Vol.:(0123456789) 1 3 International Urology and Nephrology https://doi.org/10.1007/s11255-019-02277-0 UROLOGY - ORIGINAL PAPER A novel method for pain control: infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsy using transcutaneous electrical nerve stimulation (TENS) Mustafa Suat Bolat 1  · Onder Cinar 2  · Ramazan Asci 3  · Recep Buyukalpelli 3 Received: 24 June 2019 / Accepted: 3 September 2019 © Springer Nature B.V. 2019 Abstract Purpose To describe a novel method for the control of pain during prostate biopsies, infiltration free local anesthesia tech- nique (INFLATE) for transrectal prostatic biopsies with no further needle insertions for local anesthetic infiltration. Methods A total of 138 men with elevated prostate-specific antigen levels and/or abnormal digital rectal examination find- ings were included in the study. Of the patients, 73 were assigned to the INFLATE group and 65 to the TRUS-PNB group. Demographic data, PSA levels, findings of digital rectal examinations, and multiparametric prostatic magnetic resonance imaging were recorded. In the INFLATE group, a two-channel TENStem eco basic device with two electrodes was used for pain control during the biopsy. For the TRUS-PNB group, 60 mg lidocaine gel was given intrarectally in addition to infiltration of a prilocaine and bupivacaine mixture (5 mL of 2% prilocaine + 5 mL of 0.25% bupivacaine). Pain perception was assessed using a linear numeric rating scale. Results The mean ages, BMIs, prostate volumes, and PSA levels were similar between the two groups (p > 0.05). Of the 56 participants with prostate adenocarcinoma, 28 were in the INFLATE group, and 28 were in the TRUS-PNB group with a 40.6% overall cancer detection rate. The mean preoperative and post-operative pain scores during probe insertion, biopsy and post-biopsy were similar between the groups (p > 0.05). Conclusion The results of the study confirmed that INFLATE for transrectal prostate biopsy using a TENS device could safely and effectively be used for pain control with the advantage of two fewer needle attempts with no increase in significant complications. Keywords Depression · Pain · Prostate biopsy · Transepidermal nerve stimulation Introduction Prostate cancer is one of the most diagnosed tumors among older men [1]. A prostate biopsy is one of the most com- monly used outpatient procedures for diagnosis in the prostate. Astraldi first described the finger-guided prostate biopsy [2]. Since then, the technique has evolved to its cur- rent form of transrectal ultrasound-guided prostate biopsy with a periprostatic nerve block (TRUS-PNB), which is rec- ommended by the European Association of Urology. Moreo- ver, the use of multiparametric MRIs has increased in recent years to obtain higher clinically significant prostate cancer diagnoses by targeting prostatic lesions [3]. Despite its diag- nostic importance, taking a prostate biopsy may be a bother- some procedure in which patients may suffer from fear of pain and feelings of discomfort [4]. Although some research- ers have reported low rates of infection [5], it is reasonable * Mustafa Suat Bolat msbolat@gmail.com Onder Cinar drondercinar@gmail.com Ramazan Asci rasci60@gmail.com Recep Buyukalpelli rbykalp@yahoo.com 1 Gazi State Hospital, Urology Clinic, Samsun, Turkey 2 Department of Urology, Bulent Ecevit University, Zonguldak, Turkey 3 Department of Urology, Faculty of Medicine, Ondokuzmayis University, Samsun, Turkey