Transrectal ultrasound (Trus) Biopsy of the prostate
In this paper, we aimed to Entschlüsselungs Prostata TRUS the efficacy of three different anesthesia techniques applied in 90 cases of which transrectal ultrasound TRUS -guided prostate biopsies were taken.
Between February and JulyTRUS-guided 16 core biopsies were taken from 90 patients who comply the study criteria. Patients were randomly divided into three groups each of which consists of 30 individuals. Group 1: Was applied periprostatic block anesthesia; Group 2: Was administered intrarectal lidocaine gel; Group 3: Was applied pudendal block.
Visual analog scale VAS of patients in groups was evaluated. There was no statistically significant difference between the mean ages, prostate-specific antigen values of three groups. In Groups 1 and 2, the difference between VASs was significant. Enabling pain and discomfort control in patients is very important during TRUS-guided prostate biopsy.
In our study, we observed that the periprostatic block enables more comfortable compared with patient groups with intrarectal lidocaine gel and pudendal block and better reduction in pain scores. Transrectal ultrasound TRUS -guided prostate biopsy is the golden standard used in the diagnosis of prostate cancer.
Although, prostate biopsies were carried out by finger-guided transperineal way in s Entschlüsselungs Prostata TRUS defined for the first time, then it was started to be performed by transrectal way defined by Astraldi. Today anesthesia administration during prostate biopsy is compulsory. Although there is no consensus about anesthesia to be applied, essentially the pain to be felt by patient must to be reduced.
Ninety cases with a suspicion of prostate cancer, where TRUS-guided prostate biopsy was applied between February and Julywere included Entschlüsselungs Prostata TRUS the study. Patients were randomly divided in groups of Group 3: Pudendal block group; pudendal nerve block was applied for the pudendal nerve between the sacrospinous ligament and the sacrotuberous ligament to the inferiomedial inside Alcock's canal.
Following draping after appropriate monitorization and local antisepsis and sterilization of the targeted region were provided, the fascia between the sacrotuberous and sacrospinous ligaments was entered from the gluteal region by 14 cm 22 G spinal needle by starting on the middle line via ultrasound, while patient is lying in the prone position. Sixteen core biopsies were taken from patients in each group 10 min after anesthetic procedure.
Those from whom TRUS-guided prostate biopsy was taken previously, who have bleeding diathesis or receive anticoagulant therapy, who have anus and rectum's painful conditions such as hemorrhoid, anal fissure, or stricture, who have neurologic conditions such Entschlüsselungs Prostata TRUS acute prostatitis and lower extremity paraplegia where the sensation of pain is reduced or does not exist, and patient using analgesics or narcotic drug were excluded from the Entschlüsselungs Prostata TRUS.
One day before and for 4 days after biopsy procedure, mg ciprofloxacin was given to all patients orally 2 times a day. Fleet enema was applied to all patients intrarectally before biopsy for intestinal cleansing. In order to prevent a false Entschlüsselungs Prostata TRUS rating, the beat sound of the biopsy device Entschlüsselungs Prostata TRUS made listened to patients Entschlüsselungs Prostata TRUS the procedure, and it Entschlüsselungs Prostata TRUS expressed not to take any notice of this sound.
All biopsies were taken from the same Entschlüsselungs Prostata TRUS and biopsy form, pain scales were filled by the same physician. Pain expectation of patients increases the amount of pain felt during the procedure and ultimately a Entschlüsselungs Prostata TRUS cycle where anxiety and pain increase each other mutually occurs. The pain level was scored between 1 and Entschlüsselungs Prostata TRUS analog scale is used to make some values numeric, which are unable to measure numerically.
Two end definitions of the parameter to Entschlüsselungs Prostata TRUS evaluated are written on two ends of a mm line and patient is wanted to specify that where itself status is matched by making a dot, indicating, or lining. For example, no pain is written on the end for pain, very severe pain is written on the other end and patient marks its status at that moment on this line VAS. The length of the distance from the site where no pain is present to the site where patient marked Entschlüsselungs Prostata TRUS pain of the patient.
After patients were given a right upper lateral position, 6. After the probe was had inserted rectally, prostate was imaged in sagittal and transverse plane and prostate volume was calculated by ellipsoid formulation Entschlüsselungs Prostata TRUS ultrasound device. Using full automatic 25 cm 18 G biopsy needle, standard 16 core biopsies were taken from each patient. Vital signs of the patients were observed for approximately 1 h after the procedure. All patients included into the study were informed about TRUS-guided prostate biopsy and its complications and their informed consent form were Entschlüsselungs Prostata TRUS for the procedure.
The conformity of data to a normal distribution was tested; Student's t -test, one-way variance analysis, repeated measures analysis were used in the analysis of continuous variables with the normal distribution, Mann—Whitney U-test, Kruskal—Wallis test, and Friedman test were used in the analysis of continuous variables without normal distribution.
Chi-square test was used in the analysis of categorical variables. The cases where P value is found lower than 0.
In Group 1, Group 2, and Group 3, the mean age of patients included into the study was The mean age in all groups was The mean body mass index of patients in Group 1, Group 2, and Group 3 was The mean body mass index in all groups was Serum TPSA level in all groups was The mean serum FPSA level in all groups was 2.
Total TRUS prostate volume Entschlüsselungs Prostata TRUS The mean maximal urine flow rate of patients in Group 1, Group 2, and Group 3 was The mean maximal urine flow rate in all groups was The mean urine flow rate of patients in Group 1, Group 2, and Group 3 was 9. The mean urine flow rate in all groups was Entschlüsselungs Prostata TRUS. When pathology results of patients were examined, it was observed that there are three different results Entschlüsselungs Prostata TRUS adenocarcinoma, benign prostatic Entschlüsselungs Prostata TRUS, and chronic prostatitis.
The mean VAS in all groups was 1. A statistically significant difference was determined in terms of VAS between three groups. The VAS values were separately compared between three groups. No complication required for hospitalization occurred in Entschlüsselungs Prostata TRUS patient. Transient hypotension developed in four cases where pudendal block was performed.
Transrectal ultrasound-guided prostate biopsy is the golden standard for diagnosing patients with a suspicion of cancer. Defining sextant biopsy performed by TRUS and developing of many other biopsy techniques in under the Entschlüsselungs Prostata TRUS of this method became a crucial stage in establishing histopathological diagnosis.
Directly making the biopsy procedure without applying any anesthesia method or analgesic causes pain and discomfort in patients for diagnosing the Entschlüsselungs Prostata TRUS frequently seen Entschlüsselungs Prostata TRUS cancer among urologic cancers. Pain occurs especially during inserting the probe into anal Entschlüsselungs Prostata TRUS, during taking biopsy with needle and movement of the probe.
An analgesic or anesthetic method is applied in order to increase patient cooperative and comfort during the procedure, to reduce pain and to relieve the procedure.
There are many different approaches used for that purpose. There is no consensus yet about method among clinics that will apply. Patient's susceptibility to pain, present pathologies particularly anorectal diseases, past medical history, undergone biopsy experience, sociocultural level, and mood state before the procedure are some of factors arising from patient in pain perception.
The intensity of the number of patient in Entschlüsselungs Prostata TRUS and the preference of individuals who will make biopsy are Entschlüsselungs Prostata TRUS factors affecting the method to be preferred in background for the method to be applied. In our study, we compared the efficacy of periprostatic blockage, intrarectal lidocaine gel, and pudendal block methods commonly applied to patients before the procedure on reducing pain.
We used VAS to healthily determine the level of pain felt by patient and to reveal the efficacy of the anesthesia method applied. Desgrandchamps et al. In both studies, intrarectal lidocaine gel application alone was reported not to provide statistically significant analgesia compared to ultrasonographic gel application. Issa et al.
In the study performed by Raber et al. In the study performed by Cevik et al. These patients were compared with those in whom periprostatic block was performed; pain scores of the group where intrarectal gel was applied were found higher.
Periprostatic nerve blockage was firstly defined by Nash et al. The injection to this area Entschlüsselungs Prostata TRUS nerve fibers in the prostate pedicle. Authors found that pain ratings in cases where unilateral prostatic nerve blockage is performed were significantly lower in the side injected than the side not injected.
In the yearSoloway and Öbek emphasized that anesthesia or analgesia is needed during biopsy procedure. It was reported that pain felt during the procedure is reduced in all of patients and that no important complication was seen in patients apart from one patient. Various modifications of local anesthetic infiltration were made in a way to be applied three separate points including the right, left, and apex or the apex alone; the studies revealing that these methods also are effective showed that periprostatic nerve blockage applied around prostate is effective at every localization.
In our study, we applied the infiltration in periprostatic nerve blockage between prostate base and seminal vesicle to the region where both right-left neurovascular bundles are present, where nerves do not branch yet after inserting TRUS probe. Pain scores of patients during taking biopsy with needle were recorded and compared with pudendal block and intrarectal gel group.
Pain scores in the group where periprostatic nerve blockage was applied were statistically significantly low compared to the group where intrarectal gel was applied. When those in whom intrarectal gel and pudendal block were applied were compared, it was determined that there was no statistically significant difference.
Pain scores between cases where periprostatic block was applied and pudendal block was performed were statistically significant. A transient hypotension occurred in four cases where we pudendal block applied. However, patients were followed-up out-patiently without hospitalizing.
Other than this, no serious complication occurred. Our results also are compatible with numerous studies in the literature. It was determined that TRUS-guided prostate biopsy performed by applying periprostatic blockage was easily tolerated by patients and Entschlüsselungs Prostata TRUS the level of pain was prominently reduced.
In another study performed by Obek et al. Furthermore, periprostatic blockage along with intrarectal gel was reported to provide the best analgesia. No serious complication requiring hospitalization was seen in any of patients. Similarly the superiority of intrarectal gel application along with periprostatic blockage to placebo was shown in a great number of studies. Alavi et al. Pain was determined to be significantly lower in the group where lidocaine injection and periprostatic blockage.
No any complication was reported in patients other than 2 patients developing prostatitis and receiving antibiotic therapy at hospital. In the study performed by Mallick et al. Pain was determined to be low in the group where periprostatic blockage was performed during biopsy. As a result, they suggested intrarectal gel application along with periprostatic blockage. Due to anesthesia method, no serious complication was seen in any patient. The superiority of the intrarectal gel group to the patient group where analgesia was not applied was shown in the literature.