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Transperineal biopsy under local; positioning, experience
I’m scheduled for a transperineal prostate biopsy under local anesthesia. I’ve read a fair number of posts here, but I’m looking for something more specific.
What I’m trying to understand is what the actual positioning is like: how exposed you are, how long you’re in that position, whether the rectal probe insertion and the time it stays in place is uncomfortable or just strange, and how much control you have to ask for a pause if you need one. I’ve had procedures before, but something about the mechanics of this one, the vulnerability of the position combined with being awake for it, has me more preoccupied than the pain itself.
If you’ve had a TP biopsy with local anesthesia (not sedation), I’d appreciate hearing: How you’d describe the positioning itself, and how long you were in it? Whether the local anesthetic adequately covered the probe placement, or just the needle punctures? Anything you wish someone had told you beforehand about what to expect physically, separate from pain?
Trying to go in with a realistic picture rather than a worst-case one. Thanks in advance for sharing.
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Hi, I had the same procedure which is usually done under local anesthesia. It's not that bad at all. Everything is done very professionally. You lay on back with legs up in stirrups. They immediately cover then tape your testicles & penis up out of the way, numb you, insert small probe into anus and insert 2 catheters where the biopsy needle will be inserted to take samples, usually around 15-20 samples. One nurse will stand by you holding your hand and talking to you, trying to take your mind off of it. It is basically painless but what is annoying is hearing the click each time a sample is taken, your mind makes you jump a little. It's over in about 20 mins. Not much pain after. They will have you drink a lot of water after procedure and as soon as you urinate in toilet you go home. Be prepared for some blood in urine & semen for several weeks. The first few times you ejaculate don't be alarmed if semen is bright red blood. This can be a real shock to you and partner! Wishing you the best and good luck on the results being a low Gleason score!
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10 ReactionsI had a transperineal biopsy at Mayo. Not just local anesthesia, but also conscious sedation. My question is, are you opposed to conscious sedation or have other concurrent medical conditions that are contraindications for conscious sedation. Basically it’s light sedation, and you will have no memory whatsoever of the procedure. not only do I have no memory of the procedure, but had no pain. The usual drugs used are a combination of Versed, fentanyl and at times propofol.
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3 ReactionsI know you might hear conscious sedation and think you are awake, but you are out of it. In the many years past even colonoscopies and endoscopies were done wiyh conscious sedation but now all done with anesthesia. I had three bone marrow biopsies if you want to talk about a well known extremely painful procedure, all under sedation but never felt anything. I went out and brought back immediately, did not even remember.
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3 Reactions@jheadding My doctor prefers/ recommends local. There’s an option for other but he has discouraged it. From what I’ve read, local has become more common. I’m not worried about the pain… and confident the local will work. It’s other aspects of the procedure I’m trying to get comfortable with. Thanks for your input and sharing.
@copyman Thanks! Appreciate it.
@scooterphilly
Sedation is not used in procedures just to eliminate the pain. It is used to make patient comfortable and also to induce complete stillness of a patient . My husband's surgeon actually insisted on sedation because he had patients reflexively make a sudden move or flinch and it can cause probe to miss targeted area, etc.
What was your doctor's reasoning for preferring local anesthetic only ? It is definitely cheaper for him since he does not have to pay for anesthesiologist nor for extended booking of an operating room.
If you are apprehensive and embarrassed to be in certain position there is no need for you to go through that trauma - just my personal opinion.
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1 Reaction@surftohealth88 So true! I had no idea I would have my legs and feet pulled so far back - it felt like they were almost behind my head!
And the wide eyed horror of the two young nurses staring at my puckered rear made me wish that I was asleep…or at least wearing a hood…
Phil
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3 ReactionsIt's not bad at all. You are flat on your back and your legs are strapped into stirrups (think gynecological exam), raised, and separated. There was a big man (Willy) that did all of the prep including securing the scrotom and penis out of the way and a warm blanket placed so that exposure was minimal. There was one nurse monitoring vitals but she remained up by my head. Very little to be embarrassed about despite the nature of the procedure.
It seems that the probe concerns you as well. While it can be somewhat uncomfortable, especially when the surgeon moves it around, it is not painful at all.
The surgeon will probably give you a 1,2,3 warning before each sample is taken so you won't be surprised when the spring loaded needle is fired into your prostate. They are not painful.
Pain is not really a concern. They topically numb the perineum with lidocaine, then give a couple of shots of lidocaine into the perineal area (kind of like a very mild bee sting), followed by a couple more shots of lidocaine into the prostate itself which acts as a nerve block. These are marginally briefly worse that the other shots, but are still really just a sting or pinch.
The process is over quickly. I was just as apprehensive as you and was surprised at how easy it was. Don't worry about it! Compared to what may lay ahead this is a piece of cake.
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3 Reactions@keithl56 thanks! Thats really helpful.
@surftohealth88 thanks!! He said his patients tolerate it well. I’d have to wait longer for the appointment for other sedation due to it taking place at the hospital vs his office.