ABSTRACT
Objetivo: La anestesia del plexo periprostático (APP) no es práctica habitual durante la biopsia prostática (BP).Muchos pacientes deben someterse a una segunda, o más, BP por sospecha de carcinoma. El dolor influye en la repetición de la misma pues determina que muchos pacientes rechacen el procedimiento o que éste deba realizarse en quirófano bajo anestesia. Nuestro objetivo fue valorar la utilidad de la APP en la supresión del dolor producido durante la realización de la BP así como la aceptación del procedimiento realizado en estas condiciones. Material y métodos: De octubre del 2002 a junio del 2003 planteamos un trabajo prospectivo con casos y controles en el que incluimos aleatoriamente 275 pacientes de dos centros para BP. En el primer centro se incluyeron 101 varones a los que no se les realizó APP, mientras que en el segundo fueron 174 los pacientes sometidos a BP tras APP. Usamos hasta 10 ml de lidocaína al 2% diluida al 50% administrada mediante una aguja fina del calibre 22. Al final del procedimiento se invitó al paciente a rellenar un cuestionario de satisfacción y evaluación del dolor. Resultados: En el grupo de pacientes del segundo centro se obtuvieron valores medios significativamente inferiores (p<0,005, IC 95%) en la valoración cuantitativa del dolor, que en el grupo del primer centro (1,24±0,4 vs. 2,5±1,1).Respecto a la posibilidad, si fuese necesario, de repetir la BP, a ninguno de los pacientes del segundo centro le importaría, mientras que el 10% del primer centro no la repetirían o la aceptarían sólo bajo anestesia. No se produjeron complicaciones atribuibles a la APP. Conclusión: La APP es una técnica segura que reduce significativamente el dolor durante la BP, mejorando la aceptación de la misma (AU)
Objetive: Periprostatic plexus anesthesia (PPA) is not current practice during prostate ultrasound-guided biopsy (PB). Many patients must undergo a second or more PB if a prostate carcinoma is suspected. Due to pain, many patients reject the procedure, or it has to be performed with general anesthesia. Our objective was to evaluate the utility of PPA to eliminate the pain caused by PB, as well as the acceptance of the procedure under these conditions. Patients and Methods: Between october 2002 and june 2003 we designed a randomized prospective study with 275 patients that were seen in 2 different hospitals and required PB. In the 1st group we included 101 males who underwent PB without PA. In the other group, 174 male patients submitted PB after PPA were included. 10 cc lidocaine, 2% diluted 50% was injected with a 22g needle. At the end of the procedure, patients were asked to fill in a questionnaire about their satisfaction and degree of pain felt. Results: In the second group of patients we obtained significantly inferior values (p<0.005, IC 95%) in the quantitative evaluation of pain compared with the first group (1.24±0.4 vs. 2.5 ±1.1). Ask per the possibility of repeating PB if it were necessary, none of the patients in the 2nd group would object, whereas 10% in the 1st group would not have the biopsy repeated or would only accept it if it was done with general anesthesia. No complications due to PPA were found. Conclusion: PPA is a safe procedure that significantly reduces pain during PB, improving its acquiescence among patients (AU)
Subject(s)
Male , Aged , Middle Aged , Humans , Anesthesia, Local/methods , Biopsy, Needle/methods , Lidocaine/administration & dosage , Anesthesia, Local , Ultrasonography , Hypogastric Plexus , Prospective Studies , Case-Control Studies , Pain Measurement/methods , Patient Satisfaction/statistics & numerical dataABSTRACT
OBJECTIVE: Periprostatic plexus anesthesia (PPA) is not current practice during prostate ultrasound-guided biopsy (PB). Many patients must undergo a second or more PB if a prostate carcinoma is suspected. Due to pain, many patients reject the procedure, or it has to be performed with general anesthesia. Our objective was to evaluate the utility of PPA to eliminate the pain caused by PB, as well as the acceptance of the procedure under these conditions. PATIENTS AND METHODS: Between october 2002 and june 2003 we designed a randomized prospective study with 275 patients that were seen in 2 different hospitals and required PB. In the 1st group we included 101 males who underwent PB without PA. In the other group, 174 male patients submitted PB after PPA were included. 10 cc lidocaine, 2% diluted 50% was injected with a 22g needle. At the end of the procedure, patients were asked to fill in a questionnaire about their satisfaction and degree of pain felt. RESULTS: In the second group of patients we obtained significantly inferior values (p < 0.005, IC 95%) in the quantitative evaluation of pain compared with the first group (1.24 +/- 0.4 vs. 2.5 +/- 1.1). Ask per the possibility of repeating PB if it were necessary, none of the patients in the 2nd group would object, whereas 10% in the 1st group would not have the biopsy repeated or would only accept it if it was done with general anesthesia. No complications due to PPA were found. CONCLUSION: PPA is a safe procedure that significantly reduces pain during PB, improving its acquiescence among patients.
Subject(s)
Anesthesia, Local , Pain/etiology , Pain/prevention & control , Prostate/diagnostic imaging , Prostate/pathology , Aged , Biopsy/adverse effects , Humans , Male , Prospective Studies , Prostate/innervation , Surveys and Questionnaires , UltrasonographyABSTRACT
OBJETIVO: Valorar el rendimiento diagnóstico de la segunda biopsia prostática (BP). PACIENTES Y MÉTODOS: Un total de 116 varones con BP previa de benignidad fueron sometidos a 2 o más BP por sextantes guiadas con ultrasonidos (US). Los criterios de inclusión fueron: BP previa sospechosa (PIN), PSA elevado, TR o US sospechoso.RESULTADOS: El tiempo medio transcurrido entre la primera y siguiente biopsia fue de 13 ± 11 meses. Se obtuvieron 35 malignas y 4 premalignas en las segundas biopsias realizadas, lo que da un rendimiento diagnóstico global del 33,6%. Cuando estratificamos por valor de PSA, obtenemos que con PSA 10 ng/ml, de 34,6%. CONCLUSIÓN: La repetición de la biopsia seriada de próstata en pacientes de riesgo, mejora el rendimiento diagnóstico y elimina los falsos negativos de carcinoma. prostático
OBJETIVE: To value the diagnostic yield of the second prostate biopsy (BP). PATIENTS AND METHODS: To 116 males with BP previous to kindliness surrendered to 2 or more BP for sextants guided with ultrasounds (US). The criteria of inclusion were: BP previous suspicious (PIN), high PSA, TR or suspicious US. RESULTS: The average time passed between the first and following biopsy was 13 ± 11 months. 35 malignant and 4 premalignant ones were obtained in the second realized biopsies, which gives a diagnostic global yield of 33.6%. When we stratify for value of PSA, we obtain that with PSA 10 ng/ml of 34,6%. CONCLUSION: The repetition of the serial biopsy of prostate in patients of risk, improves the diagnostic yield and eliminates the false negatives of prostate carcinoma
Subject(s)
Male , Adult , Middle Aged , Humans , Biopsy/methods , Stratified Sampling , Antigens , Prostate-Specific Antigen , Risk Factors , Predictive Value of Tests , Predictive Value of Tests , Prostatic Neoplasms/diagnosis , Prostate/cytology , Prostate/surgery , Prostate/ultrastructure , Transurethral Resection of Prostate/methods , Spectrum Analysis/methods , False Positive Reactions , Antigens/analysis , Prostate-Specific Antigen/administration & dosage , Prostate-Specific Antigen/analysis , Prostate-Specific AntigenABSTRACT
OBJECTIVE: [corrected] To value the diagnostic yield of the second prostate biopsy (BP). PATIENTS AND METHODS: To 116 males with BP previous to kindliness surrendered to 2 or more BP for sextants guided with ultrasounds (US). The criteria of inclusion were: BP previous suspicious (PIN), high PSA, TR or suspicious US. RESULTS: The average time passed between the first and following biopsy was 13 +/- 11 months. 35 malignant and 4 premalignant ones were obtained in the second realized biopsies, which gives a diagnostic global yield of 33.6%. When we stratify for value of PSA, we obtain that with PSA <4 ng/ml the yield was 23%, for PSA 4-10 ng/ml the yield was 32% and for PSA >10 ng/ml of 34.6%. CONCLUSION: The repetition of the serial biopsy of prostate in patients of risk, improves the diagnostic yield and eliminates the false negatives of prostate carcinoma.
