title: The importance of anatomical region of local anesthesia for prostate biopsy; a randomized clinical trial.
abstract: BACKGROUND
  In our study, the efficiency and reliability of lidocaine (1 cc/1%) application during transrectal ultrasound-guided (TRUS) prostate biopsy to levatores prostate was studied. Levatores prostate was visualized on a cadaver dissection previously.
  
  
  METHODS
  Eighty outpatients with lower urinary tract complaints or were suspected clinically to have prostate cancer were submitted to TRUS-guided prostate biopsy. The ages of outpatients were ranging from 45 to 81. Patients were randomized in 2 groups: Group-I, with 40 patients submitted to local anesthesia by periprostatic injection of 1 cc 1% lidocaine before biopsy; and group-II, with 40 controls the biopsy was performed without local anesthesia. The anatomical region for anesthesia was determined via dissection. The name of this anatomical region is levatores prostatae and it has got high nerve density. The process was explained to the patients and their approvals were obtained. Levatores prostatae was detected with TRUS before biopsy. Pain; related to digital rectal examination (DRE), probe insertion or biopsy, was scored via visual analog scale (VAS). The patients were evaluated about side effects of lidocaine and early and late complications of biopsy as well.
  
  
  RESULTS
  Both groups were similar in terms of mean age, PSA levels, prostate volume and VAS scores (p > 0.05). As for VAS score, on the group submitted to anesthesia was determined 2.34 ± 1.08, while for VAS score on the group submitted conventional biopsy was determined 5.8 ± 1.6. Between two groups, there was a statistical difference in terms of VSA score (p < 0.05); but there was no statistical difference about early and late complications of biopsy.
  
  
  CONCLUSIONS
  The periprostatic blockage use is clearly associated with more tolerance and patient comfort during TRUS-guided biopsy. Owing to the local anesthesia introduced to the periprostatic nerve bundle localization in levatores prostate area, the patients could tolerate the pain better.
authors.affiliation: Department of Urology, Faculty of Medicine, Trakya University, Edirne, Turkey. hakdere@yahoo.com  
authors.forename: H
authors.initials: H
authors.lastname: Akdere
authors.forename: K M
authors.initials: KM
authors.lastname: Burgazli
authors.forename: T
authors.initials: T
authors.lastname: Aktoz
authors.forename: A
authors.initials: A
authors.lastname: Acikgoz
authors.forename: M
authors.initials: M
authors.lastname: Mericliler
authors.forename: A S
authors.initials: AS
authors.lastname: Gozen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001706:Biopsy; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis; D013997:Time Factors; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine