Local anesthesia before transrectal ultrasound guided prostate biopsy: Comparison of 2 methods in a prospective, randomized clinical trial

Purpose: We compared the analgesic efficacy of the rectal administration of lidocaine gel and lidocaine periprostatic infiltration prior to transrectal ultrasound guided prostatic biopsies. Materials and Methods: A total of 328 consecutive men undergoing biopsy were entered into this study. The 166 patients randomized to group 1 received 15 cc 2% lidocaine gel administered intrarectally 10 minutes before prostate biopsy and the 162 in group 2 received 10 cc 1% lidocaine under ultrasound guidance as 2 periprostatic injections of 5 cc 5 minutes prior to biopsy. A self-administered visual analogue scale (VAS) was used to assess the pain score during anesthesia (VAS 1), during biopsy (VAS 2) and 30 minutes later (VAS 3). Results: The patients in group 1 experienced statistically less pain than those in group 2 for mean VAS 1 (0.1 vs 1.4, p <0.0001) and mean VAS 3 (0.8 vs 1.4, p <0.001) but no statistically significant difference was noted for mean VAS 2 (2.0 vs 2.6, p = 0.04). No major morbidity was reported with either anesthesia. Conclusions: We are quite convinced of the necessity of local anesthesia to decrease pain during transrectal prostate ultrasound guided biopsy. Rectal administration of lidocaine gel is safe, simple and effective even when no difference regarding pain is noted vs lidocaine periprostatic infiltration during the biopsy procedure.