Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate

We assessed the effect of transrectal ultrasound guided prostatic nerve blockade on the discomfort associated with systematic needle biopsy of the prostate.

A prospective randomized double-blind study was performed of 64 patients requiring systematic biopsy of the prostate. Patients were randomly assigned to receive an injection of 5 ml. 1% lidocaine or 5 ml. saline (0.9% sodium chloride) at the vascular pedicle on 1 side of the prostate only. They were then asked to score the severity of discomfort of the injection and subsequent biopsies on each side.

Mean pain scores were significantly lower on the side with than the side without lidocaine injection (1.6 +/- 0.9 versus 2.4 +/- 1.2, p < 0.0001) and not significantly different when saline was injected (2.9 +/- 1.2 versus 3.0 +/- 1.1, p = 0.52). Pain scores were significantly different when the lidocaine injected side was compared to the saline solution injected side (p < 0.0001) but the difference was not significant between the noninjected sides of the 2 groups (p = 0.076). Of the patients in the lidocaine group 68% reported that they would prefer to undergo biopsy with the injection compared to only 41% in the placebo group (p = 0.037). During the study no patient in either group had any adverse effect from the injection.

Transrectal ultrasound guided nerve blockade before prostatic biopsy results in a more comfortable procedure for the patient.