Local anesthesia before TRUS guided prostate biopsy: A retrospective evaluation of clinical efficacy, performance technical results and side effects on patients and image quality

Objectives:

1. To demonstrate the procedure of TRUS guided local anesthesia before performing prostate biopsy.

2. To study possible complications on patients and deterioration on image quality.

Methods: We compared retrospectively 8420 patients who underwent TRUS guided prostate biopsies performed following local periprostatic anesthesia (8–15 cc Xylocaine-2% Adrenaline transrectally-years 2000–2006, group A) to 10133 patients with TRUS guided biopsies performed without local anesthesia (1994–2005, group B). We studied the technique, its effects on patient comfort and tolerance time, quality of US image, patient complications (significant rectal hemorrhage/hematuria, infection/sepsis, urine retention) and number of specimens taken.

Results: Anesthesia group A patients tolerated the procedure better and for a longer period (17.5min) than non-anesthesia group B (11.6min). There was no significant difference between the number and severity of complications between the two groups (0.56% v 0.51%). There were no significant side effects caused by the infusion in the anesthesia group A patients. More biopsy specimens were obtained from group A in comparison to group B patients (25.2 v 14.3). Air bubbles were sometimes infused with the drug causing a “fuzzy“ image and minor difficulty in guiding the needle. However, a thorough TRUS examination prior to anesthesia helps in guiding the needle to the appropriate area, even through this artifact.

Conclusion: Although sometimes anesthesia compromises image quality, it diminishes pain and discomfort for patients and increases tolerance period and number of biopsy specimens.It does not alter the number of complications and improves patient cooperation.