Assessment and clinical factors associated with pain in patients undergoing transrectal prostate biopsy

Abstract

Objectives

To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain.

Material and methods

Analysis of a multicenter series of patients with prostate biopsy was done according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20 min into the procedure using the visual analog scale (0–10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain.

Results

A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01–1.77; p = 0.04), having a previous biopsy (RR, 2.25; 95% CI 1.44–3.52; p < 0.01), age (RR, 0.63; 95% CI 0.47–0.85; p < 0.01) and feel palpation (RR, 1.95; 95% CI 1.28–2.96; p < 0.01) were factors independently associated with greater pain during the procedure.

Conclusions

Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure.

Resumen

Objetivos

Cuantificar el grado de dolor que sufren los pacientes sometidos a biopsia transrectal de próstata ecodirigida en la práctica clínica habitual, y evaluar qué factores clínicos se encuentran asociados a un mayor dolor.

Material y métodos

Análisis de una serie multicéntrica de pacientes con biopsia de próstata según la práctica clínica habitual. La biopsia se realizó vía transrectal con un protocolo de anestesia local sobre el paquete nervioso posterolateral. Se evaluó el dolor a los 20 min del procedimiento a través de la escala visual analógica (0–10). Se analiza el grado de dolor soportado y se estudia la asociación de forma uni/multivariante de variables clínicas seleccionadas y el grado de dolor.

Resultados

Se analizaron un total de 1.188 pacientes de 64 años de mediana de edad. Un 30% de las biopsias fueron diagnósticas de tumor. La mediana de dolor fue de 2, con un 65% de pacientes con dolor ≤2. El análisis multivariante muestra que el volumen prostático (RR: 1,34, IC 95%: 1,01–1,77; p = 0,04), el hecho de tener una biopsia previa (RR: 2,25, IC 95%: 1,44–3,52; p < 0,01), la edad (RR:0,63, IC 95%: 0,47–0,85; p < 0,01) y un tacto doloroso (RR: 1,95, IC 95%: 1,28–2,96; p < 0,01), son factores asociados de forma independiente con mayor dolor durante el procedimiento.

Conclusiones

La biopsia transrectal con anestesia local es una técnica poco dolorosa. Factores como la edad, una biopsia previa, un tacto doloroso y el volumen prostático se asocian con la presencia de un mayor dolor durante el procedimiento.