Effect of Prolonged Duration of Transrectal Ultrasound-Guided Biopsy of the Prostate and Pre-Procedure Anxiety on Pain in Patients without Anesthesia
Received 21 December 2020
Accepted for publication 12 February 2021
Published 4 March 2021 Volume 2021:13 Pages 111—120
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Jan Colli
Yasushi Nakai,1 Nobumichi Tanaka,1 Toshihiko Matsubara,1 Satoshi Anai,1 Makito Miyake,1 Shunta Hori,1 Tomomi Fujii,2 Chiho Ohbayashi,2 Kiyohide Fujimoto1
1Department of Urology, Nara Medical University, Nara, Japan; 2Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
Correspondence: Nobumichi Tanaka
Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
Tel +81-744-22-3051 (ext. 2338)
Email [email protected]
Objective: To evaluate factors correlated with pain during prostate biopsy and willingness to undergo transrectal ultrasound-guided prostate biopsy (TR-PBx) again without anesthesia in patients undergoing TR-PBx without anesthesia.
Methods: This retrospective, single-center study evaluated 624 patients who underwent TR-PBx without anesthesia. Based on a nomogram using patient age and prostate volume, 6– 12 core biopsy samples were allocated. Anxiety was evaluated using the Faces Anxiety Scale before the TR-PBx. Pain was evaluated using the Faces Pain Scale at each puncture and immediately after confirmation of cessation of bleeding from the rectum after the transrectal probe was pulled out. The question “If this operation must be repeated, would you agree to undergo it again under same conditions?” was asked after the procedure was completed. The change in pain at each puncture and factors correlated with post-procedural pain were calculated using multiple regression analysis, and factors predicting an answer of “yes” to the question using binary logistic analysis were evaluated.
Results: Scores on the Faces Pain Scale significantly increased from the first core sample to last as the number of samples increased. However, the number of samples did not show significant correlation with pain evaluated after the procedure was complete. Time during the biopsy and the anxiety score had a significant correlation with the pain scale score for the completed procedure. Short duration of TR-biopsy and a low anxiety score predicted a reply of “Yes” to the question.
Conclusion: A long operative time during the TR-PBx procedure and strong pre-procedure anxiety can increase pain for patients undergoing the procedure without anesthesia and cause patients to be unwilling to undergo TR-PBx again without anesthesia.
Keywords: anesthesia, anxiety, biopsy, pain, prostate cancer