PTU - Polskie Towarzystwo Urologiczne
home page
current numbers
archival numbers
list of articles:
list przewodni/covering letter
editor
Scientific Committee
publisher
subscription
advertising
important links

Tolerance of pain during and twelve hours after transrectal ultrasound-guided biopsy of the prostate
Article published in Urologia Polska 2006/59/3.

authors

Roman Sosnowski 1, Stanisław Szempliński 2, Elza Modzelewska 2, Artur A. Antoniewicz 2, Wojciech Michalski 3, Andrzej Borówka 2
1 Klinika Nowotworów Układu Moczowego, Centrum Onkologii - Instytut w Warszawie
2 I Zespół Dydaktyki Urologicznej Kliniki Urologii CMKP, Oddział Urologii Międzyleskiego Szpitala Specjalistycznego w Warszawie
3 Biuro Badań Klinicznych i Biostatystyki, Centrum Onkologii - Instytut w Warszawie

keywords

prostate, biopsy, pain

summary

Introduction and objectives. Transrectal ultrasound-guided needle biopsy of the prostate (TRUStru-cutBx) is routinely performed to diagnose prostate cancer. Pain or discomfort may be associated with this procedure. The study was aimed at prospective evaluation of pain and identification of pain risk factors during prostate biopsy.
Material and methods. Between May 2003 and June 2004, 50 consecutive patients, were submitted to a TRUStru-cutBx to detect prostate cancer. Pain was assessed by purpose designed questionnaire. The questionnaire was self administered and patients subjectively assessed the pain intensity directly after the procedure and after next 1 and 12 hours.
The influence of six potential factors on pain intensity in 12 hours from TRUStru-cutBx was analyzed based on chi2 test. The following factors: age, prostate volume, cores number, previous biopsy and histopathological results were tested.
Results. Lack of pain or mild discomfort (0 and/or 1 VAS scale point) at 0, 1 and 12 hours were found respectively in 40%, 64% and 86% of the patients. Mild pain and/or intense pain (2 and/or 3 VAS scale points) were seen, at the designated time points, respectively in 56%, 34% and 14% and in 4%, 2% and 0% studied patients. Previous biopsy was found to be the only factor related to the increase in pain intensity felt at 12 hours post biopsy (p=0.043). The risk of complications related to the biopsy was very small. Mild hematuria, hematospermia or bleeding with the stool were found respectively in 30%, 4% and 40% of the studied group.
Conclusions. TRUStru-cutBx is a safe procedure. Repeated biopsy may be linked to increase in pain intensity therefore in patients referred for repeated biopsy additional anesthesia should be considered.

references

  1. Torp-Pedersen S, Lee F. Littrup et al: Tranrectal biopsy of the prostate guided with transrectal ultrasound: longitudinal and multiplanar scanning. Radiology 1989, 170 (1), 23-27.
  2. Słojewski M, Gołąb A, Gliniewicz B, Sikorski A: Miejscowe, celowane znieczulenie pęczków naczyniowo-nerwowych poprawia jakość życia chorych poddanych biopsji przezodbytniczej stercza. Urol Pol 2002, 1, 22-25.
  3. Irani J, Fournier F, Bon D et al: Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol 1997, 79 (4), 608-610.
  4. Clements R, Aideyan OU, Grofotis GJ, Peel WB: Side effects and patient acceptability of transrectal biopsy of the prostate. Clin Radiol 1993, 47, 125-126.
  5. Collins GN, Lloyd SN, Hehir M, McKelvie GB: Multiple transrectal ultrasound-guided prostatic biopsies-true morbidity and patient acceptance. Br J Urol 1993, 71 (4), 460-463.
  6. Wu CL, Carter HB, Naqibuddin M, Fleisher LA: Effect of local anesthetics on patient recovery after transrectal biopsy. Urology 2001, 57 (5), 925-929.
  7. Walker AE, Schelvan C, Rockall AG et al: Does pericapsular lignocaine reduce pain during transrectal ultrasonography guided biopsy of the prostate? BJU Int 2002, 90 (9), 883-886.
  8. Issa MM, Bux S, Chun T et al: A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience. J Urol 2000, 164 (2), 397-399.
  9. Desgrandchamps F, Meria P, Irani J et al: The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography-guided biopsy of the prostate: a prospective randomized placebo-controlled study. BJU Int 1999, 83 (9), 1007-1009.
  10. Antoniewicz AA: Jak poprawić jakość biopsji stercza? Rozdział w książce ,,Biopsja stercza\" pod red. AA Antoniewicza, TOP KURIER, Toruń, 2002, 73-81.
  11. Vaidy A, Soloway M: Periprostatic local anasthesia before ultrasound - guided proastate biopsy: an update of the Miami experience. Eur Urol 2001, 40, 135-138.
  12. Burzyński K: Gruczoł krokowy. Rozdział w książce ,,Diagnostyka ultrasonograficzna w urologii\" pod red. K. Burzyńskiego. Łódź 2003, 106-131.
  13. Zisman A, Leibovici D, Kleinmann J et al: The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol 2001, 165 (2), 445-454.
  14. Leibovici D, Zisman A, Siegel YI et al: Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study. J Urol 2002, 167 (2 Pt 1), 563-565.
  15. Galetti TP, Dal Moro F, Milani C: Patient\'s preparation in order to reduce pain, anxiety and complication of TRUS prostatic biopsies. Eur Urol Supp. 2002, 1 (6), 3-7.
  16. Hollabaugh RS Jr, Dmochowski RR, Steiner MS: Neuroanatomy of the male rhabdosphincter. Urology 1997, 49 (3), 426-434.
  17. Walker AE, Schelvan C, Rockall AG et al: Does pericapsular lignocaine reduce pain during transrectal ultrasonography-guided biopsy of the prostate? BJU Int 2002, 90 (9), 883-886.
  18. Klein EA, Zippe CD: Transrectal ultrasound guided prostate biopsy-defining a new standard. J Urol 2000, 163 (1), 179-180.
  19. Seymour H, Perry MJ, Lee-Elliot C et al: Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anaesthesia. BJU Int 2001, 88 (6), 540-544.
  20. Scott J, Huskisson EC: Graphic representation of pain. Pain 1976, 2 (2), 175-184.
  21. Jensen MP, Karoly P, Braver S: The measurement of clinical pain intensity: a comparison of six methods. Pain 1986, 27 (1), 117-126.
  22. Naughton CK, Ornstein DK, Smith DS, Catalona WJ: Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol 2000, 163 (1), 168-171.
  23. Chang SS, Alberts G, Wells N et al: Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol 2001, 166 (6), 2178-2180.
  24. Djavan B, Waldert M, Zlotta A et al: Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001, 166 (3), 856-860.
  25. Djavan B, Remzi M, Schulman CC, Marberger M: When and how a prostatic re-biopsy should be performed? Eur Urol Supp 2002, 1 (6), 52-59.
  26. Peyromaure M, Ravery V, Messas A et al: Pain and morbidity of an extensive prostate 10-biopsy protocol: a prospective study in 289 patients. J Urol 2002, 167 (1), 218-221.

correspondence

Roman Sosnowski
Klinika Nowotworów Układu Moczowego
ul. Roentgena 5
02-781 Warszawa
tel. 0 601 623 018
roman@is.com.pl