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or "is that gunpowder I smell?"  Show this Post


although it was a month between diagnostic tests… it appears, from searching thru my old email archives, that during that month I also had my first appointment with a urologist (I am completely at a loss as to what sort of incentive – other than money — would drive anyone into this field of medicine, but thankfully some choose it).
that appointment also involved a repeat DRE, which resulted in the exact same comment as my GP made… "I don't like the feel of that"!   and this naturally led to the confirmation of the already scheduled appointment for the biopsy.
I probably don't need to point out that technology and therefore procedures evolve very rapidly and that what was common practice more than 12 years ago is far different from what is normally done today.
Today, there are at least 3 possible ways of performing a prostate biopsy… transrectal, transurethral, or transperineal, the details of which you can easily Google for yourselves.  Whether all three were common 12 years ago, I don't know (you can probably Google that too), but I was only given one option – that being the transrectal –  which I was scheduled to have and the only one of the three that I am going to discuss.
Preparation involved some fasting, a purge and/or an enema to ensure things were "clean" and I assume that took place at home – as I don't remember any of that occurring at the urologist's office – where the biopsy was done.  The biopsy procedure as described in recent literature, can also take place in a variety of ways – in an O.R. under anesthetic or in a urologist's office lying on your side using local anesthetic in the areas the biopsies will be extracted.  I don't seem to be able to find a description of how mine went down – it would probably be considered barbaric by today's standards.
currently, it appears that all biopsy guns are spring loaded – some allow cocking with one hand, even just by pushing a button and many models are "disposable" which given the usage, kinda makes a lot of sense.  How one "cleans" the reusable types is a mystery, but I assume it involves long periods of autoclaving and other chemical baths (but hey… what's a bit of E coli between friends!).
Back then, I was told the instrument being used was powered by .22 shells – and although I can find no reference online as to the "historical" timeline of the technological changes to the biopsy gun – the comment wasn't made in jest and the sound, smell and use of the "gun" – no re-cocking (that I could hear) between rounds (as required by the spring loaded types) – would seem to indicate that was indeed the case.
So… my experience began much like a DRE – I was simply standing, bent over resting my torso on a raised exam bed.  There was NO preliminary local anesthetic applied either topically or by injection – simply the insertion of said "gun" which compared to the "digit" in DRE, felt like a tree trunk and in reality wasn't much smaller. 
I was given advance warning of the first biopsy taken – more to prepare me for the sound, I think… rather than the incredible jarring pain that accompanied it.  I was told the the succeeding ones would get easier as I got used to them.
I'm sorry, but whether powered by gunpowder or springs, I don't think anyone gets "used to" having an elephant's trunk shoved up their rectum and then having anywhere from six to twelve 18 gauge biopsy needles blasted thru the wall of their rectum into the prostate… the rectum has little in the way of nerve fibres, but the prostate is fraught with them and that's where the pain is felt (thus the reason most procedures today are done using anesthetic injected into both sides of the gland).
Rather than getting used to them, by the time the last one blasted off, I was just about ready to pass out.  I can understand why the "normal" way of doing this is lying down – because my knees were literally ready to fold up before the last "shot" echoed thru the room.  Fortunately, I had my wife to drive me home, while I curled up in a ball in the passenger seat.
now we could "hurry up and wait" for the biopsy results… expected in 2 weeks…