Acceptance of repeat transrectal ultrasonography guided prostate biopsies with local anaesthesia

Abstract

OBJECTIVE • To measure patient discomfort associated with transrectal ultrasonography guided prostate biopsy (TRUSPB) performed with periprostatic local anaesthetic (LA) infiltration and to document agreement to possible repeat biopsy, as a recent audit showed that 86% of Australian urologists performed prostate biopsies using sedation or general anaesthesia (GA), which implies many urologists think patients are unwilling to tolerate the procedure under LA block and/or may refuse a repeat procedure. PATIENTS AND METHODS • This was a prospective cohort study following all men undergoing TRUSPB in 2008. • Immediately after the procedure the men were asked to complete a visual analogue pain score. • They were then asked whether, if it was necessary to have a repeat biopsy, they would agree to LA again or request GA/sedation. RESULTS • In all, 476 men participated in the study with a mean age of 64 years. • Of these, 464 men (97.5%) tolerated the procedure well and would, if required, agree to repeat biopsy with LA. • Only 12 men (2.5%) indicated they would request GA/sedation if a repeat biopsy was necessary. CONCLUSION • The vast majority of men accepted having prostate biopsy with LA infiltration and therefore this should be the first method offered. • It may be possible to screen for men who would not tolerate biopsy under LA. • Resource saving by performing most biopsies under LA can be estimated to be >A$10 million annually.

Safety of Staged Interpolation Flaps After Mohs Micrographic Surgery in an Outpatient Setting: A Single-Center Experience

“…39 In a prospective study of patients who had previously undergone transrectal prostate biopsy with general anesthesia and had a repeat biopsy performed with local anesthesia, 98% would agree to local anesthesia for any future biopsies. 36 Although our study design precludes a systematic, formal assessment of patient attitudes toward interpolated flap repair performed under local anesthesia, our experience suggests that patients tolerate this procedure well in these settings.…”

“…A comparison of inguinal hernia repair under local or general anesthesia showed that patients receiving local anesthesia experienced significantly lower postoperative analgesic requirements, lower incidence of urinary retention, shorter duration of hospital stay, and greater satisfaction . In a prospective study of patients who had previously undergone transrectal prostate biopsy with general anesthesia and had a repeat biopsy performed with local anesthesia, 98% would agree to local anesthesia for any future biopsies . Although our study design precludes a systematic, formal assessment of patient attitudes toward interpolated flap repair performed under local anesthesia, our experience suggests that patients tolerate this procedure well in these settings.…”

Penthrox alone versus Penthrox plus periprostatic infiltration of local analgesia for analgesia in transrectal ultrasound‐guided prostate biopsy

“…Our previous feasibility study examining Penthrox for TRUS biopsy found that the cost of anaesthetic staff alone for a single TRUS‐guided biopsy at The Alfred Hospital in Melbourne in 2011 was A$421 . The cost of anaesthetic staff for the same procedure in Sydney has been calculated to be about A$399 . In contrast, the Penthrox inhaler costs A$39 per unit and 2% lignocaine for injection is less than A$0.50 per millilitre.…”

Combination of Tramadol and Lidocaine for Pain Control During Transrectal Ultrasound-guided Prostate Biopsy: A Randomized Double-blinded Study

“…They reported that the patients tolerated the procedure very well, and 97.5% of the patients stated that they would accept this method again if another PBx was required. 23 Even rare, there may be hemorrhagic and infectious complications after the PPNB, as is the case for patients who do not have PPNB. Some authors reported bacteriuria, fever, and complications requiring hospitalization after the anesthetic injection.…”