Identification of the variables associated with pain during transrectal ultrasonography-guided prostate biopsy in the era of periprostatic nerve block: The role of transrectal probe configuration

摘要

What's known on the subject? and What does the study add? Currently, peri-prostatic nerve block (PPNB) is the most effective method to reduce pain during TRUS biopsy. Although the advance in PPNB allowed a better tolerability of the procedure by most of patients, a minority of men still find the procedure unacceptably painful. We found in this study that the probe design and the needle guide affect pain encountered during different steps of TRUS guided PBx. Objective To identify the different factors that are associated with pain perceived during transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx), with special focus on the role of transrectal probe configuration. Patients and Methods We analysed prospective data on 1114 patients undergoing TRUS-guided PBx at our institute from January 2007 to August 2010. Patients completed questionnaires based on a 10-point visual analogue pain scale related to the consecutive steps of PBx: probe insertion, application of periprostatic nerve block (PPNB) and the obtaining of PBx cores. The variables of interest were age, prostate volume, DRE findings, number of previous biopsies, probe type and the number of retrieved cores. All variables were correlated to pain scores using multivariate regression analysis. Results At the probe insertion step, end-fire probes were more painful than side-fire probes. The Siemens G50 TM with metal, short plastic and long plastic needle guides (Siemens, Munich, Germany) had higher pain scores than the B&K probe (Bruel & Kjaer Medical, Copenhagen, Denmark; P = 0.09, 0.008 and 0.003, respectively). For pain at the PPNB application step, all G50TM guide subtypes and the Sonoline Prima probe (Siemens) had higher pain scores than the B&K probe, but this only reached statistical significance for the G50TM probe with short plastic guide (P = 0.03). On obtaining PBx cores, all G50 TM subtypes had higher pain scores when compared with the B&K probe (P = 0.59, 0.38 and 0.69, respectively). Conclusions The probe design and needle guide affect pain during each step of TRUS-guided PBx. Both the B&K and Sonoline Prima probes caused less pain when compared with the G50 TM probe, regardless of needle guide.