Identification of the variables associated with pain during transrectal ultrasonography-guided prostate biopsy in the era of periprostatic nerve block: the role of transrectal probe configuration


Correspondence: J. Stephen Jones, Department of Regional Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA.



What's known on the subject? and What does the study add?

  • Currently, peri-prostatic nerve block (PPNB) is the most effective method to reduce pain during TRUS biopsy. Although the advance in PPNB allowed a better tolerability of the procedure by most of patients, a minority of men still find the procedure unacceptably painful.
  • We found in this study that the probe design and the needle guide affect pain encountered during different steps of TRUS guided PBx.


  • To identify the different factors that are associated with pain perceived during transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx), with special focus on the role of transrectal probe configuration.

Patients and Methods

  • We analysed prospective data on 1114 patients undergoing TRUS-guided PBx at our institute from January 2007 to August 2010.
  • Patients completed questionnaires based on a 10-point visual analogue pain scale related to the consecutive steps of PBx: probe insertion, application of periprostatic nerve block (PPNB) and the obtaining of PBx cores.
  • The variables of interest were age, prostate volume, DRE findings, number of previous biopsies, probe type and the number of retrieved cores.
  • All variables were correlated to pain scores using multivariate regression analysis.


  • At the probe insertion step, end-fire probes were more painful than side-fire probes.
  • The Siemens G50TM with metal, short plastic and long plastic needle guides (Siemens, Munich, Germany) had higher pain scores than the B&K probe (Bruel & Kjaer Medical, Copenhagen, Denmark; P = 0.09, 0.008 and 0.003, respectively).
  • For pain at the PPNB application step, all G50TM guide subtypes and the Sonoline Prima probe (Siemens) had higher pain scores than the B&K probe, but this only reached statistical significance for the G50TM probe with short plastic guide (P = 0.03).
  • On obtaining PBx cores, all G50TM subtypes had higher pain scores when compared with the B&K probe (P = 0.59, 0.38 and 0.69, respectively).


  • The probe design and needle guide affect pain during each step of TRUS-guided PBx.
  • Both the B&K and Sonoline Prima probes caused less pain when compared with the G50TM probe, regardless of needle guide.