OBJECTIVETo assess the clinical efficacy and safety of three different methods of anesthesia during transrectal ultrasound guided prostate biopsy.

METHODSFrom July 2006 to October 2008, a total of 120 patients who underwent 12-core prostate biopsy with transrectal ultrasound guidance because of elevated prostate specific antigen and/or abnormal digital rectal examination were randomized into 4 groups, each group consisted of 30 patients. Group A received no anesthesia. Group B received an injection of 10 ml dose of 1% lidocaine (5 ml per side) into the region of the prostatic vascular pedicle at the prostate base just lateral to the junction between the seminal vesicle and prostate on each side for periprostatic nerve block (PNB). Group C received intrarectal lidocaine gel plus PNB. Group D received an injection of 4 ml dose of 1% lidocaine (2 ml per side) into 2 sites of the right and left sides of prostate for intraprostatic anesthesia plus PNB. The efficiency of anesthesia was assessed by a visual analog pain scale (VAS). All patients were followed up within one week for the evaluation of complications.

RESULTSThe combination of intraprostatic anesthesia and PNB provided significantly better pain control than PNB alone. According to VAS, only group C (2.7 +/- 1.1) scores showed significantly better pain control than other groups (P < 0.05) during probe insertion, and only group D (3.9 +/- 1.3) scores showed significantly better pain control than other groups (P < 0.05) during biopsy. No difference was observed regarding the complications rate in the 4 groups (P > 0.05).

CONCLUSIONSCombination of intraprostatic anesthesia and PNB is effective and safe technique during transrectal ultrasound guided prostate biopsy without increasing the incidence of complications. PNB or PNB plus intrarectal lidocaine gel couldn't significantly reduce pain during biopsy.