The effect of local anesthesia types on erectile function in TRUS biopsy: A prospective study

Aim: To evaluate the effect of local anesthesia types on erectile function during transrectal ultrasound guided biopsy (TRUS-Bx).Material and Methods: Between February 2014 and February 2015, 50 men who underwent TRUS-Bx at our institution were included in this prospective study. The 50 patients were randomized and divided into two groups according to the type of anesthesia used. All patients were asked to indicate the level of pain experienced on a visual analogue scale (VAS) 10 min after the TRUS biopsy. All patients had to fill in the IIEF standardized questionnaire. Groups were evaluated in terms of pre-biopsy IEFF score (IIEF-1), post-biopsy 1st month IIEF score (IIEF-2) and post-biopsy 2nd month IIEF score (IIEF -3). Patient characteristics, mean VAS score and IIEF score were compared between the two groups.Results: The mean age,IIEF-1,tPSA level, prostate volume and VAS score were 60.86±0.95 years,18.68,6.81±0.54 ng/ml,51.10±3.82 cc and 3.5±0.26 in all patients, respectively. The difference in VAS scores between the groups was statistically significant (p<0.05). In Group 1 the IIEF-1, IIEF-2, and IIEF-3 were different from each other statistically. There was no statistically significant difference between IIEF-1 and IIEF-3 scores in group 2(p=0,136 z=-1,492).So it was observed that the initial IIEF scores were reached at the end of the second month in group 2 administered 12.5 g 2% lidocaine HCl jel.Conclusion: Our study indicates that although local periprostatic anesthesia by injecting 6 ml of 2% lidocaine provides more effective anesthesia for pain relief, intrarectal 12.5g 2% lidocaine HCl jel maintains less impact on erectile dysfunction for TRUS-Bx

G1733A (RS6152) polymorphism of the androgen receptor gene in patients with prostate cancer

Aim: The causes of prostate cancer development and molecular mechanism underlying its development and progression are not clearly understood. The aim of this study is to determine the frequency of G1733A (rs6152) polymorphism of the androgen receptor (AR) gene among patients with prostate cancer, and to examine the role of this polymorphism in the development of prostate cancer. Method: DNA samples isolated from 96 individuals (49 patients with prostate cancer and 47 controls) were analyzed with real time-polymerase chain reaction (real time-PCR) in order to determine G1733A (rs6152) polymorphism genotypes and allele frequencies in the AR gene. The results were evaluated statistically. Results: Genotype frequency was determined as 91% GG and 9% AG among the controls, and 67% GG and 33% AG among the patients. G allele frequency was 95% in controls and 83% in patients, whereas A allele frequency was 5% in controls and 17% in patients. There was a statistically significant difference between patient and control groups regarding genotype frequency (p<0.05). Conclusion: Based on the results of our study, we can infer that G1733A (rs6152) polymorphism of the AR gene plays a role in development of prostate cancer in the Turkish population

The efficacy of multiparametric prostate magnetic resonance imaging in the diagnosis and treatment of prostate cancer

Aim: To investigate the accuracy of multiparametric prostate magnetic resonance imaging (mpMRI) in determining the diagnosis and treatment options of prostate cancer (PCa), and its pathology correlation. Methods: Between October 2017 and January 2018, 73 patients were subjected to an mpMRI at our clinic. Of these patients, 11 were radical prostatectomy (RP) after treatment, and four were post- radiation therapy (RT) follow-up. The remaining 58 patients were assigned to the PSA elevation and / or positive digital rectal examination (DRE) patient group in this study and their outcomes were evaluated. Results: Of the 58 patients included in the study, 13 were found to have a PI-RADS 5 on mpMRI and in 9 (90%) of 10 patients undergoing simultaneous biopsy, PCa was detected. The biopsy results of all cases evaluated as PI-RADS 1 were benign. All of the patients who were ISUP 3 and above had a PI-RADS 5. Patients with a PI-RADS score of 4 and above being ISUP 2 and above was statistically significant (p=0.011). A case had undergone a previous radical prostatectomy assessment revealed that tPSA increased to 2 ng/ml during the follow-up, and so RT was added to the treatment; although LAP was identified in the left iliac region on an mpMRI performed upon the continued increase of tPSA. During the follow-ups of the patient who had regional RT, the tPSA dropped below 0.01 ng/ml. Conclusion: The results of our study show that mpMRI can gain a new and important place in urology due to the guidance it provides in biopsies, facilitating targeted biopsy, its effectiveness in determining treatment modalities and its importance in post-PCa treatment follow-ups

Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries?

ABSTRACT Purpose To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. Materials and Methods 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. Results Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). Conclusion Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period