Erkan Demir

Pain Scores and Early Complications of Transrectal Ultrasonography-Guided Prostate Biopsy: Effect of Patient Position

Background: The aim of the study was to evaluate the pain scores and complications of transrectal ultrasonography (TRUS)-guided prostate biopsy and to compare lithotomy position (LP) versus left lateral decubitis position (LLDP). Methods: A total of 340 patients were referred for TRUS-guided biopsy. In group 1 (n = 170), biopsies were performed in LP (n = 170), and in group 2 (n = 170) biopsies were performed in LLDP (n = 170). In 68 patients, biopsies were repeated. We constituted two additional groups: in group 3 (n = 33) patients underwent biopsies in LP and LLDP, respectively, and in group 4 (n = 35) patients underwent biopsies in LLDP and LP, respectively. Pain score, infection rates, hematospermia, hematuria, rectal bleeding, and serious complications were compared between group 1 and group 2. Pain scores were compared between the four groups. Results: There were no differences between group 1 and group 2 for age, prostate volume, prostate-specific antigen level, biopsy time, hematuria, infection, hematospermia, and rectal bleeding. Pain scores were lower in group 2 than in group 1. Also, for LLDP, pain scores were lower in group 3 and group 4. Conclusion: The effect of position on pain scores in TRUS biopsy patients has not been previously described. Our study indicates that pain scale values are lower in LLDP than in LP.

The Effect of Rectal Foley Catheterization on Rectal Bleeding Rates after Transrectal Ultrasound–guided Prostate Biopsy

PURPOSE To assess whether Foley catheterization of the rectum after transrectal ultrasound (TRUS)-guided prostate biopsy decreases complication rates. MATERIALS AND METHODS Between June 2000 and September 2006, 275 consecutive patients were evaluated after undergoing TRUS-guided prostate biopsy. All procedures were performed on an outpatient basis. Patients were divided into two groups. In the first group (n = 134), a Foley catheter was inserted into the rectum and inflated to 50 cm(3) after TRUS-guided biopsy. In the second group (n = 141), catheterization was performed without balloon placement. Rectal bleeding, hematuria, hematospermia, infection, and acute urinary retention rates were compared between groups. RESULTS The mean ages of the patients were 63.3 years +/- 5.6 and 62.1 years +/- 7.2 years in the Foley catheter group and control group, respectively (P = .112). Hematuria, hematospermia, infection, and rectal bleeding occurred in 31 (23.1%), 30 (22.4), nine (6.7%), and two patients (1.5%), respectively, in the Foley catheter group; and in 36 (25.5%), 36 (25.5%), 11 (7.8%), and 25 patients (17.7%), respectively, in the control group. The incidences of infection, hematuria, and hematospermia were not significantly different between groups (P > .05). In contrast, the rectal bleeding rate was significantly lower in the Foley catheter group (1.5%) than in the control group (17.7%; P = .001). CONCLUSIONS Although it has no effect on other complications, TRUS-guided prostate biopsy with rectal Foley catheterization is a useful, practical method to decrease or prevent rectal bleeding.

Patient tolerance during cystoscopy: a randomized study comparing lidocaine hydrochloride gel and dimethyl sulfoxide with lidocaine.

PURPOSE Cystoscopy is one of the most common examinations in urologic outpatient clinics. Various anesthetic approaches have been used to make cystoscopy more tolerable for patients. The aim of the present prospective randomized study was to evaluate the efficacy of lidocaine hydrochloride gel compared to dimethyl sulfoxide (DMSO) with lidocaine in rigid cystoscopy. MATERIALS AND METHODS Male patients requiring 17F rigid cystoscopy were eligible for inclusion in this study. A total of 140 patients were divided into two groups: group 1 (n=70) received approximately 11 mL of 2% lidocaine gel intraurethrally, while in group 2 (n=70) approximately 10 mL of 40% DMSO with an amount of lidocaine equal to that in the lidocaine gel was smeared around the scope and external urethral meatus. A penile clamp was placed for 15 minutes and 5 minutes in group 1 and group 2, respectively. Immediately after cystoscopic examination pain was scored on a 10-cm visual analog scale. RESULTS The mean pain scores after the procedure for group 1 and group 2 were 3.9+/-1.1 and 2.1+/-1.0, respectively. The pain scores were significantly lower for group 2 than for group 1 (P=0.015). No patients needed additional anesthetic agents or sedatives due to insufficient analgesia, and there were no serious side effects in either group. CONCLUSIONS Our study has shown that DMSO with lidocaine gel causes significantly less delivery discomfort in the male urethra than lidocaine hydrochloride gel. The advantages of DMSO with lidocaine are the mixture takes less time to act and had lower pain scores.

Dermatomycosis in renal transplant recipients in Adana, Turkey

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Is the Homocysteine Level a Good Predictive Marker for Evaluating Kidney Function in Patients After Percutaneous Nephrolithotomy

PURPOSE The purpose of this study is to evaluate the preoperative, early and late postoperative homocysteine levels and its relationship with kidney function in patients after undergoing percutaneous nephrolithotomy (PNL). MATERIALS AND METHODS Twenty-three patients with kidney stones underwent PNL and blood samples were taken preoperatively as well as at 48 hours and three months after the operation. The homocysteine level was determined by high pressure liquid chromatography and the fluorometric method in blood samples with ethylenediaminetetraaceticacid. The Cockcroft - Gault formula was used to calculate the glomerular filtration rate (GFR). Non-contrast computed tomography was performed for all patients before surgery. Stone burden was calculated asthe sum of the area of each stone in mm2. RESULTS Fourteen male (60.9%) and nine female (39.1%) patients were recruited for this study, and the median age was 44.3 ± 15.17 (20 - 71) years. There were no statistically significant differences between the preoperative homocysteine level and the level at 48 hours post-operation (P = .460). However, the homocysteine level three months after the operation was significantly lower than the preoperative and 48 hour levels (P = .001 and P = .003, respectively). CONCLUSION Renal function, which deteriorated after the PNL procedure, was preserved or improved over time. Homocysteine may be a sensitive indicator to assess the change in renal function pre-and post-PNL.