A DOUBLE-BLIND, RANDOMIZED, CONTROLLED TRIAL OF TOPICAL GLYCERYL TRINITRATE FOR TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY
Abstract
Purpose:
We evaluated the efficacy and tolerance of topical 0.2% glyceryl trinitrate (GTN) paste vs placebo to decrease pain associated with transrectal ultrasound guided prostate biopsy.
Materials and Methods:
Between October 2003 and April 2004, 134 consecutive patients referred for a first prostate biopsy were randomized to receive topical 0.2% GTN paste or placebo 30 minutes prior to biopsy. Participants completed a 10 point visual analog pain score following the procedure.
Results:
Mean patient age was 68.5 years in the GTN group and 68.8 in the placebo group. There was a significant decrease in mean pain score in the GTN group compared with placebo (3.7 vs 4.8, p <0.05). Six patients (10%) in the GTN group complained of headache.
Conclusions:
Topical GTN paste is an effective and well tolerated method of decreasing pain associated with transrectal ultrasound guided prostate biopsy. It is safe and easy to use, and it should be offered to patients undergoing this procedure.
References
- 1 : A national survey of transrectal ultrasound-guided prostatic biopsies: time for a national guideline. Int J Clin Pract2003; 57: 773. Google Scholar
- 2 : The procedure of transrectal ultrasound guided biopsy of the prostate: a survey of patient preparation and biopsy technique. J Urol2002; 167: 566. Link, Google Scholar
- 3 : Do unto others—why I would want anesthesia for my prostate biopsy. Urology2003; 62: 973. Google Scholar
- 4 : The optimum doses of and injection locations for periprostatic nerve blockade for transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, placebo controlled study. J Urol2003; 170: 2319. Link, Google Scholar
- 5 : Optimizing local anesthesia during 10-core biopsy of the prostate. Urology2002; 60: 253. Google Scholar
- 6 : A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Lancet1997; 349: 11. Google Scholar
- 7 : Systemic levels of glyceryl trinitrate following topical application to the anoderm do not correlate with the measured reduction in anal pressure. Br J Surg2001; 88: 1613. Google Scholar
- 8 : Nitrous oxide (Entonox) inhalation and tolerance of transrectal ultrasound guided prostate biopsy: a double-blind randomized controlled study. J Urol2002; 168: 116. Link, Google Scholar
- 9 : The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology1997; 50: 562. Google Scholar
- 10 : A randomised trial of periprostatic local anaesthetic for transrectal biopsy. Prostate Cancer Prostatic Dis2003; 6: 242. Google Scholar
- 11 : Effect of local anesthetics on patient recovery after transrectal biopsy. Urology2001; 57: 925. Google Scholar
- 12 : Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol2001; 166: 2178. Link, Google Scholar
- 13 : Randomized prospective study of periprostatic local anesthesia during transrectal ultrasound-guided prostate biopsy. Urology2002; 59: 405. Google Scholar
- 14 : Rectal sensation test helps avoid pain of apical prostate biopsy. J Urol2003; 170: 2316. Link, Google Scholar
- 15 : Transrectal ultrasound examination of the prostate: complications and acceptance by patients. Br J Urol1993; 71: 457. Google Scholar
- 16 : Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol1998; 160: 2115. Link, Google Scholar
- 17 : Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol1997; 79: 608. Google Scholar
- 18 : Patients’ tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of 104 cases. BJU Int1999; 83: 792. Google Scholar
- 19 : Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure. Br J Surg2002; 89: 413. Google Scholar
From the Department of Urology, Churchill Hospital, Oxford, United Kingdom

