Anal canal dentate line: the important anatomic maker in prostate apical biopsy pain control / 中华泌尿外科杂志

ABSTRACT

Objective To explore the causes of more frequently happened painful prostate biopsy at the prostatic apex rather than at other areas of the gland and develop maneuvers to avoid this painful apical prostate biopsy. Methods The prostate apical biopsy needle ptmeture sites in the rectum were recorded and accessed. Two maneuvers were developed to avoid the pain. There were 3 groups in this clinical trail. Ten patients in the control group were performed the apical biopsies routinely without any maneuver. Ten patients in the anal canal local anesthesia group were exposed to local anesthesia with 1% lidocaine injected into anal canal ventral hemieyele prior inserting the ultrasound probe, then the ultrasound guided apical biopsies were performed. Fifteen patients were assigned to the rectal pain sensation test group. In this group, the dentate line ot anal canal was detected before the biopsy needle was aimed at apex and touched the rectal mucosa lightly. There would be no painful sensation if the puncture was above the dentate line and the painful sensation would be sharp if the puncture was below the dentate line. Then the apical biopsy was performed above the dentate line. All patients were offered apical prostate biopsies and then other areas of prostate would be biopsied. Patients were asked to score the visual analog scale (VAS) immediately after the prostate apical biopsy. Results The VAS score of apical biopsy in 3 groups were 4. 46±1.24 in control group, 1.84± 0. 75 in anal canal local anesthesia group, 1.98±0. 67 in rectal pain sensation test group (P<0.05), respectively. So, patient would have painful sensation if the prostate apical biopsy puncture site was below the rectal dentate line. The VAS score of patient was 5.24±0.83 at the time of applying the anal canal local anes thesia. There was no significant difference comparing to the control group (P>0. 05). In this study, there was 1 patient with crissum pain after biopsy in control group and 1 patient in anal canal local anesthesia group, separately. 1 patient suffered high fever (38.4 ℃) in rectal pain sensation test group. Conclusions The prostate biopsy puncture site below or above the dentate line decides if it will be a painful prostate apical biopsy or not. We can significantly decrease the painful sensation by aim the puncture sites above the anal canal dentate line. The application of anal canal anesthesia can decrease pain score caused by prostate biopsy. However, this application itself can provoke obvious pain. So the application of anal canal anesthesia has limited role in patient's pain control during the prostate biopsy.