The need to reduce patient discomfort during transrectal ultrasonography-guided prostate biopsy: what do we know? (original) (raw)
Related papers
Urology, 2005
Objectives. To introduce two forms of anesthesia and compare them with standard local anesthesia techniques. Methods. A total of 114 consecutive patients underwent prostate needle biopsy. The patients were sequentially randomized to receive different kinds of anesthesia: 2% rectal lidocaine gel, 40% dimethyl sulfoxide (DMSO) with lidocaine, perianal injection of 1% lidocaine, or periprostatic nerve block. Pain perception was separately assessed for probe insertion and biopsies using a visual pain analog score. One-way analysis of variance was used to compare the data scale among the four groups. A linear regression model was used to define the independent variables that predicted the level of pain. Results. The groups were similar in terms of age, prostate-specific antigen levels, digital rectal examination findings, prostate volume, pain tolerance, biopsy time, and number of cores taken. The lowest pain scores for probe insertion were for the perianal injection and DMSO/lidocaine groups (0.89 and 1.38, respectively). The difference between these scores and those for the other two groups was statistically significant (P Ͻ0.001). Pain perception during biopsy did not differ significantly among the DMSO/lidocaine, perianal, or periprostatic groups and was greatest in the lidocaine gel group (4.147; P Ͻ0.001). We did not observe any statistically significant correlation between the pain level during probe insertion and biopsy and pain tolerance (P ϭ 0.514 and P ϭ 0.788, respectively). The anesthesia type was the strongest single predictor of the pain level during biopsy (P Ͻ0.001). Conclusions. The use of 40% DMSO with lidocaine instilled into the rectal vault for 10 minutes avoids any need for injection and is capable of decreasing the discomfort or pain experienced during probe insertion and prostate biopsy comparable to the perianal and periprostatic protocols.
Transrectal ultrasound (TRUS) guided prostate biopsy: Three different types of local anesthesia
Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 2016
Transrectal Ultrasound (TRUS) guided prostate biopsy is regarded as the gold standard for prostate cancer diagnosis. The majority of patients perceive TRUS-guided prostate biopsy as a physically and psychologically traumatic experience. We aimed to compare in this paper the efficacy of three different anesthesia techniques to control the pain during the procedure. 150 patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy were randomly divided into three groups. Group A included 50 patients who received one hour before the procedure a mixture of 2.5% lidocaine and 2.5% prilocaine, Group B: 50 patients who received intrarectal local anesthetic administration (lidocaine 5 ml 10%) and lidocaine local spray 15 % and Group C included 50 patients who received periprostatic block anesthesia (lidocaine 10 ml 10%). Visual analogue scale (VAS) of patients in different groups was evaluated at the end of the biopsy and 30 minutes after the procedure. The VAS of patients in ...
Acceptance of repeat transrectal ultrasonography guided prostate biopsies with local anaesthesia
BJU International, 2011
• Immediately after the procedure the men were asked to complete a visual analogue pain score. • They were then asked whether, if it was necessary to have a repeat biopsy, they would agree to LA again or request GA/ sedation. RESULTS • In all, 476 men participated in the study with a mean age of 64 years. • Of these, 464 men (97.5%) tolerated the procedure well and would, if required, agree to repeat biopsy with LA. • Only 12 men (2.5%) indicated they would request GA/sedation if a repeat biopsy was necessary. CONCLUSION • The vast majority of men accepted having prostate biopsy with LA infiltration and therefore this should be the first method offered. • It may be possible to screen for men who would not tolerate biopsy under LA. • Resource saving by performing most biopsies under LA can be estimated to be > A$10 million annually. KEYWORDS prostate cancer, prostate biopsy, screening, anaesthesia OBJECTIVE • To measure patient discomfort associated with transrectal ultrasonography guided prostate biopsy (TRUSPB) performed with periprostatic local anaesthetic (LA) infiltration and to document agreement to possible repeat biopsy, as a recent audit showed that 86% of Australian urologists performed prostate biopsies using sedation or general anaesthesia (GA), which implies many urologists think patients are unwilling to tolerate the procedure under LA block and/or may refuse a repeat procedure. PATIENTS AND METHODS • This was a prospective cohort study following all men undergoing TRUSPB in 2008.
2007
Objective: Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. Materials and Methods: 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. Results: DRE pain was related to both probe pain and biopsy pain. Conclusion: Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.
Relationship between Complications due to Prostate Biopsy and the Scores of Pain and Discomfort
Urologia Internationalis, 2004
Introduction: Transrectal ultrasound (TRUS)-guided prostate biopsy is routinely performed in the prostatespecific antigen era. In this study, we evaluated morbidity and complications observed in patients undergoing TRUS-guided prostate biopsy following intrarectal lidocaine application and the relation of these complications to pain and discomfort. Patients and Methods: Between January 2000 and August 2002, a total of 128 patients underwent TRUS-guided prostate biopsy. The procedure was carried out following an intrarectal application of 10 cm 3 2% lidocaine gel. Immediately after the biopsy, pain and discomfort scores were determined using a 10point linear visual analog scale. The patients were seen 10 days later and questioned for complications. Results: At least one complication was observed in 107 patients (84%). Most frequent complications were macroscopic hematuria (90%), hematochezia (36%), and hematospermia (13%). The mean pain and discomfort scores of the patients were found to be correlated to each other (p ! 0.01). The complication-negative group had significantly lower pain and discomfort scores (p ! 0.01). The scores of the patients with hematochezia were significantly higher than the scores of the patients with other complications (p ! 0.01). Conclusions: Minor complications like hematuria, hematochezia, and hematospermia are frequently seen in patients undergoing TRUS-guided prostate biopsies. The pain and discomfort scores may be predictors of minor complications, particularly of rectal bleeding.
Urologia Journal
To assess the technical aspects determining the perceived pain during prostate biopsy via transperineal access. Materials and Methods We conducted prostate biopsy with transperineal access in local anesthesia. Between January 2007 and January 2008, data on prostatic biopsies were prospectively surveyed. The patient was requested to assess perceived pain by means of a Visual Analogue Scale ranging from 0 (no pain) to 10 (unbearable pain). Complications were recorded by telephone interviews 30 days after the biopsy. The histological diagnosis was recorded. Results 445 prostate biopsies were conducted. The average perceived pain score amounted to 2.60. At univariate analysis, a lower score was recorded in cases where the anesthetic agent was diluted with physiological saline, those in which a single cutaneous access was chosen along the middle line, those in the first bioptic series as compared to the following series and those in which no sampling involved the transition region. Howev...
International journal of innovative research in medical science, 2023
Introduction: Transrectal ultrasound guided prostate biopsy is the gold standard for diagnosis of carcinoma of the prostate. The pain of prostate biopsy is of immense challenge. Many factors have been ascribed to it. Identifying such risk factors will assist in mitigating the pain associated with this procedure. This study therefore aims to assess the role of histopathological outcome on pain of TRUS guided prostate biopsy. Methods: The study was a prospective randomized study carried out in University of Benin Teaching Hospital over a 1year period between 2017 and 2018. Consecutive patients who met indications for biopsy were randomized into Group A: intrarectal xylocaine gel group and Group B: periprostatic block group. Pain was assessed during probe insertion, biopsy and one hour post biopsy using an 11-point visual analogue scale. Association between mean pain scores and histological diagnosis in both groups was assessed using the independent t-test, association between use of intrarectal xylocain gel, periprostatic block was done using the independent t-test. Level of significance set at p <0.05. Results: There was no statistically significant difference in mean pain score during probe insertion, biopsy and post biopsy (p=0.3888), (p=0.089) and (p=0.584) respectively between benign and malignant histological diagnosis for Group A, while there was also no statistically significant difference in mean pain score during probe insertion, biopsy and post biopsy (p=0.266), (p=0.506) and (p=0.522) respectively between benign and malignant histological diagnosis in Group B. Cancer detection rate for Group A and Group B was 64.3% and 59.1% respectively, which was not statistically significant p=0.662. Conclusions: The study demonstrated that pain of TRUS guided prostate biopsy is not influenced by histopathological outcome irrespective of mode of anaesthesia. Cancer detection rate was also not influenced by choice of anaesthesia during TRUS guided prostate biopsy.