Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate

Purpose: We assessed the effect of transrectal ultrasound guided prostatic nerve blockade on the discomfort associated with systematic needle biopsy of the prostate. Materials and Methods: A prospective randomized double-blind study was performed of 64 patients requiring systematic biopsy of the prostate. Patients were randomly assigned to receive an injection of 5 ml. 1% lidocaine or 5 ml. saline (0.9% sodium chloride) at the vascular pedicle on 1 side of the prostate only. They were then asked to score the severity of discomfort of the injection and subsequent biopsies on each side. Results: Mean pain scores were significantly lower on the side with than the side without lidocaine injection (1.6 +/- 0.9 versus 2.4 +/- 1.2, p <0.0001) and not significantly different when saline was injected (2.9 +/- 1.2 versus 3.0 +/- 1.1, p = 0.52). Pain scores were significantly different when the lidocaine injected side was compared to the saline solution injected side (p <0.0001) but the difference was not significant between the noninjected sides of the 2 groups (p = 0.076). Of the patients in the lidocaine group 68% reported that they would prefer to undergo biopsy with the injection compared to only 41% in the placebo group (p = 0.037). During the study no patient in either group had any adverse effect from the injection. Conclusions: Transrectal ultrasound guided nerve blockade before prostatic biopsy results in a more comfortable procedure for the patient.