Vaidya A, Soloway M S
Department of Urology, University of Miami School of Medicine, Miami, Fla 33101, USA.
Eur Urol. 2001 Aug;40(2):135-8. doi: 10.1159/000049763.
Transrectal ultrasound (TRUS)-guided biopsy is a very common office procedure for most urologists. Pain or discomfort associated with this procedure has been addressed recently by the use of periprostatic local anesthesia. We re-address this issue with an update of our experience and emphasize the crucial steps that contribute to the success of the technique. We also analyzed the subsequent intraoperative effects of injecting lidocaine into the area of the neurovascular bundles.
Between June 1999 and December 2000, 200 patients underwent TRUS-guided biopsies of the prostate. Patients were properly consented and subjected to the procedure using periprostatic nerve block with 10 cm3 of 1% plain lidocaine. An 'ultrasonographic wheal' was created between the rectal wall and the posterior aspect of the prostate and three or four different locations along the neurovascular bundles. Pain scores were evaluated with the visual analogue scale.
TRUS biopsy of the prostate was performed in 200 consecutive patients using periprostatic local anesthesia, 40 patients (20%) had undergone previous prostate biopsy without anesthesia. The age of patients ranged from 44 to 75 years (mean 67). The number of biopsies ranged from 6 to 14. Mean time from introduction of the probe per rectum to the end of the procedure was 18 min. There were no instances of clinical infection, significant bleeding, urinary retention, diaphoresis or hypotension. The visual analogue scale ranged from 1 to 3 (mean 2). Intraoperative findings in 62 patients who subsequently underwent nerve-sparing radical retropubic prostatectomy were no different from the patients who had biopsies without a local anesthetic.
TRUS-guided biopsy of the prostate is the procedure of choice for diagnosing prostate cancer. This procedure can be accomplished with minimal pain with the use of periprostatic local anesthesia. It is an easy, safe, acceptable and reproducible technique that we believe should be considered for all patients undergoing TRUS biopsy regardless of age or number of biopsies.
经直肠超声（TRUS）引导下的前列腺穿刺活检对大多数泌尿外科医生来说是一种非常常见的门诊手术。最近，通过使用前列腺周围局部麻醉解决了与该手术相关的疼痛或不适问题。我们通过更新我们的经验重新探讨这个问题，并强调有助于该技术成功的关键步骤。我们还分析了将利多卡因注射到神经血管束区域后的术中效果。
1999年6月至2000年12月期间，200例患者接受了TRUS引导下的前列腺穿刺活检。患者均已获得适当的知情同意，并采用10立方厘米1%的普通利多卡因进行前列腺周围神经阻滞。在直肠壁与前列腺后侧以及沿神经血管束的三到四个不同位置形成“超声风疹块”。使用视觉模拟评分法评估疼痛评分。
连续200例患者使用前列腺周围局部麻醉进行了TRUS引导下的前列腺穿刺活检，其中40例患者（20%）此前未进行麻醉的情况下接受过前列腺穿刺活检。患者年龄在44至75岁之间（平均67岁）。穿刺活检次数在6至14次之间。从经直肠插入探头到手术结束的平均时间为18分钟。没有临床感染、严重出血、尿潴留、出汗或低血压的情况。视觉模拟评分范围为1至3分（平均2分）。随后接受保留神经的耻骨后前列腺根治性切除术的62例患者的术中发现与未进行局部麻醉穿刺活检的患者没有差异。
TRUS引导下的前列腺穿刺活检是诊断前列腺癌的首选方法。通过使用前列腺周围局部麻醉，该手术可以在最小的疼痛下完成。这是一种简单、安全、可接受且可重复的技术，我们认为无论年龄或穿刺活检次数如何，所有接受TRUS活检的患者都应考虑采用该技术。
