‘Multimodal’ approach to management of prostate �biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodium – a �prospective randomized trial

Abstract

We assessed the analgesic efficacy of levobupivacaine when administered as an adjuvant to diclofenac sodium in prostate biopsy pain management and effects of prostate biopsy on sexual function. Ninety patients underwent transrectal ultrasound (TRUS)-guided biopsy of the prostate and were randomly assigned to three groups: group D received diclofenac sodium suppository; Group L received periprostatic injection of levobupivacaine; group DL received diclofenac suppository and levobupivacaine in addition. Patients were asked to use a visual analogue scale score (VAS) questionnaire about pain after 10 core prostate biopsy. Sixty-two patients reported to be prostate cancer-free underwent further evaluation with the International Index of Erectile Function-5 (IIEF-5) questionnaire at 1 and 3 months after biopsy. Mean pain scores during prostate biopsy were significantly lower in group DL and were superior to the group L and group D (P < 0.001). Mean IIEF-5 score prior to biopsies was significantly higher when compared with the mean IIEF-5 score 1 month after biopsy (P < 0.0001). Mean IIEF-5 scores 1 month after biopsy were significantly lower when compared with the mean IIEF-5 scores 3 months after biopsy (P = 0.002). TRUS-guided prostate biopsies have a statistically significant impact on short-term erectile function, but this difference is not clinically significant; however, medium-term erectile function is not affected both statistically and clinically.

A prospective study of erectile function after transrectal ultrasonography‐guided prostate biopsy

“…When evaluating LUTS with the IPSS (mild, total score 0-7; moderate, [8][9][10][11][12][13][14][15][16][17][18][19]; and severe, 20-35) at baseline compared with the other time-points, similar results were found. The mean IPSS at baseline was 10.2.…”

“…The IPSS classified LUTS into three categories: mild, total score 0-7; moderate, [8][9][10][11][12][13][14][15][16][17][18][19]; and severe, 20-35. Based on the IIEF-5, ED was classified into five categories: severe, total score 5-7; moderate, 8-11; mild-to-moderate, 12-16; mild, 17-21; and no ED or normal erectile function, 22-25.…”

Prospective evaluation of the safety of transrectal ultrasound-guided transperineal prostate biopsy based on adverse events

“…Despite the variation in the rate of pre-biopsy ED, several studies reported statistically significant changes in the rates of mild-to-severe ED 1 month after biopsy. However, after follow-up, these changes reverted to baseline [25][26][27].…”

Evaluation of Erectile Dysfunction and Risk Factors After Prostate Biopsy

“…Periprostatik sinir bloğunun nörovasküler demette yarattığı hematom, ödem nedeniyle daha fazla erektil fonksiyon kaybı yarattığı görüşü diğer prospektif çalışmalarla desteklenmemiştir (4,8,9). Diğer bir çalışma ağrı skorunun daha az olmasının erektil fonksiyondaki değişime etkisi olmadığını yayınlamıştır (10). Bizim çalışmamızda anestezi yöntemi olarak transrektal %2 lidokain jel masajı yapılmış olup hastaların VAS derecesi ile IIEF-5 skor değişikliği arasında anlamlı ilişki bulunamamıştır (p>0.05).…”