Local periprostatic anesthesia between option and necessity in transrectal ultrasound-guided prostate biopsy

According to the European Association of Urology guidelines, local periprostatic anesthesia during ultrasound guided biopsy is "state of the art" without specifying the exact benefits and character of choice vs. necessity of this maneuver.

To determine the benefits of using periprostatic anesthesia as standard method of analgesia in patients undergoing transrectal ultrasound guided prostate biopsy.

We conducted a prospective randomized study involving 100 biopsy patients. The patients were randomized in two groups, 50 patients benefiting from local periprostatic anesthesia with 10 ml of lidocaine and the remaining 50 without local anesthesia. In our clinic we use the 12-core prostate biopsy procedure using 18G/20 cm caliber needles. To assess perceived pain intensity during the procedure, immediately after biopsy we applied to patients a VAS questionnaire (Visual Analogue Scale) as a simple method of quantitative evaluation of a symptom the perception of which varies greatly between individuals.

A reduction in perceived pain by 45.06% (30.47 vs. 16.74) was recorded in the group receiving local periprostatic anesthesia. It is also worth mentioning that the patients receiving anesthesia said that anesthesia punctures were the most painful (the remaining punctures being much less painful), while patients without anesthesia reported pain intensity levels more or less equal in all 12 performed punctures.

Local anesthesia is a necessity in ultrasound guided prostate biopsies as it significantly reduces pain intensity in patients undergoing this diagnostic procedure.