Prostate Biopsy in the Left Lateral Decubitus Position is Less Painful than Prostate Biopsy in the Lithotomy Position: A Randomized Controlled Trial

Abstract

PurposeThe primary objective was to assess whether transrectal ultrasound (TRUS)-guided prostate biopsy in the left lateral decubitus (LLD) position differed from the procedure in the lithotomy position regarding patients' pain perception. The secondary objective was to assess the analgesic effect of intrarectal 2% lidocaine gel in this setting.Materials and MethodsThis single-center, open-label trial enrolled 148 men undergoing prostate biopsy. Then men were randomly assigned to group 1 (LLD position, no lidocaine, n=50, "test"), group 2 (lithotomy position+lidocaine, n=50, "positive control"), and group 3 (lithotomy position, no lidocaine, n=48, "negative control"). Twelve-core samples were taken in each biopsy set. Pain was assessed by using a 10-point visual analogue scale (VAS).ResultsAcross the groups, patients were comparable regarding age, prostate-specific antigen levels, prostate volume, digital rectal examination findings, and pathohistological diagnosis. VAS scores were lower in group 1 (median, 2.95) than in group 2 (median, 4.95; p<0.001) or group 3 (median, 4.60; p<0.001). The difference between group 2 and group 3 was insignificant (p=0.268). The adjusted mean differences (with adjustment for the above covariates) were as follows: group 1 vs. group 2, -1.43 (95% confidence interval [CI]: -2.25 to -0.60; p<0.001); group 1 vs. group 3, -1.22 (95% CI: -2.04 to -0.41; p=0.001); group 2 vs. group 3, 0.20 (95% CI, -0.63 to 1.04; p=0.836); and group 1 vs. groups 2 and 3, -1.33 (95% CI, -1.92 to -0.73; p<0.001). The procedure was comparably well tolerated across the groups.ConclusionsPain perception during prostate biopsy was lower in the LLD position than in the lithotomy position. Intrarectal 2% lidocaine gel does not seem to affect pain perception.

Effect of patient position on pain scales during transrectal ultrasound-guided prostate biopsy

“…In contrast to our results, Kilciler et al [ 12 ] and Lodeta and Lodeta [ 13 ] reported that pain perception during TRUS-guided prostate biopsy is less profound in patients in the LLD position than in the lithotomy position. Those studies suggested that the lithotomy position may be more unpleasant or embarrassing than the LLD position in terms of psychological phenomenon, because the LLD position is a more relaxed and physiological position typically used for sleep and rest.…”

“…Despite the use of these techniques to reduce pain, many patients still experience a considerable degree of pain during TRUS-guided prostate biopsy [ 9 , 10 ]. Some studies have reported that a patient's pain perception during prostate biopsy is related to the patient's position, such as the left lateral decubitus (LLD) or lithotomy position [ 11 , 12 , 13 ], although this is controversial. Homogeneous data with regard to pain perception during TRUS-guided prostate biopsy are currently sparse, especially in Asian populations.…”

Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: A Prospective, Randomized and Controlled Trial

“…Moreover, the patient’s position could influence the pain level. The lithotomy position is often used in TPBx, which is more uncomfortable than the left lateral position 31 . On the other hand, most patients in the TRBx group complained about inserting the transducer; however, it was overall mild.…”

Lateral decubitus position vs. lithotomy position: which is the best way to minimize patient’s pain perception during transrectal prostate biopsy?

“…In an attempt to obtain a further relief, the effect of position which is generally selected between lithotomy and conventional left lateral decubitus (LLD) position had been researched (9-11). However, outcomes from several western studies reached contrasting conclusions, and there are no data for Asian population, who have a relatively smaller prostate.…”

“…Although techniques including intrarectal lidocaine gel, periprostatic nerve block, and intravenous sedation with opioid drug, have been suggested to decrease the discomfort ( 5 - 7 ), the majority of patients still experience a considerable degree of pain ( 8 ). In an attempt to obtain a further relief, the effect of position which is generally selected between lithotomy and conventional left lateral decubitus (LLD) position had been researched ( 9 - 11 ). However, outcomes from several western studies reached contrasting conclusions, and there are no data for Asian population, who have a relatively smaller prostate.…”