Periprostatic Nerve Block Research Articles

Comparing the Efficacy of US Guided Pudendal Nerve Block plus Periprostatic Nerve Block versus Periprostatic Nerve Block Alone for Pain Control of Patients During and After Transrectal Biopsy of the Prostate Gland

Abstract Background Cancer prostate is considered one of the most common cancers among male population. Trans rectal ultrasound (TRUS) guided biopsy has become the main procedure for diagnosing prostate carcinoma, In order to definitively diagnose prostate carcinoma, (TRUS)-guided prostate biopsy is needed. Aim of the Work To compare the efficacy, safety of Pudendal nerve block plus periprostatic nerve block with the standard technique (periprostatic nerve block). Patients and Methods during a period of 6 months duration A total of 30 patients (group 1 [Pedundal nerve block plus periprostatic nerve block], n = 15; group 2 [periprostatic nerve block], n = 15) were included in the study. all patients were instructed about how to assess pain and discomfort level using a visual analog scale (VAS) from 0 to 10, with an 11-point score (0 = no pain, 10 = intolerable pain). Results in our study 30 male patients were divided into 2 groups, group 1 underwent to (PPNB) and group 2 (PPNB + pudendal block). The mean age of the studied group was 58.8 ± 10 years old. All patients hadn’t previous history for prostate surgery nor for rectoanal disease. In our study we evaluated pain scores immediately after the procedure. Regarding the relation between VAS and two studied group, there was an increase in VAS in group 1 more than group 2 along the three sets of follow up with statistical difference between two studied groups in all follow ups as p-Value was <0.05. Conclusion our data suggest that combined bilateral pudendal nerve block plus periprostatic nerve block is more effective than periprostatic nerve block alone in reducing the pain during TRUS guided prostate biopsy.

Is Periprostatic Nerve Block Innocent on Erectile Functions in Prostate Biopsy? Randomized, Controlled, Prospective Observational Study

Is Periprostatic Nerve Block Innocent on Erectile Functions in Prostate Biopsy? Randomized, Controlled, Prospective Observational Study

(233) Treatment of Benign Prostatic Hyperplasia. How to Preseve the Ejaculatory Function with the Transperineal Laser Ablation of the Prostate

Abstract Introduction Benign prostatic hyperplasia (BPH) can be the cause of Lower urinary tract symptomps (LUTS). Endoscopic treatments like the trans-urethral resection of the prostate (TURP) is still the gold standard technique to treat this condition. This technique often leads to sexual dysfunction as retrograde ejaculation. Objective The objective of the study was to evaluate the safety and the efficacy of this new technique. The transperineal laser ablation of the prostate (TPLA) is a new minimal invasive technique used to treat BPH that reduces the prostate volume preserving the ejaculatory function. Methods This is a prospective study done in accordance with the Declaration of Helsinki. 168 patients (pts) (age 60.5 ± 10.5 years) with LUTS and BPH were enrolled. Mean prostate volume was 71.5 ± 25.5 m (from 30 to 100 grams). Inclusions criteria were: Peak urinary flow (Q max): ≤15 mL/sec, International Prostatic Symptoms Score (IPSS) >19, Postvoid residual (PVR): > 100 mL. Exclusion criteria were: catheterized pts, history of neurodegenerative disease, positive urinary culture, prostate volume > 100 grams, Clinical suspicion of prostate cancer (Abnormal digital rectal examination, PSA levels). The procedure was performed under local anaesthesia (Periprostatic nerve block) plus sedation. Under US guidance, up to four 21G applicators with a length of 15 cm were inserted into the prostate tissue. Each treatment was performed with diode lasers operating at 980 nm with 1800 joules per lobe at a power of 5 watts. The primary endpoint was the reduction of prostate volume (misured at 6 months follow-up) and preservation of the ejaculation in the treated pts. Secondary endpoints included operating time, ablation time, energy used, hospitalization time, catheterization time and International Prostate Symptom Score (IPSS) variation, quality of life (QoL), Q max and PVR. Results All procedures have been successful from a technical point of view. The average operating time was (38 ± 6.5 min) and the average ablation time was (12.4 ± 2.8 min). The average energy used was (11.622 ± 4350.5 J), the average hospital stay was (1.7 ± 0.2 days) and the average catheterization time was (6.1 ± 4.0 days.) At 6 months, IPSS improved from (22.5±2.1 points) to (12.3±1.8 points) (P < 0.001). QoL was improved from (4.8±0.2) to (1.8. ± 0.3) (P < 0.05) and Q max was improved from (4.6 ± 3.1 mL/s) to (12.8 ±2.6 mL/s) (P < 0.001). Moreover, PVR was improved from (120±59.3 ml) to (46.7±27.9ml) (P<0.001); the average prostate volume at 6 months improved from (71.5 ± 25.5 grams) to (48.8 ± 21.8 grams) (P < 0.05). 130 out of 150 sexually active subjects (86.6%) maintained ejaculation following treatment at 6 months. 44 subjects (26,5%) needed recatheterization for acute urinary retention. Perineal pain was reported in 5 subjects, urethrorrhagia in 8 subjects. Conclusions TPLA is a safe, feasible and promising procedure for the treatment of LUTS in BPH. This procedure induces coagulative necrosis in the treated tissue, reducing the prostate volume while preserving the ejaculatory function Disclosure No

EFFICACY OF TOPICAL DILTIAZEM COMBINED WITH LOCAL XYLOCAINE TO DECREASE THE PAIN DURING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

Transrectal Ultrasound Guided Biopsy (TRUS) has been the gold standard in the detection of prostate cancer. The cancer detection rate is higher in biopsy protocols taking more core needles. The periprostatic nerve block (PPNB) has become most widely accepted form of anaesthesia for performing TRUS biopsy*1, but PPNB does not reduce the pain during the insertion of rectal ultrasound probe. The act of probe insertion was described as most uncomfortable in a randomized trial of pain perception during TRUS guided biopsy.*2 Calcium channel blockers like diltiazem cream acts by blocking the slow calcium channel located in the anal sphincter bro muscular cell membranes to achieve smooth muscle relaxation, and hence reduce the resting anal sphincter pressure

Comparison of intrarectal heated lidocaine gel and periprostatic nerve block for pain control in transrectal ultrasound-guided prostate biopsy: A randomized controlled non-inferiority trial.

To investigate whether intrarectal local anesthesia with heated lidocaine gel (IRLAH) is non-inferior to periprostatic nerve block (PNB) for reducing pain in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We performed a randomized controlled non-inferiority trial with 100 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from August 2019 to July 2020. These participants were randomly assigned to a group receiving intrarectal local anesthesia with 20mL of heated (40°C) 2% lidocaine gel (n=50) or PNB (n=50). The primary outcome was a pain score on a 0-10 visual analogue scale (VAS) at four time points with the non-inferiority margin of 1; VAS-1: during local anesthesia application; VAS-2: during probe insertion; VAS-3: during biopsy; VAS-4: 30minutes after the procedure. The secondary outcome included complications during and after the procedure. The IRLAH group (0.1) met non-inferiority as well as superiority criteria for mean VAS-1 score vs. the PNB group (2.33) (P<0.001), as the difference (95% confidence interval [CI]) between the two groups was-2.23 (-2.66 to-1.79) and the upper bound of the 95% CI were both below the prespecified non-inferiority margin and below zero. For mean VAS-3 score, the difference (95% CI) was 0.3 (-0.38 to 0.98) and the upper bound of the 95% CI did not exceed the predefined non-inferiority margin indicating that IRLAH was non-inferior (IRLAH group, 3.44; PNB group, 3.14). Also, non-inferiority was shown for pain scores at VAS-2 and VAS-4. There were no significant differences in complications. IRLAH is a noninvasive and non-inferior alternative to PNB for pain control in TRUS-guided prostate biopsy without increased risk of complications.

Impact of virtual reality on pain management in transrectal MRI-guided prostate biopsy.

The beneficial effect of virtual reality (VR) on pain management in the context of transrectal MRI-guided prostate biopsy is not well established. However, it remains unclear whether an adjunctive of VR also improves pain management. This study aimed to evaluate the impact of VR as adjunctive in pain management in transrectal MRI-guided prostate biopsy (PB). We retrospectively evaluated the pain intensity incidence in the 153 patients with PB indication (of which 102 were naïve of PB) who were admitted to our hospital since the acquisition of the Healthy Mind virtual reality headset on 19 January 2021. Baseline characteristics of patients who received local anesthesia with 1% lidocaine periprostatic nerve block (PPNB) (Group SOC, N = 78) and patients who received VR associated with PPNB (Group VR, N = 75) were largely similar. One PB with general anesthesia was excluded. The mean pain score at day zero was respectively 3.4 (±2.5) and 2.9 (±2.3) for SOC and VR (p = 0.203). However, the mean pain score at day zero was significantly lower in naïve PB patients with VR [2.7 (±2.0)] than in naïve PB patients with SOC [3.8 (±2.5), p = 0.012] when patients were stratified in PB status. Similar results were found on day 3 for the analysis including naïve-PB patients with SOC vs. with VR [0.4 (±2.5) vs. 0.2 (±2.0); p = 0.023)]. The pain intensity was significantly lower in naïve PB patients with VR than in naïve PB patients with SOC. There were no side effects from VR and tolerability was excellent.

Freehand transperineal prostate biopsy with a coaxial needle under local anesthesia: Experience from a single institution in Malaysia

BackgroundFreehand transperineal prostate biopsy (TPPBx) using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer (PCa). It only requires the same equipment used for transrectal ultrasound-guided (TRUS) biopsy. Our study is the first in Malaysia to report this experience and its outcomes. We aim to determine PCa detection rate and pain tolerability of freehand TPPBx utilizing a coaxial needle under local anesthesia (LA). MethodsInstitutional review board approval was obtained from National Medical Research Register (NMRR ID-21-02052-VIL). We retrospectively reviewed the medical records of patients who underwent TPPBx between August 2020 and April 2022. Records were reviewed for patients’ characteristics, prostate volume, prostate-specific antigen (PSA) results, biopsy results and pain tolerability. Data was analyzed to determine PCa and clinically significant prostate cancer (csPCa) detection rate. LA was achieved using perineal skin infiltration and a periprostatic nerve block. The commonly used standard side-firing transrectal ultrasound with its Prostate Biplane Transducer was used as an imaging guide. The principles of the Ginsburg protocol were followed. Pain tolerability was assessed using a visual analog scale. ResultsA total of 55 patients with elevated PSA levels underwent freehand TPPBx under LA. The mean age was 67.3 years, the median PSA was 14.2 ng/mL, and the median PSA density (PSAD) was 0.33 ng/mL/cc. The optimal PSAD cutoff for predicting csPCa was 0.35 ng/mL/cc (area under the curve [AUC], 0.792; sensitivity, 87.5%; specificity, 69.2%). PCa was detected in 24 patients (43.6%), of whom 16 (29.1%) had csPCa. The median pain scores during LA infiltration and biopsy were four and two, respectively, which were significant different (P < 0.05). TPPBx exhibited an infection rate of zero. ConclusionThe PCa detection rate and patient tolerability of freehand TPPBx using a coaxial needle are similar to those of a contemporary published series. The use of existing equipment that is used for TRUS biopsy allows for widespread use and transition from TRUS biopsy.

Saddle block anesthesia with 20 mg prilocaine hydrochloride 2% hyperbaric solution and intravenous fentanyl administration for transperineal MRI/US fusion-guided prostate biopsy

Introduction: MRI-Ultrasound (MRI/US) fusion-guided transperineal prostate biopsy (TPB) is gaining popularity in the diagnostic algorithm of prostate cancer. It is associated with higher pain score than the other methods of prostate biopsy. Effective analgesia is a key point for providing patient comfort and preventing his movement in response to pain with subsequent mismatch of the fused MRI/ US images. The mismatch could lead to inaccurate targeting of suspected cancer lesions. The preferred method of analgesia in an outpatient setting is topical intrarectal administration of lidocaine and periprostatic nerve block, but the pain and the discomfort from the procedure are not completely eliminated. Hypothetically, saddle block anesthesia has an expected better efficacy in relieving the pain from the MRI/US-TPB. Aim: To evaluate the efficacy and safety of saddle block anesthesia in patients undergoing MRI/US-TPB and сomparative analysis between patients who have received and have not received intravenous fentanyl Material and methods: A prospective randomized study was conducted on 12 consecutive patients undergoing MRI/US-TPB. Saddle block anesthesia was performed with 20 mg prilocaine hydrochloride 2% hyperbaric solution to all patients. 6 patients received intravenous fentanyl at a dose of 1mcg/kg (Group 1) and 6 patients did not receive intravenous fentanyl. It was examined: patient’s age, weight, height, BMI and ASA class; duration from the dural puncture to the end of the surgical intervention; taken number of prostate biopsies; presence of intraoperative pain; motor blockage; presence of a difference of more than 20%, before and after saddle block anesthesia, of non-invasively measured blood pressure and heart rate; additional medication; presence of early postoperative complications and recovery time from anesthesia Results: The comparative analysis of the preoperative characteristics of the both groups did not reveal significant statistical difference. There were comparatively similar indicators for surgical intervention and regional anesthesia in both groups. The both anesthesia techniques showed safety profile with hemodynamic stability, without additional medicine administration and lack of early post-anesthesia complications. Pain did not occur during inserting and moving the US probe into the anal canal and puncturing the perineal skin and the underlying tissues. 50% (3) of the patients in Group 2 had pain during the puncture of the prostate gland and biopsy extraction, while in Group 1 - 0% (0) of the patients reported presence of pain. There was a slightly delayed onset of the first postoperative pain in Group 1 - 113.17 ± 15.11 min. compared to Group 2 - 99.83 ± 11.51 min. Conclusion: The saddle block anesthesia with 20 mg prilocaine hydrochloride 2% hyperbaric solution in combination with intravenous fentanyl at a dose of 1 mcg/kg is a safe anesthesia technique, associated with excellent analgesic profile, low incidence of anesthesia-related complications and rapid recovery in patients undergoing MRI/US-TPB. Key words: saddle block, transperineal MRI/US fusion-guided prostate biopsy, prilocaine hydrochloride 2% hyperbaric solution

MP53-14 FEASIBILITY OF TRANSPERINEAL PROSTATE BIOPSIES UNDER LOCAL ANESTHESIA: A COMPARATIVE STUDY WITH THE TRANSRECTAL APPROACH

You have accessJournal of UrologyCME1 May 2022MP53-14 FEASIBILITY OF TRANSPERINEAL PROSTATE BIOPSIES UNDER LOCAL ANESTHESIA: A COMPARATIVE STUDY WITH THE TRANSRECTAL APPROACH Camille Berquin, Dries Develtere, Hannah Van Puyvelde, Elisabeth Pauwels, Ruben De Groote, Frederiek D'Hondt, Peter Schatteman, Alex Mottrie, and Geert De Naeyer Camille BerquinCamille Berquin More articles by this author , Dries DeveltereDries Develtere More articles by this author , Hannah Van PuyveldeHannah Van Puyvelde More articles by this author , Elisabeth PauwelsElisabeth Pauwels More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Frederiek D'HondtFrederiek D'Hondt More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , Alex MottrieAlex Mottrie More articles by this author , and Geert De NaeyerGeert De Naeyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is an emerging shift from transrectal (TR) to transperineal (TP) prostate biopsies because of lower infection rates. In the past TP biopsies mostly involved general/spinal anesthesia, being perceived too painful for local anesthesia (LA). Therefor the aim of this study is to evaluate the feasibility of TP prostate biopsies under LA based on patient-reported outcome measurements (PROMs). METHODS: This study is a monocentric prospective observational cohort study with a non-inferiority design. Data were collected from all patients with a clinical suspicion of prostate cancer, eligible for LA, at the OLV Aalst Urology Department. The biopsy method was determined by the clinician based on the localization and volume of the suspect lesions on MRI and DRE. All patients received prophylactic fluoroquinolones. For the TP approach we used 30 mL of 1% Xylocaïne to obtain LA: 10 mL for the perineal skin and 20 mL for the periprostatic nerve block (PNB). Systemic biopsies and targeted biopsies were taken. In the TR group PNB of 10 mL was given for a classical template with 12 biopsy cores.To evaluate tolerability, we used a visual analog score (VAS) for pain during the different steps of the procedure: insertion of the TR probe, LA to the prostate and the biopsies. The TP group had an additional VAS score for the LA of the skin. IPSS was recorded at different times: baseline, after 12, 24 and 48 hours. At these times patients also received questionnaires about possible complications of the procedure (hematuria, hematospermia, rectal blood loss and fever). RESULTS: In total 128 patients got enrolled: 61 TR and 67 TP. The median age was 73y (IQR 66-78,5) and 68y (IQR 64-73) for the TR and TP group respectively. The median baseline IPSS were 6 (IQR 2,5-11) for the TP group and 7 (IQR 3-13) for the TP group. The mean VAS scores, IPSS and complications are listed per group in Table 1. Fever occurred in 2 patients (3,3%) in the TR group, while only in 1 patient (1,5%) in the TP group. All 3 were treated with oral antibiotics. Only 1 patient in the TP group (1,5%) suffered from urinary retention, for which he received a suprapubic catheter. CONCLUSIONS: Based on PROMs, we can conclude that TP biopsies under LA can be performed with similar pain scores and complications rates as TR biopsies. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e900 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camille Berquin More articles by this author Dries Develtere More articles by this author Hannah Van Puyvelde More articles by this author Elisabeth Pauwels More articles by this author Ruben De Groote More articles by this author Frederiek D'Hondt More articles by this author Peter Schatteman More articles by this author Alex Mottrie More articles by this author Geert De Naeyer More articles by this author Expand All Advertisement PDF DownloadLoading ...

Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy

We analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site. We collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 min after biopsy. For all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039). Base and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.

The role of music in outpatient prostate biopsy: A comprehensive literature review.

Prostate biopsy is a standard urological procedure and a valuable tool for identifying prostate cancer. To assess the effect of music on outpatient prostate biopsy, we aimed to conduct a systematic review of literature to understand if music reduced the use of analgesics and anxiolytics. The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The databases searched included MEDLINE, Scopus, CINAHL, Clinicaltrials.gov, EMBASE, Cochrane library, and Google Scholar, from inception of databases to February 2021. The primary outcome measures were the effect of music on pain and anxiety from the procedure. The initial search yielded 212 articles and after going through titles and abstracts, and six studies (570 patients) were included for the final review. It included five randomized-controlled trials and one case-control study. These studies were done in Korea, USA, Taiwan, and Turkey. Patients had a combination of either local anesthetic gel or periprostatic nerve block or intravenous pethidine. The choice of music was varied and most offered a choice of music to patients. Four of the six studies showed significantly reduced pain and anxiety with the use of music, and the willingness for repeat procedures was higher in two studies. This review has demonstrated that listening to music is associated with reduced anxiety and pain during prostate biopsy. It is likely to, therefore, increase procedural satisfaction, and willingness to undergo the procedure again considering repeated biopsy is sometimes needed in these patients. As music is simple, inexpensive, and easily accessible, it should be routinely offered to patients for outpatient and office-based urological procedures.

Efficacy of additional periprostatic apex nerve block on pain in each of 12 transrectal prostate core biopsies: a retrospective study

BackgroundWe identified pain variation according to prostate biopsy sites and compared differences in pain relief according to the site of periprostatic nerve block (PNB).MethodsThis retrospective study collected data from 312 patients who underwent transrectal prostate biopsies between January 2019 and August 2020. Patients were stratified into two groups according to the site of local anesthesia (base vs. base and apex PNB), with each block achieved with 2.5 cm3 of 2% lidocaine. Pain scores were assessed using the visual analog scale at the following time points: probe insertion, PNB at base, PNB at apex, each of the 12 core biopsy sites, and 15 min after biopsy. The results were analyzed using a linear mixed model.ResultsThe average pain scores were significantly higher in the base-only PNB group than were those in the base and apex PNB group (3.88 vs 2.82, p < 0.001). In the base-only PNB group, the pain scores increased from base to apex (p < 0.001), and the pain at each site also gradually increased as the biopsy proceeded (p < 0.001). In contrast, in the base and apex PNB group, there was minor change in pain scores throughout the procedure.ConclusionsThe pain scores varied at each site during the prostate biopsy. The provision of a base and apex PNB provided greater pain relief than does base-only PNB during prostate biopsy.

Transrectal ultrasound-guided prostate biopsy: periprostatic block versus caudal block for analgesia\u2014a randomized trial

BackgroundTransrectal ultrasound (TRUS)-guided prostate biopsy is a potentially painful procedure, due to the insertion of the TRUS probe in the anus and multiple passes of the biopsy needle through the rectum and prostate. Several methods of reducing pain and discomfort have been described. These include intra-rectal local anaesthetic gel (IRLA) instillation, periprostatic nerve block (PPNB), caudal block (CB) and oral analgesics. CB has potential complications of dural puncture and anaesthetic failure, while PPNB may be complicated by intravascular injection with systemic local anaesthetic toxicity. Only few studies have compared transrectal PPNB with CB with equivocal results. This study compared transrectal PPNB to CB in terms of efficacy of analgesia and incidence of complications.MethodsA prospective randomized clinical trial was carried out among 80 consenting patients with an indication for TRUS-guided prostate biopsy in the Urology division of [BLINDED FOR PEER REVIEW]. Eighty participants were each randomized to either of Group A (CB with 10 ml of 2% lidocaine) or Group B (PPNB with a total of 20 ml of 1% lidocaine). Pain was assessed using an 11-point numerical rating scale (NRS), and questions on satisfaction with the procedure and willingness for a repeat procedure were asked. The incidence of complications was also recorded.ResultsThere were no significant differences in the mean ages, body mass indices (BMIs), prostate-specific antigen (PSA) levels, digital rectal examination (DRE) findings and prostate sizes between the two groups. The mean NRS scores at administration of block, insertion of TRUS probe, prostate biopsy, 30 min and 1 day after biopsy were 2.9 ± 2.3, 2.1 ± 2.2, 3.1 ± 2.6, 1.4 ± 2.2 and 0.2 ± 0.4 respectively for CB and 3.1 ± 2.2, 2.3 ± 1.2, 2.8 ± 2.7, 1.4 ± 1.7 and 0.3 ± 0.5, respectively, for the PPNB group. There were no significant differences between the mean scores in both groups. There were also no statistically significant differences in the incidences of complications in both groups.ConclusionThe two methods of analgesia are similar in efficacy and are equally safe to employ in the performance of TRUS-guided prostate biopsy. Both methods can be learned to increase the repertoire of the urologist when faced with a TRUS-guided prostate biopsy.Trial registrationPACTR, PACTR202012779661309. Registered 11th December 2020—Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14564.

Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis.

To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability. Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint™ TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs). Some 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n=234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'. Our data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.

Association of local anesthetic method and prostate volume with the occurrence of prostate biopsy complications

Background: Due to the invasive nature of prostate biopsy, it is associated with various complications. The study aimed to determine the association of local anesthetic method and prostate volume with the occurrence of these prostate biopsy complications. Materials and Methods: It was a prospective study carried out in 106 patients with indications for prostate biopsy. They were randomized into two equal groups receiving either intrarectal lidocaine gel or periprostatic nerve block. Prostate volume was determined using transrectal ultrasound, and patients were further divided into three prostate volume classes (20-40 ml, 40-100 ml, and ≥100 ml). Systematic sextant prostate biopsy was done, and the occurrence of complications (pain, bleeding, infection, and urinary retention) was documented. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software. Results: The pain scores of patients were similar irrespective of their prostate volume even with the use of different types of anesthesia. There was no significant tendency for the occurrence of bleeding, infection, and voiding complications when periprostatic nerve block or intrarectal lidocaine gel was used for pain relief. Postbiopsy cystourethritis was, however, significantly associated with the volume of the prostate (P = 0.006). Conclusion: The choice of local anesthesia does not affect the occurrence of complications following transrectal prostate biopsy. There is, however, a significant potential for the development of postbiopsy cystourethritis in patients with larger prostates.

Anorectal application of 5% lidocaine cream reduces pain prior to periprostatic nerve block during transrectal ultrasound guided prostate biopsy: Randomized, prospective controlled study

Objectives Trans rectal ultrasound guided prostate biopsy with periprostatic nerve block (PPNB) is performed following probe insertion and manipulation leaving these initial maneuvers uncovered in terms of pain control. We evaluated whether topical analgesia reduces pain during early stages of the procedure. Patients and methods Seven group prospective, randomized controlled study: groups 1–3: nerve block with 5 ml 1% lidocaine bilaterally plus perianal topical application of 10 ml 5% lidocaine cream. Groups 4–6 as in 1–3 plus digital application of 10 ml 5% lidocaine cream internally on rectal walls. For each approach exposure times were 5 (groups 1 and 4), 10 (groups 2 and 5) and 20 (groups 3 and 6) min, respectively. The control group (7) received PPNB only. Patients filled a 0–10 visual analogue scale (VAS) at five points: after probe insertion, during probe manipulation, following PPNB, after prostate biopsies and a global pain estimation. Results Two hundred and fifty-two patients were enrolled. Significant differences in VAS between all study groups and controls were observed at the pre-biopsy stages of the procedure. In multivariate analysis adjusted for prostate specific antigen, diabetes mellitus status, spinal disease, abnormal digital rectal examination and non- benign prostate hyperplasia histology, significance remained for probe insertion and intra-rectal manipulation. For each exposure time no significant differences were observed between topical application and topical + intra-rectal application. After PPNB, differences between study and control groups disappeared. Conclusion Topical anesthesia significantly reduces pain during early stages of prostate biopsy. Perianal application sufficed whereas intra-rectal application of local anesthetics does not add to pain control. Perianal application for 10 min seems to be optimal.

The application of a targeted periprostatic nerve block in transperineal template-guided prostate biopsies.

Our study aims to evaluate the anesthetic efficacy of multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted periprostatic nerve block (PNB) for transperineal template-guided prostate biopsy (TTPB). The patients who underwent mpMRI/TRUS fusion-guided prostate biopsy from May 2018 to March 2019 were randomized into two groups using a random number table. The intervention group (n=47) and the control group (n=45) received targeted PNB and traditional PNB, respectively. Visual analog scale (VAS) and visual numeric scale (VNS) scores were used to assess the patients' pain and quantify their satisfaction. The total detection rate for prostate cancer was 45.7%, with a comparable positive rate between the intervention group (42.6%) and the control group (48.9%), which meant there was no significant difference between the groups (P=0.542). Patient age, prostate-specific antigen, prostate volume, suspicious lesions on mpMRI, number of cores, operation time, and biopsy time were comparable between the groups. The VAS scores during biopsy were significantly lower in the intervention group than in the control group [2 (1 to 3) vs. 2 (1 to 4), P=0.019]. Conversely, the VNS scores during biopsy were higher in the intervention group [3 (2 to 4) vs. 3 (2 to 3), P=0.015]. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure between the two groups. There were no significant differences between the groups for complications, such as hematuria, urinary retention, infection, hemospermia, and vasovagal reaction (P>0.05). Targeted PNB significantly relieved the pain and did not increase the incidence of complications for patients when compared with traditional PNB.

Efficacy of Glyceryl Trinitrate Ointment for Perianal- Intrarectal Local Anesthesia in Transrectal Ultrasound- Guided Prostate Biopsy- Compared to Topical Lignocaine

Objective: Anorectal pain and discomfort during transrectal ultrasound (TRUS)-guided prostate biopsy is an important issue of this procedure. Therefore present study was designed to compare whether the use of topical glyceryl trinitrate (GTN) ointment or lignocaine gel is more effective as an adjunct to periprostatic nerve block (PPNB) in reducing pain associated with transrectal ultrasound (TRUS)-guided prostate biopsy. Methods: In all, 120 consecutive patients having their first TRUS-guided prostate biopsy were randomized to receive either 0.4% GTN ointment or 2% lignocaine gel, 10 minutes or 5 minutes respectively before biopsy. All patients had a biopsy preceded by an injection with 5 ml of 2% lignocaine local anaesthesia. Results: A 100-point visual analogue score was used to record overall pain due to the presence of the probe, the biopsy itself and pain after the procedure. There was no significant difference in age, PSA level and prostate volume between the groups. There was a significantly lower mean pain score due to probe insertion, in the GTN than lignocaine group (18.32 vs 37.48, P &lt; 0.001); pain perception was lower for the whole procedure in the GTN group (16.59 vs 35.17, P &lt; 0.001); and was most pronounced in men aged d”65 years (21.45 vs 40.7, P &lt; 0.001). Five patients (8.3%) in the GTN group complained of headache. Conclusion: So it can be concluded that, topical GTN ointment is safe and effective in reducing the discomfort and pain associated with TRUS-guided prostate biopsy, in particular the insertion of the ultrasound probe. It might be of maximum benefit in the younger patient(d”65years). Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.14-19

Comparative Study of Intraprostatic Infiltration With Lidocaine Injection and Periprostatic Nerve Block for Pain Free Trus Guided Prostate Biopsy

Objectives: To compare the efficacy of intraprostatic infiltration of lidocain injection and periprostatic nerve block for pain free TRUS guided prostate biopsies. Methods: A hospital based prospective experimental study was conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka from July 2007 to June 2009 to compare the different anesthesia technique for TRUS guided prostate biopsy for the detection of carcinoma prostate. All male patients aged over 55 years having lower urinary tract symptoms (LUTS) attending to urology OPD as well as in patient department were evaluated by history, physical examination including D/R/E and necessary investigations to identify the potential candidates for prostate biopsy and potential participants were counselled for prostate biopsy. Before taking biopsy patients were again judged by selection and exclusion criteria. Overall general examination as well as examination of urinary system and anorectal region was done. DRE was done to see the size, consistency and nodularity of prostate prior to biopsy. Who fulfilled the selection criteria included in this study in out patient basis or admitted in the urology ward and numbered chronologically, odd numbers for group-I includes periprostatic nerve block and even numbers for group-II includes intraprostatic infiltration of lidocain injection. They underwent 10 core prostate biopsy (standard 6 plus lateral 4 core) and hypoechoic lesion directed biopsy to see the unique cancer detection rate in each lobe. Data were analyzed using SPSS (Statistical package for social science) software program. The test of significance were chi-square, student t test, Fisher exact test, Mann Whitney test. Probability value (P Value&lt;0.05) was considered significant. Results: Intensity of pain using visual analogue scale (VAS) demonstrates that the mean pain intensity during probe insertion was significantly less in Group-I than that in Group-II (5.8 ± 1.3 vs. 6.7 ± 1.3, p = 0.007). The mean pain intensity during anesthesia was also significantly less in the former group compared to the latter group (4.5 ± 1.2 vs. 5.1 ± 1.1, p = 0.036). Then the pain intensity of both the groups decreased, but the decrease was significantly faster and steeper in Group-II than in Group-I (p = 0.001). The pain intensity of Group-II 30 minutes after biopsy further decreased to 1.9 cm on visual analogue scale, while the pain intensity of Group-I increased from 4.1 cm during biopsy to 4.4 cm 30 minutes after biopsy (p &lt; 0.001) . Results of the study revealed that -intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with conventional periprostatic nerve block. Conclusions: Intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with periprostatic nerve block. It is a simple, safe and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.87-93

Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis.

We identify which nonantibiotic strategies could reduce the risk of infectious complications following prostate biopsy. We performed a literature search on MEDLINE®, Embase® and the Cochrane Database for randomized controlled trials (inception to May 2020) assessing nonantibiotic interventions in prostate biopsy. Primary outcome was pooled infectious complications (fever, sepsis and symptomatic urinary tract infection) and secondary outcome was hospitalization. Cochrane risk of bias tool and GRADE approach were used to assess the bias and the certainty of evidence. The study protocol was registered with PROSPERO (CRD42015026354). A total of 90 randomized controlled trials (16,941 participants) were included in the analysis, with 83 trials being categorized into one of 10 different interventions. Transperineal biopsy was associated with significantly reduced infectious complications as compared to transrectal biopsy (RR 0.55, 95% CI 0.33-0.92, p=0.02, I2=0%, 1,330 participants, 7 studies). Rectal preparation with povidone-iodine was also shown to reduce infectious complications (RR 0.50, 95% CI 0.38-0.65, p <0.000001, I2=27%, 1,686 participants, 8 studies) as well as hospitalization (RR 0.38, 95% CI 0.21-0.69, p=0.002, I2=0%, 620 participants, 4 studies). We found no difference in infectious complications/hospitalization for 6 other interventions, ie number of biopsy cores, periprostatic nerve block, number of injections for periprostatic nerve block, needle guide type, needle type and rectal preparation with enema. In 2 interventions (needle diameter, rectal preparation with chlorhexidine) meta-analysis was not possible. Finally, 7 studies had unique interventions. The certainty of evidence was rated as low/very low for all interventions. Transperineal biopsy significantly reduces infectious complications compared to transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, rectal preparation with povidone-iodine is highly recommended. The other investigated nonantibiotic strategies did not significantly influence infection and hospitalization after prostate biopsy.