1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
Finkelstein S, Oliogu E, Yee A, Milton L, Rivlin L, Henry P, Behroozian T, Chow E, Finkelstein J. Literature review on the use of methoxyflurane in the management of pain in cancer-related procedures. Support Care Cancer 2023; 31:232. [PMID: 36961562 DOI: 10.1007/s00520-023-07694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Self-administered methoxyflurane, also known as Penthrox, at a sub-anesthetic dose is a short-term, fast-acting, and safe analgesic that may provide suitable pain relief for cancer patients. This review aims to compile the existing evidence on methoxyflurane and its efficacy in reducing pain during cancer-related procedures. METHODS A literature search was conducted through OVID Medline and Embase. The search was limited to articles published between 2012 and 2021 and studies were included if they assessed the efficacy of methoxyflurane to reduce pain in cancer-related procedures. All types of cancer were included. RESULTS The literature search yielded seven studies published between 2012 and 2021. The studies analyzed assessed methoxyflurane use in prostate biopsy, colonoscopy, removal of brachytherapy rods, and bone marrow biopsy. Various research designs were employed, including three randomized controlled trials, two prospective observational studies, one retrospective, and one non-randomized controlled trial. In all, methoxyflurane has a demonstrated ability to reduce pain in these procedures. CONCLUSION In the limited studies available in evaluating the efficacy of methoxyflurane for reducing procedural pain during cancer-related procedures, all have demonstrated clinical equivalency or superiority. Pain relief appears to be equivalent however methoxyflurane overcomes the standard limitations of respiratory sedation and has demonstrated quicker procedural recovery times than traditional sedation methods. The accumulated data to date supports the use of methoxyflurane which can supplement or supplant current methods of analgesia in cancer-related procedures.
Collapse
Affiliation(s)
- Samuel Finkelstein
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Etinosa Oliogu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lauren Milton
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Patrick Henry
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Tara Behroozian
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Joel Finkelstein
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| |
Collapse
|
3
|
Comparison of intrarectal heated lidocaine gel and periprostatic nerve block for pain control in transrectal ultrasound-guided prostate biopsy: A randomized controlled non-inferiority trial. Prostate Int 2023; 11:8-12. [PMID: 36910899 PMCID: PMC9995686 DOI: 10.1016/j.prnil.2022.07.004] [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: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background To investigate whether intrarectal local anesthesia with heated lidocaine gel (IRLAH) is non-inferior to periprostatic nerve block (PNB) for reducing pain in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. Methods We performed a randomized controlled non-inferiority trial with 100 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from August 2019 to July 2020. These participants were randomly assigned to a group receiving intrarectal local anesthesia with 20 mL of heated (40°C) 2% lidocaine gel (n = 50) or PNB (n = 50). The primary outcome was a pain score on a 0-10 visual analogue scale (VAS) at four time points with the non-inferiority margin of 1; VAS-1: during local anesthesia application; VAS-2: during probe insertion; VAS-3: during biopsy; VAS-4: 30 minutes after the procedure. The secondary outcome included complications during and after the procedure. Results The IRLAH group (0.1) met non-inferiority as well as superiority criteria for mean VAS-1 score vs. the PNB group (2.33) (P < 0.001), as the difference (95% confidence interval [CI]) between the two groups was -2.23 (-2.66 to -1.79) and the upper bound of the 95% CI were both below the prespecified non-inferiority margin and below zero. For mean VAS-3 score, the difference (95% CI) was 0.3 (-0.38 to 0.98) and the upper bound of the 95% CI did not exceed the predefined non-inferiority margin indicating that IRLAH was non-inferior (IRLAH group, 3.44; PNB group, 3.14). Also, non-inferiority was shown for pain scores at VAS-2 and VAS-4. There were no significant differences in complications. Conclusion IRLAH is a noninvasive and non-inferior alternative to PNB for pain control in TRUS-guided prostate biopsy without increased risk of complications.
Collapse
|