Yang Yubo, Liu Zhenhua, Wei Qiang, Cao Dehong, Yang Lu, Zhu Yuchun, Wei Xin, Tang Zhuang, Liu Liangren, Han Ping
Urol Int. 2017;99(4):373-383. doi: 10.1159/000481830. Epub 2017 Oct 30.
The study aims to review the current evidence to determine the efficiency and safety of intrarectal topical anesthesia (ITA) for transrectal ultrasound-guided prostate biopsy.
A comprehensive search of the literature was performed using Medline, Embase and Cochrane central register of controlled trials. All randomized controlled trials (RCTs) comparing the efficacy and safety of periprostatic nerve block (PNB), ITA, and PNB combined with ITA were included. The mean pain scores after the biopsy procedure, the mean pain scores after the probe insertion and adverse events were evaluated.
Thirty-2 RCTs were identified in the meta-analysis. ITA could significantly reduce pain during probe insertion compared to control and placebo. The PNB group had less pain after the prostate biopsy than the ITA group. PNB combined with ITA could significantly reduce pain during the biopsy procedure compared to ITA alone. No significant differences were found in adverse events in ITA versus control, ITA versus placebo, and ITA versus PNB.
ITA could reduce pain after probe insertion and pain after biopsy although it was inferior to PNB in reducing pain during prostate biopsy. ITA combined with PNB was more effective than ITA alone. In addition, it was safe to perform ITA for prostate biopsy.
本研究旨在回顾当前证据，以确定经直肠超声引导下前列腺穿刺活检术中直肠内局部麻醉（ITA）的有效性和安全性。
使用Medline、Embase和Cochrane对照试验中央注册库对文献进行全面检索。纳入所有比较前列腺周围神经阻滞（PNB）、ITA以及PNB联合ITA的疗效和安全性的随机对照试验（RCT）。评估活检术后的平均疼痛评分、探头插入后的平均疼痛评分以及不良事件。
在荟萃分析中确定了32项RCT。与对照组和安慰剂相比，ITA可显著减轻探头插入过程中的疼痛。PNB组前列腺活检后的疼痛比ITA组轻。与单独使用ITA相比，PNB联合ITA可显著减轻活检过程中的疼痛。在ITA与对照组、ITA与安慰剂以及ITA与PNB之间的不良事件方面未发现显著差异。
ITA可减轻探头插入后的疼痛和活检后的疼痛，尽管在减轻前列腺活检过程中的疼痛方面不如PNB。ITA联合PNB比单独使用ITA更有效。此外，对前列腺活检进行ITA操作是安全的。
