Korean J Urol.  2012 Feb;53(2):87-91.

Prostate Biopsy in the Left Lateral Decubitus Position is Less Painful than Prostate Biopsy in the Lithotomy Position: A Randomized Controlled Trial

• Lodeta B
• Lodeta M

Abstract

PURPOSE
The primary objective was to assess whether transrectal ultrasound (TRUS)-guided prostate biopsy in the left lateral decubitus (LLD) position differed from the procedure in the lithotomy position regarding patients' pain perception. The secondary objective was to assess the analgesic effect of intrarectal 2% lidocaine gel in this setting.
MATERIALS AND METHODS
This single-center, open-label trial enrolled 148 men undergoing prostate biopsy. Then men were randomly assigned to group 1 (LLD position, no lidocaine, n=50, "test"), group 2 (lithotomy position+lidocaine, n=50, "positive control"), and group 3 (lithotomy position, no lidocaine, n=48, "negative control"). Twelve-core samples were taken in each biopsy set. Pain was assessed by using a 10-point visual analogue scale (VAS).
RESULTS
Across the groups, patients were comparable regarding age, prostate-specific antigen levels, prostate volume, digital rectal examination findings, and pathohistological diagnosis. VAS scores were lower in group 1 (median, 2.95) than in group 2 (median, 4.95; p<0.001) or group 3 (median, 4.60; p<0.001). The difference between group 2 and group 3 was insignificant (p=0.268). The adjusted mean differences (with adjustment for the above covariates) were as follows: group 1 vs. group 2, -1.43 (95% confidence interval [CI]: -2.25 to -0.60; p<0.001); group 1 vs. group 3, -1.22 (95% CI: -2.04 to -0.41; p=0.001); group 2 vs. group 3, 0.20 (95% CI, -0.63 to 1.04; p=0.836); and group 1 vs. groups 2 and 3, -1.33 (95% CI, -1.92 to -0.73; p<0.001). The procedure was comparably well tolerated across the groups.
CONCLUSIONS
Pain perception during prostate biopsy was lower in the LLD position than in the lithotomy position. Intrarectal 2% lidocaine gel does not seem to affect pain perception.

Keyword

Biopsy, Fine-needle; Pain; Prostatic neoplasms

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Digital Rectal Examination
Humans
Lidocaine
Male
Pain Perception
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Lidocaine
Prostate-Specific Antigen

Reference

1. Croatian National Institute of Public Health. accessed December 16, 2010. http://www.hzjz.hr/rak/novo.htm.

2. Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine E. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med. 1987. 317:909–916.

3. Spirnak JP, Resnick MI. Gillenwater JY, Grayhack JT, Howards SS, Mitchell ME, editors. Ultrasound. Adult & pediatric urology. 2002. Philadelphia: Lippincott Williams & Wilkins;140.

4. Presti JC. Prostate biopsy: current status and limitations. Rev Urol. 2007. 9:93–98.

5. 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.

6. 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.

7. 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.

8. Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis. 2007. 10:127–136.

9. Díaz Pérez GA, Meza Montoya L, Morante Deza C, Pow-Sang Godoy M, Destefano Urrutia V. Pain during transrectal ultrasound guided needle biopsy of the prostate: comparison of the use or not of lidocaine gel. Actas Urol Esp. 2009. 33:134–137.

10. Song SH, Kim JK, Song K, Ahn H, Kim CS. Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound-guided prostate biopsy: a prospective randomized study. Int J Urol. 2006. 13:707–710.

11. Kilciler M, Demir E, Bedir S, Erten K, Kilic C, Peker AF. Pain scores and early complications of transrectal ultrasonography-guided prostate biopsy: effect of patient position. Urol Int. 2007. 79:361–363.

12. Bruyère F, Faivre d'Arcier B, Haringanji DC, Boutin JM, Haillot O, Lanson Y. Effect of patient position on pain experienced during prostate biopsy. Urol Int. 2007. 78:351–355.

13. Heidenreich A, Bolla M, Joniau S, Mason MD, Matveev V, Mottet N, et al. Guidelines on prostate cancer. EAU Guidelines. 2011. Arnhem: European Association of Urology.

14. Jadhav SA, Sukumar S, Kumar G, Bhat SH. Prospective analysis of psychological distress in men being investigated for prostate cancer. Indian J Urol. 2010. 26:490–493.

15. Von Knobloch R, Weber J, Varga Z, Feiber H, Heidenreich A, Hofmann R. Bilateral fine-needle administered local anaesthetic nerve block for pain control during TRUS-guided multi-core prostate biopsy: a prospective randomised trial. Eur Urol. 2002. 41:508–514.

16. Turgut AT, Olçücüoğlu E, Koşar P, Geyik PO, Koşar U. Complications and limitations related to periprostatic local anesthesia before TRUS-guided prostate biopsy. J Clin Ultrasound. 2008. 36:67–71.