Use of local anesthesia in transrectal ultrasound guided prostatic biopsy

Transrectal ultrasound (TRUS) guided biopsy of the prostate is the gold standard for detecting prostate cancer. Intraprostatic administration of local anesthesia significantly decreases pain during prostatic biopsy. Transrectal ultrasound guided intraprostatic lidocaine administration along with intrarectally lidocaine gel is a new local anesthesia technique for prostatic biopsy. It was a randomized prospective, comparative, interventional type of the study. A total of 60 patients of age over 55 years included in the study among them 30 patients with transrectal lidocaine gel was in Group I and 30 patients with intraprostatic lidocaine injection with intra rectal gel were in Group II. The mean age was almost identically distributed between the two groups (p=0.668). About 47% of patients in Group I exhibited hard prostate on digital rectal examination (DRE), 33.3% single nodule and 20% multinodule compared to 33.3% of patients in Group II had hard prostate, 26.7% single nodule and 40% multinodule (p=0.236). The mean serum prostate specific antigen (PSA) was significantly higher in Group II than that in Group I (36.7±9.2 vs. 7.5±5.8ng/ml; p=0.007). The mean pain intensity during biopsy was almost two times higher in Group I than in Group II (p<0.001). The present study concludes that the intraprostatic lidocaine injection along with intra rectal lidocaine gel is less painful method and can be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.