Local, ultrasound-guided blockade of neuro-vascular boundles improves quality of life of patients after transrectal prostate biopsy
Article published in Urologia Polska 2002/55/1.

authors

Marcin Słojewski, Adam Gołąb, Bartłomiej Gliniewicz, Andrzej Sikorski: Katedra i Klinika Urologii Pomorskiej Akademii Medycznej w Szczecinie Kierownik kliniki: prof, dr hab. Andrzej Sikorski

keywords

prostate cancer biopsy quality of life local anesthesia

summary

Introduction. Transrectal, ultrasonographically guided core prostate biopsy remains the main method of prostate cancer diagnostic. Despite it is painful procedure for 70-80% of patients, most of urologists have been performing this without any anesthesia.

Objective. To evaluate the quality of life men who had undergone prostate biopsy with local blockade of neuro-vascular boundles (NVB).

Material and methods. In 55 randomized patients among 105, NVB blockade was performed before prostate biopsy. Control group consists of remaining 50 men. After 10 days patients were asked for filling the self-constructed questionnaire concerning pain after biopsy, use of analgetic drugs, fever, presence of blood in urine, stool and semen; the decision about rc-biopsy if needed. Results. In both groups age, biopsy type and the number of cores were similar. Pain afer biopsy was reported by 37% of patients with NVB blockade and 57% of patients biopted without anaesthesia (p<0,05). Pain during micturition, dysuria and the use of analgetics drugs were reported in both groups in 20%, 33% and 8,8% i 15% respectively. Due to „post-biopsy\" symptoms 6,6% and 5,2% in both groups were consulted by family doctor or urologist. In group with NVB blockade 95% and 75% in non-anaethesized group, would accept the decision of re-biopsy (p<0,05).

Conclusion. Local, ultrasound-guided NVB blockade is safe, cheap and highly effective. We have observed no complications. Patients significantly less complaint of biopsy and post-biopsy pain and often agree for second biopsy. In our opinion, this method improves the quality of life of patients after prostate biopsy

references

1. Desgrandchamps F, Mcria P, Irani J, Desgrippes A, Teillac P, LeDuc A; The rectal administration oflidocaine gel and tolerance of transrectal ultrasonography-guided biopsy of the prostate: a prospective randomized placebo-controlled study. BJU Int 1999; 83, 1007-1009.
2. Crandwell MC, Cooke RW, Wallace DM: Patients\\\' tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of 104 cases. BJU Int 1999; 83,792-795.
3. Clements R, Aideyan OU, Griffiths GJ, Peeling WB: Side effects and patients acceptability of transrectal biopsy of the prostate. Clin Radiol 1993; 47, 125-126.
4. Seymour H, Perry MJ, Lee-Eliol C, Dundas D, Patel U: Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anasthesia. BJU Int 2001; 88, 540-544.
5. Soloway MS, Obek C: Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol 2000; 163; 172-173.
6. Chang SS, Alberts G, Wells N, Smith JA, Cookson MS: Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol 2001; 166; 2178-2180.
7. Moffat NA: Transurethral prostatic resections under local ane-stehsin. J Urol 1977; 188; 607-608.
8. Sinha B, Haikcl G, Langc PH, Moon TD, Narayan P: Transurethral resection of the prostate with local anesthesia in 100 patients. J Urol 1986; 135; 719-721.
9. Nash PA, Bruce JE, Indudhara R, Shinohara K: Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol 1996; 155; 607-609.
10. Reddy PK: New technique to anesthetize the prostate for transurethral balloon dilatation. Urol Clin North Am 1990; 17; 55-56.
11. Naughton CK, Ornstein DK, Smith DS, Catalona WJ: Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol 2000; 163; 179-180.
12. Alavi AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL: Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods. J Urol 2001; 166; 1343-1345.
13. Wu CL, Carter BH, Naqibuddin M, Fleisher LA: Effect of local anesthetic on patient recovery after transrectal biopsy. Urology 2001; 57; 925-929.

correspondence