• Vol. 42 No. 4, 168–172
  • 15 April 2013

Does Periprostatic Block Increase the Transrectal Ultrasound (TRUS) Biopsy Sepsis Rate in Men with Elevated PSA?

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ABSTRACT

Introduction: Periprostatic nerve block (PPNB) is a common local anaesthetic technique in transrectal ultrasound-guided (TRUS) prostate biopsy, but concerns remain over the increased theoretical risks of urinary tract infection (UTI) and sepsis from the additional transrectal needle punctures. This study reviewed our biopsy data to assess this risk.

Materials and Methods: Retrospective data collected from 177 men who underwent TRUS biopsy between July 2007 and December 2009 in a single institution were analysed. PPNB was administered using 1% xylocaine at the prostatic base and apex and repeated on the contralateral side under ultrasound guidance. Complications, including UTI sepsis, bleeding per rectum and acute retention of urine (ARU) were noted. Every patient was tracked for the first 2 weeks for complications until his clinic review. Demographic profile, biopsy parameters and histological findings were reviewed. Univariate and multivariate analysis of possible risk factors for development of sepsis after TRUS biopsy were performed. Statistical analysis was performed using SPSS 17.0.

Results: Ninety (51%) men received PPNB and 87 (49%) did not. The groups were matched in age (PPNB: mean 62.7 ± 5.8 years; without PPNB: mean 64.4 ± 5.7 years) and prebiopsy prostate specific antigen (PSA) levels (PPNB: mean 8.2 ± 3.9 ng/mL; without PPNB: mean 8.3 ± 3.7 ng/mL). The PPNB group had a larger prostate volume, with more cores taken (P <0.05). On univariate and multivariate analysis controlling for age, PSA, prostate volume, number of cores taken and histological prostatitis, PPNB was not a significant risk factor for sepsis. Sepsis rates were 5.6% in the PPNB group and 5.7% in the other group (P = 0.956). Overall prostate cancer detection rate was 33.3%.

Conclusion: The risk of sepsis was not increased in patients who received PPNB, even though this group had larger gland volumes and more biopsy cores taken.


The progressive increase in the number of biopsy cores taken during transrectal ultrasound-guided (TRUS) needle biopsy of the prostate over the past decade has necessitated the introduction of anaesthetic techniques to minimise patient discomfort and pain. The sextant biopsy strategy was the gold standard for several years until the late 1990s when several publications reported high false-negative rates from missed cancers. This led to the introduction of extended-biopsy schemes in current use, which involved taking at least 10 to 14 cores. A study conducted at our own institution showed that a 10-core biopsy strategy gave better detection rates for prostate cancer and this has been put in practice since.

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