Topical diltiazem before transrectal ultrasonography-guided biopsy of the prostate: a randomized controlled trial.
BACKGROUND
Injection of local anaesthetic agents around the prostatic nerve bundles during transrectal ultrasonography (TRUS) biopsy of the prostate has shown to reduce the pain associated with the procedure. It has been shown that some of the discomfort associated with the procedure is secondary to spasm of the anal sphincter. Topical diltiazem can relax the anal sphincter. Our aim was to evaluate the use of topical diltiazem cream as an adjunct to periprostatic nerve block in reducing pain associated with TRUS-guided prostatic biopsy.


METHODS
Between September 2009 and September 2010, 114 patients were enrolled in the trial (from two centres). Patients undergoing TRUS biopsy of prostate were randomized into diltiazem and placebo groups. Patients were asked to fill out a questionnaire at the end of the procedure. The questionnaire enquired about discomfort associated with various parts of the procedure using a 10-cm visual analogue scale (VAS).


RESULTS
For discomfort due to the presence of the probe, pain during the biopsy and overall pain prior to leaving the department, mean VAS was higher for the placebo group, but the difference was not statistically significant.


CONCLUSIONS
Diltiazem cream has a better side effect profile than glyceryl trinitrate cream and is better tolerated. Although we have demonstrated trends favouring diltiazem use as an adjunct to local anaesthetic in TRUS biopsy of the prostate, this did not reach a statistically significant level. The pain scores associated with TRUS biopsy in our cohort were lower than those in the published literature. This phenomenon might have contributed to the results observed in this trial.
Urology, Midcentral Health, Palmerston North, New Zealand.
Homayoun
H
Zargar
Urology, Waikato Hospital, Hamilton, New Zealand.
Daniel
D
Marshall
Statistics, AgResearch, Palmerston North, New Zealand.
Ganesh
G
Siva
Urology, Midcentral Health, Palmerston North, New Zealand.
Quinten
Q
King
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001706:Biopsy / Q000379:methods; D003131:Combined Modality Therapy; D004110:Diltiazem / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000779:Anesthetics, Local; D004110:Diltiazem
TRUS biopsy; anal spasm; diltiazem; pain