Factors affecting the sense of pain perceived during prostate biopsy performed under transrectal ultrasonography guidance in patients with high prostate specific antigen level or abnormal digital rectal examination findings were investigated in this study. Four different types of anesthesia were performed on 210 patients in whom prostate biopsy was taken at our clinic. Topical anesthesia with perianal lidocaine cream, local block with perianal lidocaine injection, perianal lidocaine cream plus intrarectal lidocaine gel and perianal lidocaine cream plus anal dilation by finger were administered in Groups 1, 2, 3 and 4, respectively. Prostate volumes of the patients were measured by transrectal ultrasonography. Pain perceived during biopsy and placement of the transrectal ultrasonography probe into rectum was questionned by visual analog scale. Fifty, 80, 40 and 40 out of 210 patients comprised Groups 1, 2, 3 and 4, respectively. Mean age of the groups was 62.70±9.15, 65.80±7.93, 63.11±8.32 and 62.70±8.48 years; mean prostate volume of the groups was 58.87±29.84, 56.69±28.91, 49.44±22.82 and 61.46±21.84 cc; mean prostate specific antigen level of the groups was 9.74±9.36, 12.0±15.05, 7.71±2.91 and 11.12±13.82 ng/ml, respectively, and no statistically significant differences were observed among the groups (p=0.157, p=0.458 and p=0.547, respectively). Pain perceived during the placement of transrectal ultrasonography probe into rectum was 0.60±0.88, 0.83±1.06, 0.22±0.44 and 0.58±0.84, respectively, and independent from the type of anesthesia (p=0.242). Pain perceived during biopsy was 1.39±0.94, 1.70±0.96, 2.22±1.39 and 1.51±0.99, respectively, and also independent from all four types of anesthesia (p=0.170). There was no correlation between prostate volume and age and pain score (p>0.05). According to our results, neither of four different types of anesthesia we performed during biopsy under the guidance of transrectal ultrasonography showed superiority to others regarding pain score. Age of the patient and prostate volume had also no effect on the pain score.

Keywords: Anesthesia, pain, biopsy, transrectal ultrasonography