Identifying the variables associated with pain during transrectal ultrasonography of the prostate.
OBJECTIVE
The purpose of this study was to prospectively investigate the degree of pain experienced by the patients receiving transrectal ultrasonography (TRUS) of the prostate by applying a visual analog scale. We also identified the clinical parameters influencing pain during the TRUS examination.


METHODS
Records were obtained from a prospective database for male patients who received TRUS of prostate in the outpatient department of Chang Gung Memorial Hospital, Taiwan, from January 2014 to June 2014. The patients underwent a detailed physical examination and medical history review. Immediately after the TRUS examination, the patients completed questionnaires based on a ten-point visual analog pain scale. The variables of interest were age, body mass index, prostate volume, prostate sagittal length, prostate-specific antigen, previous TRUS experience, external hemorrhoids, anal surgical history, prostate calcification, and image artifact caused by stool in the rectum. All variables were correlated to the visual analog scale by applying multivariate regression analysis.


RESULTS
By using linear regression analysis, we identified the independent factors that affected the pain score during the TRUS examination. The patients who received the examination for the first time or had longer prostate sagittal lengths, external hemorrhoids, anal surgical history, or stool stored in the rectum experienced more pain during the TRUS examination. Furthermore, the pain was reduced when we provided the patients with a detailed explanation before the procedure and allowed them to observe the real-time images during the examination.


CONCLUSIONS
Although a TRUS examination is uncomfortable for patients, after having identified the factors affecting pain, physicians can assist patients in reducing pain during the procedure, thus providing higher quality examinations.
Department of Urology, Chang Gung Memorial Hospital at Linkou, Kwei-Shan, Tao-Yuan, Taiwan ; School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Chen-Pang
CP
Hou
Department of Urology, Chang Gung Memorial Hospital at Linkou, Kwei-Shan, Tao-Yuan, Taiwan ; School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Yu-Hsiang
YH
Lin
Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Meng-Chiao
MC
Hsieh
Department of Urology, Chang Gung Memorial Hospital at Linkou, Kwei-Shan, Tao-Yuan, Taiwan ; School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Chien-Lun
CL
Chen
Department of Urology, Chang Gung Memorial Hospital at Linkou, Kwei-Shan, Tao-Yuan, Taiwan ; School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Phei-Lang
PL
Chang
School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Ying-Chen
YC
Huang
Department of Urology, Chang Gung Memorial Hospital at Linkou, Kwei-Shan, Tao-Yuan, Taiwan ; School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Ke-Hung
KH
Tsui
TRUS; VAS; benign prostate hyperplasia; digital examination; pain score; transrectal; ultrasound