The Effects of Combination of Intrarectal Lidocaine-gel with Periprostatic Lidocaine Injection on the Pain Relief in Repeated Transrectal Prostate Biopsy / 대한비뇨기과학회지

ABSTRACT

PURPOSE: We evaluated the effectiveness of intrarectal lidocaine-gel and periprostatic nerve block, or the combined method, on the reduction of pain during repeated transrectal prostate biopsy. MATERIALS AND METHODS: 61 patients with a negative pathology after an initial sextant biopsy, with no sedatives or analgesia, were rebiopsied using the 12 extended biopsy technique. The patients scheduled for a repeat prostate biopsy were randomized to the combination method (group 1, 19 patients), periprostatic nerve block (group 2, 23 patients) or intrarectal lidocaine-gel (group 3, 19 patients). After the repeat biopsy, the rectal pain during probe insertion, pain intensity during prostate biopsy and complication rates were recorded. Pain was evaluated by a 10-point linear visual analogue scale (VAS). An ANOVA test was used as the statistical analysis for the assessment of VAS, with p<0.05 considered significant. RESULTS: No significant difference was found in mean patient age, prostate specific antigen level, prostate volume and complication rates between the groups. The VAS during probe insertion were significantly lower in group 1 and 3 (mean 1.74 and 1.84) than in group 2 (mean 3.96, p<0.001). The VAS during biopsy was significantly lower in group 1 (mean 3.05) than group 3 (mean 4.63, p<0.001). CONCLUSIONS: Periprostatic nerve block decreased pain during the repeated prostate biopsy, but had no effect on the pain felt during transrectal probe insertion. Intrarectal lidocaine-gel decreased the pain only during probe insertion. However, the combination of intrarectal lidocaine-gel and periprostatic nerve block was effective in reducing the pain, both at biopsy and during probe insertion, in the repeated 12 core biopsy.