University of Pittsburgh Medical Center, Division of Health Services Research, Department of Urology, Pittsburgh, PA.
University of Pittsburgh, School of Medicine, Pittsburgh, PA.
Urology. 2023 Dec;182:33-39. doi: 10.1016/j.urology.2023.09.010. Epub 2023 Sep 22.
To report the outcomes of performing transperineal prostate biopsy in the office setting using the novel anesthetic technique of tumescent local anesthesia. We report anxiety, pain, and embarrassment of patients who underwent this procedure compared to patients who underwent a transrectal prostate biopsy using standard local anesthesia.
Consecutive patients undergoing either a transperineal prostate biopsy under tumescent local anesthesia or a transrectal prostate biopsy with standard local anesthetic technique were prospectively enrolled. The tumescent technique employed dilute lidocaine solution administered using a self-filling syringe. Patients were asked to rate their pain before, during, and after their procedure using a visual analog scale. Patient anxiety and embarrassment was assessed using the Testing Modalities Index Questionnaire.
Between April 2021 and June 2022, 430 patients underwent a transperineal prostate biopsy using tumescent local anesthesia and 65 patients underwent a standard transrectal prostate biopsy. Patients who underwent a transperineal biopsy had acceptable but significantly higher pain scores than those who underwent a transrectal prostate biopsy (3.9 vs 1.6, P-value <.01). These scores fell to almost zero immediately following their procedure. Additionally, transperineal biopsy patients were more likely to experience anxiety (71% vs 45%, P < .01) and embarrassment (32% vs 15%, P < .01).
Transperineal biopsy using local tumescent anesthesia is safe and well-tolerated. Despite the benefits, patients undergoing a transperineal prostate biopsy under tumescent anesthesia still experienced worse procedural pain, anxiety, and embarrassment. Additional studies examining other adjunctive interventions to improve patient experience during transperineal prostate biopsy are needed.
报告使用新型肿胀局部麻醉技术在办公室环境下进行经会阴前列腺活检的结果。我们报告了接受这种手术的患者与接受标准局部麻醉的经直肠前列腺活检患者相比的焦虑、疼痛和尴尬感。
连续接受肿胀局部麻醉下经会阴前列腺活检或标准局部麻醉技术下经直肠前列腺活检的患者被前瞻性纳入。肿胀技术使用自填充注射器给予稀释的利多卡因溶液。患者在手术前、手术中和手术后使用视觉模拟评分法（VAS）评估他们的疼痛程度。使用测试模式指数问卷评估患者的焦虑和尴尬程度。
在 2021 年 4 月至 2022 年 6 月期间，430 名患者接受了肿胀局部麻醉下的经会阴前列腺活检，65 名患者接受了标准的经直肠前列腺活检。接受经会阴活检的患者疼痛评分高于接受经直肠前列腺活检的患者（3.9 对 1.6，P 值<0.01），但可以接受。这些评分在手术后立即降至几乎为零。此外，经会阴活检患者更可能感到焦虑（71%对 45%，P<0.01）和尴尬（32%对 15%，P<0.01）。
使用局部肿胀麻醉的经会阴活检是安全且耐受良好的。尽管有这些益处，但接受肿胀麻醉下经会阴前列腺活检的患者仍经历更严重的手术疼痛、焦虑和尴尬。需要进一步研究其他辅助干预措施，以改善经会阴前列腺活检期间患者的体验。
