Sistematik ultrasonografi eşliğinde transrektal prostat biyopsisi yapılan hastalarda yaşın ağrı algısı üzerine etkisi

Yıl 2025, Cilt: 18 Sayı: 2, 4 - 4

Salih Bürlukkara , Coşkun Bostancı

https://doi.org/10.31362/patd.1516001

Öz

Amaç: Transrektal ultrason eşliğinde prostat biyopsisinde (TRUS-PB) transrektal prob ve biyopsi iğnesinin prostat dokusuna yerleştirilmesi sonucu oluşan ağrı düzeylerine yaşın etkisini araştırmak.
Gereç ve yöntem: Çalışmaya 308 hasta dahil edildi. Bu hastalar yaşlarına göre gruplara ayrıldı: Grup 1'de 65 yaş ve altı 103 hasta, Grup 2'de 66-70 yaş arası 100 hasta ve Grup 3'te 70 yaş üstü 105 hasta vardı. Çalışmaya dahil edilen hastalara anestezik olarak 11 ml %2'lik lidokain jel intrarektal olarak uygulandı. Biyopsi işleminden 30 dakika sonra her hastanın ağrısını, 0 (ağrı yok) ile 10 (en şiddetli ağrı) arasında değişen VAS skorunu kullanarak ölçtük. Hastalara rektal prob yerleştirilmesi ve manevralar sırasındaki ağrı düzeyi (VAS-p) ve biyopsi almak için iğnenin prostattan içeri sokulması sırasındaki ağrı düzeyi (VAS-b) soruldu.
Bulgular: VAS-p skoru Grup 2'de diğer yaş gruplarına göre daha düşüktü. Gruplar VAS-b açısından değerlendirildiğinde 3 grup arasında anlamlı fark görülmedi. Tüm hastalarda probun yerleştirilmesi sırasında hissedilen ağrı biyopsi sırasında hissedilen ağrıdan daha fazlaydı ve bu istatistiksel olarak anlamlıydı (p<0,001). Prostat hacmi ağrı skoru ile karşılaştırıldığında, prostat hacmindeki her birim artış VAS-p'de ağrı olasılığını 1.014 kat artırıyordu.
Sonuç: Biyopsi yapılan hastalarda ağrı duyusunun çoğunlukla prob yerleştirilmesi sırasında hissedildiği ve bu ağrı duyusunun prostat büyüklüğü arttıkça arttığı görülmektedir.

Anahtar Kelimeler

Ağrı skoru, anestezi, prostat biyopsisi, transrektal ultrason

Proje Numarası

2023/1446

The effect of age on pain perception among patiens undergoing systematic ultrasonography guided transrectal prostate biopsy

Öz

Purpose: To investigate the effect of age on the pain levels caused by placing the transrectal probe and biopsy needle into the prostate tissue in transrectal ultrasound-guided prostate biopsy (TRUS-PB).
Materials and methods: The study included 308 patients. These patients into groups based on age: Group 1 had 103 patients aged 65 or younger, Group 2 had 100 patients aged 66-70, and Group 3 had 105 patients over 70. 11 ml 2% lidocaine gel was administered intrarectally to the patients included in the study as anesthesia. Thirty minutes after the biopsy procedure, we measured each patient's pain using the VAS score, which ranged from 0 (no pain) to 10 (worst pain). Patients were asked for pain level during the insertion of the rectal probe and the maneuvers (VAS-p) and the pain level during the insertion of the needle through the prostate to take a biopsy (VAS-b).
Results: VAS-p score was lower in Group.2 than in the other age groups. When the groups were evaluated in terms of VAS-b, no significant difference was observed between the 3 groups. Across all patients, the pain felt during probe insertion was greater than the pain felt during biopsy and this was statistically significant (p<0.001). When prostate volume was compared with pain score, each unit increase in prostate volume increased the probability of pain in VAS-p by 1.014 times.
Conclusion: Pain sensation in patients undergoing biopsy is mainly felt during probe insertion and that this pain sensation increases with increasing prostate size.

Anahtar Kelimeler

Anesthesia, pain score, prostate biopsy, transrectal ultrasound

Etik Beyan

Permission was obtained from Karabük University Ethics Committee (approval number: 2023/1446, date:06/11/2023)

Destekleyen Kurum

None

Proje Numarası

2023/1446

Teşekkür

None

Kaynakça

• 1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet Tieulent J, Jemal A. Global cancer statistics. CA Cancer J Clin 2015;65:87-108. https://doi.org/10.3322/caac.21262
• 2. Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2021;79:243-262. https://doi.org/10.1016/j.eururo.2020.09.042
• 3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30. https://doi.org/10.3322/caac.21332
• 4. Hergan L, Kashefi C, Parsons JK. Local anesthetic reduces pain associated with transrectal ultrasound-guided prostate biopsy: a meta-analysis. Urology 2007;69:520-525. https://doi.org/10.1016/j.urology.2006.12.005
• 5. Giannarini G, Autorino R, Valent F, et al. Combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block for pain control during transrectal ultrasound guided prostate biopsy: a randomized, controlled trial. J Urol 2009;181:585-591. https://doi.org/10.1016/j.juro.2008.10.002
• 6. Von Knobloch R, Weber J, Varga Z, Feiber H, Heidenreich A, Hofmann R. Bilateral fine-needle administered local anaesthetic nerve block for pain control during TRUS-guided multi-core prostate biopsy: a prospective randomised trial. Eur Urol 2002;41:5008-514. https://doi.org/10.1016/S0302-2838(02)00072-6
• 7. Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A. Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocain cream. World J Urol 2004;22:281-284. https://doi.org/10.1007/s00345-003-0386-4
• 8. Autorino R, De Sio M, Di Lorenzo G, et al. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol 2005;174:2091-2097. https://doi.org/10.1097/01.ju.0000181212.51025.06
• 9. Tiong HY, Liew LCH, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis 2007;10:127-136. https://doi.org/10.1038/sj.pcan.4500935
• 10. Bingqian L, Peihuan L, Yudong W, Jinxing W, Zhiyong W. Intraprostatic local anesthesia with periprostatic nerve block for transrectal ultrasound guided prostate biopsy. J Urology 2009;182:479-483. https://doi.org/10.1016/j.juro.2009.04.029
• 11. Dell’atti L, Borea PA, Russo GR. Age: “a natural anesthetic” in pain perception during the transrectal ultrasound-guided prostate biopsy procedure. Urologia 2011;78:257-261. https://doi.org/10.5301/RU.2011.8850
• 12. Krausewitz P, Schmeller H, Spitzer C, Ellinger J, Ritter M, Petrowski K, Conrad R. Emotion-centered versus fact-centered medical information to alleviate pain and anxiety in prostate biopsy: A randomized trial. Prostate. 2023. https://doi.org/10.1002/pros.24659.
• 13. Diaz GM, Webb LT, Rabil MJ, Lokeshwar SD, Choksi AU, Leapman MS, Sprenkle PC. Risk Factors and Contemporary Management Options for Pain and Discomfort Experienced During a Prostate Biopsy. Curr Urol Rep. 2024 Oct;25(10):243-252. doi: 10.1007/s11934-024-01220-w.
• 14. Desgrandchamps F, Meria P, Irani J, Desgrippes A, Teillac P, Le Duc A. The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography-guided biopsy of the prostate: a prospective randomized placebo-controlled study. BJU Int 1999;83:1007-1009. https://doi.org/10.1046/j.1464-410x.1999.00080.x
• 15. Peyromaure M, Ravery V, Messas A, Toublanc M, Boccon Gibod L, Boccon-Gibod L. Pain and morbidity of an extensive prostate 10-biopsy protocol: a prospective study in 289 patients. J Urol 2002;167:218-221. https://doi.org/10.1016/S0022-5347(05)65416-X
• 16. Aus G, Damber JE, Hugosson J. Prostate biopsy and anaesthesia: an overview. Scand J Urol Nephrol 2005;39:124-129. https://doi.org/10.1080/00365590510007784
• 17. Kravchick S, Peled R, Ben Dor D, Dorfman D, Kesari D, Cytron S. Comparison of different local anesthesia techniques during TRUS-guided biopsies: a prospective pilot study. Urology 2005;65:109-113. https://doi.org/10.1016/j.urology.2004.08.013
• 18. Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent - update 2013. Eur Urol 2014;65:124-137. https://doi.org/10.1016/j.eururo.2013.09.046