WEBVTT

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This podcast is created by Coelis.

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We have to be actors in the changing of the practice and we have to change it now because it's a better way,

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because it's the way of the future.

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So the sooner we do it,

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the better we're going to be in the future.

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Hello Prostatol community,

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welcome back to another exciting episode where we explore the frontiers of urology.

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I'm Thomas,

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your host,

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and today's episode holds a special place in my heart because recently

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I had the incredible opportunity to step into the operating room alongside the brilliant Dr.

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Julien Ragt from Hôpital Cochon.

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Together,

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we were on a mission to witness and understand the transpareneal biopsies approach.

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As we transition in today's conversation,

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I'm eager to pick Dr.

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Anrac Brain on the logistical intricacies of implementing the Transparenal approach.

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From the meticulous planning to the live execution,

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we'll unravel the behind-the-scenes magic that makes this procedure both revolutionary and essential in the realm of urology.

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Without further ado,

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let's welcome back Dr.

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Julien Ract.

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Thank you for joining us again,

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and get ready for an episode that goes behind theory,

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taking you on a journey into the real-world application of Transparenal Biopsies.

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Bonjour,

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Dr.

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Enract.

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Hello,

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Thomas.

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We are really pleased to welcome you for this podcast.

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Comment ça va aujourd'hui?

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I'm fine.

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I'm really happy to be here.

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It's always a pleasure to hear your really nice introduction.

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Thank you so much.

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I'm blushing now.

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Before to start,

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could you please introduce yourself for our listeners?

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Yes,

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my name is Julien Enract.

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I live in Paris.

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I work in the Hôpital Cochin since four years.

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I'm a urologist.

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I did my med school in Paris Descartes Université.

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I worked on the prostatic biopsies,

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and I also work in the research unit in

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Necker Enfant Malade.

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We do basic science about prostatic disease in general.

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Thank you for this presentation.

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For those of you who want to learn more about Dr.

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Enracht and his practice,

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feel free to listen to our first episode about transperineal prostate biopsy.

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Could you tell us if you now regret switching to transperineal prostate biopsy?

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No,

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we don't regret the transperineal biopsy.

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It's been now two or three years that we do only transperineal prostate biopsy.

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We practice the biopsy in the ambulatory operating room.

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So it allows us to use either the general anesthesia or the local anesthesia.

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It's very comfortable for the patient and for the surgeon.

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And now with the experience that we have...

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With the team which is trained,

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we can do eight patients in the morning.

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It's basically

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30 minutes for one patient,

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including cleaning the room after.

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So if you have the experience,

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it can be really,

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really fast,

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as fast as the transrectal.

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It reminds me of my visit at Hôpital Cochin a few days before this podcast,

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and definitely it was just fascinating to see how it works well for you and your team.

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What are the main...

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Concrete advices you give to physicians who want to set up Transparenal Prostate Biopsy under local anesthesia.

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So I think you first want to choose where you will perform the biopsy.

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You have the option to do it in the office and you have the option to do it in the operating room.

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The question is,

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do you have access to the operating room?

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If you have access to the operating room,

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it's easier because you have all the team,

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you have the nurses,

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you have the anesthesiologist who can help you.

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You can put patients under general anesthesia if needed.

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You can use the local anesthesia,

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of course.

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So it gives you freedom.

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If you don't have access to the OR,

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and it's the case for many hospitals in France,

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you can do it in the office,

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but it takes more organization,

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I think,

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because most of the time you're kind of alone in the office.

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You have only one nurse,

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maybe no nurse.

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So you have to be well organized.

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And I think you can do less patient than in the operating room.

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But it's the question of organization.

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So you have to really think what is the most adapted technique and the most adapted way.

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for you in your hospital.

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So to put it in a nutshell,

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it's a matter of where we will perform the biopsies and the organization,

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right?

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Yes,

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it is.

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What are the equipment needed?

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So if you're already performing fusion transrectal biopsy,

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you already have a sonograph,

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but you need a new probe.

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Because as we said in transperineal biopsy,

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you need a sagittal view when you see the base and the apex of the prostate to see the whole needle.

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And this kind of sagittal view is only offered by a new probe.

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So you need that probe,

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you need a stabilization arm.

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We already talked about it in the previous episode of the podcast.

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And it's very important.

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I say it again.

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It gives you stability,

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it gives you free hand,

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it gives you all you need,

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I think,

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to do a good biopsy,

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a very precise biopsy,

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because it's a matter of precision.

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So being stable is one of the key to the success.

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So except that,

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you don't need much thing.

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If you have the probe,

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the sonograph,

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It's important to have a needle driver,

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but it's basically really cheap and easy material to get.

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Does it need a lot of training?

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The training is important,

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but it was published before.

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The learning curve is quite short.

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If you are well taught,

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you can perform the prostate biopsy if you see something like 10 or 20 cases.

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But to be honest,

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like in every technique,

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you have to get familiar with the material.

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The device is new,

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so you have to learn how to use it.

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It's easy if you use a transrectal route for the fusion biopsy because it's basically the same device,

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but the stabilization arm,

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the needle driver are quite different.

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So when you get used to them,

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and it's quite fast,

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you're going to be very,

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very soon very comfortable.

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And what does that imply for the patient?

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So the main point for the patient is the low rate of infection.

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The low rate of infection is very important because there was a reason of getting the patient in the hospital again for prostatitis.

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Prostatitis could be very serious.

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And the other thing,

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we talked about it already,

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it's the absence of antibioprophylaxis.

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It's a good thing for the patient because he won't have resistance.

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And it's a good thing for all the patients because we are not increasing the resistance because we don't use any antibiotics.

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So I think...

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These are the two main points.

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Is it longer than the transrectal approach?

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To learn?

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To perform?

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To perform,

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yes.

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It can be a bit longer,

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but I think it's longer at the beginning because there is more devices,

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the stabilization arm,

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the needle driver.

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So it looks more complicated,

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but actually I think it's not.

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So to perform at the beginning,

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it's longer,

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but when you're used to it,

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I think it's basically the same time than the transrectal.

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The local anesthesia takes more time because it's more complex to do very good.

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periprostatic nerve block under transperineal guidance.

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To learn,

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I think it's actually faster than the transrectal.

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But the problem is that everybody is trained to transrectal right now and not to the transperineal.

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So I don't think we have the occasion to compare except for the resident.

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But actually,

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we don't really train the resident to transrectal anymore in Cochon Hospital.

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We train them to the future and the future is transperineal.

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So I'm sure that we are finishing right now.

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We have a high interest about transplurineal approach.

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If you have to convince Center to invest in transplurineal prostate biopsy system,

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what would you say?

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First of all,

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I think it's better for the patient.

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We said it,

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we don't have almost not infection,

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it's less than 1% and it's very important because prostatitis is rare,

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but prostatitis can be serious and you don't want your patient to be hospitalized,

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sometimes in intensive united care.

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So that's the first point.

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The second point is it's the future.

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It's in the European guidelines.

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It's going to be in the French guidelines.

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It's going to be one day in the USA guidelines.

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It's inevitable.

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So we are not changing the practice.

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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,

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because it's the way of the future.

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So the sooner we do it,

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the better we're going to be in the future.

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Just a last thing,

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you are performing Transparenal Prostate Biopsy in your daily practice,

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and you also support other physicians who want to set up this approach.

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Is it correct?

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Yes,

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we do that.

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We organized workshops to teach people the Transparenal Route.

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We actually started in 2019 in Cochin Hospital,

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and we observed that it takes time and it takes a lot of tips and tricks about the organization.

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We just talk about it,

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about the technique itself.

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And as in every technique,

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if someone who knows how to do it teaches you,

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it's easier,

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it's faster,

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and you do it better.

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So,

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yes,

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we organized teaching like that and people are going from different countries to learn the technique,

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to see the patient secrets,

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to see everything that we do to make it easier,

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to make it faster.

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And I think it's a very,

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very good way to learn if you have the occasion.

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If you have physicians who are listening to us right now and are interested to be trained by you,

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they just need to contact you to be involved in this workshop?

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Yes,

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of course.

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We would be happy to welcome them in Hôpital Cochin.

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And you will see it's a very nice place in front of the Jardin du Luxembourg.

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So I encourage you to come and visit us.

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I will be there,

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maybe for another podcast.

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Thanks a lot,

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Julien,

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Dr.

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Honrath,

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for these concrete elements.

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What are your next plans now?

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No,

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we are focusing on the focal therapy.

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As you know,

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focal therapy is rising now.

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So we use the same device.

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We use the transperineal route.

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So I think it's the next step.

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It's experimental right now.

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So we are driving studies to evaluate the selection of the patient,

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who is candidate for this focal therapy,

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what is the best energy to use it.

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And I think it's linked with the biopsy because it's the same principle.

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You are targeting a lesion visible in MRI with the sonography using a fusion of images.

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So it's the same thing.

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In one way you biopsy it,

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in one way you treat it.

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We can even imagine one day to practice a one-day care,

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you know.

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We biopsy the lesion and we treat it in the same way.

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So maybe that would be the future,

265
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I hope.

266
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It sounds good.

267
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We are looking forward to follow this exciting project.

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I don't know if you remember last time I asked you if you were a song,

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would it be?

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I remember.

271
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And you were happy.

272
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So now my question is,

273
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if you were a movie,

274
00:11:28.587 --> 00:11:29.491
would it be Dr.

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00:11:29.531 --> 00:11:29.792
Honrath?

276
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I think I would be the Godfather.

277
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To shoot the prostate.

278
00:11:36.696 --> 00:11:36.980
Yes,

279
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to shoot the prostate.

280
00:11:38.213 --> 00:11:38.712
Precisely.

281
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Thank you.

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Thank you again for your time.

283
00:11:48.144 --> 00:11:50.663
And I hope to see you soon here with us.

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Thank you,

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00:11:51.255 --> 00:11:51.563
Thomas.

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288
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291
00:12:05.700 --> 00:12:06.723
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292
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295
00:12:15.209 --> 00:12:18.625
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296
00:12:19.348 --> 00:12:22.065
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00:12:22.568 --> 00:12:25.323
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00:12:28.199 --> 00:12:29.366
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Thank you.