title: How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature.
abstract: OBJECTIVE
  There is growing interest among urologists on the need for decreasing pain during transrectal ultrasound (TRUS) guided prostate biopsy.
  
  
  METHODS
  We performed a systematic MEDLINE search of clinical trials of any kind of anesthesia, analgesia or sedation during TRUS guided prostate biopsy published since 2000. We critically analyzed the impact of pain and discomfort associated with the procedure, the described methods for evaluating it and the different techniques that have been described.
  
  
  RESULTS
  There is strong evidence in the current literature that patient tolerance and comfort during TRUS guided prostate biopsy can be improved by anesthesia/analgesia. What remains is the need to urge all urologists to introduce it in clinical practice as a routine part of the procedure, whatever the biopsy scheme.
  
  
  CONCLUSIONS
  Of the various options periprostatic anesthetic infiltration has been shown to be safe, easy to perform and highly effective. It should be considered the gold standard at the moment, even if the optimal technique remains to be established. Further studies addressing this issue are warranted.
authors.affiliation: Urology Clinic, Second University, Department of Oncology, Federico II University, Vico Santo Spirito 54, 80132 Naples, Italy. ricautor@tin.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.forename: Sisto
authors.initials: S
authors.lastname: Perdonà
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Massimo
authors.initials: M
authors.lastname: D'Armiento
mesh_terms: D000777:Anesthetics / Q000008:administration & dosage*; D001340:Autonomic Nerve Block; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D002986:Clinical Trials as Topic; D005782:Gels; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D018084:Ultrasonography, Interventional
chemical_list: D000777:Anesthetics; D005782:Gels