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Demirtaş A, Sönmez G, Tombul ŞT, Demirtaş T. Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy. Int Braz J Urol 2020; 46:557-562. [PMID: 32213209 PMCID: PMC7239274 DOI: 10.1590/s1677-5538.ibju.2019.0154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. Materials and Methods Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS <3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. Results 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p <0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). Conclusion FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.
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Affiliation(s)
| | - Gökhan Sönmez
- Department of Urology, Kayseri City Hospital, Kayseri, Turkey
| | | | - Türev Demirtaş
- Department of Medical History and Ethics, Erciyes University, Kayseri, Turkey
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2
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Sonmez G, Tombul ST, Demirtas T, Demirtas A. Risk factors associated with pain in fusion prostate biopsy. Prostate Int 2020; 8:185-189. [PMID: 33425797 PMCID: PMC7767937 DOI: 10.1016/j.prnil.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Multiparametric prostate magnetic resonance imaging (mpMRI)–guided fusion prostate biopsy is an emerging technique in the diagnosis of prostate cancer and provides extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. We aimed to investigate the clinical and anatomical risk factors aggravating the pain experienced by patients undergoing mpMRI-guided fusion prostate biopsy. Methods The prospective study included 319 patients aged 45–75 years who had a prostate-specific antigen <10 ng/ml and a Prostate Imaging Reporting and Data System ≥3 lesion and underwent combined biopsy (targeted biopsy + 12-core standard prostate biopsy) under local anesthesia (intrarectal lidocaine gel + periprostatic nerve block). Immediately after the biopsy procedure, pain assessment was achieved using Visual Analog Scale (VAS). The relationship between the VAS and 13 clinical parameters was evaluated using ordinal logistic regression analysis. Results The 319 patients had a mean age of 62.39 ± 6.98 years and a median prostate-specific antigen level of 7.20 (range, 5.20–8.50) ng/ml. The VAS was found to be correlated with 4 of 13 parameters, including (i) a shorter prostate–anus surface distance (cutoff value, 55.5 mm), (ii) a narrower anorectal angle (cutoff value, 106.5°), (iii) a larger total prostate volume (cutoff, 61.6 mm3), and (iv) having no history of prior biopsy (biopsy-naive patients). Conclusion Anatomical measurements that can be achieved by using mpMRI images (TPV, PASD and ARA) may be useful in the identification of patients at an increased risk of pain during biopsy and also in taking analgesic precautions in such patients.
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Affiliation(s)
- Gokhan Sonmez
- Erciyes University, Department of Urology, Kayseri, Turkey
| | | | - Turev Demirtas
- Erciyes University, Department of Medical History and Ethics, Kayseri, Turkey
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3
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Cindolo L, Bertolo R, Minervini A, Sessa F, Muto G, Bove P, Vittori M, Bozzini G, Castellan P, Mugavero F, Falsaperla M, Schips L, Celia A, Bada M, Porreca A, Pastore A, Al Salhi Y, Giampaoli M, Novella G, Rizzetto R, Trabacchin N, Mantica G, Pini G, Lombardo R, Tubaro A, Antonelli A, De Nunzio C. External validation of Cormio nomogram for predicting all prostate cancers and clinically significant prostate cancers. World J Urol 2020; 38:2555-2561. [PMID: 31907633 DOI: 10.1007/s00345-019-03058-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/12/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Recently, the Cormio et al. nomogram has been developed to predict prostate cancer (PCa) and clinically significant PCa using benign prostatic obstruction parameters. The aim of the present study was to externally validate the nomogram in a multicentric cohort. METHODS Between 2013 and 2019, patients scheduled for ultrasound-guided prostate biopsy were prospectively enrolled at 11 Italian institutions. Demographic, clinical and histological data were collected and analysed. Discrimination and calibration of Cormio nomogram were assessed with the receiver operator characteristics (ROC) curve and calibration plots. The clinical net benefit of the nomogram was assessed with decision curve analysis. Clinically significant PCa was defined as ISUP grade group > 1. RESULTS After accounting for inclusion criteria, 1377 patients were analysed. 816/1377 (59%) had cancer at final pathology (574/816, 70%, clinically significant PCa). Multivariable analysis showed age, prostate volume, DRE and post-voided residual volume as independent predictors of any PCa. Discrimination of the nomogram for cancer was 0.70 on ROC analysis. Calibration of the nomogram was excellent (p = 0.94) and the nomogram presented a net benefit in the 40-80% range of probabilities. Multivariable analysis for predictors of clinically significant PCa found age, PSA, prostate volume and DRE as independent variables. Discrimination of the nomogram was 0.73. Calibration was poor (p = 0.001) and the nomogram presented a net benefit in the 25-75% range of probabilities. CONCLUSION We confirmed that the Cormio nomogram can be used to predict the risk of PCa in patients at increased risk. Implementation of the nomogram in clinical practice will better define its role in the patient's counselling before prostate biopsy.
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Affiliation(s)
- Luca Cindolo
- Urology Department, "Villa Stuart" Private Hospital, Via Trionfale, 5952-00136, Rome, Italy.
| | | | - Andrea Minervini
- Department of Urology, Azienda Ospedaliera Careggi, Universitá di Firenze, Florence, Italy
| | - Francesco Sessa
- Department of Urology, Azienda Ospedaliera Careggi, Universitá di Firenze, Florence, Italy
| | - Gianluca Muto
- Department of Urology, Azienda Ospedaliera Careggi, Universitá di Firenze, Florence, Italy
| | - Pierluigi Bove
- Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy
| | - Matteo Vittori
- Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy
| | | | | | | | | | - Luigi Schips
- Department of Urology, SS. Annunziata Hospital, Chieti, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Maida Bada
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Antonio Pastore
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Giovanni Novella
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Rizzetto
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicoló Trabacchin
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Riccardo Lombardo
- Department of Urology, Ospedale Sant'Andrea-Universitá di Roma "Sapienza", Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea-Universitá di Roma "Sapienza", Rome, Italy
| | - Alessandro Antonelli
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea-Universitá di Roma "Sapienza", Rome, Italy
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4
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Torres JP, Rodrigues A, Morais N, Anacleto S, Rodrigues RM, Mota P, Leão R, Lima E. Efficacy and safety of a combined anesthetic technique for transrectal prostate biopsy: a single center, prospective, randomized study. Cent European J Urol 2019; 72:258-262. [PMID: 31720027 PMCID: PMC6830480 DOI: 10.5173/ceju.2019.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/09/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction A transrectal ultrasound-guided (TRUS) biopsy is the gold standard for diagnosis of prostatic neoplasia. This exam is associated with pain and discomfort, and numerous methods of analgesia during this procedure have been described. There is still no consensus among urologists about the pain control technique that should be performed, even though the periprostatic basal nerve block is the most studied technique. The main objective of this study is to evaluate the benefit of adding local periapical prostatic anesthesia to the traditional periprostatic basal nerve block during TRUS biopsy. Material and methods A total of 70 patients with indication for TRUS biopsy were enrolled in this study. Patients were randomized into 2 groups. Group 1 received a periprostatic basal nerve block. Group 2 received both periapical prostatic and periprostatic basal nerve blocks . The pain experienced during different moments of the procedure (introduction of the probe, anesthesia administration, removal of cores and 30 minutes after biopsy) was assessed using visual analog scales of one to ten. The rate of complications at 30 days post-biopsy was also assessed. Results The difference in pain during the distinct moments of the TRUS biopsy was not significant between the two groups. There were no significant differences concerning age, level of total prostate-specific antigen (PSA) and prostate volume in both groups. There were also no statistically significant differences between the groups regarding the occurrence of complications and pathological findings. Conclusions The administration of concurent periprostatic basal and periapical nerve blocks has no significant benefits as compared to a periprostatic basal nerve block alone.
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Affiliation(s)
| | | | - Nuno Morais
- Department of Urology, Hospital de Braga, Portugal
| | | | | | - Paulo Mota
- Department of Urology, Hospital de Braga, Portugal.,Institute of Life and Health Sciences, University of Minho, Portugal
| | - Ricardo Leão
- Department of Urology, Hospital de Braga, Portugal
| | - Estêvão Lima
- Department of Urology, Hospital de Braga, Portugal.,Institute of Life and Health Sciences, University of Minho, Portugal
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5
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A novel method for pain control: infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsy using transcutaneous electrical nerve stimulation (TENS). Int Urol Nephrol 2019; 51:2119-2126. [PMID: 31493104 DOI: 10.1007/s11255-019-02277-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe a novel method for the control of pain during prostate biopsies, infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsies with no further needle insertions for local anesthetic infiltration. METHODS A total of 138 men with elevated prostate-specific antigen levels and/or abnormal digital rectal examination findings were included in the study. Of the patients, 73 were assigned to the INFLATE group and 65 to the TRUS-PNB group. Demographic data, PSA levels, findings of digital rectal examinations, and multiparametric prostatic magnetic resonance imaging were recorded. In the INFLATE group, a two-channel TENStem eco basic device with two electrodes was used for pain control during the biopsy. For the TRUS-PNB group, 60 mg lidocaine gel was given intrarectally in addition to infiltration of a prilocaine and bupivacaine mixture (5 mL of 2% prilocaine + 5 mL of 0.25% bupivacaine). Pain perception was assessed using a linear numeric rating scale. RESULTS The mean ages, BMIs, prostate volumes, and PSA levels were similar between the two groups (p > 0.05). Of the 56 participants with prostate adenocarcinoma, 28 were in the INFLATE group, and 28 were in the TRUS-PNB group with a 40.6% overall cancer detection rate. The mean preoperative and post-operative pain scores during probe insertion, biopsy and post-biopsy were similar between the groups (p > 0.05). CONCLUSION The results of the study confirmed that INFLATE for transrectal prostate biopsy using a TENS device could safely and effectively be used for pain control with the advantage of two fewer needle attempts with no increase in significant complications.
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6
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Els M, Heyns C, van der Merwe A, Zarrabi A. Prospective comparison of the novel visual prostate symptom score (VPSS) versus the international prostate symptom score (IPSS), and assessment of patient pain perception with regard to transrectal ultrasound guided prostate biopsy. Int Braz J Urol 2019; 45:137-144. [PMID: 30620160 PMCID: PMC6442140 DOI: 10.1590/s1677-5538.ibju.2018.0496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/14/2018] [Indexed: 11/29/2022] Open
Abstract
Objective: To compare the International Prostate Symptom Score (IPSS) and novel Visual Prostate Symptom Score (VPSS) in patients with lower urinary tract symptoms (LUTS), to correlate scores with uroflowmetry and prostate volume and assess patient perceptions regarding pain prior to, and after prostate biopsy. Materials and Methods: Patients with LUTS who had an indication for transrectal ultrasound (TRUS) biopsy were included. Patients completed the IPSS-, VPSS- and prostate biopsy pain assessment questionnaires. Assessment included uroflowmetry, post- void residual volume and prostate volume (measured with TRUS). Results: One hundred men were included. There were statistically significant correlations between the VPSS score and IPSS score (correlation coefficient (r) = 0.802); VPSS and Qmax (r = −0.311); VPSS and. Qave (r = −0.344); prostate volume with VPSS (r = 0.194) and Qmax (r = −0.260). The VPSS was quicker to complete than the IPSS (mean 100 vs. 165 seconds). The mean anticipated pain score before biopsy was 2.8 (range 0-6), and after biopsy (experienced pain) it was 1.8 (range 0-5). The pain during biopsy was less than expected in 67% of patients. Conclusion: In men with LUTS scheduled to undergo prostate biopsy, the VPSS score correlated positively with the IPSS score. Men with limited education take less time to complete the VPSS. Patient's perception of expected pain or discomfort during TRUS-guided prostate biopsy was significantly higher than the pain actually experienced during biopsy. Men with lower education level had significantly higher expectation of pain prior to biopsy, but similar pain during biopsy.
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Affiliation(s)
- M Els
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - C Heyns
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - A van der Merwe
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - A Zarrabi
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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7
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Kim SJ, Lee J, An DH, Park CH, Lim JH, Kim HG, Park JY. A randomized controlled comparison between periprostatic nerve block and pelvic plexus block at the base and apex of 14-core prostate biopsies. World J Urol 2019; 37:2663-2669. [PMID: 30864006 DOI: 10.1007/s00345-019-02722-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/06/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare the pain control efficacies of the pelvic plexus block (PPB), periprostatic nerve block (PNB), and controls during a 14-core basal and apical core prostate biopsy. METHODS This randomized controlled study, performed between January 2015 and January 2016, included patients with an abnormal serum prostate-specific antigen (PSA > 3 ng/mL) level or a palpable nodule on digital rectal examination. The enrolled patients were randomized into three groups: Group 1, intrarectal local anesthesia (IRLA, 10 mL of 2% lidocaine jelly) and PPB with 3.0 mL of 2% lidocaine injected at the bilateral pelvic plexus; Group 2, IRLA and PNB with 3.0 mL of 2% lidocaine injected at both periprostatic nerves; and Group 3, only IRLA. Patients answered the visual analog scale (VAS) questionnaire at 6 time points. RESULTS This study consisted of 163 patients (Group 1 = 55, Group 2 = 55, and Group 3 = 53). Pain at the apical biopsy location was less in Groups 1 and 2 than in Group 3 (p < 0.001, p < 0.001) and between the two local anesthetic groups (PNB + IRLA vs PPB + IRLA). Group 2 patients reported less pain than Group 1 patients (p = 0.022). Pain during the basal core biopsy was significantly less in Groups 1 and 2 than in Group 3 (p = 0.002, p < 0.001), but there were no significant differences in pain control between the two methods (PNB + IRLA vs PPB + IRLA, p = 0.054) during basal core biopsy. CONCLUSIONS PNB + IRLA is an effective local anesthetic method for reducing pain when performing apical biopsies compared with PPB + IRLA or IRLA alone.
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Affiliation(s)
- Sung Jin Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea
| | - Jongpill Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Hyeon An
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Hoo Park
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea
| | - Ju Hyun Lim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea
| | - Han Gwun Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea
| | - Jong Yeon Park
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea.
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8
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Cost and efficacy comparison of five prostate biopsy modalities: a platform for integrating cost into novel-platform comparative research. Prostate Cancer Prostatic Dis 2018; 21:524-532. [PMID: 29988098 DOI: 10.1038/s41391-018-0056-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 03/16/2018] [Accepted: 03/24/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The cornerstone of prostate cancer diagnosis remains the transrectal ultrasound-guided biopsy (TRUS-BX), which most frequently occurs in the office setting under local anesthesia. However, there are now other techniques of prostate biopsy aimed at improving outcomes such as patient comfort, significant cancer detection, and infectious complications. The purpose of the present study is to compare the cost and efficacy outcomes of five different approaches. METHODS We compared the comprehensive costs of a random sample size of 20-30 cases from each of the following: (1) local anesthesia TRUS-BX (reference), (2) sedation TRUS-BX, (3) general anesthesia transperineal template biopsy (TP), (4) sedation MRI-TRUS fusion biopsy (FB), and (5) sedation in-bore MRI biopsy (IB-MRI). Cost categories included pre-procedure, anesthesia pharmacy and recovery, and the technical/professional costs from urology, radiology, and pathology services. For procedure outcomes, we compared the larger cohorts of TRUS-BX, TP, and FB in terms of indication, cancer yield, and downstream decision impact. RESULTS Compared with standard TRUS-BX, the total costs of sedation TRUS-BX, TP, FB, and IB-MRI increased significantly ×1.9 (90%), ×2.5 (153%), ×2.5 (150%), and ×2.2 (125%), respectively (p < 0.001). Although there was no statistical difference between the total costs of TP, FB, and IB-MRI, these costs were significantly higher than those of TRUS-BX under either local anesthesia or sedation (p < 0.05). The cost of TRUS-BX under sedation was significantly higher than that of TRUS-BX under local anesthesia (p < 0.001). Compared to TRUS-BX, more significant cancers were detected in FB (16% vs. 36%) and TP (16% vs. 34%) groups (p < 0.001). CONCLUSIONS Compared with standard TRUS-BX, the additions of imaging, sedation anesthesia, and transperineal template increase costs significantly, and can be considered along with known improvements in accuracy and side effects. Ongoing efforts to combine imaging and transperineal biopsy, especially in an outpatient/local anesthesia setting may lead to a higher cost/benefit.
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9
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Cazarim GDS, Verçosa N, Carneiro L, Pastor R, da Silva EFV, Barrucand L, Cavalcanti IL. A 50-50% mixture of nitrous oxide-oxygen in transrectal ultrasound-guided prostate biopsy: A randomized and prospective clinical trial. PLoS One 2018; 13:e0195574. [PMID: 29702684 PMCID: PMC5922537 DOI: 10.1371/journal.pone.0195574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/20/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Transrectal ultrasound-guided biopsy (TUSPB) is the standard method of diagnosis for prostate cancer, and although it is well tolerated by some patients, it presents a discomfort rate of 65 to 90%, which may be associated with pain. For convenience, it is agreed that a method of analgesia and sedation is necessary. For this purpose, this study aimed to evaluate the impact of inhalation of a 50–50% N2O-O2 gas mixture on pain intensity in these patients. Material and methods Randomized, double-blinded clinical trial, conducted at Antônio Pedro University Hospital (Hospital Universitário Antônio Pedro), Niterói, RJ, Brazil, containing two groups of 42 patients: a control (C) group, which received 100% oxygen inhalation, and a nitrous oxide (NO) group, which received inhalation of the 50–50% N2O-O2 mixture, self-administered during TUSPB. The pain intensity and degree of satisfaction were evaluated through a visual analogue scale (VAS), as was the frequency of adverse events. Results Eighty-four patients were included in the study, with 42 in each group. The mean pain intensity was lower in the NO group than in the C group [2.52 (0–10) vs 5.95 (0–10), p < 0.001], and the degree of satisfaction was higher in the NO group than in the C group (8.14 vs. 4.69, p < 0.001). The adverse effects were somnolence, dizziness, nausea, vomiting, discomfort and euphoria without differences between the groups. Conclusion The 50–50% N2O-O2 mixture was effective in reducing pain intensity and increasing the degree of satisfaction in TUSPB, with tolerable side effects.
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Affiliation(s)
- Gabriel da Silva Cazarim
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
- * E-mail:
| | - Nubia Verçosa
- Department of Anesthesiology, Federal University of Rio de Janeiro, University hospital Clementino Fraga Fihlo, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonel Carneiro
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
| | - Rachel Pastor
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
| | | | - Louis Barrucand
- Department of Statistic, Federal University of Rio de Janeiro, University hospital Clementino Fraga Fihlo, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ismar Lima Cavalcanti
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
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10
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Grummet J, Pepdjonovic L, Huang S, Anderson E, Hadaschik B. Transperineal vs. transrectal biopsy in MRI targeting. Transl Androl Urol 2017; 6:368-375. [PMID: 28725578 PMCID: PMC5503965 DOI: 10.21037/tau.2017.03.58] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Prostate biopsy is typically performed via either the transrectal or transperineal approach. MRI-targeted biopsy, whether using any of the three options of cognitive fusion, MRI-ultrasound fusion software, or in-bore MRI-guided biopsy, can also be performed via either transrectal or transperineal approaches. As an extension of traditional random prostate biopsy, the transrectal approach is far more commonly used for MRI-targeted biopsy due to its convenience. However, in the context of today’s increasing multi-drug resistance of rectal flora, the transperineal approach is being used more often due to its lack of septic complications. In addition, only a first-generation cephalosporin, not a fluoroquinolone, is required as antibiotic prophylaxis. Evidence shows excellent detection rates of significant prostate cancer using magnetic resonance imaging (MRI)-targeted and/or systematic transperineal biopsy (TPB). However, there are no head-to-head studies comparing the different MRI-targeted methods within TPB. To provide truly patient-centred care, the biopsy technique using the safest method with the highest detection rate of significant cancer should be used. Depending on healthcare context and hospital resource utilization, MRI-targeted TPB is an excellent option and should be performed wherever available and feasible. Whilst building capacity for TPB in one’s practice, the routine use of rectal culture swabs prior to any transrectal biopsies is strongly encouraged. Independent of biopsy route, the addition of systematic cores needs to be discussed with the patient weighing maximal detection of significant cancer against increased detection of insignificant lesions.
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Affiliation(s)
- Jeremy Grummet
- Australian Urology Associates, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | | | - Sean Huang
- Australian Urology Associates, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Elliot Anderson
- Australian Urology Associates, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
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11
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Seo KH, Yoo HS, Kim HY, Jeon YS. The effects of meperidine in patients undergoing deep sedation for transrectal ultrasound-guided prostate biopsy: a randomized, controlled, double-blind study. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Urabe F, Kimura T, Shimomura T, Onuma H, Yamamoto T, Sasaki H, Miki J, Kuruma H, Miki K, Egawa S. Prospective comparison of the efficacy of caudal versus periprostatic nerve block, both with intrarectal local anesthesia, during transrectal ultrasonography-guided prostatic needle biopsy. Scand J Urol 2017; 51:245-250. [PMID: 28443752 DOI: 10.1080/21681805.2017.1318299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of caudal block (CB) versus periprostatic nerve block (PPNB), both with intrarectal local anesthesia (IRLA), in reducing pain during transrectal ultrasonography (TRUS)-guided prostatic biopsy. MATERIALS AND METHODS This study included 532 patients: 266 patients received CB with IRLA and 266 patients PPNB with IRLA. A visual analogue scale (VAS) was applied to prospectively evaluate pain (1) at induction of anesthesia, (2) at insertion of the TRUS probe, (3) at needle penetration to the prostate, and (4) throughout the biopsy procedure. Pain scores were compared to evaluate differences between groups. The secondary endpoint of serious complication rate was also evaluated. As a subanalysis, the pain scores were compared in patients with high body mass index (BMI ≥25 kg/m²). RESULTS Overall, the pain score in the PPNB group was significantly lower than in the CB group at induction of anesthesia (mean ± SD: 2.0 ± 1.9 vs 2.9 ± 2.1, p = .0001) but higher at insertion of the TRUS probe (2.7 ± 2.5 vs 1.9 ± 1.7, p = .009). The pain score did not differ significantly between groups at needle penetration or throughout the biopsy. Univariate analyses indicated no significant association between VAS scores and patient demographics. Overall rates of serious complications did not differ between the two groups (5.6% vs 5.3%, p = .85). In patients with high BMI, the pain score was significantly lower in the PPNB group than in the CB group throughout the procedure (2.5 ± 2.0 vs 3.5 ± 2.5, p = .03). CONCLUSIONS Both procedures were equally effective in reducing pain, and the incidence of serious complications was similar. PPNB with IRLA may be more applicable than CB with IRLA in obese patients.
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Affiliation(s)
- Fumihiko Urabe
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Takahiro Kimura
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Tatsuya Shimomura
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Hajime Onuma
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Toshihiro Yamamoto
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Hiroshi Sasaki
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Jun Miki
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Hidetoshi Kuruma
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Kenta Miki
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
| | - Shin Egawa
- a Department of Urology , Jikei University School of Medicine , Tokyo , Japan
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13
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Mochtar CA, Atmoko W, Umbas R, Hamid ARAH. Prostate cancer detection rate in Indonesian men. Asian J Surg 2017; 41:163-169. [PMID: 28209461 DOI: 10.1016/j.asjsur.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/08/2017] [Accepted: 01/11/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSES OF THE STUDY To evaluate the overall detection rate of prostate cancer in biopsies according to serum prostate-specific antigen levels, determine the number of cores biopsied in Indonesian men, and provide a correlated staging of prostate cancer patients at varying intervals of prostate-specific antigen levels. METHODS We retrospectively analyzed the data from Indonesian men who had undergone prostate biopsy at two national referral medical centers in Jakarta from January 1995 to December 2014. Prostate biopsy was performed when levels of prostate-specific antigen were>4.0 ng/mL or malignancy was suspected upon digital rectal examination. RESULTS Of 2942 men who underwent biopsies, 844 (28.7%) were diagnosed with prostate cancer. When patients were stratified into five subgroups by serum prostate-specific antigen levels (< 4.0, 4.0-9.9, 10.0-19.9, 20.0-100.0, and>100.0 ng/mL), the overall detection rate of prostate cancer was 21.0%, 9.3%, 13.1%, 35.4%, and 92.9%, respectively. The detection rate was significantly higher in patients who underwent 10-core biopsies than in patients who underwent 6-core biopsies (31.6% vs. 22.4%, p<0.001). The receiver operating characteristic analysis to detect locally advanced/metastatic prostate cancer found that serum prostate-specific antigen levels of 42.7 ng/mL had a sensitivity of 74%, specificity of 73%, positive predictive value of 85.2%, and negative predictive value of 57.5%, with area under the curve of 0.81 (95% confidence interal 0.78 to 0.84). CONCLUSION The overall detection rate of prostate cancer in Indonesian men was 28.7%. The prostate cancer detection rate appeared to be lower than that observed in white men.
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Affiliation(s)
- Chaidir Arif Mochtar
- Department of Surgery, Division of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Widi Atmoko
- Department of Surgery, Division of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Rainy Umbas
- Department of Surgery, Division of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Agus Rizal Ardy Hariandy Hamid
- Department of Surgery, Division of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia.
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14
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Yan P, Wang XY, Huang W, Zhang Y. Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis. J Pain Res 2016; 9:787-796. [PMID: 27785093 PMCID: PMC5067058 DOI: 10.2147/jpr.s117451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS A literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale. RESULTS A total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: -0.22, 95% CI: -0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: -1.32, 95% CI: -1.68 to -0.95, P<0.00001), placebo injection (WMD: -2.62, 95% CI: -3.16 to -2.07, P<0.00001), or IRLA (WMD: -1.31, 95% CI: -1.40 to -1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.45, 95% CI: -0.62 to -0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.73, 95% CI: -0.92 to -0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia. CONCLUSION This meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed to validate this result.
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Affiliation(s)
- Pu Yan
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Xiao-Yan Wang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Wei Huang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Yong Zhang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
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15
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Du J, Johnston J, Studd R. Does waiting after peri-prostatic nerve block reduce pain during transrectal ultrasound-guided prostate biopsy? A randomized controlled trial. ANZ J Surg 2016; 87:262-265. [DOI: 10.1111/ans.13597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/17/2016] [Accepted: 03/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jason Du
- Department of Urology; Wellington Hospital; Wellington New Zealand
| | - James Johnston
- Department of Urology; Wellington Hospital; Wellington New Zealand
| | - Rodney Studd
- Department of Urology; Wellington Hospital; Wellington New Zealand
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16
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Kilic O, Akand M, Kulaksizoglu H, Haliloglu AH, Tanidik S, Piskin MM, Yurdakul T. Intravenous paracetamol for relief of pain during transrectal-ultrasound-guided biopsy of the prostate: A prospective, randomized, double-blind, placebo-controlled study. Kaohsiung J Med Sci 2015; 31:572-9. [PMID: 26678937 DOI: 10.1016/j.kjms.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/07/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022] Open
Abstract
Transrectal-ultrasound-guided prostate biopsy (TRUS-PBx) is the standard procedure for diagnosing prostate cancer. The procedure does cause some pain and discomfort; therefore, an adequate analgesia is necessary to ensure patient comfort, which can also facilitate good-quality results. This prospective, randomized, double-blinded, placebo-controlled study aimed to determine if intravenous (IV) paracetamol can reduce the severity of pain associated with TRUS-PBx. The study included 104 patients, scheduled to undergo TRUS-PBx with a suspicion of prostate cancer, that were prospectively randomized to receive either IV paracetamol (paracetamol group) or placebo (placebo group) 30 minutes prior to TRUS-PBx. All patients had 12 standardized biopsy samples taken. Pain was measured using a 10-point visual analog pain scale during probe insertion, during the biopsy procedure, and 1 hour postbiopsy. All biopsies were performed by the same urologist, whereas a different urologist administered the visual analog pain scale. There were not any significant differences in age, prostate-specific antigen level, or prostate volume between the two groups. The pain scores were significantly lower during probe insertion, biopsy procedure, and 1 hour postbiopsy in the paracetamol group than in the placebo group. In conclusion, the IV administration of paracetamol significantly reduced the severity of pain associated with TRUS-PBx.
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Affiliation(s)
- Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey.
| | - Haluk Kulaksizoglu
- Department of Urology, School of Medicine, Bilim University, Istanbul, Turkey
| | - Ahmet H Haliloglu
- Department of Urology, School of Medicine, Ufuk University, Ankara, Turkey
| | - Seher Tanidik
- Department of Biochemistry, Medicana Hospital, Konya, Turkey
| | - Mehmet M Piskin
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Talat Yurdakul
- Department of Urology, Kolan International Hospital Şişli, Istanbul, Turkey
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17
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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; 41:859-63. [PMID: 26689511 PMCID: PMC4756962 DOI: 10.1590/s1677-5538.ibju.2014.0337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Studies about the anesthesia techniques during transrectal ultrasound guided prostate biopsy (TRUS-Bx) are usually focused on pain relief. Although patients' tolerance is an important issue in TRUS-Bx, cancer detection rate (CDR) must not be ignored. In this study, we compared the impact of intrarectal lidocaine gel anesthesia (IRLA) and periprostatic nerve blockade (PNB) techniques on CDR. MATERIALS AND METHODS A total of 422 patients underwent 10 core-TRUS-Bx because of elevated serum prostate specific antigen (PSA) level (>2.5ng/mL) and/or suspicious digital rectal examination findings. Patients were divided into two groups according to the applied anesthesia technique: IRLA group and PNB group. Age, serum PSA level, prostate volume, visual analogue scale (VAS) score and CDR were recorded and compared statistically with chi square and unpaired t-tests. RESULTS Of the patients 126/422 (29.9%) underwent TRUS-Bx by using IRLA whereas 296/422 (70.1 %) by PNB technique. The mean, age, serum PSA level and prostate volume were similar between the two groups. CDR was 19.8% and 25.4% in IRLA and PNB groups, respectively (p=0.001). The mean VAS score of the PNB group (1.84±0.89) was significantly lower than that for IRLA group (3.62±1.06) (p=0.001). CONCLUSIONS Our results revealed that PNB is superior to IRLA in terms of CDR. Further studies are required to confirm our findings.
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Affiliation(s)
- Mustafa Zafer Temiz
- Department of Urology, Bitlis State Hospital, Besminare, Bitlis, Turkey
- Correspondence address: Mustafa Zafer Temiz, MD, Department of Urology, Bitlis State Hospital, Besminare Mahallesi 13000, Besminare, BITLIS, Turkey, Fax: + 90 434 246-8424, E-mail:
| | - Engin Kandirali
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
| | - Murat Tuken
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
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18
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Nassiri N, Natarajan S, Margolis DJ, Marks LS. Targeted Prostate Biopsy: Lessons Learned Midst the Evolution of a Disruptive Technology. Urology 2015; 86:432-8. [PMID: 26166671 DOI: 10.1016/j.urology.2015.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 05/26/2015] [Accepted: 07/07/2015] [Indexed: 12/24/2022]
Abstract
Lessons learned during a 6-year experience with more than 1200 patients undergoing targeted prostate biopsy via MRI/ultrasound fusion are reported: (1) the procedure is safe and efficient, requiring some 15-20 minutes in an office setting; (2) MRI is best performed by a radiologist with specialized training, using a transabdominal multiparametric approach and preferably a 3T magnet; (3) grade of MRI suspicion is the most powerful predictor of biopsy results, eg, Grade 5 usually represents cancer; (4) some potentially important cancers (15%-30%) are MRI-invisible; (5) Targeted biopsies provide >80% concordance with whole-organ pathology. Early enthusiasm notwithstanding, cost-effectiveness is yet to be resolved, and the technologies remain in evolution.
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Affiliation(s)
- Nima Nassiri
- Department of Urology, University of California at Los Angeles, Los Angeles, CA
| | - Shyam Natarajan
- Department of Urology, University of California at Los Angeles, Los Angeles, CA; Departments of Urology and Biomedical Engineering, University of California at Los Angeles, Los Angeles, CA
| | - Daniel J Margolis
- Department of Radiology, University of California at Los Angeles, Los Angeles, CA
| | - Leonard S Marks
- Department of Urology, University of California at Los Angeles, Los Angeles, CA.
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19
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Caliskan B, Mutlu N. Intrarectal ice application prior to transrectal prostate biopsy: a prospective randomised trial accessing pain and collateral effects. Int Braz J Urol 2015; 41:101-8; discussion 109. [PMID: 25928515 PMCID: PMC4752062 DOI: 10.1590/s1677-5538.ibju.2015.01.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 06/06/2014] [Indexed: 11/26/2022] Open
Abstract
Objectives To analyze the efficacy of intrarectal ice application as an anesthetic method prior to transrectal ultrasound (TRUS) guided prostate biopsy. Materials and Methods A total of 120 consecutive men were included into the study prospectively. Patients were equally randomized as group 1 and 2 with 60 patients each. Ice was applied as an anesthetic method 5 minutes before procedure to the patients in group 1. Patients in group 2 were applied 10 ml of 2% lidocaine gel 10 minutes before procedure. Twelve core biopsy procedure was performed for all patients. The pain level was evaluated using a visual analogue scale (VAS). Results Median pain score was 3.5 (1-8) in group 1 and 5 (1-8) in group 2. There is significantly difference between groups regarding the mean sense of pain level during the procedure. (p=0.007) There was also no difference in complications between two groups about presence and duration of macroscopic hematuria and rectal bleeding. Conclusions Intrarectal ice application prior to TRUS prostate biopsy has an effect on reducing pain. Development of new techniques about cold effect or ice can make this method more useful and decrease complication rates.
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Affiliation(s)
| | - Nazim Mutlu
- Department of Urology, University of Kocaeli, Turkey
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20
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Huang S, Pepdjonovic L, Konstantatos A, Frydenberg M, Grummet J. Penthrox alone versus Penthrox plus periprostatic infiltration of local analgesia for analgesia in transrectal ultrasound-guided prostate biopsy. ANZ J Surg 2015; 86:139-42. [PMID: 25655403 DOI: 10.1111/ans.12974] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND The objective of this study was to compare pain intensity in patients undergoing transrectal ultrasound (TRUS)-guided biopsy of the prostate with Penthrox alone compared with Penthrox plus periprostatic infiltration of local analgesia (PILA). METHOD Seventy-two subjects participated in this study after receiving appropriate education. Forty-two patients self-administered inhaled Penthrox (3 mL methoxyflurane) alone for analgesia (Group A), followed by 30 patients who self-administered Penthrox and received PILA with 5 mL of 2% lignocaine. All subjects had TRUS biopsy performed. Immediately after the procedure, patients were asked to rate their pain intensity using a numerical verbal rating scale from 0 to 10. RESULTS Baseline characteristics of the two groups were similar. Patients in Group B reported significantly lower post TRUS biopsy median pain intensity of 2 (1-3) compared with Group A subjects who reported a median post TRUS biopsy pain intensity of 3 (2-5) (P = 0.014). A total of 72 men underwent TRUS-guided biopsy. All patients indicated they would be happy to have another TRUS-guided prostate biopsy in the future. CONCLUSION Our study shows that Penthrox plus PILA shows promise as an efficacious and easily tolerated analgesic technique for outpatient TRUS biopsy, keeping resource use to a minimum. Planning for a multi-centre, double-blind randomized control trial comparing Penthrox plus PILA with PILA alone is presently underway.
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Affiliation(s)
- Sean Huang
- Department of Urology, Bairnsdale Regional Health Service, Bairnsdale, Victoria, Australia.,Department of Urology, Alfred Health, Melbourne, Victoria, Australia
| | - Lana Pepdjonovic
- Department of Urology, Bairnsdale Regional Health Service, Bairnsdale, Victoria, Australia
| | - Alex Konstantatos
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia and Perioperative Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Urology, Bairnsdale Regional Health Service, Bairnsdale, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia.,Department of Urology, Monash Health, Melbourne, Victoria, Australia
| | - Jeremy Grummet
- Department of Urology, Bairnsdale Regional Health Service, Bairnsdale, Victoria, Australia.,Department of Urology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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21
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Nazir B. Pain during transrectal ultrasound-guided prostate biopsy and the role of periprostatic nerve block: what radiologists should know. Korean J Radiol 2014; 15:543-53. [PMID: 25246816 PMCID: PMC4170156 DOI: 10.3348/kjr.2014.15.5.543] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/01/2014] [Indexed: 11/15/2022] Open
Abstract
Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.
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Affiliation(s)
- Babar Nazir
- Department of Oncologic Imaging, National Cancer Centre, Singapore 169610
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22
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Wang J, Wang L, Du Y, He D, Chen X, Li L, Nan X, Fan J. Addition of intrarectal local analgesia to periprostatic nerve block improves pain control for transrectal ultrasonography-guided prostate biopsy: A systematic review and meta-analysis. Int J Urol 2014; 22:62-8. [DOI: 10.1111/iju.12595] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jue Wang
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
- Department of Urology; Panzhihua Central Hospital; Panzhihua China
| | - Lei Wang
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
| | - Yiqing Du
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
| | - Dalin He
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
| | - Xingfa Chen
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
| | - Lei Li
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
| | - Xunyi Nan
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
| | - Jinhai Fan
- Department of Urology; First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an
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23
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Li R, Ruckle HC, Creech JD, Culpepper DJ, Lightfoot MA, Alsyouf M, Nicolay L, Jellison F, Baldwin DD. A Prospective, Randomized, Controlled Trial Assessing Diazepam to Reduce Perception and Recall of Pain During Transrectal Ultrasonography-Guided Biopsy of the Prostate. J Endourol 2014; 28:881-6. [DOI: 10.1089/end.2014.0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Roger Li
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Herbert C. Ruckle
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Jon D. Creech
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - David J. Culpepper
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | | | - Muhannad Alsyouf
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Lesli Nicolay
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Forrest Jellison
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - D. Duane Baldwin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
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Abstract
A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection and avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. Magnetic resonance imaging-guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers. Hematuria, hematospermia, and rectal bleeding are common complications of prostate needle biopsy, but are generally self-limiting and well tolerated. All men should receive antimicrobial prophylaxis before biopsy.
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25
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Lee C, Woo HH. Penthrox inhaler analgesia in transrectal ultrasound-guided prostate biopsy. ANZ J Surg 2014; 85:433-7. [DOI: 10.1111/ans.12694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Chanyang Lee
- Summer Research Scholarship; The University of Sydney; Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical School; The University of Sydney; Sydney New South Wales Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; The University of Sydney; Sydney New South Wales Australia
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26
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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. [DOI: 10.1111/bju.12433] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chanyang Lee
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
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27
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Tsuji FH, Chambó RC, Agostinho AD, Trindade Filho JCS, de Jesus CMN. Sedoanalgesia with midazolam and fentanyl citrate controls probe pain during prostate biopsy by transrectal ultrasound. Korean J Urol 2014; 55:106-11. [PMID: 24578806 PMCID: PMC3935066 DOI: 10.4111/kju.2014.55.2.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/11/2013] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To assess the pain intensity of patients administered midazolam and fentanyl citrate before undergoing transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS This was a study in patients with different indications for prostate biopsy in whom 5 mg of midazolam and 50 µg of fentanyl citrate was administered intravenously 3 minutes before the procedure. After biopsy, pain was assessed by use of a visual analogue scale (VAS) in three stages: VAS 1, during probe introduction; VAS 2, during needle penetration into prostate tissue; and VAS 3, in the weeks following the exam. Pain intensity at these different times was tested with stratification by age, race, education, prostate volume, rebiopsy, and anxiety before biopsy. Pain was ranked according to the following scores: 0 (no pain), 1-3 (mild pain), 4-7 (moderate pain), and 8-10 (severe pain). Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon two-tailed tests with a significance of 5%. RESULTS Pain intensity was not influenced by any risk factors. The mean VAS 1 score was 1.95±1.98, the mean VAS 2 score was 2.73±2.55, and the mean VAS 3 score was 0.3±0.9, showing greater pain at the time of needle penetration than in other situations (VAS 2>VAS 1>VAS 3, p=0.0013, p=0.0001, respectively). Seventy-five percent of patients reported a VAS pain scale of less than 3.1 or mild pain. CONCLUSIONS Intravenous sedation and analgesia with midazolam and fentanyl citrate is a good method for reducing pain caused by prostate biopsy, even during probe insertion.
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Affiliation(s)
- Fábio Hissachi Tsuji
- Graduate in Base of Surgery Program, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil
| | - Renato Caretta Chambó
- Graduate in Base of Surgery Program, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil
| | - Aparecido Donizeti Agostinho
- Department of Urology, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil
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Moudouni SM, Zahraoui MR, Adarmouch L, Lakmichi MA, Bentani N, Jarir R, Dahami Z, Amine M, Sarf I. [The local anesthesia for the prostatic biopsies echo-guided: forward-looking randomized study comparing two methods]. Prog Urol 2014; 24:108-13. [PMID: 24485080 DOI: 10.1016/j.purol.2013.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/02/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The realization of the prostatic biopsies is a painful act. The objective of our work was to compare the analgesic efficiency of the injection of the lidocaine at the level of periprostatics laterals and apical areas compared with the use of gel of lidocaine intrarectal associated with the taking of oral tramadol. PATIENTS AND METHODS Between November 2007 and December 2009, 60 patients admitted in the service of urology of the university hospital Mohammed VI of Marrakesh for prostatic biopsies were randomized in two groups. The group 1 (30 patients) received two tablets from tramadol 50mg with 10 mL of gel of lidocaine 2% intrarectal while 30 patients of the group 2 received 10 mL from lidocaine 2% injected at the level of periprostatics laterals and apicales. The pain was estimated by a visual analog scale (AVS) at the introduction of the probe of echography (AVS 1), at the time of the biopsy (AVS 2) and 20 minutes later (AVS 3). RESULTS There was no significant difference between both groups concerning AVS 1 means. The average score of the pain was significantly lower in the group 2 for the AVS 2 and AVS 3. CONCLUSION The periprostatics anesthesia assured a better control of the pain at the time of the prostatic biopsy and 20 minutes later, without increase of the complications. We recommend it to decrease the pain and the discomfort related to this technique.
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Affiliation(s)
- S M Moudouni
- Service d'urologie du CHU Mohammed VI, Marrakech, Maroc.
| | - M R Zahraoui
- Service d'urologie du CHU Mohammed VI, Marrakech, Maroc.
| | - L Adarmouch
- Laboratoire d'épidémiologie et de biostatistique, faculté de médecine et de pharmacie de Marrakech, université Caddi Ayad, Maroc
| | - M A Lakmichi
- Service d'urologie du CHU Mohammed VI, Marrakech, Maroc
| | - N Bentani
- Service d'urologie du CHU Mohammed VI, Marrakech, Maroc
| | - R Jarir
- Service d'urologie du CHU Mohammed VI, Marrakech, Maroc
| | - Z Dahami
- Service d'urologie du CHU Mohammed VI, Marrakech, Maroc
| | - M Amine
- Laboratoire d'épidémiologie et de biostatistique, faculté de médecine et de pharmacie de Marrakech, université Caddi Ayad, Maroc
| | - I Sarf
- Service d'urologie du CHU Mohammed VI, Marrakech, Maroc
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Fitzsimons NJ, Sun L, Moul JW. Medical technologies for the diagnosis of prostate cancer. Expert Rev Med Devices 2014; 4:227-39. [PMID: 17359227 DOI: 10.1586/17434440.4.2.227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prostate cancer is an extremely prevalent problem, especially in our aging population. The prostate-specific antigen test has revolutionized prostate cancer screening. Significant advances have been made in the usage of prostate-specific antigen and its derivatives, biomarkers, diagnostic imaging techniques, biopsy strategy, biopsy needle design and anesthetic agents. Further improvement in prostate cancer detection hinges on the development of an imaging technique that is tumor specific and sensitive to biological aggressiveness.
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Affiliation(s)
- Nicholas J Fitzsimons
- Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, NC 27710, USA.
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Zargar H, Marshall D, Siva G, King Q. Topical diltiazem before transrectal ultrasonography-guided biopsy of the prostate: a randomized controlled trial. ANZ J Surg 2013; 85:430-2. [PMID: 24237929 DOI: 10.1111/ans.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Injection of local anaesthetic agents around the prostatic nerve bundles during transrectal ultrasonography (TRUS) biopsy of the prostate has shown to reduce the pain associated with the procedure. It has been shown that some of the discomfort associated with the procedure is secondary to spasm of the anal sphincter. Topical diltiazem can relax the anal sphincter. Our aim was to evaluate the use of topical diltiazem cream as an adjunct to periprostatic nerve block in reducing pain associated with TRUS-guided prostatic biopsy. METHOD Between September 2009 and September 2010, 114 patients were enrolled in the trial (from two centres). Patients undergoing TRUS biopsy of prostate were randomized into diltiazem and placebo groups. Patients were asked to fill out a questionnaire at the end of the procedure. The questionnaire enquired about discomfort associated with various parts of the procedure using a 10-cm visual analogue scale (VAS). RESULTS For discomfort due to the presence of the probe, pain during the biopsy and overall pain prior to leaving the department, mean VAS was higher for the placebo group, but the difference was not statistically significant. CONCLUSION Diltiazem cream has a better side effect profile than glyceryl trinitrate cream and is better tolerated. Although we have demonstrated trends favouring diltiazem use as an adjunct to local anaesthetic in TRUS biopsy of the prostate, this did not reach a statistically significant level. The pain scores associated with TRUS biopsy in our cohort were lower than those in the published literature. This phenomenon might have contributed to the results observed in this trial.
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Affiliation(s)
| | | | - Ganesh Siva
- Statistics, AgResearch, Palmerston North, New Zealand
| | - Quinten King
- Urology, Midcentral Health, Palmerston North, New Zealand
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Jindal T, Mandal SN, Biswas G, Karmakar D. Evaluation of the efficacy of a combination of diltiazem and periprostatic nerve block in pain control during transrectal ultrasonography-guided biopsy of the prostate. Ann R Coll Surg Engl 2013; 95:361-4. [PMID: 23838501 PMCID: PMC4165141 DOI: 10.1308/003588413x13629960046318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The choice of analgesia during prostate biopsy remains controversial. The pain has dual origin: from the insertion of the probe as well as the biopsy itself. Periprostatic nerve block (PPNB) is currently the gold standard modality for decreasing pain of prostate biopsy but it does not alleviate the pain of probe insertion. A randomised controlled trial was performed to test the efficacy and safety of the combination of topical application of diltiazem gel and PPNB for pain control during transrectal ultrasonography guided prostate biopsy. METHODS A total of 73 patients who were to undergo their first prostate biopsy were randomised to receive either 2ml of 2% topical diltiazem gel or a placebo 15 minutes before the biopsy. All the patients then had a PPNB using 1% lignocaine. A ten- point visual analogue scale was used to record the pain immediately after the insertion of the probe and during the biopsy. Any adverse effects were also recorded. RESULTS There was no significant difference in the mean age and prostate volumes between the groups. There was a significantly lower mean pain score due to probe insertion in those patients who received topical diltiazem than in the placebo group (p<0.0001). There was no significant difference between the pain scores during the biopsy itself between the two groups. CONCLUSIONS Topical diltiazem significantly reduces the pain of probe insertion during prostate biopsy and can be used effectively as an adjuvant to PPNB.
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Affiliation(s)
- T Jindal
- Department of Urology, Calcutta National Medical College, 32 Gorachand Road, Beniapukur, Kolkata - 700 014, India.
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Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64:876-92. [PMID: 23787356 DOI: 10.1016/j.eururo.2013.05.049] [Citation(s) in RCA: 676] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/24/2013] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
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Gan VHL, Kuo TLC, Lee LS, Huang HH, Sim HG. Does Periprostatic Block Increase the Transrectal Ultrasound (TRUS) Biopsy Sepsis Rate in Men with Elevated PSA? ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n4p168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Periprostatic nerve block (PPNB) is a common local anaesthetic technique in transrectal ultrasound-guided (TRUS) prostate biopsy, but concerns remain over the increased theoretical risks of urinary tract infection (UTI) and sepsis from the additional transrectal needle punctures. This study reviewed our biopsy data to assess this risk. Materials and Methods: Retrospective data collected from 177 men who underwent TRUS biopsy between July 2007 and December 2009 in a single institution were analysed. PPNB was administered using 1% xylocaine at the prostatic base and apex and repeated on the contralateral side under ultrasound guidance. Complications, including UTI sepsis, bleeding per rectum and acute retention of urine (ARU) were noted. Every patient was tracked for the first 2 weeks for complications until his clinic review. Demographic profile, biopsy parameters and histological findings were reviewed. Univariate and multivariate analysis of possible risk factors for development of sepsis after TRUS biopsy were performed. Statistical analysis was performed using SPSS 17.0. Results: Ninety (51%) men received PPNB and 87 (49%) did not. The groups were matched in age (PPNB: mean 62.7 ± 5.8 years; without PPNB: mean 64.4 ± 5.7 years) and prebiopsy prostate specific antigen (PSA) levels (PPNB: mean 8.2 ± 3.9 ng/mL; without PPNB: mean 8.3 ± 3.7 ng/mL). The PPNB group had a larger prostate volume, with more cores taken (P <0.05). On univariate and multivariate analysis controlling for age, PSA, prostate volume, number of cores taken and histological prostatitis, PPNB was not a significant risk factor for sepsis. Sepsis rates were 5.6% in the PPNB group and 5.7% in the other group (P = 0.956). Overall prostate cancer detection rate was 33.3%. Conclusion: The risk of sepsis was not increased in patients who received PPNB, even though this group had larger gland volumes and more biopsy cores taken.
Key words: Periprostatic nerve block (PPNB), Sepsis, Transrectal ultrasound-guided (TRUS) prostate biopsy
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Moussa AS, El-Shafei A, Diaz E, Gao T, Zaytoun OM, Fareed K, Ulchaker JC, Jones JS. Identification of the variables associated with pain during transrectal ultrasonography-guided prostate biopsy in the era of periprostatic nerve block: the role of transrectal probe configuration. BJU Int 2013; 111:1281-6. [PMID: 23465033 DOI: 10.1111/j.1464-410x.2012.11689.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the different factors that are associated with pain perceived during transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx), with special focus on the role of transrectal probe configuration. PATIENTS AND METHODS We analysed prospective data on 1114 patients undergoing TRUS-guided PBx at our institute from January 2007 to August 2010. Patients completed questionnaires based on a 10-point visual analogue pain scale related to the consecutive steps of PBx: probe insertion, application of periprostatic nerve block (PPNB) and the obtaining of PBx cores. The variables of interest were age, prostate volume, DRE findings, number of previous biopsies, probe type and the number of retrieved cores. All variables were correlated to pain scores using multivariate regression analysis. RESULTS At the probe insertion step, end-fire probes were more painful than side-fire probes. The Siemens G50 with metal, short plastic and long plastic needle guides (Siemens, Munich, Germany) had higher pain scores than the B&K probe (Bruel & Kjaer Medical, Copenhagen, Denmark; P = 0.09, 0.008 and 0.003, respectively). For pain at the PPNB application step, all G50(TM) guide subtypes and the Sonoline Prima probe (Siemens) had higher pain scores than the B&K probe, but this only reached statistical significance for the G50(TM) probe with short plastic guide (P = 0.03). On obtaining PBx cores, all G50(TM) subtypes had higher pain scores when compared with the B&K probe (P = 0.59, 0.38 and 0.69, respectively). CONCLUSIONS The probe design and needle guide affect pain during each step of TRUS-guided PBx. Both the B&K and Sonoline Prima probes caused less pain when compared with the G50(TM) probe, regardless of needle guide.
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Affiliation(s)
- Ayman S Moussa
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Grummet J, Huang S, Konstantatos A, Frydenberg M. The 'green whistle': a novel method of analgesia for transrectal prostate biopsy. BJU Int 2013. [PMID: 23194132 DOI: 10.1111/j.1464-410x.2012.11613.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PATIENTS AND METHODS • Patients undergoing TRUS-guided biopsies were each given a Penthrox inhaler to self-administer during the procedure and instructed in its use. • Immediately after the procedure, patients were asked to rate their pain using a verbal rating scale from 0 to 10. RESULTS • In all, 42 consecutive men underwent a TRUS-guided biopsy. • The median pain score was 3. • All 42 patients stated they would be happy to undergo the same procedure again. The only adverse effects reported by patients were brief light-headedness and a sickly sweet taste. CONCLUSION • This study of our initial experience using Penthrox suggests that it may have a role in analgesia for TRUS-guided biopsy. • It may provide safe, adequate analgesia that is easy for urologists to use and avoids excessive use of resources. • Planning for a randomised control trial comparing Penthrox to the current 'gold standard' of prostatic infiltration of local anaesthetic is presently underway.
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Affiliation(s)
- Jeremy Grummet
- Department Of Surgery, Monash University, Bairnsdale, Victoria, Australia.
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Malavaud B, Cussenot O, Mottet N, Rozet F, Ruffion A, Smets L, Stoevelaar H. Impact of adoption of a decision algorithm including PCA3 for repeat biopsy on the costs for prostate cancer diagnosis in France. J Med Econ 2013; 16:358-63. [PMID: 23231342 DOI: 10.3111/13696998.2012.757552] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A recent expert study (RAND Appropriateness Method (RAM)) including a panel of 12 European urologists reported that the PCA3 score may be instrumental in taking appropriate prostate biopsy (PBx) decisions, mainly for repeat PBx. This study determined the cost/benefit balance of introducing PCA3 in the decision-making for PBx in France. METHODS Two RAM models, without and with PCA3, were retrospectively applied to a sample of 808 French men who had PBx in 2010 (78% first, 22% repeat). Outcome measures included the proportion of PBx that could have been avoided (i.e., judged inappropriate) in the French sample according to both RAM models, and the estimated impact of application of these models on the annual number of PBx and associated costs for France (based on most recent published data). RESULTS Complete profiles were available for 698 men. In the model without PCA3, 2% of PBx were deemed inappropriate. Knowledge of PCA3 would have avoided another 7% of PBx. Repeat PBx would have been avoided in 5% of cases without PCA3 and in 37% with PCA3. For France, application of the RAM model including PCA3 would result in 18,345 fewer repeat PBx. It would be budget-neutral in the unlikely hypothesis of no complications or no costs incurred by complications and would save €1.7 million for a mean cost for complications of €100/procedure or €5 million for a mean cost for complications of €280/procedure, calculated based on US and Canadian data. LIMITATIONS Limitations of the study are the theoretical nature of the analysis and the fact that PCA3 distributions had to be derived from other sources. CONCLUSIONS Adoption of RAM expert recommendations including PCA3 for repeat PBx decisions in clinical practice in France would reduce the number of repeat PBx and control costs.
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Cantiello F, Cicione A, Autorino R, Cosentino C, Amato F, Damiano R. Pelvic Plexus Block is More Effective than Periprostatic Nerve Block for Pain Control During Office Transrectal Ultrasound Guided Prostate Biopsy: A Single Center, Prospective, Randomized, Double Arm Study. J Urol 2012; 188:417-21. [DOI: 10.1016/j.juro.2012.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Indexed: 11/28/2022]
Affiliation(s)
| | - Antonio Cicione
- Urology Unit, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Center for Laparoscopic and Robotic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Carlo Cosentino
- School of Biomedical Engineering, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Francesco Amato
- School of Biomedical Engineering, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Rocco Damiano
- Urology Unit, Magna Græcia University of Catanzaro, Catanzaro, Italy
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Jindal T, Mandal SN, Mukherjee S, Karmakar D. Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for pain relief during transrectal ultrasound guided biopsy of the prostate. Int Braz J Urol 2012; 38:405-10. [PMID: 22765856 DOI: 10.1590/s1677-55382012000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Transrectal ultrasound biopsy of prostate is a painful procedure. The introduction of the rectal probe is one of the major contributors to the pain associated with this procedure. Drugs that relax the anal sphincter should theoretically decrease this pain. This study was done to compare the efficacy and safety of two topical medications that relax the anal sphincter, diltiazem and nitroglycerine, in decreasing the pain associated with transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS 66 patients who were to undergo their first prostate biopsy were randomized to receive either 2 mL of 2 % topical diltiazem or 2 mL of 0.2 % topical nitroglycerine or placebo 20 minutes before prostate biopsy. All patients also received 15 mL of intrarectal lignocaine. A 10-point visual analogue score was used to record the pain immediately after the insertion of the probe, during biopsy and at the end of the procedure. RESULTS The pain scores due to probe insertion, during biopsy and at the end of the procedure in patients who received topical diltiazem or nitroglycerine were significantly lower compared to the placebo group (p < 0.001). There were no significant differences in the pain scores between the patients receiving diltiazem compared to those receiving nitroglycerine. Higher incidence of headache and fall in blood pressure was noted in patients who received nitroglycerine compared to those receiving diltiazem. CONCLUSION Topical diltiazem and nitroglycerine are equally effective in reducing the pain associated with transrectal prostatic biopsy. Diltiazem is safer compared to nitroglycerine.
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Affiliation(s)
- Tarun Jindal
- Department of Urology, Calcutta National Medical College, Kolkata, India.
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Izol V, Soyupak B, Seydaoglu G, Aridogan IA, Tansug Z. Three different techniques for administering analgesia during transrectal ultrasound-guided prostate biopsy: a comparative study. Int Braz J Urol 2012; 38:122-8. [DOI: 10.1590/s1677-55382012000100017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2011] [Indexed: 11/21/2022] Open
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Tüfek İ, Akpinar H, Atuğ F, Öbek C, Esen HE, Keskin MS, Kural AR. The Impact of Local Anesthetic Volume and Concentration on Pain During Prostate Biopsy: A Prospective Randomized Trial. J Endourol 2012; 26:174-7. [DOI: 10.1089/end.2011.0344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- İlter Tüfek
- Department of Urology, Istanbul Acibadem University, School of Medicine, Istanbul, Turkey
| | - Haluk Akpinar
- Department of Urology, Istanbul Bilim University, School of Medicine, Istanbul, Turkey
| | - Fatih Atuğ
- Department of Urology, Istanbul Bilim University, School of Medicine, Istanbul, Turkey
| | - Can Öbek
- Department of Urology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Halil Ertürk Esen
- Department of Computational Science and Engineering, Informatics Institute, Istanbul Technical University, Istanbul, Turkey
| | - Mehmet Selçuk Keskin
- Department of Urology, Istanbul Acibadem University, School of Medicine, Istanbul, Turkey
| | - Ali Riza Kural
- Department of Urology, Acibadem Maslak Hospital, Istanbul, Turkey
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Cicione A, Cantiello F, De Nunzio C, Tubaro A, Damiano R. Prostate Biopsy Quality Is Independent of Needle Size: A Randomized Single-Center Prospective Study. Urol Int 2012; 89:57-60. [DOI: 10.1159/000339250] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/04/2012] [Indexed: 01/28/2023]
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Kang SG, Tae BS, Min SH, Ko YH, Kang SH, Lee JG, Kim JJ, Cheon J. Efficacy and cost analysis of transrectal ultrasound-guided prostate biopsy under monitored anesthesia. Asian J Androl 2011; 13:724-7. [PMID: 21623389 DOI: 10.1038/aja.2011.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Sedation may result in reduction in pain during transrectal ultrasound (TRUS)-guided prostate biopsies. We aimed to evaluate the efficacy and safety of a combination of propofol and remifentanil infusion during TRUS-guided prostate biopsy and the related increases in health care costs. From January to September 2010, 100 men undergoing a transrectal prostate biopsy were randomized into two groups. In Group 1, 50 patients received a combined infusion of propofol and remifentanil; in Group 2, 50 patients received lidocaine jelly. After TRUS-guided biopsies were performed, pain and patient satisfaction were evaluated by a 10-point visual analog scale (VAS), and a cost-related patient satisfaction questionnaire was completed by all patients. Patients were also asked whether they would be willing to undergo repeat biopsy by the same method. Patients in Group 1 showed a significantly lower VAS score than those in Group 2 (mean VAS score: 0.9±1.1 versus 6.3±2.5; P<0.001). In addition, the patient satisfaction scale was significantly higher in Group 1 (P=0.002). Although the overall cost was significantly higher in Group 1 (P=0.006), patient satisfaction scales considering cost were also higher in this group (P=0.009). A combination of propofol and remifentanil is a safe and effective way to decrease patient pain and increase patient satisfaction during TRUS-guided prostate biopsy. Although the costs were higher in the group that received sedation, as expected, the patients exhibited heightened satisfaction and willingness to repeat biopsies by the same method.
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Affiliation(s)
- Sung Gu Kang
- Department of Urology, Korea University School of Medicine, Korea University Robotic Urologic Surgery Center, Korea University Hospital, Seoul 136-705, Korea
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Comparison Between Lidocaine and Glyceryl Trinitrate Ointment for Perianal-intrarectal Local Anesthesia Before Transrectal Ultrasonography-guided Prostate Biopsy: A Placebo-controlled Trial. Urology 2011; 77:905-8. [DOI: 10.1016/j.urology.2010.09.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/28/2010] [Accepted: 09/30/2011] [Indexed: 11/21/2022]
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Ozok HU, Sagnak L, Ates MA, Karakoyunlu N, Topaloglu H, Ersoy H. The efficiency of a sedative or analgesic supplement to periprostatic nerve blockage for pain control during transrectal ultrasound-guided prostate biopsy - a prospective, randomized, controlled, double blind study. Arch Med Sci 2010; 6:787-92. [PMID: 22419940 PMCID: PMC3298350 DOI: 10.5114/aoms.2010.17096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/05/2010] [Accepted: 05/19/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim was to examine the effect of a sedative or analgesic supplement to periprostatic nerve blockage (PNB) on pain reduction during probe insertion and needle penetration in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We also investigated the effects of this procedure on the positive response rate in re-biopsy. MATERIAL AND METHODS One hundred TRUS-guided prostate biopsy patients due to prostate-specific antigen (PSA) levels higher than 2.5 ng/ml and/or abnormal rectal examination findings were evaluated. Group 1 (PNB) was given periprostatic lidocaine injection before the procedure. Group 2 (analgesic) was given tramadol and PNB. Group 3 (sedative) was given midazolam and PNB. Group 4 (control) was not given any anaesthesia or analgesics. Pain scores were assessed during probe insertion and needle penetration by a visual analogue scale. RESULTS During probe insertion, the mean pain score of the sedative group was lower than that of the control, analgesic and PNB groups (p < 0.001, p = 0.009, and p < 0.001, respectively). During needle penetration, the mean pain score of the control group was higher than that of the other groups (p < 0.001). The rate of positive response to re-biopsy was found to be 56% in the control group and between 92% and 100% in the other three groups (p < 0.001). CONCLUSION According to our results, it can be concluded that midazolam, given supplementary to PNB, contributes as an effective and safe alternative for pain control during both probe insertion and penetration of the biopsy needle into the prostate capsule; however, tramadol supplement does not provide any additional contributions.
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Affiliation(s)
- Hakki U Ozok
- 3 Urology Clinic, Ankara Dis¸kapi Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey
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The efficacy of periprostatic local anaesthetic infiltration in transrectal ultrasound biopsy of prostate: a prospective randomised control study. World J Urol 2010; 28:673-6. [DOI: 10.1007/s00345-010-0578-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 06/25/2010] [Indexed: 10/19/2022] Open
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Kaplon DM, Barzell W. Editorial comment. Urology 2010; 75:1027; author reply 1028. [PMID: 20451709 DOI: 10.1016/j.urology.2009.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 11/04/2009] [Accepted: 11/06/2009] [Indexed: 11/26/2022]
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Cho JM, Lee SW, Kang JY, Yoo TK. Safety and efficacy of combined transrectal ultrasound-guided prostate needle biopsy and transurethral resection of the prostate. Korean J Urol 2010; 51:101-5. [PMID: 20414421 PMCID: PMC2855484 DOI: 10.4111/kju.2010.51.2.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 01/04/2010] [Indexed: 12/31/2022] Open
Abstract
Purpose This study was conducted to examine whether simultaneous transrectal prostate needle biopsy (TPNB) owing to an increase in prostate-specific antigen (PSA) levels is safe and effective in patients who are scheduled for transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Materials and Methods Combined TPNB and TURP was performed in a total of 42 patients aged 60 years and older who had gray-zone PSA values (4-10 ng/ml) and PSA density (PSAD) values of 0.12 and less. The frequencies of fever, sepsis, and epididymitis were assessed after surgery. The diagnostic accuracy was assessed, and the results of histologic examination were evaluated in terms of TPNB or TURP. In addition, the diagnostic accuracy was assessed according to age. Results Prostate cancer was diagnosed in 6 (14.3%) of the 42 patients: 2 patients were diagnosed with prostate cancer by TPNB only, 3 patients by TURP only, and 1 patient by combined TPNB and TURP. Four (25%) of the 16 patients aged under 70 years and 2 (7.8%) of the 26 patients aged 70 years and older were diagnosed with prostate cancer. Fever was observed in 9 patients (21.4%), 4 (9.5%) of whom had a fever of higher than 38℃. The fever normalized the day after surgery in all 9 patients. No septicemia was noted. There were no serious complications related to combined TPNB and TURP. Conclusions The results of this study suggest that combined TPNB and TURP may be safe and effective in patients who require TURP.
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Affiliation(s)
- Jeong Man Cho
- Department of Urology, Eulji University School of Medicine, Seoul, Korea
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Antonelli A, Simeone C, Giovanessi L, Zambolin T, Zani D, Cunico SCOSCIANI. Which Technical Aspects have an Impact on Perceived Pain during Transperineal Prostate Biopsy? A Prospective Study Involving 445 Cases. Urologia 2009. [DOI: 10.1177/039156030907600406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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. However, the multivariate analysis showed that only the single cutaneous access was statistically significant. In those cases, also the rates of delayed perineal pain were significantly lower. The cancer diagnosis rate showed no correlations with the type of cutaneous access. Conclusions A single median cutaneous access reduces the pain associated to transperineal prostatic biopsy.
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Affiliation(s)
- A. Antonelli
- Chair of Urology, University of Brescia, Brescia
| | - C. Simeone
- Chair of Urology, University of Brescia, Brescia
| | | | - T. Zambolin
- Chair of Urology, University of Brescia, Brescia
| | - D. Zani
- Chair of Urology, University of Brescia, Brescia
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Autorino R, Giannarini G. Editorial comment. Doppler ultrasonography-guided pelvic plexus block before systematic needle biopsy of the prostate: a prospective randomized study. Urology 2009; 74:271-2; author reply 272. [PMID: 19646608 DOI: 10.1016/j.urology.2009.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 11/17/2022]
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Akpınar H, Tüfek İ, Atuğ F, Esen EH, Kural AR. Doppler Ultrasonography-guided Pelvic Plexus Block before Systematic Needle Biopsy of the Prostate: A Prospective Randomized Study. Urology 2009; 74:267-271.e1. [DOI: 10.1016/j.urology.2009.01.082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/18/2009] [Accepted: 01/21/2009] [Indexed: 10/20/2022]
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