title: Identification of the variables associated with pain during transrectal ultrasonography-guided prostate biopsy in the era of periprostatic nerve block: the role of transrectal probe configuration.
abstract: OBJECTIVE
  To identify the different factors that are associated with pain perceived during transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx), with special focus on the role of transrectal probe configuration.
  
  
  METHODS
  We analysed prospective data on 1114 patients undergoing TRUS-guided PBx at our institute from January 2007 to August 2010. Patients completed questionnaires based on a 10-point visual analogue pain scale related to the consecutive steps of PBx: probe insertion, application of periprostatic nerve block (PPNB) and the obtaining of PBx cores. The variables of interest were age, prostate volume, DRE findings, number of previous biopsies, probe type and the number of retrieved cores. All variables were correlated to pain scores using multivariate regression analysis.
  
  
  RESULTS
  At the probe insertion step, end-fire probes were more painful than side-fire probes. The Siemens G50 with metal, short plastic and long plastic needle guides (Siemens, Munich, Germany) had higher pain scores than the B&K probe (Bruel & Kjaer Medical, Copenhagen, Denmark; P = 0.09, 0.008 and 0.003, respectively). For pain at the PPNB application step, all G50(TM) guide subtypes and the Sonoline Prima probe (Siemens) had higher pain scores than the B&K probe, but this only reached statistical significance for the G50(TM) probe with short plastic guide (P = 0.03). On obtaining PBx cores, all G50(TM) subtypes had higher pain scores when compared with the B&K probe (P = 0.59, 0.38 and 0.69, respectively).
  
  
  CONCLUSIONS
  The probe design and needle guide affect pain during each step of TRUS-guided PBx. Both the B&K and Sonoline Prima probes caused less pain when compared with the G50(TM) probe, regardless of needle guide.
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors: Ayman S
authors: AS
authors: Moussa
authors: Ahmed
authors: A
authors: El-Shafei
authors: Ed
authors: E
authors: Diaz
authors: Tianming
authors: T
authors: Gao
authors: Osama M
authors: OM
authors: Zaytoun
authors: Khaled
authors: K
authors: Fareed
authors: James C
authors: JC
authors: Ulchaker
authors: J Stephen
authors: JS
authors: Jones
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods*; D011467:Prostate / Q000294:innervation*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012007:Rectum; D011795:Surveys and Questionnaires