In a European multi-centre trial, it was demonstrated that high-quality bowel preparation was associated with a higher rate of complete examination, shortened procedural time and lower rate of procedure difficulty when compared with low-quality bowel preparation [ 6].
The number of passes needed per procedure has not been defined, but the decision to perform more than one puncture depends on procedure difficulty, risk of complications, quality of the first specimen obtained and the pathologist's requests.
In comparison, areas with which patients tend to be least satisfied include pain experienced resulting from the procedure, difficulty in descending stairs and an inability to kneel post TKA [8].
These complication also reported from the study conducted in Nigeria, excessive bleeding at the time of the procedure, difficulty with urination and having collapsed [ 13].
Prior studies correlating higher difficulty score and lower success were heterogeneous without sufficient adjustment for confounders; Verma et al. found no correlation between conventional cannulation success and procedure difficulty for trainees [ 21].
The reported immediate complications were excessive bleeding at the time of the procedure, difficulty with urination, shock during the procedure [ 2, 13], ulceration of the genital region and injury to adjacent tissue [ 2].
