***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE We evaluated the efficiency of various amounts of local anesthesia and various numbers of injection sites to determine the most effective pain control with the least number of injections and the amount of injected medium in patients who underwent transrectal ultrasound guided prostate biopsy . MATERIAL S AND METHODS Transrectal ultrasound guided 8 core biopsy of the prostate was performed in 175 consecutive men . Patients were r and omized into 7 groups with 25 per group . Group 1 received 5 cc saline and groups 2 to 7 received 2.5 , 5 or 10 cc 1 % lidocaine injected as local anesthesia at basal or basal plus apical locations . The patients were then evaluated for pain and other complications to determine whether there was a difference regarding groups . RESULTS Mean pain scores were significantly lower than in saline group for all anesthesia injected groups except group 2 with a 2.5 cc bilateral basal injection . The most effective pain control was achieved by 10 cc anesthetic injections . Basal plus apical injections were not superior than only basal injections for pain control . There was no significant difference in the hematuria , hematospermia , rectal bleeding or infection rate among the groups . Increasing the number of injections and amount of lidocaine had no effect on complication rates . CONCLUSION Our placebo controlled , prospect i ve , r and omized study indicated that 10 cc local anesthetic injections supply significantly better pain control than lower doses for periprostatic nerve blockade during prostate biopsy . Although bilateral basal plus apical 10 cc lidocaine injections result ed in the lowest mean pain score , there was no statistically significant difference from 10 cc bilateral basal injections Introduction : To test the hypothesis that periprostatic block could completely relief  prostatic biopsy-associated pain . Material s and Methods : Patients scheduled for transrectal ultrasound guided prostate biopsy  were r and omized ( 1:1:1 ratio ) to no analgesia ( group A ) , endorectal enema of 1 % lidocaine gel ( group B ) or transrectal periprostatic block ( group C ) . All patients underwent 10 core TRUS-guided biopsy .  After the procedure , a ten visual analogue pain score ( VAS ) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained . The study design included interim analysis of pain score after the first 60 patients were enrolled . Kruskal-Wallis test for unpaired data was used for statistical analysis . Data are presented as mean , median ( range ) . Results : Sixty patients were enrolled between May 2003 and December 2003 and all patients were evaluable . Mean and median age was 68.5 and 69 ( range 53–82 ) years , respectively .  Mean and median PSA was 86.8 and 9 ng/ml ( range 0.58–4.111 ) , respectively . No major side effects were observed . Patients in group A scored at VAS a median 4 , mean 5.5 ± 2.3 ( range 3–10 ) . Patients in group B scored a median 4 , mean 5.5 ± 2.7 ( range 3–10 ) ( p = 0.237 ) . Patients receiving periprostatic injections of carbocaine ( group C ) scored a median 0 , mean 0.5 ± 0.8 ( range 0–2 ) . The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostatic biopsy without anesthesia or with intrarectal anesthetic jelly ( p = 0.00001 ) . In the periprostatic block group 65 % of patients referred no pain after the procedure ( VAS = 0 ) while all patients in the other groups experience some degree of pain . Conclusion : The use of bilateral periprostatic block is a very effective and useful technique , well tolerated by the patient , which almost completely abolishes the pain and discomfort associated with the prostatic biopsy procedure Background : We aim to compare the degree of pain control and complications in three types of anesthesia using periprostatic nerve block ( PPNB ) plus intrarectal local anesthesia ( IRLA ) , low-dose spinal anesthesia , and intravenous ( IV ) sedation in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy . Material s and Methods : In this clinical trial study , 106 patients were participated from December 2015 to December 2016 at Alzahra Hospital , Isfahan , Iran . Patients were r and omly allocated into three groups to receive PPNB plus IRLA ( n = 36 ) , low-dose spinal anesthesia ( n = 35 ) and IV sedation ( n = 35 ) before TRUS-guided prostate biopsy .  Pain scores were recorded using a 10 point visual analog scale right after the biopsy was done . Early and late complications were assessed using a question naire after the procedure and in follow-up of patients . Results : Overall , the pain score in the low-dose spinal anesthesia group was significantly lower than PPNB plus IRLA and IV sedation groups ( P < 0.001 ) . The differences in pain scores between PPNB plus IRLA group and IV sedation group were not significant ( P = 0.30 ) . Urinary retraction and fever were significantly more frequent in low-dose spinal anesthesia and IV sedation , retrospectively ( P = 0.04 , P = 0.03 ) . No significant difference in late complications was found among the groups . Conclusion : This study demonstrates that low-dose spinal anesthesia is superior to PPNB plus IRLA and IV sedation in terms of pain controlling and was associated with higher tolerance of the examination and patient comfort PURPOSE Transrectal ultrasonography guided prostate biopsy is the principle procedure in the histological diagnosis of prostate cancer . Recently a trend toward increasing the number of cores has been popularized . This practice further increases the need for a proper anesthetic application . However , there is no consensus on a st and ard local anesthetic strategy , while groups at most institutions currently prefer periprostatic anesthesia . We prospect ively evaluated the contribution of intraprostatic anesthesia for transrectal prostate biopsies even when the sampling number was doubled to 12 cores . MATERIAL S AND METHODS A total of 200 patients who underwent prostate biopsy with transrectal ultrasound guidance were included . The 2 groups received the usual periprostatic anesthesia . Consequently patients were prospect ively r and omized into 2 groups . Group 1 received additional intraprostatic lidocaine injection , while group 2 received the same amount of injection of 0.9 % NaCl . The efficiency of applied local anesthesia was assessed by a visual analog pain scale . RESULTS The study groups were comparable regarding patient age , prostate size and cancer rate . Pain scores revealed that the combination of intraprostatic and periprostatic local anesthesia provided significantly better pain control than periprostatic infiltration alone . No difference was observed regarding the morbidity rate in the 2 groups . CONCLUSIONS The current study suggested that adding intraprostatic local anesthesia provides a significantly efficient strategy during transrectal ultrasound prostate biopsy , even in cases of 12-core sampling . Subsequent trials are needed to establish a st and ard analgesia policy for prostate biopsy We assessed the analgesic efficacy of levobupivacaine when administered as an adjuvant to diclofenac sodium in prostate biopsy pain management and effects of prostate biopsy on sexual function . Ninety patients underwent transrectal ultrasound (TRUS)‐guided biopsy of the prostate and were r and omly assigned to three groups : group D received diclofenac sodium suppository ; Group L received periprostatic injection of levobupivacaine ; group DL received diclofenac suppository and levobupivacaine in addition . Patients were asked to use a visual analogue scale score ( VAS ) question naire about pain after 10 core prostate biopsy . Sixty‐two patients reported to be prostate cancer‐free underwent further evaluation with the International Index of Erectile Function‐5 ( IIEF‐5 ) question naire at 1 and 3 months after biopsy . Mean pain scores during prostate biopsy were significantly lower in group DL and were superior to the group L and group D ( P < 0.001 ) . Mean IIEF‐5 score prior to biopsies was significantly higher when compared with the mean IIEF‐5 score 1 month after biopsy ( P < 0.0001 ) . Mean IIEF‐5 scores 1 month after biopsy were significantly lower when compared with the mean IIEF‐5 scores 3 months after biopsy ( P = 0.002 ) . TRUS‐guided prostate biopsies have a statistically significant impact on short‐term erectile function , but this difference is not clinical ly significant ; however , medium‐term erectile function is not affected both statistically and clinical ly OBJECTIVES To introduce two forms of anesthesia and compare them with st and ard local anesthesia techniques . METHODS A total of 114 consecutive patients underwent prostate needle biopsy . The patients were sequentially r and omized to receive different kinds of anesthesia : 2 % rectal lidocaine gel , 40 % dimethyl sulfoxide ( DMSO ) with lidocaine , perianal injection of 1 % lidocaine , or periprostatic nerve block . Pain perception was separately assessed for probe insertion and biopsies using a visual pain analog score . One-way analysis of variance was used to compare the data scale among the four groups . A linear regression model was used to define the independent variables that predicted the level of pain . RESULTS The groups were similar in terms of age , prostate-specific antigen levels , digital rectal examination findings , prostate volume , pain tolerance , biopsy time , and number of cores taken . The lowest pain scores for probe insertion were for the perianal injection and DMSO/lidocaine groups ( 0.89 and 1.38 , respectively ) . The difference between these scores and those for the other two groups was statistically significant ( P < 0.001 ) . Pain perception during biopsy did not differ significantly among the DMSO/lidocaine , perianal , or periprostatic groups and was greatest in the lidocaine gel group ( 4.147 ; P < 0.001 ) . We did not observe any statistically significant correlation between the pain level during probe insertion and biopsy and pain tolerance ( P = 0.514 and P = 0.788 , respectively ) . The anesthesia type was the strongest single predictor of the pain level during biopsy ( P < 0.001 ) . CONCLUSIONS The use of 40 % DMSO with lidocaine instilled into the rectal vault for 10 minutes avoids any need for injection and is capable of decreasing the discomfort or pain experienced during probe insertion and prostate biopsy comparable to the perianal and periprostatic protocol AIM This study was design ed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound (TRUS)-guided prostate biopsy . METHODS Ninety men undergoing transrectal prostate biopsy from July through December 2004 were r and omized into three groups of 30 patients each . Before the biopsy , patients in Group 1 received 20 mL of 2 % lidocaine gel intrarectally ; patients in Group 2 received 5 mL ( 2.5 mL per side ) of 2 % lidocaine solution injected near the junction of the seminal vesicle with the base of the prostate ( along the neurovascular bundles ) , and patients in Group 3 ( control group ) received 5 mL ( 2.5 mL per side ) of normal saline injected along the neurovascular bundles . Pain level after the biopsy was assessed using a 10-point linear visual analog scale ( VAS ) . Results were statistically compared by the Wilcoxon Rank Sum test . RESULTS Patients in Group 2 had significantly lower VAS scores than those in Group 3 ( 3.6 + /- 2.1 vs 5.8 + /- 1.9 , P < 0.0001 ) , but those in Group 1 did not ( 5.5 + /- 2.7 vs 5.8 + /- 1.9 , P = 0.67 ) . Gross hematuria , rectal bleeding , and hemospermia occurred in 36 ( 40.0 % ) , 6 ( 7 % ) and 5 ( 6 % ) patients . One patient had temporary vasovagal syncope . No patient reported febrile urinary tract infection or urinary retention . CONCLUSIONS Periprostatic injection of local anaesthetic is a safe technique that significantly reduces pain during prostate biopsy , whereas intrarectal lidocaine injection did not reduce pain . This safe , simple technique should be applied in men undergoing TRUS-guided prostate biopsy to limit patient discomfort OBJECTIVE To compare the level of pain experienced by patients during transrectal ultrasound-guided prostatic biopsy  using intrarectal 2 % lidocaine gel versus plain lubricant gel . DESIGN Prospect i ve double-blind r and omised controlled trial . SETTING Regional hospital , Hong Kong . PATIENTS From March 2002 to December 2003 , patients who underwent ultrasound-guided prostate biopsy at a Geriatric Urology Centre . MAIN OUTCOME MEASURES Pain and discomfort scores measured by horizontal visual analogue scales . RESULTS A total of 338 consecutive patients were r and omised to lidocaine gel or plain lubricant gel groups . The two groups were statistically similar in demographic and disease characteristics . There were no significant statistical differences in pain or discomfort 
    Output:
    
Our results demonstrate that PNB + IVS ( rank 1 ) and SPA ( rank 2 ) were the most effective methods for pain control .
In conclusion , the most effective way to alleviate PBx-related pain appears to be PNB + IVS and SPA .