Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anaesthesia

Objective To prospectively evaluate the efficacy and safety of periprostati c local anaesthesia (LA) during prostatic biopsy guided by transrectal ultr asonography (TRUS), as 20-65% of men report moderate to severe pain, and th ere is anecdotal and published evidence that periprostatic anaesthesia impr oves patients' tolerance. Patients and methods In all, 157 patients were prospectively recruited and sequentially randomized to receive either LA or no anaesthesia. Sextant bio psies were taken in all men but some had more than six biopsies. All were a sked to complete questionnaires immediately after TRUS-guided biopsy and fo r the subsequent week, giving pain scores and recording any morbidity, incl uding symptoms of infection; analgesic use was also surveyed. Results Patients given LA had significantly lower pain scores at the time o f biopsy than those given no anaesthesia, with median (SD) pain scores of 1 .53 (0.7) and 1.95 (0.65) (P<0.001), respectively. In addition, there was a trend towards less analgesic use by those given LA, although this was not statistically significant. There was no difference in the amount of haematu ria, haematochezia or haematospermia, or infection rate, between the groups . The additional cost and time of the procedure was minimal (<pound>3.00 an d 3 min/per patient, respectively). Conclusion Periprostatic LA infiltration is a quick and simple procedure wh ich significantly improves immediate pain with no added morbidity; we stron gly advocate its use to improve patient tolerance of TRUS-guided prostate b iopsy.