Hypoechoic space formation with periprostatic nerve block: Myth or reality?

Introduction: The most efficacious and commonly applied anesthetic technique for prostate biopsy is periprostatic block. In a previous publication, the creation of a 'hypoechoic space' at the injection site was described. This was reported to be a routine and essential part of the technique in various subsequent series. We were interested in assessing the incidence of the formation of such a hypoechoic area, and more importantly, whether it had any impact on pain management. Materials and Methods: One hundred and eleven consecutive patients were prospectively evaluated. Local anesthetic consisted of 2.5 ml of 2% lidocaine for each side of the prostate. Infiltration was done within the neurovascular space at the base of the prostate just lateral to the junction between the prostate and the seminal vesicle. The creation of a hypoechoic nodule was recorded in three categories: no formation, unilateral or bilateral formation. Three groups were compared regarding the intensity of pain using a numeric analog scale. Results: No hypoechoic area was formed in 30 (27%) patients. A unilateral nodule was created in 40 (36%), and a bilateral nodule was seen in 41 (37%) patients. The median pain scores were 3.3, 2.5 and 1.3 for the no hypoechoic wheal, unilateral and bilateral wheal groups, respectively (p < 0.0001). Conclusion: Our results suggest that the creation of a hypoechoic space with anesthetic infiltration for prostate biopsy is indeed an important aspect of the technique with regard to pain control; however, it may not be accomplished in every case. Copyright (C) 2006 S. Karger AG, Basel

The Clinical Effect of Bipolar and Monopolar Transurethral Resection of the Prostate More Than 60 Milliliters

OBJECTIVE To compare the effect, safety, and complication rates of monopolar vs bipolar transurethral prostate resection (TURP) in patients with prostate gland larger than 60 mL

Factors affecting the survival of patients treated by standard nephroureterectomy for transitional cell carcinoma of the upper urinary tract

Purpose: In this study we tried to evaluate the predictive factors for survival in patients with upper urinary tract tumors. Materials and methods: From 1993 to 2003, 46 patients were treated by standard nephroureterectomy for upper urinary tract tumor, but only 24 patients (52%) who had regular follow-up were included in the study. Age, sex, presenting symptoms of the patients, tumor localization, tumor stage and grade were analyzed with respect to survival. Univariate and multivariate analyses were done using Kaplan-Meier method with log-rank test and Cox proportional hazards regression model, respectively. Results: The median of patient age was 61 years (34-74). Of the 24 patients, 9 (37.5%) were disease-free and alive at a mean time of 54 (26-97) months, 8 (33.3%) died of disease at a mean period of 23.4 months (2 because of bladder tumor, 2 had liver metastases, I had lung metastasis and 3 had lung and liver metastases) and 7 (29.2%) died disease-free at a mean period of 30.3 months. Metastases were detected in a mean period of 11.8 (6-24) months. Survival according to tumor stage Ta, T1-2, and invasive tumors were 87.5, 43.9, 15.7 months (p=0.0001), respectively. Survival of the patients with low-grade tumors was significantly longer than those with high-grade tumors (77.3 and 31.4 months, respectively, p = 0.01). Patients with pelvis tumors when compared to ureter tumors (28.5 and 61.6 months, respectively, p = 0.038) and those presenting with flank pain when compared to those presenting with macroscopic hematuria and bladder cancer (17.7, 45.7, and 57.9 months, respectively, p=0.046) had shorter survival rates. When multivariate analyses were done using Cox regression test, the only factor that affected survival was the stage of the tumor. Age and gender had no impact on survival. Conclusions: In univariate analysis, the stage, grade, localization of the tumor and presenting symptoms were found important predictors that affect the prognosis of the transitional carcinoma of the upper tract. However, tumor stage was the only independent predictor of survival in multivariate analysis. For high grade and high stage tumors, really effective adjuvant treatments along with aggressive surgery may be considered

Assessment of the continence status and patients' satisfaction after retropubic radical prostatectomy: a questionnaire based study

Objective The aim of this study was to assess the continence status and patients' satisfaction after retropubic radical prostatectomy by a self-administered questionnaire composed of 12 questions