Introduction Over the last two decades the spreading of PSA dosage has led to a dramatic increase in the indication for ultrasound-guided prostate biopsy, which is most commonly implemented through the transrectal access, as initially described by Hodge (1). The alternative ac- cess, i.e. transperineal access, although showing similar and - according to some authors - even greater diagnos- tic potential than transrectal access, met with less suc- © Wichtig Editore, 2009 Which technical aspects have an impact on perceived pain during transperineal prostate biopsy? A prospective study involving 445 cases A. ANTONELLI, C. SIMEONE, L. GIOVANESSI, T. ZAMBOLIN, D. ZANI, S. COSCIANI CUNICO Chair of Urology, University of Brescia, Brescia Urologia / Vol. 76 no. 4, 2009 / pp. 252-257 Reducing pain during transperineal prostatic biopsy ABSTRACT. To assess the technical aspects determining the perceived pain during prostate biopsy via transperineal access. MATERIALS AND METHODS. We conducted prostate biopsy with transperineal access in local anes- thesia. Between January 2007 and January 2008, data on prostatic biopsies were prospec- tively surveyed. The patient was requested to assess perceived pain by means of a Visual Ana- logue Scale ranging from 0 (no pain) to 10 (unbearable pain). Complications were recorded by telephone interviews 30 days after the biopsy. The histological diagnosis was recorded. RESULTS. 445 prostate biopsies were conducted. The average perceived pain score amount- ed to 2.60. At univariate analysis, a lower score was recorded in cases where the anesthetic agent was diluted with physiological saline, those in which a single cutaneous access was chosen along the middle line, those in the first bioptic series as compared to the following series and those in which no sampling involved the transition region. However, the multi- variate analysis showed that only the single cutaneous access was statistically significant. In those cases, also the rates of delayed perineal pain were significantly lower. The cancer diagnosis rate showed no correlations with the type of cutaneous access. CONCLUSIONS. A single median cutaneous access reduces the pain associated to transper- ineal prostatic biopsy. (Urologia 2009; 76: 252-57) KEY WORDS: Prostate biopsy, Transperineal, Pain PAROLE CHIAVE: Biopsia prostatica, Transperitoneale, Dolore 0391-5603/252-06$15.00/0