Skip to main content
SpringerLink
Log in

A randomized controlled comparison between periprostatic nerve block and pelvic plexus block at the base and apex of 14-core prostate biopsies

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To compare the pain control efficacies of the pelvic plexus block (PPB), periprostatic nerve block (PNB), and controls during a 14-core basal and apical core prostate biopsy.

Methods

This randomized controlled study, performed between January 2015 and January 2016, included patients with an abnormal serum prostate-specific antigen (PSA > 3 ng/mL) level or a palpable nodule on digital rectal examination. The enrolled patients were randomized into three groups: Group 1, intrarectal local anesthesia (IRLA, 10 mL of 2% lidocaine jelly) and PPB with 3.0 mL of 2% lidocaine injected at the bilateral pelvic plexus; Group 2, IRLA and PNB with 3.0 mL of 2% lidocaine injected at both periprostatic nerves; and Group 3, only IRLA. Patients answered the visual analog scale (VAS) questionnaire at 6 time points.

Results

This study consisted of 163 patients (Group 1 = 55, Group 2 = 55, and Group 3 = 53). Pain at the apical biopsy location was less in Groups 1 and 2 than in Group 3 (p < 0.001, p < 0.001) and between the two local anesthetic groups (PNB + IRLA vs PPB + IRLA). Group 2 patients reported less pain than Group 1 patients (p = 0.022). Pain during the basal core biopsy was significantly less in Groups 1 and 2 than in Group 3 (p = 0.002, p < 0.001), but there were no significant differences in pain control between the two methods (PNB + IRLA vs PPB + IRLA, p = 0.054) during basal core biopsy.

Conclusions

PNB + IRLA is an effective local anesthetic method for reducing pain when performing apical biopsies compared with PPB + IRLA or IRLA alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Eastham J (2017) Prostate cancer screening. Investig Clin Urol 58:217–219. https://doi.org/10.4111/icu.2017.58.4.217

    Article  PubMed  PubMed Central  Google Scholar 

  2. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N (2014) EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent—update 2013. Eur Urol 65:124–137. https://doi.org/10.1016/j.eururo.2013.09.046

    Article  PubMed  Google Scholar 

  3. Akduman B, Akduman D, Tokgoz H, Erol B, Turker T, Ayoglu F, Mungan NA (2011) Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology 78:250–255. https://doi.org/10.1016/j.urology.2011.02.065

    Article  PubMed  Google Scholar 

  4. Gaylis F, Nasseri R, Fink L, Calabrese R, Dato P, Cohen E (2016) Prostate biopsy complications: a dual analysis. Urology 93:135–140. https://doi.org/10.1016/j.urology.2016.03.035

    Article  PubMed  Google Scholar 

  5. Nash PA, Bruce JE, Indudhara R, Shinohara K (1996) Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol 155:607–609. https://doi.org/10.1016/S0022-5347(01)66464-4

    Article  CAS  PubMed  Google Scholar 

  6. Li M, Wang Z, Li H, Yang J, Rao K, Wang T, Wang S, Liu J (2017) Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: a meta-analysis. Sci Rep 7:40421. https://doi.org/10.1038/srep40421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A (2004) Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocain cream. World J Urol 22:281–284. https://doi.org/10.1007/s00345-003-0386-4

    Article  PubMed  Google Scholar 

  8. Alavi AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL (2001) Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods. J Urol 166:1343–1345. https://doi.org/10.1016/S0022-5347(05)65765-5

    Article  CAS  PubMed  Google Scholar 

  9. Autorino R, De Sio M, Di Lorenzo G, Damiano R, Perdona S, Cindolo L, D’Armiento M (2005) How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol 174:2091–2097. https://doi.org/10.1097/01.ju.0000181212.51025.06

    Article  PubMed  Google Scholar 

  10. Wu CL, Carter HB, Naqibuddin M, Fleisher LA (2001) Effect of local anesthetics on patient recovery after transrectal biopsy. Urology 57:925–929. https://doi.org/10.1016/S0090-4295(01)00930-X

    Article  CAS  PubMed  Google Scholar 

  11. Akpinar H, Tufek I, Atug F, Esen EH, Kural AR (2009) Doppler ultrasonography-guided pelvic plexus block before systematic needle biopsy of the prostate: a prospective randomized study. Urology 74:267–271.e261. https://doi.org/10.1016/j.urology.2009.01.082

    Article  PubMed  Google Scholar 

  12. Cantiello F, Cicione A, Autorino R, Cosentino C, Amato F, Damiano R (2012) Pelvic plexus block is more effective than periprostatic nerve block for pain control during office transrectal ultrasound guided prostate biopsy: a single center, prospective, randomized, double arm study. J Urol 188:417–422. https://doi.org/10.1016/j.juro.2012.04.003

    Article  PubMed  Google Scholar 

  13. Jindal T, Mukherjee S, Sinha RK, Kamal MR, Ghosh N, Saha B, Mitra N, Sharma PK, Mandal SN, Karmakar D (2015) Transrectal ultrasonography (TRUS)-guided pelvic plexus block to reduce pain during prostate biopsy: a randomised controlled trial. BJU Int 115:892–896. https://doi.org/10.1111/bju.12872

    Article  PubMed  Google Scholar 

  14. Hollabaugh RS Jr, Dmochowski RR, Steiner MS (1997) Neuroanatomy of the male rhabdosphincter. Urology 49:426–434. https://doi.org/10.1016/s0090-4295(96)00497-9

    Article  PubMed  Google Scholar 

  15. Stirling BN, Shockley KF, Carothers GG, Maatman TJ (2002) Pain perception during transrectal ultrasound guided prostate needle biopsy: an objective analysis of local anesthesia use. Prostate Cancer Prostatic Dis 5:209–211. https://doi.org/10.1038/sj.pcan.4500598

    Article  CAS  PubMed  Google Scholar 

  16. Berger AP, Frauscher F, Halpern EJ, Spranger R, Steiner H, Bartsch G, Horninger W (2003) Periprostatic administration of local anesthesia during transrectal ultrasound-guided biopsy of the prostate: a randomized, double-blind, placebo-controlled study. Urology 61:585–588. https://doi.org/10.1016/S0090-4295(02)02406-8

    Article  PubMed  Google Scholar 

  17. Stirling BN, Shockley KF, Carothers GG, Maatman TJ (2002) Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies. Urology 60:89–92. https://doi.org/10.1016/S0090-4295(02)01671-0

    Article  PubMed  Google Scholar 

  18. Moussa AS, Meshref A, Schoenfield L, Masoud A, Abdel-Rahman S, Li J, Flazoura S, Magi-Galluzzi C, Fergany A, Fareed K, Jones JS (2010) Importance of additional “extreme” anterior apical needle biopsies in the initial detection of prostate cancer. Urology 75:1034–1039. https://doi.org/10.1016/j.urology.2009.11.008

    Article  PubMed  Google Scholar 

  19. Soloway MS, Obek C (2000) Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol 163:172–173. https://doi.org/10.1016/S0022-5347(05)67997-9

    Article  CAS  PubMed  Google Scholar 

  20. Yan P, Wang XY, Huang W, Zhang Y (2016) Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis. J Pain Res 9:787–796. https://doi.org/10.2147/jpr.S117451

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bastide C, Lechevallier E, Eghazarian C, Ortega JC, Coulange C (2003) Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate: risk factors. Prostate Cancer Prostatic Dis 6:239–241. https://doi.org/10.1038/sj.pcan.4500664

    Article  CAS  PubMed  Google Scholar 

  22. Ochiai A, Babaian RJ (2004) Update on prostate biopsy technique. Curr Opin Urol 14:157–162

    Article  Google Scholar 

  23. Bjurlin MA, Carter HB, Schellhammer P, Cookson MS, Gomella LG, Troyer D, Wheeler TM, Schlossberg S, Penson DF, Taneja SS (2013) Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol 189:2039–2046. https://doi.org/10.1016/j.juro.2013.02.072

    Article  PubMed  PubMed Central  Google Scholar 

  24. Guo LH, Wu R, Xu HX, Xu JM, Wu J, Wang S, Bo XW, Liu BJ (2015) Comparison between ultrasound guided transperineal and transrectal prostate biopsy: a prospective, randomized, and controlled trial. Sci Rep 5:16089. https://doi.org/10.1038/srep16089

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Pepe P, Aragona F (2014) Prostate biopsy: results and advantages of the transperineal approach—twenty-year experience of a single center. World J Urol 32:373–377. https://doi.org/10.1007/s00345-013-1108-1

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by Gangneung Asan Hospital Medical Institute and was funded by the Asan Foundation (2014-009).

Author information

Authors and Affiliations

  1. Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea

    Sung Jin Kim, Chang-Hoo Park, Ju Hyun Lim, Han Gwun Kim & Jong Yeon Park

  2. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jongpill Lee & Dong Hyeon An

Authors
  1. Sung Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jongpill Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dong Hyeon An
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chang-Hoo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ju Hyun Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Han Gwun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jong Yeon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SJK: data management, data analysis, manuscript writing/editing. JL: data collection, data analysis. DHA: data collection data analysis. CP: data analysis. JHL: project development. HGK: manuscript writing/editing. JYP: project development, manuscript editing.

Corresponding author

Correspondence to Jong Yeon Park.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 477 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, S.J., Lee, J., An, D.H. et al. A randomized controlled comparison between periprostatic nerve block and pelvic plexus block at the base and apex of 14-core prostate biopsies. World J Urol 37, 2663–2669 (2019). https://doi.org/10.1007/s00345-019-02722-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-02722-w

Keywords

Search

Navigation