Transrectal ultrasound-guided prostate biopsy, periprostatic local anesthesia and pain tolerance.

Mustafa Hiroš,Ediba Spužić-Čelić,Mirsad Selimović,Hajrudin Spahović,Sabina Sadović

doi:10.17305/bjbms.2010.2740

Mustafa Hiroš, Ediba Spužić-Čelić + Show 3 more

Open Access

https://doi.org/10.17305/bjbms.2010.2740

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Abstract

We have evaluated objectively pain tolerance in transrectal ultrasound-guided prostate biopsy (TRUS) using local periprostatic per rectal anesthesia as compared to the conventional method. From November 2008 to May 2009, 90 patients underwent transrectal ultrasound-guided prostate biopsy at Department of Urology, Clinical Center University Sarajevo. 90 patients who fulfilled the inclusion criteria were randomized into 3 groups of 30 patients each. Group 1 received periprostatic local anesthesia with 2% lidocaine, group 2 received Voltaren supp placed in rectum an hour before biopsy while group 3 received no local anesthesia. Pain scale responses were analyzed for each aspect of the biopsy procedure with a visual analog scale of 0-none to 10-maximal. There was no difference between the 3 groups in pain scores during digital rectal examination, intrarectal injection and probe insertion. The mean pain scores during needle insertion in group 1 receiving periprostatic nerve block and in group 2 receiving Voltaren supp were 3,10 +/- 2,32 and 5,15 +/- 2,01 respectively. In group 3 (no local anesthesia), mean pain scores were 6,06 +/- 2,95 which was found to be significantly different (p < 0,001). However, morbidity after the biopsy was not statistically different between all 3 groups. TRUS-guided prostate biopsy is a traumatic and painful experience, but the periprostatic blockage use is clearly associated with more tolerance and patient comfort during the exam. It is an easy, safe, acceptable and reproducible technique and should be considered for all patients undergoing TRUS biopsy regardless of age or number of biopsies.

Highlights

Transrectal ultrasound-guided prostate biopsy has become essential in diagnostic investigation of patients with clinical suspicion of prostatic neoplasia due to gland alterations resulting from abnormality on the digital rectal examination or rising of the prostatic specific antigen (PSA) (, )
Prostatic biopsy indication has been increasing in the last years as a result of the increase in life expectancy, better diagnostic methods, and Public Health Campaigns intensification (, ). is procedure is performed by most urologists, in the United States and in England, without any kind of anaesthesia or sedation (, )
Transrectal ultrasound prostatic biopsy has evolved into a standard procedure for diagnosing prostate cancer. ough improvements in the biopsy procedure have been introduced over the years, pain and discomfort still remain the most common side effects

Summary

Introduction

Transrectal ultrasound-guided prostate biopsy has become essential in diagnostic investigation of patients with clinical suspicion of prostatic neoplasia due to gland alterations resulting from abnormality on the digital rectal examination or rising of the prostatic specific antigen (PSA) ( , ). Prostatic biopsy indication has been increasing in the last years as a result of the increase in life expectancy, better diagnostic methods, and Public Health Campaigns intensification ( , ). Apart from the embarrassment and the anxiety, this exam is almost always accompanied by pain sensation, because of TRUS probe introduction, or by biopsy itself ( ). Some series show that to of patients have pain during the exam, making the realization of this diagnostic procedure traumatic ( , ). Placed in rectum to the conventional prostate biopsy procedure. In order to achieve this, we used objective criteria for pain analysis, considering the importance of pain components related to puncture itself, to the transrectal probe, and evaluating the satisfaction and tolerance facing the possibility of re-biopsy need

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