it allows us to use either the general anesthesia or the local anesthesia.
It's very comfortable for the patient and for the surgeon.
And now with the experience that we have...
With the team which is trained,
we can do eight patients in the morning.
It's basically
30 minutes for one patient,
including cleaning the room after.
So if you have the experience,
it can be really,
really fast,
as fast as the transrectal.
It reminds me of my visit at Hôpital Cochin a few days before this podcast,
and definitely it was just fascinating to see how it works well for you and your team.
What are the main...
Concrete advices you give to physicians who want to set up Transparenal Prostate Biopsy under local anesthesia.
So I think you first want to choose where you will perform the biopsy.
You have the option to do it in the office and you have the option to do it in the operating room.
The question is,
do you have access to the operating room?
If you have access to the operating room,
it's easier because you have all the team,
you have the nurses,
you have the anesthesiologist who can help you.
You can put patients under general anesthesia if needed.
You can use the local anesthesia,
of course.
So it gives you freedom.
If you don't have access to the OR,
and it's the case for many hospitals in France,
you can do it in the office,
but it takes more organization,
I think,
because most of the time you're kind of alone in the office.
You have only one nurse,
maybe no nurse.
So you have to be well organized.
And I think you can do less patient than in the operating room.
But it's the question of organization.
So you have to really think what is the most adapted technique and the most adapted way.
for you in your hospital.
So to put it in a nutshell,
it's a matter of where we will perform the biopsies and the organization,
right?
Yes,
it is.
What are the equipment needed?
So if you're already performing fusion transrectal biopsy,
you already have a sonograph,
but you need a new probe.
Because as we said in transperineal biopsy,
you need a sagittal view when you see the base and the apex of the prostate to see the whole needle.
And this kind of sagittal view is only offered by a new probe.
So you need that probe,
you need a stabilization arm.
We already talked about it in the previous episode of the podcast.
And it's very important.
I say it again.
It gives you stability,
it gives you free hand,
it gives you all you need,
I think,
to do a good biopsy,
a very precise biopsy,
because it's a matter of precision.
So being stable is one of the key to the success.
So except that,
you don't need much thing.
If you have the probe,
the sonograph,
It's important to have a needle driver,
but it's basically really cheap and easy material to get.
Does it need a lot of training?
The training is important,
but it was published before.
The learning curve is quite short.
If you are well taught,
you can perform the prostate biopsy if you see something like 10 or 20 cases.
But to be honest,
like in every technique,
you have to get familiar with the material.
The device is new,
so you have to learn how to use it.
It's easy if you use a transrectal route for the fusion biopsy because it's basically the same device,
but the stabilization arm,
the needle driver are quite different.
So when you get used to them,
and it's quite fast,
you're going to be very,
very soon very comfortable.
And what does that imply for the patient?
So the main point for the patient is the low rate of infection.
The low rate of infection is very important because there was a reason of getting the patient in the hospital again for prostatitis.
Prostatitis could be very serious.
And the other thing,
we talked about it already,
it's the absence of antibioprophylaxis.
It's a good thing for the patient because he won't have resistance.
And it's a good thing for all the patients because we are not increasing the resistance because we don't use any antibiotics.
So I think...
These are the two main points.
Is it longer than the transrectal approach?
To learn?
To perform?
To perform,
yes.
It can be a bit longer,
but I think it's longer at the beginning because there is more devices,
the stabilization arm,
the needle driver.
So it looks more complicated,
but actually I think it's not.
So to perform at the beginning,
it's longer,
but when you're used to it,
I think it's basically the same time than the transrectal.
The local anesthesia takes more time because it's more complex to do very good.
periprostatic nerve block under transperineal guidance.
To learn,
I think it's actually faster than the transrectal.
But the problem is that everybody is trained to transrectal right now and not to the transperineal.
So I don't think we have the occasion to compare except for the resident.
But actually,
we don't really train the resident to transrectal anymore in Cochon Hospital.
We train them to the future and the future is transperineal.
So I'm sure that we are finishing right now.
We have a high interest about transplurineal approach.
If you have to convince Center to invest in transplurineal prostate biopsy system,
what would you say?
First of all,
I think it's better for the patient.
We said it,
we don't have almost not infection,
it's less than 1% and it's very important because prostatitis is rare,
but prostatitis can be serious and you don't want your patient to be hospitalized,
sometimes in intensive united care.
So that's the first point.
The second point is it's the future.
It's in the European guidelines.
It's going to be in the French guidelines.
It's going to be one day in the USA guidelines.
It's inevitable.
So we are not changing the practice.
So we have to be active in the changing of the practice and we have to change it now because it's a better way,
because it's the way of the future.
So the sooner we do it,
the better we're going to be in the future.
Just a last thing,
you are performing Transparenal Prostate Biopsy in your daily practice,
and you also support other physicians who want to set up this approach.
Is it correct?
Yes,
we do that.
We organized workshops to teach people the Transparenal Route.
We actually started in 2019 in Cochin Hospital,
and we observed that it takes time and it takes a lot of tips and tricks about the organization.
We just talk about it,
about the technique itself.
And as in every technique,
if someone who knows how to do it teaches you,
it's easier,
it's faster,
and you do it better.
So,
yes,
we organized teaching like that and people are going from different countries to learn the technique,
to see the patient secrets,
to see everything that we do to make it easier,
to make it faster.
And I think it's a very,
very good way to learn if you have the occasion.
If you have physicians who are listening to us right now and are interested to be trained by you,
they just need to contact you to be involved in this workshop?
Yes,
of course.
We would be happy to welcome them in Hôpital Cochin.
And you will see it's a very nice place in front of the Jardin du Luxembourg.
So I encourage you to come and visit us.
I will be there,
maybe for another podcast.
Thanks a lot,
Julien,
Dr.
Honrath,
for these concrete elements.
What are your next plans now?
No,
we are focusing on the focal therapy.
As you know,
focal therapy is rising now.
So we use the same device.
We use the transperineal route.
So I think it's the next step.
It's experimental right now.
So we are driving studies to evaluate the selection of the patient,
who is candidate for this focal therapy,
what is the best energy to use it.
And I think it's linked with the biopsy because it's the same principle.
You are targeting a lesion visible in MRI with the sonography using a fusion of images.
So it's the same thing.
In one way you biopsy it,
in one way you treat it.
We can even imagine one day to practice a one-day care,
you know.
We biopsy the lesion and we treat it in the same way.
So maybe that would be the future,
I hope.
It sounds good.
We are looking forward to follow this exciting project.
I don't know if you remember last time I asked you if you were a song,
would it be?
I remember.
And you were happy.
So now my question is,
if you were a movie,
would it be Dr.
Honrath?
I think I would be the Godfather.
To shoot the prostate.
Yes,
to shoot the prostate.
Precisely.
Thank you.
Thank you again for your time.
And I hope to see you soon here with us.
Thank you,
Thomas.
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