Comparison of the efficacy of topical diltiazem nd nitroglycerine before transrectal ultrasound guided biopsy of the prostate

Introduction and objectives:
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 the pain of probe insertion. This study was done to compare the safety and efficacy of two topical medications, diltiazem and nitroglycerine to decrease pain associated with transrectal ultrasound guided prostate biopsy.

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 15 minutes before prostate biopsy. All the patients 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. Any adverse effects reported by the patients were also recorded.

There was no significant difference in mean age and prostate volume between the groups. There was a significantly lower pain score due to probe insertion, during biopsy and at the end of the procedure in patients who received topical diltiazem or nitroglycerine as compared to the placebo group (p<0.001, Mann Whitney test). There were no significant differences between the pain scores between the patients receiving diltiazem as compared to those receiving nitroglycerine. Significantly higher incidence of headache and fall in blood pressure was noted in patients who received nitroglycerine as compared to those receiving diltiazem.

Topical diltiazem and nitroglycerine are equally effective in reducing the pain associated with transrectal biopsy of the prostate. Diltiazem is safer as compared to nitroglycerine and should be preferred.

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