Metin İshak ÖZTÜRK, Orhan KOCA, EYÜP VELİ KÜÇÜK, Muzaffer Oğuz KELEŞ, Mustafa GÜNEŞ, Muhammet İhsan KARAMAN

Transrektal ultrason eşliğinde yapılan prostat biyopsisinde ağrı düzeyinin yaş ve coğrafi bölge ile ilişkisi

Amaç: Çalışmamızda; transrektal ultrasonografi (TRUS) eşliğinde yapılan prostat biyopsisinde hasta toleransının, hastanın yaşı ve yaşadığı bölge ile ilişkisi değerlendirildi. Gereç ve Yöntem: Polikliniğimize başvuran ve yapılan değerlendirme sonucunda TRUS eşliğinde prostat biyopsisi önerilen, ortalama yaşı 67.9 (46–82) yıl olan 162 hasta değerlendirilmeye alındı. Hastalara biyopsiden önce ultrason jeli uygulandı, ilave herhangi bir ağrı kesici veya anestezik yöntem kullanılmadı. Tüm hastalara klasik 8 kadran biyopsi uygulandı. 8 kadran üstü biyopsi gerekenler ile ilave rektal veya anal hastalığı olanlar çalışmadan çıkarıldı. Tolerans değerlendirme kriteri olarak Visüel Analog Skala (VAS) kullanıldı. 0=ağrı yok, 10=dayanılmaz ağrı olarak belirtilen skalanın sonuçları istatistiksel olarak One-Way ANOVA ile değerlendirildi. Bulgular: Hastaların VAS ile değerlendirilmesi sonucunda hastaların ortalama ağrı düzeyleri, bölgelere göre sırasıyla Karadeniz kökenlilerde (23 hasta) 4.9, Doğu Anadolu kökenlilerde (26 hasta) 3.6, İç Anadolu kökenli olanlarda (24 hasta) 3.6, Marmara bölgesi kökenlilerde (21 hasta) 2.2, Ege kökenlilerde (20 hasta) 1.9, Akdeniz kökenlilerde (19 hasta) 1.5, Güneydoğu Anadolu kökenlilerde (29 hasta) 1.4 olarak tespit edildi. Karadeniz bölgesi kökenli olanların ağrı düzeyi diğer tüm bölgelerden, Doğu ve İç Anadolu kökenli olanların ağrı düzeyi diğer bölgelerden anlamlı olarak farklıydı. Ayrıca hasta toleransının istatistiksel anlamlı olmamakla beraber yaşla azaldığı görüldü. Sonuç: TRUS eşliğinde yapılan prostat biyopsisinde hasta memleketinin ağrı düzeyini anlamlı olarak etkilediği görülmüştür. Ağrı algılamasında yaş da etkili olmakla beraber istatistiksel anlamlı fark bulunamamıştır. Bu sonuçların daha geniş çalışmalarla desteklenmesi durumunda, prostat biyopsisi yapılacak hastalara bilgi verilirken, bunun da göz önünde bulundurulmasının yararlı olabileceği düşünüldü.

The relation of pain with age and geographical location in transrectal ultrasonography-guided prostate biopsy

Objective: In this study the relationship of patient tolerance in transrectal ultrasonography (TRUS) guided prostate biopsies, with age and geographical location was evaluated. Materials and methods: One hundred sixty-two patients with a mean age of 67.9 years (range, 46–82 years) who underwent TRUS-guided prostate biopsies in our clinic were examined. Ultrasound gel was applied before the biopsy procedure, and no additional anesthetic methods or analgesics were used. All the patients underwent a standard 8-core biopsy. Patients, who required > 8 core biopsies and those with additional rectal or anal disease, were excluded from the study. The Visual Analog Scale (VAS), which ranged from 0=no pain to 10=unbearable pain, was used as the tolerance assessment criterion. The results were statistically assessed by one-way ANOVA. Results: The number of patients evaluated and the mean pain scores according to regions were as follows: Black Sea region (n=23), 4.9; East Anatolian region (n=26), 3.6; Central Anatolian region (n=24), 3.6; Marmara region (n=21), 2.2; Aegean region (n=20), 1.9; Mediterranean region (n=19), 1.5; and Southeast Anatolian region (n=29), 1.4. The mean pain score of patients from the Black Sea region was significantly higher than the other regions; whereas the mean pain scores of patients in the East and Central Anatolian regions were significantly higher than the other regions, except Black Sea region. On the other hand, although not statistically significant, patient tolerance was found to decrease with age. Conclusion: The geographical locations of the patients were shown to affect the pain levels significantly, in cases of TRUS-guided prostate biopsies. Pain perception, although not statistically significant, was affected by age. In case the results of the present study are confirmed in large-scale studies, it may be beneficial to consider this issue in counseling the patients undergoing prostate biopsies

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1.Holm HH, Gammelgaard J. Ultrasonically guided precise needle placement in the prostate and the seminal vesicles. J Urol. 1981; 125: 385–7.
2.Patel HR, Lee F, Arya M, et al: A national survey of transrectal ultrasound-guided prostatic biopsies: time for a national guideline. Int J Clin Pract. 57: 773-4, 2003.
3.Crundwell MC, Cooke RW, Wallace DM: Patients’ tolerance of transrectal ultrasound guided prostate biopsy: an audit of 104 cases. BJU Int. 83: 792-5, 1999.
4.McGrath P: 'The biggest worry..': research findings on pain management for Aboriginal peoples in Northern Territory, Australia. Rural Remote Health. 6(3): 549, 2006.
5.Chapman W, Jones C: Variations in cutaneous and visceral pain sensitivity in normal subjects. Clin Invest. 23: 81–91, 1944.
6.Clark WC, Clark SB: Pain responses in Nepalese porters. Science. 209: 410–2, 1980.
7.Avcı A, Tahmaz L, Özgök A, et al: The efficacy of intrarectally local anesthesia with lidocaine gel on the comfort of the patient during transrectal ultrasound-guided 12 cores prostate biopsies (in Turkish). Turkish Journal of Urology. 29: 159-163, 2003.
8.Holm HH and Gammelgaard J: Ultrasonically guided precise needle placement in the prostate and the seminal vesicles. J Urol. 125(3): 385-7, 1981.
9.Clements R, Aideyan OU, Griffiths GJ, et al: Side effects and patient acceptability of transrectal biopsy of the prostate. Clin Radiol. 47: 125-6, 1993.
10.Collins GN, Lloyd SN, Hehir M, et al: Multiple transrectal ultrasound guided prostatic biopsies; true morbidity and patient acceptance. Br J Urol. 71: 460-3, 1993.
11.Gürdal M, Kireççi S, Tekin A, et al: Use of intrarectal lidocaine gel during transrectal ultrasonography guided prostate biopsy: A double blind, randomized, placebo controlled study on patient’s tolerance (in Turkish). Turkish Journal of Urology. 29: 407 409, 2003.
12.Soloway MS and Öbek C: Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol. 163: 172-3, 2000.
13.Berry PH, Dahl JL: The new JCAHO pain standards: Implications for pain management nurses. Pain Manag Nurs. 1:3–12, 2000.
14.Johnson S. Introduction: Legal and regulatory issues in pain management. J Law Med Ethics. 26: 265–6, 1998.
15.Lasch KE: Culture, pain, and culturally sensitive pain care. Pain Manag Nurs. suppl 1:16–22, 2000.
16.Tan EC, Lim Y, Teo YY, Goh R, et al: Ethnic Differences in Pain Perception and Patient-Controlled Analgesia Usage for Postoperative Pain. J Pain. 9(9):849-55, 2008.
17.Edwards RR, Moric M, Husfeldt B, et al: Ethnic similarities and differences in the chronic pain experience: a comparison of african american, Hispanic, and white patients. Pain Med. 6(1):88-98, 2005.
18.Green CR, Anderson KO, Baker TA, et al: The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain. Pain Med. 4(3):277-94, 2003.
19.Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al: Race, gender, and partnership in the patient-physician relationship. JAMA. 282:583–9, 1999.
20.Weisse CS, Sorum PC, Sanders KN, et al: Do gender and race affect decisions about pain management? J Gen Intern Med. 16:211–7, 2001.
21.Cole LJ, Farrell MJ, Gibson SJ, et al: Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging. May 28 [Epub ahead of print], 2008.
22.Wewers ME, Lowe NK: A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing & Health. 13: 227-236, 1990.
23.Mueller PR, Biswal S, Halpern EF, et al: Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication- a prospective study. Radiology. 215:684-8, 2000.
24.De Sio M, Massimo D, Di Lorenzo G, et al: The need to reduce patient discomfort during transrectal ultrasonography- guided prostate biopsy: what do we know? BJU Int. 96: 977-83, 2005.