McCabe John E, Hanchanale Vishwanath S, Philip Joe, Javle Pradip M
Michael Heal Department of Urology, Leighton Hospital, Crewe, UK.
BJU Int. 2007 Sep;100(3):536-8; discussion 538-9. doi: 10.1111/j.1464-410X.2007.06990.x. Epub 2007 May 29.
To evaluate the use of topical glyceryl trinitrate (GTN) ointment as an adjunct to periprostatic nerve block in reducing pain associated with transrectal ultrasonography (TRUS)-guided prostatic biopsy.
In all, 148 consecutive patients (mean age 67.0 years) having their first TRUS-guided biopsy were randomized to receive either 0.2% GTN ointment or placebo 10 min before biopsy. All patients had a biopsy preceded by an injection with 10 mL of 1% lidocaine local anaesthesia. A 10-point visual analogue score was used to record 'Overall discomfort due to the presence of the probe', the biopsy itself and pain after the procedure.
There was no significant difference in age, PSA level and prostate volume between the groups. There was a significantly lower mean pain score due to probe insertion in the GTN than placebo group (1.94 vs 3.24, P < 0.01); pain perception was lower for the whole procedure in the GTN group, and was most pronounced in men aged <60 years (2.13 vs 4.61, P < 0.005).
Topical GTN ointment is safe and effective in reducing the discomfort associated with TRUS-guided biopsy of the prostate, in particular the insertion of the ultrasound probe. It might be of maximum benefit in the younger patient and those having a repeat biopsy who previously failed to tolerate the procedure well.
评估局部使用硝酸甘油（GTN）软膏作为前列腺周围神经阻滞的辅助手段，以减轻经直肠超声（TRUS）引导下前列腺活检相关疼痛的效果。
共有148例首次接受TRUS引导活检的连续患者（平均年龄67.0岁）被随机分为两组，分别在活检前10分钟接受0.2% GTN软膏或安慰剂。所有患者在活检前均注射10 mL 1%利多卡因局部麻醉。采用10分视觉模拟评分法记录“因探头存在导致的总体不适”、活检过程本身以及术后疼痛情况。
两组患者在年龄、前列腺特异抗原（PSA）水平和前列腺体积方面无显著差异。GTN组因探头插入导致的平均疼痛评分显著低于安慰剂组（1.94对3.24，P<0.01）；GTN组整个活检过程中的疼痛感受较低，在年龄<60岁的男性中最为明显（2.13对4.61，P<0.005）。
局部使用GTN软膏在减轻TRUS引导下前列腺活检相关不适方面安全有效，尤其是超声探头插入时。对于年轻患者以及既往对该操作耐受性差的重复活检患者可能益处最大。
