Department of Urology, Faculty of Medicine, Trakya University, Edirne, Turkey.
Eur Rev Med Pharmacol Sci. 2013 Nov;17(21):2890-5.
In our study, the efficiency and reliability of lidocaine (1 cc/1%) application during transrectal ultrasound-guided (TRUS) prostate biopsy to levatores prostate was studied. Levatores prostate was visualized on a cadaver dissection previously.
Eighty outpatients with lower urinary tract complaints or were suspected clinically to have prostate cancer were submitted to TRUS-guided prostate biopsy. The ages of outpatients were ranging from 45 to 81. Patients were randomized in 2 groups: Group-I, with 40 patients submitted to local anesthesia by periprostatic injection of 1 cc 1% lidocaine before biopsy; and group-II, with 40 controls the biopsy was performed without local anesthesia. The anatomical region for anesthesia was determined via dissection. The name of this anatomical region is levatores prostatae and it has got high nerve density. The process was explained to the patients and their approvals were obtained. Levatores prostatae was detected with TRUS before biopsy. Pain; related to digital rectal examination (DRE), probe insertion or biopsy, was scored via visual analog scale (VAS). The patients were evaluated about side effects of lidocaine and early and late complications of biopsy as well.
Both groups were similar in terms of mean age, PSA levels, prostate volume and VAS scores (p > 0.05). As for VAS score, on the group submitted to anesthesia was determined 2.34 ± 1.08, while for VAS score on the group submitted conventional biopsy was determined 5.8 ± 1.6. Between two groups, there was a statistical difference in terms of VSA score (p < 0.05); but there was no statistical difference about early and late complications of biopsy.
The periprostatic blockage use is clearly associated with more tolerance and patient comfort during TRUS-guided biopsy. Owing to the local anesthesia introduced to the periprostatic nerve bundle localization in levatores prostate area, the patients could tolerate the pain better.
在我们的研究中，研究了在经直肠超声引导（TRUS）前列腺活检中利多卡因（1 毫升/1%）在前列腺提肌中的应用的效率和可靠性。前列腺提肌先前在尸体解剖中得到了可视化。
80 名有下尿路症状或临床上怀疑患有前列腺癌的门诊患者接受了 TRUS 引导下的前列腺活检。门诊患者的年龄在 45 岁至 81 岁之间。患者随机分为两组：组 I，40 例患者在活检前通过前列腺周围注射 1 毫升 1%利多卡因进行局部麻醉；组 II，40 例对照，活检不进行局部麻醉。麻醉区域的解剖结构通过解剖确定。这个解剖区域的名称是前列腺提肌，它具有很高的神经密度。向患者解释了这个过程，并获得了他们的同意。在活检前，通过 TRUS 检测前列腺提肌。通过视觉模拟量表（VAS）对数字直肠检查（DRE）、探头插入或活检相关的疼痛进行评分。还评估了患者对利多卡因的副作用以及活检的早期和晚期并发症。
两组在平均年龄、PSA 水平、前列腺体积和 VAS 评分方面相似（p > 0.05）。在接受麻醉的组中，VAS 评分确定为 2.34 ± 1.08，而在接受常规活检的组中，VAS 评分确定为 5.8 ± 1.6。两组间 VAS 评分有统计学差异（p < 0.05）；但活检的早期和晚期并发症无统计学差异。
前列腺周围阻断术与 TRUS 引导下活检过程中患者的耐受性和舒适度的提高明显相关。由于在前列腺提肌区域的前列腺周围神经束定位中引入了局部麻醉，患者能够更好地耐受疼痛。
