A novel method for pain control: infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsy using transcutaneous electrical nerve stimulation (TENS)

  • Mustafa Suat BolatEmail author
  • Onder Cinar
  • Ramazan Asci
  • Recep Buyukalpelli
Urology - Original Paper



To describe a novel method for the control of pain during prostate biopsies, infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsies with no further needle insertions for local anesthetic infiltration.


A total of 138 men with elevated prostate-specific antigen levels and/or abnormal digital rectal examination findings 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.


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).


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.


Depression Pain Prostate biopsy Transepidermal nerve stimulation 


Author contribution

MSB: Protocol/project development, data collection or management, data analysis, manuscript writing/editing. OC: Data analysis, manuscript writing/editing, protocol/project development. RB: Data analysis, manuscript writing/editing. RA: Data analysis, manuscript writing/editing. This study has been approved by the appropriate institutional and/or national research ethics committee (21.01.2019/B.30.2.ODM.0.20.08/1913-67) and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Gazi State Hospital, Urology ClinicSamsunTurkey
  2. 2.Department of UrologyBulent Ecevit UniversityZonguldakTurkey
  3. 3.Department of Urology, Faculty of MedicineOndokuzmayis UniversitySamsunTurkey

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