Complications and limitations related to periprostatic local anesthesia before TRUS-guided prostate biopsy.
OBJECTIVE
To assess the frequency of complications specifically related to local anesthetic infiltration prior to transrectal ultrasound (TRUS)-guided prostate biopsy.


METHODS
A total of 200 patients receiving 10 cm(3) (5 cm(3) on each side) of 2% lidocaine injected around the periprostatic nerve plexus under TRUS guidance before prostate biopsy were included. Various complications presumed to be associated with local anesthesia were noted during and after the biopsy procedure. Two weeks later, periprostatic tissue integrity and vascularization were re-examined with TRUS Doppler examination to assess for fibrosis or infection.


RESULTS
The most common finding was pain due to puncture with the needle used for local anesthesia (27%). Also recorded were the need for repeated injections during the biopsy procedure (4.5%), symptoms associated with systemic lidocaine toxicity (2%), urinary incontinence (1.5%), and degradation of the image resolution due to anesthetic injection (1%). Increased vascularization within the periprostatic region was uncommon (2%) on the 2-week follow-up examination. No TRUS finding consistent with rectal wall hematoma or other periprostatic change and no erectile dysfunction associated with the procedure occurred. There was a significant difference in overall pain scores between the subgroups of patients (p < 0.001).


CONCLUSIONS
TRUS-guided periprostatic nerve blockade is an effective method for relieving discomfort from prostate biopsy with very few complications.
Department of Radiology, Ankara Training and Research Hospital, Ankara 06590, Turkey.
Ahmet T
AT
Turgut
Esin
E
Olçücüoğlu
Pinar
P
Koşar
Pinar Ozdemir
PO
Geyik
Uğur
U
Koşar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001706:Biopsy / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*
D000779:Anesthetics, Local