The Impact of Local Anesthetic Volume and Concentration on Pain During Prostate Biopsy: A Prospective Randomized Trial

Effect of Virtual Reality Glasses Application on Pain, Anxiety, and Patient Satisfaction During a Transrectal Prostate Biopsy: A Randomized Controlled Trial

BACKGROUND

This study aims to determine the effect of virtual reality glasses application on pain, anxiety, and patient satisfaction during a transrectal prostate biopsy.

MATERIALS AND METHODS

The study was conducted with pre-tests, post-tests, and a control group, using a randomized controlled experimental research design. A total of 70 patients (35 in the intervention group and 35 in the control group) were included in the study. The intervention group watched a video with virtual reality glasses during the biopsy process. A Descriptive Information Form, State-Trait Anxiety Inventory (STAI-I, STAI-II), Scale of Patient Perception of Hospital Experience with Nursing Care (PPHEN), and Visual Analog Scale for Pain (VAS) were used for data collection. To evaluate the data, numbers, percentages, mean, standard deviation, chi-square, paired sample t test, independent samples t test, regression analysis, and Cronbach's alpha Reliability Coefficient were used.

RESULTS

There was no significant difference between the groups in terms of descriptive and clinical characteristics (p > .05). The mean VAS and STAI post-test scores of the patients in the intervention group were lower than the control group, and the difference between them was statistically significant (p < .05). The mean PPHEN post-test scores of the patients in the intervention group were significantly higher than those in the control group (p < .05).

CONCLUSION

The application of virtual reality glasses during a transrectal prostate biopsy significantly reduced the level of pain and anxiety and increased patient satisfaction.

Application of single-point prostate biopsy in elderly patients with highly suspected prostate cancer

Objective

To explore the feasibility of single-point prostate biopsy in elderly patients with highly suspected prostate cancer.

Methods

Forty-three patients with a prostate imaging reporting and data system score (PI-RADS) of 5, age ≥ 80 years and/or PSA ≥ 100 ng/ml and/or Eastern Cooperative Oncology Group score ≥ 2 were enrolled in our hospital from March 2020 to June 2022. Targeted surgery of these patients was performed using only precise local anesthesia in the biopsy area. The biopsy tissues were examined by intraoperative frozen section examination (IFSE). If the result of IFSE was negative, traditional systematic biopsy and further routine pathological examination were performed. The positive rate of biopsy, operation time, complications and pain score were recorded.

Results

The positive rate of prostate biopsy was 94.7%. The results of IFSE in two patients were negative, and the routine pathological results of further systematic biopsy of those patients were also negative. The visual analog scale and visual numeric scale were 2 (2-4) and 3 (2-3), respectively, during the biopsy procedure. The mean time of operation was 8.5 ± 2.1 min from the beginning of anesthesia to the end of biopsy. It took 35.3 ± 18.7 minutes to obtain the pathological report of IFSE. The incidences of complication hematuria and urinary retention were 10.5% and 2.6%, respectively.

Conclusion

For elderly patients with highly suspected prostate cancer, single-point prostate biopsy can be used to quickly and safely obtain pathological results.

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

Background

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).

Methods

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.

Results

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).

Conclusions

Targeted PNB significantly relieved the pain and did not increase the incidence of complications for patients when compared with traditional PNB.

Ultrasound Guidance Enhances the Efficiency of Brachial Plexus Block and Ameliorates the Vascular Injury Compared with Nerve Stimulator Guidance in Hand Surgery Patients

Background: Nerve stimulation guidance and ultrasound guidance are two major methods that have been widely accepted and applied in axillary brachial plexus block. However, the differences between the effects of these two types of guidance still need to be further elucidated for clinical usage. Materials and Methods: Overall, 208 patients undergoing elective upper limb surgeries and receiving axillary brachial plexus block were recruited in our study. The patients were randomly assigned to receive either ultrasound guidance (group U, n = 112) or nerve stimulation (group N, n = 96). Pinprick test was performed for assessing the sensory blockades. The pain was evaluated by visual analog scale (VAS). Reactive oxygen species (ROS) levels were measured by dichloro-dihydro-fluorescein diacetate staining and serum levels of nitric oxide (NO), nitric oxide synthases (NOS), tumor necrosis factor (TNF)-α, and monocyte chemoattractant protein 1 (MCP1) were evaluated by ELISA. Results: Ultrasound guidance significantly enhanced the quality of the sensory blockade and reduced the VAS scores when compared with the nerve stimulator guidance. In addition, the production of ROS, NO, NOS, TNF-α, and MCP-1 were significantly alleviated by ultrasound guidance. Conclusion: Ultrasound-guided brachial plexus block relieves pain during operation, provides higher success rates in the nerve block, causes less vascular damage and results in lower levels of inflammatory cytokines secretion when compared with neurostimulator-directed brachial plexus blockage.

Effect of prostate volume on the peripheral nerve block anesthesia in the prostate biopsy: A strobe-compliant study

OBJECTIVE

The objective of this study was to evaluate the anesthetic efficacy of periprostatic nerve block (PNB) in transrectal ultrasound (TRUS)-guided biopsy on different prostate volume.

METHODS

A total of 568 patients received prostate biopsy in our hospital from May 2013 to September 2015 and were retrospectively studied. All patients were divided into local anesthesia group (LAG) and nerve block group (NBG). Then each group was subdivided into 4 subgroups (20-40, 40-60, 60-100, and >100 mL groups) according to different prostate volume range. Visual analogue scale (VAS) and visual numeric scale (VNS) were used to assess the patient's pain and quantify their satisfaction. The scores and complications were compared between the groups.

RESULTS

The age and serum prostate-specific antigen (PSA) level before biopsy had no significant differences at intergroup or intragroup level. The VAS scores were significantly lower in the NBG than those in the LAG in terms of prostate volume (1 (1-2) versus 2 (1-3), 2 (1-3) versus 2 (2-4), 2 (2-3) versus 3 (2-5), 4 (3-5) versus 5 (4-7), all P < 0.05). Conversely, the VNS scores were higher in the NBG (4 (3-4) versus 3.5 (3-4), 3 (3-4) versus 3 (3-3), 3 (2-4) versus 3 (2-3), 2 (2-2) versus 1 (1-2), all P < 0.05). Patients with smaller prostate volume undergoing PNB or local anesthesia experienced significantly lower pain and higher satisfaction scores than those with large prostate. Whether in PNB or local anesthesia group, patients with large prostate volume had more chance to have hematuria, hemospermia, urinary retention than smaller one except infection (P < 0.05). Those complications had no significant differences between LAG and NBG (P > 0.05).

CONCLUSION

Compared with local anesthesia, ultrasound-guided PNB has superior analgesic effect and equal safety, but for patients with a large prostate volume, the analgesic effect is inefficient.

High level of patient satisfaction and comfort during diagnostic urological procedures performed by urologists and residents

OBJECTIVE

The aim of this study was to investigate how patients experience diagnostic urological procedures performed by urologists, junior residents and senior residents, and to assess the influence of procedure-related factors on patient experiences.

METHODS

Data were collected during 222 procedures: 84 transrectal ultrasound-guided prostate biopsies (TRUSP; urologists n = 39, residents n = 45) and 138 urethrocystoscopies (UCS; urologists n = 44, residents n = 94) in six hospitals. Patient experiences were assessed using a questionnaire focusing on pain, comfort and satisfaction (visual analogue scale, 0-10) and communication aspects on a four-point Likert scale. Clinical observations were made to identify influencing factors.

RESULTS

Median values for patient experiences across procedures were 10 (range 5-10) for patient satisfaction, 2 (0-9) for pain and 8 (0-10) for comfort. Generalized estimating equations revealed no significant differences between urologists, senior residents and junior residents in terms of experienced patient comfort, satisfaction or pain. Procedural time was longer for residents, but this did not correlate significantly with patient-experienced comfort (p = 0.3). In UCS, patient comfort and satisfaction were higher in the supine position for male and female patients, respectively (p < 0.01). In TRUSP, local anaesthesia resulted in a significant decrease in pain (p = 0.002) and an increase in comfort (p = 0.03). Finally, older patients experienced less pain and gave higher comfort and satisfaction responses than younger patients.

CONCLUSIONS

Patients expressed high levels of satisfaction and comfort during diagnostic urological procedures. Experiences were not affected by the level of training, suggesting highly developed interpersonal and communication skills for residents in an early stage of residency training. Patients demonstrated significant preferences for local anaesthesia in TRUSP and performance of UCS in the supine position over the lithotomy position.

Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: A Prospective, Randomized, and Controlled Trial

This prospective study of comparing transperineal prostate biopsy (TPBx) with transrectal prostate biopsy (TRBx) was aimed to provide evidence for clinicians to select the appropriate biopsy approach under different conditions. TPBx (n = 173) and TRBx (n = 166) were performed randomly for 339 patients who were suspicious of prostate cancer (PCa). The cancer detection rate (CDR), complication rate, visual analogue scale (VAS) score, most painful procedure, number of repeated biopsy and additional anesthesia, and operating time (starting from lying down on the operating table to getting up) were recorded. The results showed that TPBx and TRBx were equivalent in CDR (35.3% vs. 31.9%) and minor complication rate (44.9% vs. 41.0%) (both P > 0.05). The major complication rate was lower in TPBx than in TRBx (0.6% vs. 4.3%, P < 0.05). TPBx was more time-consuming (17.51 ± 3.33 min vs. 14.73 ± 3.25 min) and painful (VAS score: 4.0 vs. 2.0); and it had higher rates of repeated biopsy (3.2% vs. 1.1%) and additional anesthesia (15.0% vs. 1.2%) (all P < 0.05). In summary, both TPBx and TRBx are effective to detect PCa. The major complication rate for TRBx is higher, whereas TPBx procedure is more complex and painful.

Complications of prostate biopsy

Biopsy of the prostate is a common procedure with minor complications that are usually self-limited. However, if one considers that millions of men undergo biopsy worldwide, one realizes that although complication rate is low, the number of patients suffering from biopsy complications should not be underestimated and can be a clinically relevant problem for healthcare professionals. In this review, the authors present diagnosis and management of postbiopsy of prostate complications. Bleeding is the most common complication observed after prostate biopsy, but the use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication to prostate biopsy. Emerging resistance to ciprofloxacin is the most probable cause of the increasing risk of infectious complications after prostate biopsy. Even though extremely rare, fatal complications are possible and were described in case reports.

Systematic review of complications of prostate biopsy

CONTEXT

Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment.

OBJECTIVE

To perform a systematic review of complications from prostate biopsy.

EVIDENCE ACQUISITION

A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality.

EVIDENCE SYNTHESIS

After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare.

CONCLUSIONS

Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.