A prospective study of transperineal prostatic block for transurethral needle ablation for benign prostatic hyperplasia: The Emory University experience

Purpose: We evaluate the feasibility, effectiveness and role of transperine al prostate block in providing anesthesia during minimally invasive radio f requency thermal therapy of the prostate. Materials and Methods: A total of 38 consecutive patients undergoing transu rethral needle ablation for symptomatic benign prostatic hyperplasia were e ntered in this prospective study. All patients received transperineal prost atic block as the main method of anesthesia. A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concen tration ratio) was used. Pain control during the instillation of transperin eal prostatic block and transurethral needle ablation was assessed using a 10-point linear analog pain scale and questionnaire. Results: Median patient age was 65.5 years (range 47 to 79), with 21% of me n in the eighth decade of life. Median American Urological Association symp tom score was 25.0 (range 14 to 35), bother score was 20.0 (11 to 28), qual ity of life score was 4.0 (3 to 6) and peak urinary flow rate was 8.9 cc pe r second (3.5 to 15.7). Median sonographic prostate volume was 35.0 cc (ran ge 17 to 129). Median volume of anesthetic agent used was 40.0 cc (range 30 to 60) per case (1.1 cc solution per 1 cc prostate tissue). No adverse eve nts were encountered. Median pain score was 3.3 (range 1 to 6) during insti llation of transperineal prostatic block and 1.0 (0 to 6) during transureth ral needle ablation. Transperineal prostatic block proved highly effective and was a satisfactory method of anesthesia during transurethral needle abl ation as judged by postoperative questionnaire. No sedation, narcotic or an algesia was required. All procedures were performed in the outpatient cysto scopy suite or office setting without support of an anesthesia team or cons cious sedation monitoring. Conclusions: Transperineal prostatic block is a safe, convenient, effective and satisfactory method of minimally invasive anesthesia for transurethral needle ablation of the prostate in an outpatient office setting. Elderly p atients and those at high surgical risk can be treated safely using this ap proach. Considerable cost saving is seen secondary to omission of charges r elated to anesthesia team support, recovery room facility and conscious sed ation monitoring.