ABSTRACT
Although considered a minor diagnostic procedure, TRUS-guided prostatic needle biopsy can cause substantial discomfort and pain. In this randomized double-blind placebo controlled study, we evaluated the efficacy of 2% lidocaine gel applied rectally on the patients' tolerance during TRUS-guided prostatic needle biopsy. The study was conducted on 93 patients who were referred to TRUS-guided prostatic biopsy because of increased serum PSA level and/or abnormal digital rectal examination. Twenty ml of 2% lidocaine gel were instilled intra-rectally 15 minutes before the procedure in the study group [group I, n = 47] while in the control group [group II, n = 46], the same amount of ultrasound gel was applied. In addition to the standard sextan
biopsies, further three cores were obtained from more lateral peripheral sites on each side. After the procedure, Patients' tolerance to pain was assessed based on a 5-point visual analogue scale [VAS, 0= no pain, 1 = mild, 2 = moderate, 3 - severe, 4 = intolerable pain]. The mean patient age was 64.5 +/- 6.5 years for group I and 66.1 +/- 8.2 years for group II and the mean biopsy time was 6.7 +/- 4.5 and 6.8 +/- 4.1 minutes respectively. The mean VAS pain score was slightly lower in patients who received lidocaine [1.9 +/- 0.7 vs. 2.1 +/- 0.8 in the control group] but this difference was not statistically significant [p = 0.442]. Instillation of intra-rectal lidocaine did not improve the Patients' tolerance to extended TRUS-guided needle prostatic biop