[Tolerability and complications of the ultrasound guided transrectal biopsy of the prostate extended to 10 cores. The role of neurovascular bundle blockage with lidocaine].
OBJECTIVE
The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles.


METHODS
A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events.


RESULTS
The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0.0002). The results of the visual analogical scale for pain were 2.46 +/- 1.67 and 4.5 +/- 2.11 for the anesthesia/without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission.


CONCLUSIONS
The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.
Unidad de Ecografía, Universidad de Alcalá de Henares, Madrid, España. rafael.rodriguez-patron@wanadoo.es
Rafael R
RR
Rodríguez-Patrón Rodríguez
Teodoro
T
Mayayo Dehesa
Francisco Javier
FJ
Burgos Revilla
Mónica
M
Alonso González
Ricardo
R
García González
Alberto
A
Lennie Zucharino
D000779:Anesthetics, Local / Q000627:therapeutic use*; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D009407:Nerve Block; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D011795:Surveys and Questionnaires; D014463:Ultrasonography
D000779:Anesthetics, Local; D008012:Lidocaine