The application of a targeted periprostatic nerve block in transperineal template-guided prostate biopsies

Abstract

Background: Our study aims to evaluate the anesthetic efficacy of multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted periprostatic nerve block (PNB) for transperineal template-guided prostate biopsy (TTPB).

Methods: The patients who underwent mpMRI/TRUS fusion-guided prostate biopsy from May 2018 to March 2019 were randomized into two groups using a random number table. The intervention group (n=47) and the control group (n=45) received targeted PNB and traditional PNB, respectively. Visual analog scale (VAS) and visual numeric scale (VNS) scores were used to assess the patients' pain and quantify their satisfaction.

Results: The total detection rate for prostate cancer was 45.7%, with a comparable positive rate between the intervention group (42.6%) and the control group (48.9%), which meant there was no significant difference between the groups (P=0.542). Patient age, prostate-specific antigen, prostate volume, suspicious lesions on mpMRI, number of cores, operation time, and biopsy time were comparable between the groups. The VAS scores during biopsy were significantly lower in the intervention group than in the control group [2 (1 to 3) vs. 2 (1 to 4), P=0.019]. Conversely, the VNS scores during biopsy were higher in the intervention group [3 (2 to 4) vs. 3 (2 to 3), P=0.015]. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure between the two groups. There were no significant differences between the groups for complications, such as hematuria, urinary retention, infection, hemospermia, and vasovagal reaction (P>0.05).

Conclusions: Targeted PNB significantly relieved the pain and did not increase the incidence of complications for patients when compared with traditional PNB.

Keywords: Magnetic resonance imaging (MRI); biopsy; nerve block; prostate.

Figure 1

mpMRI/TRUS image fusion. (A) Multiple sequences of mpMRI, the regions of interest are delineated on T2WI. The prostate target is contoured in purple. The suspected area of prostate cancer target is contoured in blue. The bilateral NVB target is contoured in yellow and red, respectively. (B) The reconstructed MRI axial images are synchronously displayed adjacent to the TRUS axial image on the same monitor. With the brightness of MRI image adjusted, the MRI image with a red background can be seen behind the TRUS image, and the goodness of fit between the MRI and the TRUS image could be observed and adjusted. (C,D)Targeted PNB was performed under the guidance of the mpMRI/TRUS image fusion. Infiltrative anesthesia for NVB in yellow and red contours was performed, respectively. The bright white spots inside yellow (C) and red (D) contours were the needlepoint of the ANSll 0.5 mm × 112 mm spinal needle.

Figure 2

The flow diagram of the study according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.