Can the probe movement direction affect pain in patients undergoing transrectal ultrasound-guided prostate biopsy? Probe direction and pain in prostate biopsy

Ali Akkoç; Murat Topçuoğlu; Murat Uçar; Erkan Karadağ; Semih  Keskin; Deniz Demir

doi:10.28982/josam.8416

Authors

Ali Akkoç Department of Urology, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Türkiye https://orcid.org/0000-0002-4325-1075
Murat Topçuoğlu Department of Urology, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Türkiye https://orcid.org/0000-0003-2155-5171
Murat Uçar Department of Urology, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Türkiye https://orcid.org/0000-0002-8690-0485
Erkan Karadağ Department of Urology, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Türkiye https://orcid.org/0009-0009-2197-7359
Semih Keskin Department of Urology, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Türkiye https://orcid.org/0009-0005-7887-0203
Deniz Demir Department of Urology, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Türkiye https://orcid.org/0009-0007-8730-7660

DOI:

https://doi.org/10.28982/josam.8416

Keywords:

prostate cancer, biopsy, VAS, pain, probe direction

Abstract

Background/Aim: Prostate biopsy is the gold standard for prostate cancer diagnosis, but patient discomfort remains a major limitation. While numerous studies have investigated anesthesia and analgesia, the influence of transrectal ultrasound probe movement direction has not yet been examined in clinical studies. This study aimed to evaluate whether the direction of transrectal ultrasound probe movement affects pain perception and complication rates during systematic prostate biopsy.

Methods: In this retrospective cohort study, 246 patients undergoing 12-core transrectal ultrasound-guided biopsy between 2019 and 2025 were analyzed. Patients were stratified into three groups according to the probe movement sequence applied by the performing urologist. Pain was assessed using the visual analogue scale (VAS; 0–10) at five time points: probe insertion, probe manipulation, needle puncture, 30 minutes post-biopsy, and two hours post-biopsy. Complications within 30 days were recorded, including rectal bleeding, hematuria, fever, and urinary retention. Statistical analyses included one-way ANOVA with effect size estimation (η²) for continuous variables and χ² or Fisher’s exact test for categorical variables.

Results: Baseline characteristics and cancer detection rates were comparable across groups. Pain scores during probe manipulation (VAS 2), needle puncture (VAS 3), and 30 minutes post-biopsy (VAS 4) differed significantly among the groups, with Group B reporting the lowest values and Group A the highest (all P<0.001). No significant differences were observed for probe insertion (VAS 1, P=0.30) or two hours post-biopsy (VAS 5, P=0.19). Hematuria occurred in 40–42% of cases, rectal bleeding in 9.6–19.5%, and fever in 2.4–5.2%. Although these differences were not statistically significant (rectal bleeding, P=0.09; fever, P=0.47; hematuria, P=0.94; urinary retention, P=0.86), both rectal bleeding and fever were most frequent in Group A and least frequent in Group B.

Conclusion: Beyond anesthetic technique, probe maneuver direction significantly influences pain perception during transrectal ultrasound-guided biopsy. Group B’s shorter cumulative probe trajectory (≈22–24% reduction) corresponded with consistently lower pain and fewer complications. To our knowledge, this is the first study to identify probe movement strategy as a determinant of biopsy tolerance. Incorporating this approach offers a simple, low-cost modification with potential to improve patient comfort and safety.

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