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Is periprostatic local anesthesia for transrectal ultrasound guided prostate biopsy associated with increased
Can Obek1, Bülent Onal, Burak Ozkan
1Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey.
Purpose:
Periprostatic local anesthesia for prostate biopsy requires 2 or more extra needle punctures and injection of the local anesthetic through the highly colonized rectum. To our knowledge we report the first prospective randomized trial to assess the infectious or hemorrhagic complications associated with this method.
Materials And Methods:
A total of 100 consecutive patients with sterile urine cultures underwent transrectal ultrasound guided prostate biopsy. They were randomized to receive a periprostatic nerve block or no anesthesia. Patients were evaluated for the amount of rectal and urethral bleeding, and symptoms and signs of infection after biopsy.
Results:
The amount of urethral bleeding was slight and similar in the 2 groups. Rectal bleeding was significantly less in the patients who received anesthesia. High fever (greater than 37.8C) was more frequent in the nerve block group and 2 patients in this group required rehospitalization. Bacteriuria in post-biopsy urine cultures was significantly more common in the anesthesia group.
Conclusions:
Our results suggest that periprostatic local anesthesia for prostate biopsy does not increase the risk of urethral bleeding. It is associated with a decreased incidence of rectal bleeding, presumably due to decreased patient discomfort. The incidence of bacteriuria was significantly higher in the anesthesia group. High fever and hospitalization due to infectious complications were also more common in the local anesthesia group, although not statistically significant. Prospective randomized trials seem warranted to determine the optimum antibiotic prophylaxis regimen in patients undergoing biopsy with a periprostatic nerve block.
Insights
Periprostatic local anesthesia for prostate biopsy reduced rectal bleeding but increased bacteriuria and fever. Further trials are needed to optimize antibiotic prophylaxis for this anesthesia method.
Area of Science:
- Urology
- Anesthesiology
Background:
- Prostate biopsy anesthesia involves rectal injections, posing infection risks.
- Assessing complications of periprostatic local anesthesia is crucial.
Purpose of the Study:
- To evaluate infectious and hemorrhagic complications of periprostatic local anesthesia versus no anesthesia during prostate biopsy.
Main Methods:
- 100 patients with sterile urine underwent transrectal ultrasound-guided prostate biopsy.
- Randomized trial comparing periprostatic nerve block anesthesia to no anesthesia.
- Patients monitored for bleeding, infection symptoms, and signs post-biopsy.
Main Results:
- Urethral bleeding was similar; rectal bleeding was less with anesthesia.
- Anesthesia group had higher rates of fever and bacteriuria.
- Two anesthesia patients required rehospitalization due to infection.
Conclusions:
- Periprostatic anesthesia reduces rectal bleeding but increases bacteriuria.
- Higher fever and hospitalization rates observed in the anesthesia group.
- Further research needed for optimal antibiotic prophylaxis with periprostatic nerve blocks.