Related Experiment Video
Updated: Jan 6, 2026
Transperineal Prostate Biopsy Using a Cone-shaped Double-hole Method with Dual-plane Probe Guidance
Published on: June 6, 2025
Comparison of two analgesia applied to periprostatic nerve blockage during transrectal ultrasound guided prostate
Halil Cagri Aybal1, Taha Numan Yikilmaz2, Halil Basar3
1Department of Urology, Polatli Duatepe State Hospital, Ankara, Turkiye.
Objective:
A combination of local anesthetic treatments provides better pain alleviation than periprostatic nerve block (PPNB) alone during a prostate biopsy procedure. The primary objective of this study was to compare Visual Analog Scale (VAS) pain levels during transrectal ultrasound (TRUS)- guided prostate biopsy whilst the use of prilocaine-lidocaine cream, diclofenac suppository, or PPNB only in a prospective, randomized study.
Methods:
This study included 162 patients who had TRUS-guided prostate biopsies performed at the Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Center within a 6 month period, from April to October 2017. Three groups of patients were randomly assigned: group 1 underwent PPNB plus prilocaine-lidocaine cream, group 2 received diclofenac suppository along with PPNB, and group 3 underwent PPNB alone. The VAS was used to measure the degree of pain: VAS 1 was used to record the pain at the time the ultrasound probe was inserted, VAS 2 was used to document the pain during PPNB, and VAS 3 was used to record the pain during needle biopsy. Following the biopsy, any complications or negative consequences were recorded.
Results:
Mean age or serum prostate specific antigen (PSA) levels were similar between the three groups. The VAS 1, VAS 2, and VAS 3 pain scores showed statistically significant difference among the three groups (p=0.001). Between groups 1 and 2, there was a statistically significant difference in VAS 1 pain scores (p=0.01). There was no statistically difference in VAS 2 and VAS 3 pain scores between the groups 1 and 2 (p=0.08 and p=0.23, respectively). Patients between the groups 3 and other groups had significantly difference in VAS pain scores (p<0.05).
Conclusion:
In this study, we highlight that when applied as an adjuvant to PPNB, either 5% prilocaine-lidocaine cream or a 100 mg diclofenac suppository reduced pain levels relative to PPNB alone. When compared to a 100 mg diclofenac suppository, prilocaine-lidocaine cream significantly reduces pain during the insertion and manipulation of the ultrasound probe.
