1. Transrectal Ultrasound Guided Prostate Biopsy in IBD/Crohn’s Disease case Carrie Fitzgerald Uro-1 MM September 2008 GCH

2. 51 yo AA male seen in office PSA 3.6 (velocity.82) Family history positive for CaP DRE not preformed secondary to anal stricture PMHx: Crohn’s disease SocHx: smoker, ETOH use

3. ROS: –Crohn’s diagnosed age 37; intermittant diarrhea, intermittant RLQ abd pain, bloating, tenesmus, without nausea or vomiting –No history of anorectal fistulas or abscesses –No h/o eneterenteric or enterovesicular or enterocutaneous fistulas PE: –No anal fissures, fistulas, hemmorrhoids –Anorectal stricture ~16 Fr

4. Medication –Sulfasalazine –Prednisone taper 3 months prior

5. Transrectal ultrasound guided prostate biopsy scheduled for OR Pt IV sedation Stricture digitalized by general surgery DRE completed Limited transrectal ultrasound guided prostate biopsy (6 cores)

6. Literature search Keywords: prostate biopsy and CD/IBD, perineal biopsy and CD/IBD, strictures and CD/IBD, biopsy and CD/IBD, prostate cancer and CD/IBD PubMedMedlineEbscoFirstSearch

7. A technique of transrectal ultrasound guided transperineal random prostate biopsy in patients with Ulcerative colitis and an ileal pouch. Fergany, A and Angermeier, KW. Journal of Urology Jul 164 (1): 205-6.

8. Research questions –Risk of fistula (UC/Crohns) –Risk increase in active disease, with corticosteroids, in chronic disease, with fissures, previous fistulas, strictures –Perineal biopsy a viable option –Should patient have a prebiopsy sigmoidoscopy, evaluation –Are there any external clinical findings that should encourage/discourage a practitioner from performing transrectal biopsy

9. CDAI: Crohn’s Disease Activity Index Number of liquid or soft stools each day for seven days Abdominal painAbdominal pain (graded from 0-3 on severity) each day for seven days Abdominal pain General well being, subjectively assessed from 0 (well) to 4 (terrible) each day for seven days Presence of complications* Taking Lomitil or opiates for diarrhea Presence of an abdominal mass (0 as none, 2 as questionable, 5 as definite) Absolute deviation of Hematocrit from 47% in men and 42% in women Hematocrit Percentage deviation from standard weight COMPLICATIONS =Extraintestinal symptoms (fever, uveitis, arthritis, arthralgias, apthous ulcers, erythema garnulusum, fissures, fistulas, abscesses X 2 X 5 X 20 X 30 X 10 X 6 X 1

14. http://www.ibdjohn.com/cdai/

15. Discussion