Visual pain score during transrectal ultrasound-guided prostate biopsy using no anaesthesia or three different types of local anaesthetic application.

OBJECTIVE: To evaluate the pain score during transrectal ultrasound (TRUS)-guided prostate biopsy using three different anaesthetic applications and no anaesthesia. MATERIAL AND METHODS: One-hundred men undergoing TRUS-guided prostate biopsy were prospectively enrolled in this study. Patients were randomized to four groups. Group 1 (n = 25) received no anaesthesia, group 2 (n = 25) was administered a perianal lidocaine injection, group 3 (n = 25) was administered a periprostatic lidocaine injection, and group 4 (n = 25) was administered a combination of perianal-intrarectal lidocaine-prilocaine cream. The anaesthetic application was given 5 min before the procedure. All patients were asked to indicate the level of pain experienced on a visual analogue scale (VAS) during three situations, including when the TRUS probe was inserted and 15 min and 2 weeks after biopsy. RESULTS: Mean pain scores were similar in all groups at the time of probe insertion. Mean pain scores showed statistically significant differences between group 1 and the other groups, except for group 4, 15 min after the procedure. Group 3 showed better pain control 15 min after biopsy and this difference was statistically significant (p < 0.043).The VAS scores were similar 2 weeks after the procedure in all groups. CONCLUSIONS: Anaesthetic application before TRUS-guided prostate biopsy may be advocated. The application of periprostatic lidocaine seems to be the most advantageous method for lowering the perception of pain.

Prevalence of antibiotic resistance in fecal flora before transrectal ultrasound-guided prostate biopsy and the clinical impact of targeted antibiotic prophylaxis.

OBJECTIVES: In this study, we aimed to evaluate ciprofloxacin resistance and the presence of extended-spectrum beta-lactamase producing organisms (ESBLs) in the population of patients with indication to undergo prostate biopsy. Our additional aim was to compare the targeted antibiotic prophylaxis and sepsis rates after transrectal ultrasound guided prostate biopsy in patients who received routine ciprofloxacin prophylaxis and to evaluate the predictive factors of antibiotic resistance. METHODS: Between September 2012 and January 2014, 300 patients were randomized to two groups. The first group (Group 1, n=156) received routine ciprofloxacin prophylaxis and the second group (Group 2, n=144) received a targeted prophylactic antibiotic regime that was adequate for rectal swab culture results. Rectal swab cultures were collected two weeks before the procedure. After the procedure, patients were followed for one month and told to return to the hospital if they developed a fever (>38°C), shivering, dysuria or fatigue. RESULTS: In Group 1, four patients (2.6%) returned to our clinic with signs of sepsis; no patient in Group 2 returned to our clinic (p= 0.124). When the rectal swab culture results of Group 2 were evaluated, there were ESBLs in 18 patients (12.5%), quinolone resistance in 26 patients (18%), and both ESBLs and quinolone resistance in 15 patients (10.4%). There were no statistically significant differences between antibiotic resistance and urologic operations, urinary tract infections, prior catheterization history, the presence of a catheter during prostate biopsy and antibiotic usage history due to a high PSA level. CONCLUSION: In our study, the rates of ESBL presence and ciprofloxacin resistance in rectal flora were not negligible. However, by obtaining rectal swab cultures prior to performing transrectal prostate biopsies and using targeted prophylaxis before prostate biopsy, the sepsis rates were reduced; however, this effect was statistically insignificant. Additional studies with a larger patient population could help to evaluate the targeted prophylaxis procedure.