S29 Transrectal ultrasound-guided prostate biopsy, periprostatic local anesthesia and pain tolerance
We have evaluated objectively pain tolerance in transrectal ultrasound-guided prostate biopsy (TRUS) using local periprostatic per rectal anesthesia as compared to the conventional method. From November 2008 to May 2009, 90 patients underwent transrectal ultrasound-guided prostate biopsy at Department of Urology, Clinical Center University Sarajevo. 90 patients who fulfilled the inclusion criteria were randomized into 3 groups of 30 patients each. Group 1 received periprostatic local anesthesia with 2% lidocaine, group 2 received Voltaren supp placed in rectum an hour before biopsy while group 3 received no local anesthesia. Pain scale responses were analyzed for each aspect of the biopsy procedure with a visual analog scale of 0-none to 10-maximal. There was no difference between the 3 groups in pain scores during digital rectal examination, intrarectal injection and probe insertion. The mean pain scores during needle insertion in group 1 receiving periprostatic nerve block and in group 2 receiving Voltaren supp were 3,10 +/- 2,32 and 5,15 +/- 2,01 respectively. In group 3 (no local anesthesia), mean pain scores were 6,06 +/- 2,95 which was found to be significantly different (p < 0,001). However, morbidity after the biopsy was not statistically different between all 3 groups. TRUS-guided prostate biopsy is a traumatic and painful experience, but the periprostatic blockage use is clearly associated with more tolerance and patient comfort during the exam. It is an easy, safe, acceptable and reproducible technique and should be considered for all patients undergoing TRUS biopsy regardless of age or number of biopsies.
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ABSTRACT: To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) as a single non-invasive method in detecting prostate cancer (PCa) and to deduce its clinical utility. A systematic literature search was performed to identify relevant original studies. Quality of included studies was assessed by QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). Data were extracted to calculate sensitivity and specificity as well as running the test of heterogeneity and threshold effect. The summary receiver operating characteristic (SROC) curve was drawn and area under SROC curve (AUC) served as a determination of the diagnostic performance of DWI for the detection of PCa. A total of 21 studies were included, with 27 subsets of data available for analysis. The pooled sensitivity and specificity with corresponding 95 % confidence interval (CI) were 0.62 (95 % CI 0.61-0.64) and 0.90 (95 % CI 0.89-0.90), respectively. Pooled positive likelihood ratio and negative likelihood ratio were 5.83 (95 % CI 4.61-7.37) and 0.30 (95 % CI 0.23-0.39), respectively. The AUC was 0.8991. Significant heterogeneity was observed. There was no notable publication bias. DWI is an informative MRI modality in detecting PCa and shows moderately high diagnostic accuracy. General clinical application was limited because of the absence of standardized DW-MRI techniques. aEuro cent DWI provides incremental information for the detection and evaluation of PCa aEuro cent DWI has moderately high diagnostic accuracy in detecting PCa aEuro cent Patient condition, imaging protocols and study design positively influence diagnostic performance aEuro cent General clinical application requires optimization of image acquisition and interpretation.
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To examine whether or not the combination of diclofenac suppository with peri-prostatic nerve block (PPNB) was effective in reducing the degree of pain experienced during transrectal ultrasound (TRUS)-guided prostate biopsy in a randomised single-blind placebo-controlled trial.Patients and Methods
In all, 96 patients having a planned TRUS-guided prostate biopsy were randomised into one of the following arms on a 1:1 basis: 10 mL 1% lignocaine PPNB and placebo suppository (control) or 10 mL 1% lignocaine PPNB and 100 mg diclofenac suppository (treatment). Pain scores were recorded using the Numerical Rating Scale for pain (0–10) at the following time-points: (i) introduction of probe, (ii) during biopsy, (iii) 1 h after biopsy, (iv) later that evening (≈6 h after biopsy) and (v) 1 day after biopsy. Patients were asked about their preferred method for pain control if a repeat TRUS-guided prostate biopsy was required: local anaesthetic (LA) again or intravenous sedation.ResultsThere were no significant differences in age (P = 0.653) or PSA level (P = 0.584) between either study arm. The differences in pain scores between the control and treatment groups were not significant at Time 1 (probe insertion; P = 0.299), Time 2 (biopsy; P = 0.983), Time 4 (evening after; P = 0.231) and Time 5 (1 day after biopsy; P = 0.384). At Time 3 (1 h after biopsy), the control pain scale scores were statistically significantly higher than the treatment pain scale scores (P = 0.044). There was no difference between treatment (87%) and control (80%) groups as to whether they would prefer to repeat the biopsy under LA (P = 0.373).Conclusion
The use of a diclofenac suppository with PPNB did not show any clinically meaningful effect in decreasing pain or improving tolerability of TRUS-guided prostate biopsy and is not recommended. PPNB TRUS-guided biopsy is extremely well tolerated, with >80% of patients electing for subsequent LA biopsy if required.
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