J Korean Med Sci.  2022 Apr;37(15):e115. 10.3346/jkms.2022.37.e115.

Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes

• Kim HY
• Choi YH
• Lee SJ

• KMID: 2528173
• DOI: http://doi.org/10.3346/jkms.2022.37.e115

Abstract

Background
Sedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure’s prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes.
Methods
A retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates.
Results
The cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction.
Conclusion
Sedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.

Keyword

Prostatic Neoplasms; Image-Guided Biopsy; Deep Sedation; Propofol

Reference

1. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989; 142(1):71–74. PMID: 2659827.

2. Shoji S. Magnetic resonance imaging-transrectal ultrasound fusion image-guided prostate biopsy: current status of the cancer detection and the prospects of tailor-made medicine of the prostate cancer. Investig Clin Urol. 2019; 60(1):4–13.

3. Das CJ, Razik A, Sharma S, Verma S. Prostate biopsy: when and how to perform. Clin Radiol. 2019; 74(11):853–864. PMID: 31079953.

4. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017; 71(4):618–629. PMID: 27568654.

5. Lee C, Woo HH. Current methods of analgesia for transrectal ultrasonography (TRUS)-guided prostate biopsy -- a systematic review. BJU Int. 2014; 113(Suppl 2):48–56. PMID: 24053451.

6. 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(2):127–136. PMID: 17211441.

7. Tobias-Machado M, Verotti MJ, Aragao AJ, Rodrigues AO, Borrelli M, Wroclawski ER. Prospective randomized controlled trial comparing three different ways of anesthesia in transrectal ultrasound-guided prostate biopsy. Int Braz J Urol. 2006; 32(2):172–179. PMID: 16650294.

8. Kang SG, Tae BS, Min SH, Ko YH, Kang SH, Lee JG, et al. Efficacy and cost analysis of transrectal ultrasound-guided prostate biopsy under monitored anesthesia. Asian J Androl. 2011; 13(5):724–727. PMID: 21623389.

9. Soltanizadeh S, Degett TH, Gögenur I. Outcomes of cancer surgery after inhalational and intravenous anesthesia: a systematic review. J Clin Anesth. 2017; 42:19–25. PMID: 28797751.

10. Perry NJ, Buggy D, Ma D. Can anesthesia influence cancer outcomes after surgery? JAMA Surg. 2019; 154(4):279–280. PMID: 30649136.

11. Peters JL, Thompson AC, McNicholas TA, Hines JE, Hanbury DC, Boustead GB. Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation. BJU Int. 2001; 87(9):827–830. PMID: 11412220.

12. Barends CR, Absalom AR, Struys MM. Drug selection for ambulatory procedural sedation. Curr Opin Anaesthesiol. 2018; 31(6):673–678. PMID: 30124543.

13. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995; 7(1):89–91. PMID: 7772368.

14. Seymour H, Perry MJ, Lee-Elliot C, Dundas D, Patel U. Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anaesthesia. BJU Int. 2001; 88(6):540–544. PMID: 11678747.

15. Vaidya A, Soloway MS. Periprostatic local anesthesia before ultrasound-guided prostate biopsy: an update of the Miami experience. Eur Urol. 2001; 40(2):135–138. PMID: 11528189.

16. 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(2 Pt 1):563–565. PMID: 11792919.

17. Rodriguez A, Kyriakou G, Leray E, Lobel B, Guillé F. Prospective study comparing two methods of anaesthesia for prostate biopsies: apex periprostatic nerve block versus intrarectal lidocaine gel: review of the literature. Eur Urol. 2003; 44(2):195–200. PMID: 12875938.

18. Wu CL, Carter HB, Naqibuddin M, Fleisher LA. Effect of local anesthetics on patient recovery after transrectal biopsy. Urology. 2001; 57(5):925–929. PMID: 11337296.

19. Turgut AT, Ergun E, Koşar U, Koşar P, Ozcan A. Sedation as an alternative method to lessen patient discomfort due to transrectal ultrasonography-guided prostate biopsy. Eur J Radiol. 2006; 57(1):148–153. PMID: 16159704.

20. Choo MS, Lee DS. Does deep sedation with analgesia have positive effects on anxiety, pain and compliance in patients before and after prostate biopsy? Int J Clin Pract. 2020; 74(8):e13517. PMID: 32346965.

21. Temiz MZ, Kandirali E, Colakerol A, Tuken M, Semercioz A. Local anesthesia type affects cancer detection rate in transrectal ultrasound guided prostate biopsy. Int Braz J Urol. 2015; 41(5):859–863. PMID: 26689511.

22. Combrisson H, Robain G, Cotard JP. Comparative effects of xylazine and propofol on the urethral pressure profile of healthy dogs. Am J Vet Res. 1993; 54(12):1986–1989. PMID: 8116926.

23. Matsuura S, Downie JW. Effect of anesthetics on reflex micturition in the chronic cannula-implanted rat. Neurourol Urodyn. 2000; 19(1):87–99. PMID: 10602250.

24. Merguerian PA, Corbett ST, Cravero J. Voiding ability using propofol sedation in children undergoing voiding cystourethrograms: a retrospective analysis. J Urol. 2006; 176(1):299–302. PMID: 16753428.

25. Bozlu M, Ulusoy E, Doruk E, Cayan S, Canpolat B, Schellhammer PF, et al. Voiding impairment after prostate biopsy: does tamsulosin treatment before biopsy decrease this morbidity? Urology. 2003; 62(6):1050–1053. PMID: 14665353.

26. Tobias JD, Leder M. Procedural sedation: a review of sedative agents, monitoring, and management of complications. Saudi J Anaesth. 2011; 5(4):395–410. PMID: 22144928.

27. Lee YM, Kang B, Kim YB, Kim HJ, Lee KJ, Lee Y, et al. Procedural sedation for pediatric upper gastrointestinal endoscopy in Korea. J Korean Med Sci. 2021; 36(20):e136. PMID: 34032029.