Is periprostatic local anesthesia for transrectal ultrasound guided prostate biopsy associated with increased infectious or hemorrhagic complications? A prospective randomized trial.
OBJECTIVE
Periprostatic local anesthesia for prostate biopsy requires 2 or more extra needle punctures and injection of the local anesthetic through the highly colonized rectum. To our knowledge we report the first prospective randomized trial to assess the infectious or hemorrhagic complications associated with this method.


METHODS
A total of 100 consecutive patients with sterile urine cultures underwent transrectal ultrasound guided prostate biopsy. They were randomized to receive a periprostatic nerve block or no anesthesia. Patients were evaluated for the amount of rectal and urethral bleeding, and symptoms and signs of infection after biopsy.


RESULTS
The amount of urethral bleeding was slight and similar in the 2 groups. Rectal bleeding was significantly less in the patients who received anesthesia. High fever (greater than 37.8C) was more frequent in the nerve block group and 2 patients in this group required rehospitalization. Bacteriuria in post-biopsy urine cultures was significantly more common in the anesthesia group.


CONCLUSIONS
Our results suggest that periprostatic local anesthesia for prostate biopsy does not increase the risk of urethral bleeding. It is associated with a decreased incidence of rectal bleeding, presumably due to decreased patient discomfort. The incidence of bacteriuria was significantly higher in the anesthesia group. High fever and hospitalization due to infectious complications were also more common in the local anesthesia group, although not statistically significant. Prospective randomized trials seem warranted to determine the optimum antibiotic prophylaxis regimen in patients undergoing biopsy with a periprostatic nerve block.
Obek
Can
C
Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey.
Onal
Bülent
B
Ozkan
Burak
B
Onder
Ali U
AU
Yalçin
Veli
V
Solok
Vural
V
D000368:Aged; D000772:Anesthesia, Local; D019072:Antibiotic Prophylaxis; D001437:Bacteriuria / Q000209:etiology*; D001707:Biopsy, Needle; D019160:Endosonography; D005335:Fever of Unknown Origin / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011467:Prostate / Q000473:pathology*; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008012:Lidocaine