ABSTRACT
Intrarectal lidocaine application and apical periprostatic nerve block are a safe technique that significantly reduces pain during transrectal prostate biopsy. We compare prospectively the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound -guided prostate biopsy. From June 2005 to February 2006, 100 consecutive patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in endorectally [Group I], 10 cc of 1% lidocaine solution injected into the prostate apex to induce bilateral periprostatic nerve block [Group II], or intrarectal 10 cc of ultrasound gel as placebo [Groupe III]. Pain was evaluated by a 10- point linear visual analogue pain scale [VAS], and a 5-point digital visual scale [DVS]. The side effects of the drugs and complications were also evaluated. The three groups counted respectively: 33, 33 and 34 patients and were statically comparable as the age, prostate volume, PS A level and the number of biopsies. The mean pain score on the VAS was respectively 4,1; 4,6 and 3,5 for the three groups. The DVS score was 2,5; 2,8 and 2,15 [p < 0.001]. Pain scores were significantly lower in Group 3 and equivalent between Groups 1 and 2. There is no difference in complication rate between the three groups. Compared to intrarectal lidocaine application, apical periprostatic nerve block is a safe technique that significantly reduces pain during transrectal prostate biopsy, with no increase in the complication rate