Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for
pain relief during transrectal ultrasound guided biopsy of the prostate.
Author(s): Jindal T, Mandal SN, Mukherjee S, Karmakar D.
Affiliation(s): Department of Urology, Calcutta National Medical College, Kolkata, India.
drtarunjindal@gmail.com
Publication date & source: 2012, Int Braz J Urol. , 38(3):405-10
INTRODUCTION AND OBJECTIVE: Transrectal ultrasound biopsy of prostate is a
painful procedure. The introduction of the rectal probe is one of the major
contributors to the pain associated with this procedure. Drugs that relax the
anal sphincter should theoretically decrease this pain. This study was done to
compare the efficacy and safety of two topical medications that relax the anal
sphincter, diltiazem and nitroglycerine, in decreasing the pain associated with
transrectal ultrasound guided prostate biopsy.
MATERIALS AND METHODS: 66 patients who were to undergo their first prostate
biopsy were randomized to receive either 2 mL of 2 % topical diltiazem or 2 mL of
0.2 % topical nitroglycerine or placebo 20 minutes before prostate biopsy. All
patients also received 15 mL of intrarectal lignocaine. A 10-point visual
analogue score was used to record the pain immediately after the insertion of the
probe, during biopsy and at the end of the procedure.
RESULTS: The pain scores due to probe insertion, during biopsy and at the end of
the procedure in patients who received topical diltiazem or nitroglycerine were
significantly lower compared to the placebo group (p < 0.001). There were no
significant differences in the pain scores between the patients receiving
diltiazem compared to those receiving nitroglycerine. Higher incidence of
headache and fall in blood pressure was noted in patients who received
nitroglycerine compared to those receiving diltiazem.
CONCLUSION: Topical diltiazem and nitroglycerine are equally effective in
reducing the pain associated with transrectal prostatic biopsy. Diltiazem is
safer compared to nitroglycerine.
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