Diclofenac suppository administration in conjunction with lidocaine gel during transrectal ultrasound-guided prostate biopsy: Prospective, randomized, placebo-controlled study

Objectives. To evaluate the additional analgesic efficacy of the rectal administration of diclofenac suppository compared with placebo in patients undergoing transrectal ultrasound-guided prostate biopsy. Methods. A total of 40 consecutive men undergoing biopsy were enrolled in this study. Patients were randomized equally into two treatment groups. In group 1, patients received an intrarectal 100-mg diclofenac suppository 1 hour before biopsy. In group 2, patients received a glycerin suppository as a placebo intrarectally 1 hour before biopsy. All patients received 10 mL of 2% lidocaine gel intrarectally 10 minutes before biopsy. A self-administrated visual analog scale was used to measure the pain scores at the end of the biopsy and 2 hours and 1 day after the biopsy. Results. The mean patient age was 63.3 +/- 6.8 years and 61.6 +/- 6.7 years in groups 1 and 2, respectively. The mean pain score in groups 1 and 2 was 3.4 +/- 1.3 versus 5.9 +/- 1.7 (P <0.0001), respectively, at the end of the biopsy. The mean pain score at 2 hours and 1 day after the procedure was 1.2 +/- 1.0 versus 3.6 +/- 1.4 (P <0.0001) and 0.5 +/- 0.9 versus 1.4 +/- 1.3 (P = 0.017) in groups 1 and 2, respectively. Conclusions. Intrarectal diclofenac suppository administration is a simple, safe, and effective procedure to reduce pain and improve patients' tolerance of transrectal ultrasound-guided prostate biopsy. We recommend intrarectal diclofenac suppository administration, together with intrarectally administered lidocaine gel, in men undergoing transrectal ultrasound-guided prostate biopsy.