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Ueda N, Sato M, Mori S, Matsukawa A, Oki Y, Kujime Y, Mizuno R, Horitani H, Yamamoto T, Fukae S, Yoshinaga M, Matsushita M, Akiyama M, Kamido S, Honda A, Nakayama J, Tei N, Miyake O. Lower Dose of 5 mL of 1% Lidocaine is More Suitable than the Conventional 10 mL for Caudal Block in Transrectal Prostate Biopsy: A Retrospective Cohort Study. Adv Urol 2024; 2024:9331738. [PMID: 38389652 PMCID: PMC10881246 DOI: 10.1155/2024/9331738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives In Japan, caudal block with 1% lidocaine is commonly used for transrectal prostate biopsy. Although 10 mL of 1% lidocaine is commonly used, the appropriate dosage of 1% lidocaine has not been studied. Our hospital routinely uses two different doses (5 or 10 mL) of 1% lidocaine for caudal block for transrectal prostate biopsy. Herein, we retrospectively evaluated the efficacy and safety of both doses of 1% lidocaine. Methods This retrospective study included 869 patients who underwent transrectal prostate biopsy with caudal block at our hospital. The amount of 1% lidocaine was determined by the day of the week on which the biopsy was performed, and the patient voluntarily chose the day of the biopsy, unaware of the dose of 1% lidocaine used on that day. Pain, anal sphincter tonus, cancer diagnosis rate, and early complications were compared. Results In total, 466 and 403 patients received 5 and 10 mL of 1% lidocaine for a caudal block, respectively. After propensity-score matching for patient characteristics, each group contained 395 patients. The pain score, anal sphincter tonus score, or prostate cancer diagnosis rate were not significantly different between the two groups. However, rectal bleeding was significantly more frequent and severe in the 10-mL than the 5-mL group (p=0.018 and p=0.0036, respectively). The incidence of other complications was not significantly different between the groups. Conclusions Our results suggest that 5 mL of 1% lidocaine may be more suitable than 10 mL for caudal block during transrectal prostate biopsy.
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Affiliation(s)
- Norichika Ueda
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Mototaka Sato
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Shunsuke Mori
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Atsuki Matsukawa
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Yuta Oki
- Department of Urology, Osaka Rosai Hospital, 1179-3 Nagasanecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Yuma Kujime
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Ryoya Mizuno
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Hiromu Horitani
- Department of Urology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka 587-8588, Japan
| | - Tetsuya Yamamoto
- Department of Urology, Ikeda City Hospital, 3-1-18 Jonan, Ikeda, Osaka 563-8510, Japan
| | - Shota Fukae
- Department of Urology, Hyogo Prefectural Nishinomiya Hospital, 13-9 Rokutanjicho, Nishinomiya, Hyogo 662-0918, Japan
| | - Mitsuhiro Yoshinaga
- Department of Urology, Minoh City Hospital, 5-7-1 Kayano, Minoh, Osaka 562-0014, Japan
| | - Makoto Matsushita
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Mai Akiyama
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Satoshi Kamido
- Pharmaceuticals and Medical Devices Agency, 3-3-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-0013, Japan
| | - Ayako Honda
- Department of Anesthesiology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Jiro Nakayama
- Department of Urology, Suita Tokushukai Hospital, 21-1 Senriokanishi, Suita, Osaka 565-0814, Japan
| | - Norihide Tei
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Osamu Miyake
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
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Osama S, Serboiu C, Taciuc IA, Angelescu E, Petcu C, Priporeanu TA, Marinescu A, Costache A. Current Approach to Complications and Difficulties during Transrectal Ultrasound-Guided Prostate Biopsies. J Clin Med 2024; 13:487. [PMID: 38256621 PMCID: PMC10816968 DOI: 10.3390/jcm13020487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Prostate cancer is one of the most common male malignancies worldwide. It affects middle-aged men (45-60 years) and is the leading cause of cancer-related mortality in Western countries. The TRUS (trans rectal ultrasound)-guided prostate biopsy has been a standard procedure in prostate cancer detection for more than thirty years, and it is recommended in male patients with an abnormal PSA (prostate-specific antigens) or abnormalities found during digital rectal examinations. During this procedure, urologists might encounter difficulties which may cause subsequent complications. This manuscript aims to present both the complications and the technical difficulties that may occur during TRUS-guided prostate biopsy, along with resolutions and solutions found in the specialized literature. The conclusions of this manuscript will note that the TRUS-guided prostate biopsy remains a solid, cost-efficient, and safe procedure with which to diagnose prostate cancer. The complications are usually self-limiting and do not require additional medical assistance. The difficulties posed by the procedure can be safely overcome if there are no other available alternatives. Open communication with the patients improves both pre- and post-procedure compliance.
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Affiliation(s)
- Salloum Osama
- Pathology Department, Carol Davila University of Medicine and Pharmacy, 050096 Bucharest, Romania; (S.O.); (I.-A.T.); (A.C.)
| | - Crenguta Serboiu
- Cellular Biology and Histology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Iulian-Alexandru Taciuc
- Pathology Department, Carol Davila University of Medicine and Pharmacy, 050096 Bucharest, Romania; (S.O.); (I.-A.T.); (A.C.)
| | - Emil Angelescu
- Urology Department, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania; (E.A.); (T.A.P.)
| | - Costin Petcu
- Urology Department, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania; (E.A.); (T.A.P.)
| | - Tiberiu Alexandru Priporeanu
- Urology Department, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania; (E.A.); (T.A.P.)
| | - Andreea Marinescu
- Radiology and Imaging Department, Carol Davila University of Medicine and Pharmacy, 050095 Bucharest, Romania
| | - Adrian Costache
- Pathology Department, Carol Davila University of Medicine and Pharmacy, 050096 Bucharest, Romania; (S.O.); (I.-A.T.); (A.C.)
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Rappaport YH, Kravchick S, Neheman A, Beberashvili I, Stav K, Roizman S, Zisman A. Anorectal application of 5% lidocaine cream reduces pain prior to periprostatic nerve block during transrectal ultrasound guided prostate biopsy: Randomized, prospective controlled study. Scand J Urol 2021; 55:149-154. [PMID: 33595427 DOI: 10.1080/21681805.2021.1885484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Trans rectal ultrasound guided prostate biopsy with periprostatic nerve block (PPNB) is performed following probe insertion and manipulation leaving these initial maneuvers uncovered in terms of pain control. We evaluated whether topical analgesia reduces pain during early stages of the procedure. PATIENTS AND METHODS Seven group prospective, randomized controlled study: groups 1-3: nerve block with 5 ml 1% lidocaine bilaterally plus perianal topical application of 10 ml 5% lidocaine cream. Groups 4-6 as in 1-3 plus digital application of 10 ml 5% lidocaine cream internally on rectal walls. For each approach exposure times were 5 (groups 1 and 4), 10 (groups 2 and 5) and 20 (groups 3 and 6) min, respectively. The control group (7) received PPNB only. Patients filled a 0-10 visual analogue scale (VAS) at five points: after probe insertion, during probe manipulation, following PPNB, after prostate biopsies and a global pain estimation. RESULTS Two hundred and fifty-two patients were enrolled. Significant differences in VAS between all study groups and controls were observed at the pre-biopsy stages of the procedure. In multivariate analysis adjusted for prostate specific antigen, diabetes mellitus status, spinal disease, abnormal digital rectal examination and non- benign prostate hyperplasia histology, significance remained for probe insertion and intra-rectal manipulation. For each exposure time no significant differences were observed between topical application and topical + intra-rectal application. After PPNB, differences between study and control groups disappeared. CONCLUSION Topical anesthesia significantly reduces pain during early stages of prostate biopsy. Perianal application sufficed whereas intra-rectal application of local anesthetics does not add to pain control. Perianal application for 10 min seems to be optimal.
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Affiliation(s)
- Yishai H Rappaport
- Department of Urology, Shamir Medical Center (Asaf HaRofe), Zerifin, Israel
| | - Sergey Kravchick
- Department of Urology, Upstate Urology of UHS, Johnson City, NY, USA
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Asaf HaRofe), Zerifin, Israel
| | - Ilia Beberashvili
- Department of Nephrology, Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Asaf HaRofe), Zerifin, Israel
| | - Shmuel Roizman
- Department of Urology, Shamir Medical Center (Asaf HaRofe), Zerifin, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Asaf HaRofe), Zerifin, Israel
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Demirtaş A, Sönmez G, Tombul ŞT, Demirtaş T. Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy. Int Braz J Urol 2020; 46:557-562. [PMID: 32213209 PMCID: PMC7239274 DOI: 10.1590/s1677-5538.ibju.2019.0154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. Materials and Methods Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS <3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. Results 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p <0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). Conclusion FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.
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Affiliation(s)
| | - Gökhan Sönmez
- Department of Urology, Kayseri City Hospital, Kayseri, Turkey
| | | | - Türev Demirtaş
- Department of Medical History and Ethics, Erciyes University, Kayseri, Turkey
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Choo MS, Lee DS. Does deep sedation with analgesia have positive effects on anxiety, pain and compliance in patients before and after prostate biopsy? Int J Clin Pract 2020; 74:e13517. [PMID: 32346965 DOI: 10.1111/ijcp.13517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 01/26/2023] Open
Abstract
AIMS To investigate whether deep sedation for transrectal prostate biopsy could reduce anxiety and pain and enhance rebiopsy compliance. METHODS A two-centre prospective observation study was conducted under two different anaesthetic conditions: deep sedation with analgesia and local anaesthesia with lidocaine. A 12-core prostate biopsy was taken in all patients. Scores on a 0-10 visual analogue scale, the State-Trait Anxiety Inventory-X-1, the Beck Anxiety Inventory and a five-level Likert satisfaction scale were evaluated. Finally, all patients were asked about their willingness to undergo the same procedure again if necessary and whether they wanted to change the anaesthetic method (deep sedation to local anaesthesia or local to sedation) if a repeat procedure was required. RESULTS A total of 135 patients were included in this study, including 69 patients in the sedation group and 66 patients in the local group. Lower pain scores (P < .001) and higher satisfaction scores (P = .019) were observed in the sedation group than in the local group after the procedure. Anxiety scores in the sedation group were significantly decreased after the procedure, whereas those were not changed in the local group. The question regarding rebiopsy compliance tended to be more positive in the sedation than in the local group (73.9% vs 62.1%, respectively, P = .099). The proportion of patients who wanted to change their anaesthetic method was much higher in the local than in the sedation group (68.2% vs 11.6%, respectively, P < .001). CONCLUSION Deep sedation with analgesia during transrectal prostate biopsy could reduce pain and postprocedural anxiety and enhance rebiopsy compliance. Considering the psychological and oncological benefits, we strongly recommend inducing deep sedation during transrectal prostate biopsy.
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Affiliation(s)
- Min Soo Choo
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Dong Sup Lee
- Department of Urology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
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