Szempliński Stanisław, Kamecki Hubert, Mokrzyś Mateusz, Zawadzki Marek, Zagożdżon Bartłomiej, Dębowska Małgorzata, Sosnowski Roman, Poletajew Sławomir, Kryst Piotr, Nyk Łukasz
Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Urology, St. Anna Hospital, Piaseczno, Poland.
Transl Androl Urol. 2023 Aug 31;12(8):1250-1258. doi: 10.21037/tau-23-139. Epub 2023 Aug 14.
Biopsy by transperineal (TP) approach is recommended standard for prostate cancer (PC) diagnosis. To avoid pain, patients undergoing TP biopsy may be offered sedation or general anesthesia. Our aim was to investigate the degree of patient-reported pain for magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy of the prostate being performed under local anesthesia (LA) and to study for possible factors associated with increased risk of significant pain (SP) in this setting.
In this retrospective observational study, we reviewed data of consecutive patients without a prior diagnosis of PC who underwent MRI/US software fusion biopsy of the prostate under LA with lidocaine at two centers between May 2020 and April 2022, and who reported their periprocedural pain on a Wong-Baker FACES Pain Rating Scale (0-10). We defined SP as reported pain score of 6-10. Patient and procedure characteristics together with SP were studied for interdependencies.
A total of 299 patients were included. Median pain score was 2 (interquartile range: 2-4), with SP having been reported by 55 (18.4%) patients. Among patient characteristics, only age demonstrated association with SP [odds ratio (OR), per 10 years =0.53, 95% confidence interval (CI): 0.35-0.80, P=0.003] and patients aged 62 or above were significantly less likely to report SP (OR =0.33, 95% CI: 0.18-0.60, P<0.001).
Performing TP MRI/US fusion prostate biopsy under LA is associated with low rates of SP, with the risk being significantly lower in older men. The results of this study can serve as evidence resource for preprocedural counselling in patients especially concerned about the risk of pain.
经会阴（TP）穿刺活检是前列腺癌（PC）诊断的推荐标准方法。为避免疼痛，接受TP活检的患者可选择镇静或全身麻醉。我们的目的是调查在局部麻醉（LA）下进行前列腺磁共振成像（MRI）/超声（US）融合活检时患者报告的疼痛程度，并研究在此情况下与严重疼痛（SP）风险增加相关的可能因素。
在这项回顾性观察研究中，我们回顾了2020年5月至2022年4月期间在两个中心连续接受LA联合利多卡因进行前列腺MRI/US软件融合活检且此前未诊断为PC的患者数据，这些患者在Wong-Baker面部表情疼痛评分量表（0-10）上报告了其围手术期疼痛情况。我们将SP定义为报告的疼痛评分为6-10分。研究患者和手术特征与SP之间的相互关系。
共纳入299例患者。中位疼痛评分为2分（四分位间距：2-4），55例（18.4%）患者报告有SP。在患者特征中，只有年龄与SP相关[优势比（OR），每10岁=0.53，95%置信区间（CI）：0.35-0.80，P=0.003]，62岁及以上患者报告SP的可能性显著降低（OR =0.33，95% CI：0.18-0.60，P<0.001）。
在LA下进行TP MRI/US融合前列腺活检时SP发生率较低，老年男性的风险显著更低。本研究结果可为特别关注疼痛风险的患者术前咨询提供证据参考。
