European Radiology

, Volume 29, Issue 12, pp 6965–6970 | Cite as

Comparison of analgesic techniques in MRI-guided in-bore prostate biopsy

  • M. Quentin
  • C. Arsov
  • T. Ullrich
  • B. Valentin
  • A. Hiester
  • D. Blondin
  • P. Albers
  • G. Antoch
  • L. SchimmöllerEmail author



To evaluate different analgesic techniques in MRI-guided in-bore prostate biopsy (IB-GB) regarding the influence on patient procedural experience of pain.


Two hundred fifty-two consecutive patients who had received an IB-GB either with intrarectal instillation of 2% lidocaine gel (n = 126, group A) or with periprostatic nerve block (PPNB) with 2% mepivacaine (n = 126, group B) were retrospectively included in this study. Pain scores were measured on a visual analog scale, the operating room time (ORT) was recorded for each biopsy and correlations between the parameters were analysed.


Pain scores for IB-GB were slightly lower in group B compared with group A (2.0 ± 1.9; 2.4 ± 1.7; p = 0.02). In group A, significantly more targeted biopsy cores were acquired (group B: 5.2 ± 1.1; group A: 5.6 ± 0.8; p < 0.01). ORT was comparable and not significantly different in both groups. There was only a weak correlation between pain scores and ORT in group B (rS = 0.22; p = 0.01), but no correlation between pain scores and the number of biopsy cores or the prostate volume.


Pain levels are generally low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel. A statistically significant, slightly lower pain score was documented for PPNB and might be preferred when the focus is analgesia. On the other hand, due to the minor difference and easier administration, intrarectal gel instillation seems to be a reasonable practice for standard analgesia for MRI-guided in-bore biopsy.

Key Points

• Pain levels were low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel as analgesic method.

• PPNB prior to IB-GB resulted in a slightly lower pain score but required a higher effort.

• Intrarectal gel anaesthesia seems to be a reasonable practice for standard analgesia for IB-GB in an outpatient setting.


Prostate cancer Analgesics Image-guided biopsy Magnetic resonance–guided interventional procedures 



Cognitive fusion–guided biopsy


European Association of Urology


MRI/US fusion–guided prostate biopsy


MRI-guided in-bore prostate biopsy


Interquartile range


Multiparametric magnetic resonance imaging


Operating room time


Prostate cancer


Periprostatic nerve block


Prostate-specific antigen


Spearman correlation coefficient


Transrectal ultrasound-guided



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Lars Schimmöller.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported:

Some patients in study group A were previously enrolled in a prospective randomised trial assessing the diagnostic efficacy of IB-GB and FUS-GB ( identifier: NCT02220517; Arsov C, Rabenalt R, Blondin D, et al (2015) Eur Urol).

Patients in study group B were previously enrolled in a prospective randomised trial assessing the diagnostic efficacy of IB-GB in comparison with TRUS-GB in biopsy-naïve men with elevated PSA ( identifier: NCT01553838; Quentin M, Blondin D, Arsov C, et al (2014) J Urol).


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • M. Quentin
    • 1
  • C. Arsov
    • 2
  • T. Ullrich
    • 1
  • B. Valentin
    • 1
  • A. Hiester
    • 2
  • D. Blondin
    • 1
  • P. Albers
    • 2
  • G. Antoch
    • 1
  • L. Schimmöller
    • 1
    Email author
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Dusseldorf, Medical FacultyDusseldorfGermany
  2. 2.Department of UrologyUniversity Dusseldorf, Medical FacultyDusseldorfGermany

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