BackgroundA meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy.Materials and methodsA literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale.ResultsA total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: −0.22, 95% CI: −0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: −1.32, 95% CI: −1.68 to −0.95, P<0.00001), placebo injection (WMD: −2.62, 95% CI: −3.16 to −2.07, P<0.00001), or IRLA (WMD: −1.31, 95% CI: −1.40 to −1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.45, 95% CI: −0.62 to −0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.73, 95% CI: −0.92 to −0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia.ConclusionThis meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed to validate this result.

We report a rare case of a papillary renal cell carcinoma seeding along a percutaneous biopsy tract detected at the time of partial nephrectomy in a 51-year-old man with a 3.5 cm renal mass discovered on computed tomography scan (CT scan). Although renal percutaneous biopsy is now considered as an accurate and safe technique to provide valuable diagnostic information for indeterminate renal lesions, some inherent risks have been reported to associate with this procedure. One of the risks is tumor needle tract seeding, which is a very rare complication of renal percutaneous biopsy. Our well-documented case report could provide some useful information to evaluate the prognosis of patients with tumor seeding along a percutaneous biopsy tract.