A prospective, double blind, placebo controlled, clinical trial comparing the effect of intrarectally applied and periprostatically injected lidocaine on the pain scores of patients undergoing transrectal ultrasound guided prostate biopsy

ABSTRACT

Background: Transrectal ultrasound guided prostate biopsy has placed a role in the urologist armamentarium. Considered as a minor procedure, TRUS guided prostate biopsies has currently been performed without any anesthesia. Recent studies have observed that prostate biopsy is perceived as painfulObjective: A. To compare the effect of intrarectal lubricant gel application, intrarectal lidocaine gel application and periprostatic lidocaine injection on the pain scores of patients undergoing transrectal ultrasound guided prostate biopsy. B. To determine the differences in morbidity after the procedureMaterials and Methods: From January 2004 to August 2004, 100 men underwent prostate biopsy at a tertiary hospital. Patients were distributed into 3 groups (control, lidocaine gel, lidocaine injection). A visual analog scale was used to assess the pain score. The Shapiro-Wilk test was performed on all epidemiologic data as well as on the patients pain scores. Statistical analysis used includes analysis of variance for age and Kruskal-Wallis test for PSA level, prostate volume and pain score. Tukey and Mann Whitney U test were subsequently doneResults: Ultrasound guided prostate biopsy was done in 100 cases. There were no statistical difference as to age, PSA level and prostate volume between the 3 groups. There was no statistical difference in the pain scores of patients after intrarectal lubricant gel application and intrarectal lidocaine application. (4.933 versus 4.250, p 0.1375). However, there was a statistical difference in the pain scores of patients after intrarectal lidocaine gel application and periprostatic injection (4.250 versus 2.158, p 0.0001) and intrarectal lubricant gel application and periprostatic injection (4.933 versus 2.158, p 0.0001)Conclusions: Periprostatic lidocaine injection effectively lowers the pain scores of prostate biopsy than those who received lidocaine gel or lubricant gel. Improvement in patient tolerance permits the number of biopsy cores to be increased as necessary without increasing patient distress. Routine use of local anesthesia in the formed of periprostatic lidocaine injection is highly recommended in future biopsies