Can pain during digital rectal examination help us to decide the necessity and the method of anesthesia for transrectal ultrasound guided prostate needle biopsy?

Abstract

Objective: Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. Materials and Methods: 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. Results: DRE pain was related to both probe pain and biopsy pain. Conclusion: Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results

“…In their study, in which all patients were positioned in modified lithotomy, 61% reported moderate to unbearable pain, and 22% reported moderate to unbearable urinary urgency or urge to defecate during DRE (9). Using a VAS, Furlan et al reported a mean pain score of 1.68 for DRE in supine position (6), and Kaygisiz et al found a mean pain score of 2.59 in left lateral position (10). In our study, mean and median pain scores were respectively 4.63 and 5.00 ± 2.3 for the entire cohort, similar among the different positions evaluated.…”

Acceptance of repeat transrectal ultrasonography guided prostate biopsies with local anaesthesia

“…Also the highest pain score for the present cohort was for probe insertion. An association between reporting significant discomfort with DRE and subsequently being unable to tolerate TRUSPB under LA has been reported previously [18,19]. This suggests that another simpler way of ‘screening out’ candidates before a TRUSPB may be to identify those who find DRE particularly uncomfortable.…”

Procedural sedation and analgesia as an adjunct to periprostatic nerve block for prostate biopsy: A prospective randomized trial

“…PNB may still be the best option for the majority of cases, although PSAA+PNB might be a better option for some others. It has already been shown that one may predict the level of pain the patient will experience from the biopsy by using simple measurements such as a modified submaximal tourniquet test or pain during prostate examination . Those tests might be supplemented with others and enriched with tools for establishing anxiety level, a factor known to elevate pain .…”