Intrarectal ice application prior to transrectal prostate biopsy: a prospective randomised trial accessing pain and collateral effects

Abstract

Objectives To analyze the efficacy of intrarectal ice application as an anesthetic method prior to transrectal ultrasound (TRUS) guided prostate biopsy.Materials and Methods A total of 120 consecutive men were included into the study prospectively. Patients were equally randomized as group 1 and 2 with 60 patients each. Ice was applied as an anesthetic method 5 minutes before procedure to the patients in group 1. Patients in group 2 were applied 10 ml of 2% lidocaine gel 10 minutes before procedure. Twelve core biopsy procedure was performed for all patients. The pain level was evaluated using a visual analogue scale (VAS).Results Median pain score was 3.5 (1-8) in group 1 and 5 (1-8) in group 2. There is significantly difference between groups regarding the mean sense of pain level during the procedure. (p=0.007) There was also no difference in complications between two groups about presence and duration of macroscopic hematuria and rectal bleeding.Conclusions Intrarectal ice application prior to TRUS prostate biopsy has an effect on reducing pain. Development of new techniques about cold effect or ice can make this method more useful and decrease complication rates.

Prostate Biopsy: Which Technique for Which Results at Lomé University Hospital in 2017?

“…Perineal infiltration of xylocaine combined with periprostatic infiltration would not be sufficient in the transperineal approach, and authors reported that for this pathway the best options would be pudendal block, caudal block or spinal anesthesia [16] [17]. The use of intra rectal ice has been tested by some teams with benefits on the perception of pain [18] [19]. The maneuver was perceived as very painful in our series.…”

What should be done to minimize pain without any sexual function deterioration in the transrectal prostate biopsy ?

“…Thus, it is extremely important to provide analgesia/anesthesia during TRUS-Bx for the comfort of the patient and being able to produce multiple biopsies during the operation. Methods such as intrarectal ice application, intrarectal lidocaine gel instillation, oral or rectal non-steroidal anti-inflammatory drugs, sedation and general anesthesia, and periprostatic nerve block (PNB) were used for anesthesia [ 9 , 10 , 15 ].…”