Local anaesthetic for transrectal ultrasound-guided prostate biopsy: a prospective, randomized, double blind, placebo-controlled study.

OBJECTIVE: To evaluate the efficacy of local anaesthetic (LA) infiltration in decreasing the discomfort experienced by patients undergoing transrectal ultrasound (TRUS)-guided biopsy of prostate. PATIENTS AND METHODS: 98 patients were randomized to receive 3x3ml of 1% lidocaine (n=55) or saline (n=43). The injection sites were basolaterally on each side to infiltrate the neuro-vascular bundle and one at the apex. Generally 12 systematic random biopsies were performed after which patients were asked to grade the pain of the whole procedure using a visual analogue scale ranging from 0 to 10. RESULTS: The LA group had a significantly lower pain score compared with placebo. The mean pain scores were 3.0 and 4.3 (p<0.001), respectively. Using an unpaired t-test, the difference between means was -1.96 to -0.51 with 95% confidence interval. There were no significant problems associated with the infiltration of either saline or LA. CONCLUSION: Local anaesthesia for TRUS biopsy is simple and well tolerated. It significantly reduces the pain associated with the procedure. We recommend its usage as a part of standard TRUS biopsy of the prostate.

The choice of timing for diuresis renography: the F + 0 method.

OBJECTIVE: To investigate a method of diuresis renography where the radiopharmaceutical and frusemide (diuretic) are given simultaneously, in contrast to conventional renography which involves an intravenous injection with frusemide 20 min after administering the radiopharmaceutical (F + 20) or 15 min before (F - 15), with particular interest in the effect of this change on assessing split renal function and interpreting upper tract drainage dynamics. PATIENTS AND METHODS: In a prospective study, 29 patients (18 women and 11 men, mean age 47 years, range 21--86) were assessed. Each patient had two renograms taken over a 48-h period, either by the F + 20 or F - 15, and the F + 0 method: Data for split renal function and drainage curves were obtained in the usual way. Two independent assessments of the drainage curves were obtained and the results compared. RESULTS: The split function assessments were identical (< 5% variation) in all but two patients; 26 of 29 (90%) gave identical conclusions about the drainage curves. The three patients with discrepancies between the studies had either hugely dilated upper tracts or otherwise had multiple complicating factors, e.g. impaired renal function, neuropathic bladder. CONCLUSIONS: F + 0 renography has been used in paediatric urological practice before, but there are no comparative studies and no data on its use in adults. This prospective study confirmed that in investigating dilated upper tracts, the F + 0 technique gives similar results to the conventional techniques. The F + 0 method has the potential to reduce the time required to undertake standard F + 20 renography but it may not be useful in evaluating the grossly dilated upper tract, where the F-15 technique has the best record in terms of reducing equivocal results.