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

PURPOSE: The 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 METHODS: This 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). RESULTS: Across 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. CONCLUSIONS: Pain 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.