Korean J Radiol.  2007 Jun;8(3):231-235. 10.3348/kjr.2007.8.3.231.

Prospective Analysis on the Relation between Pain and Prostate Volume during Transrectal Prostate Biopsy

• Yun TJ
• Lee HJ
• Kim SH
• Lee SE
• Byun SS
• Hong SK
• Cho JY
• Seong CK

• KMID: 1779439
• DOI: http://doi.org/10.3348/kjr.2007.8.3.231

Abstract

OBJECTIVE
We wanted to assess the relationship between pain and the prostate volume during transrectal ultrasound (TRUS) guided biopsy. MATERIALS AND METHODS: Between July and September 2006, 71 patients scheduled for TRUS biopsy of the prostate were considered for inclusion to this study. These patients underwent periprostatic neurovascular bundle block with lidocaine prior to biopsy. Pain was assessed using a Visual Analogue Scale (VAS) during periprostatic neurovascular bundle block (VAS 1), during biopsy (VAS 2), and 20 minutes after biopsy (VAS 3). The mean pain scores were analyzed in the large prostate group (prostate volume > 40 cc) and the small prostate group (prostate volume < or = 40 cc). P values < 0.05 were considered significant. RESULTS: The mean prostate volume was 42.2 cc (standard deviation: 8.6). The mean pain scores of VAS 1, 2 and 3 were 4.70 +/- 1.61, 3.15 +/- 2.44 and 1.05 +/- 1.51, respectively. In the large prostate group, the mean pains scores of VAS 1, 2 and 3 were 4.75 +/- 1.76, 3.51 +/- 2.76 and 1.29 +/- 1.70, respectively, whereas in the small prostate group, the means pain scores were 4.66 +/- 1.46, 2.77 +/- 2.0, and 0.80 +/- 1.26, respectively. Although there were no statistical differences of VAS 1, the larger prostate group revealed higher pain scores of VAS 2 and 3 compared with the small prostate group (p < 0.05). CONCLUSION: Patients with larger prostate volumes tend to feel more pain during and after TRUS guided prostate biopsy. Our findings suggest that additional analgesic strategies may be necessary when the patients with larger prostate undergo TRUS guided prostate biopsy.

Keyword

Prostate; Prostate, interventional procedure; Prostate, biopsy

MeSH Terms

Aged
Anesthetics, Local/therapeutic use
*Biopsy, Fine-Needle
Humans
Lidocaine/therapeutic use
Male
Middle Aged
Nerve Block
*Pain Measurement
Prospective Studies
Prostate/*pathology
Ultrasonography, Interventional

Figure

• 

  Fig. 1 Ultrasonographic image of the anesthetic injection site during periprostatic neurovascular bundle block. Arrow indicates the site of lidocaine injection (P; prostate).

Reference

1. Clements R, Aideyan OU, Griffiths GJ, Peeling WB. Side effects and patient acceptability of transrectal biopsy of the prostate. Clin Radiol. 1993. 47:125–126.

2. Collins GN, Lloyd SN, Hehir M, McKelvie GB. Multiple transrectal ultrasound-guided prostatic biopsies-true morbidity and patient acceptance. Br J Urol. 1993. 71:460–463.

3. Bastide C, Lechevallier E, Eghazarian C, Ortega JC, Coulange C. Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate: risk factors. Prostate Cancer Prostatic Dis. 2003. 6:239–241.

4. Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol. 1998. 160:2115–2120.

5. Irani J, Fournier F, Bon D, Gremmo E, Dore B, Aubert J. Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol. 1997. 79:608–610.

6. Issa MM, Bux S, Chun T, Petros JA, Labadia AJ, Anastasia K, et al. A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience. J Urol. 2000. 164:397–399.

7. Wu CL, Carter HB, Naqibuddin M, Fleisher LA. Effect of local anesthetics on patient recovery after transrectal biopsy. Urology. 2001. 57:925–929.

8. Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol. 2001. 165:445–454.

9. Aus G, Hermansson CG, Hugosson J, Pedersen KV. Transrectal ultrasound examination of the prostate: complications and acceptance by patients. Br J Urol. 1993. 71:457–459.

10. Presti JC Jr. Prostate biopsy: how many cores are enough? Urol Oncol. 2003. 21:135–140.

11. Naughton CK, Ornstein DK, Smith DS, Catalona WJ. Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol. 2000. 163:168–171.

12. Autorino R, De Sio M, Di Lorenzo G, Damiano R, Perdona S, Cindolo L, et al. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol. 2005. 174:2091–2097.

13. Leibovici D, Zisman A, Siegel YI, Sella A, Kleinmann J, Lindner A. Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study. J Urol. 2002. 167:563–565.

14. Nash PA, Bruce JE, Indudhara R, Shinohara K. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol. 1996. 155:607–609.

15. Hollabaugh RS Jr, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology. 1997. 49:426–434.

16. Hollabaugh RS Jr, Dmochowski RR, Kneib TG, Steiner MS. Preservation of putative continence nerves during radical retropubic prostatectomy leads to more rapid return of urinary continence. Urology. 1998. 51:960–967.

17. Soloway MS, Obek C. Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol. 2000. 163:172–173.

18. Alavi AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL. Local anesthesia for ultrasound guided prostate biopsy a prospective randomized trial comparing 2 methods. J Urol. 2001. 166:1343–1345.

19. Stirling BN, Shockley KF, Carothers GG, Maatman TJ. Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies. Urology. 2002. 60:89–92.

20. Inal G, Yazici S, Adsan O, Ozturk B, Kosan M, Cetinkaya M. Effect of periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy on patient comfort: a randomized placebo controlled study. Int J Urol. 2004. 11:148–151.

21. Schostak M, Christoph F, Muller M, Heicappell R, Goessl G, Staehler M, et al. Optimizing local anesthesia during 10-core biopsy of the prostate. Urology. 2002. 60:253–257.