Jayanta M. Barua

Nitrous Oxide (Entonox) Inhalation and Tolerance of Transrectal Ultrasound Guided Prostate Biopsy: A Double-blind Randomized Controlled Study

PURPOSE We performed a randomized, placebo controlled double-blind trial to evaluate the effectiveness of Entonox (BOC Gases, Manchester, United Kingdom), that is 50% nitrous oxide and oxygen, as analgesia during transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS Patients referred for transrectal ultrasound guided prostate biopsy for the first time as an outpatient procedure were recruited subject to exclusion criteria and randomized to breathe Entonox or air via similar breath activated devices. At the end of the procedure patients completed a visual pain analog scale. Patients who refused study participation also completed the visual analog pain scale to assess the placebo effect of receiving gas through a mask. RESULTS A total of 110 patients were studied. Statistical analysis using 1-way analysis of variance showed a highly significant difference in pain perception among the 3 groups (F [2,107] = 73.348, p <0.001). This significant decrease in pain was noted in the Entonox versus air and Entonox versus placebo groups. There was no significant difference in the air and placebo groups. Seven of the 51 patients receiving Entonox complained of feeling drowsy during the procedure, which resolved at completion of the procedure. In this group 49 patients would undergo this procedure again if needed. In 2 of the 45 patients in the group receiving air the procedure was abandoned due to pain, while another 19 would prefer more analgesia and 2 would prefer general anesthesia if the procedure was to be repeated. CONCLUSIONS Our study shows that Entonox is a safe, rapidly acting and effective form of analgesia for the pain of prostate biopsy. We believe that it should be the analgesia of choice for this procedure.

Renal cell carcinoma: incidental detection during routine ultrasonography in men presenting with lower urinary tract symptoms

Objective To compare renal cell carcinomas (RCCs) presenting incidentally in patients referred for lower urinary tract symptoms (LUTS) with those presenting symptomatically, by stage, intervention and outcome.

ASPIRIN USE AND TRANSRECTAL ULTRASONOGRAPHY-GUIDED PROSTATE BIOPSY: A NATIONAL SURVEY

There is sparse and conflicting published evidence about the management of aspirin before prostatic biopsy [1,2]. There is also no consensus on the period before the procedure for which aspirin should be stopped. Stopping aspirin before TRUS-guided prostate biopsy might minimize peri-operative blood loss, but might also increase the risk of a significant cardiovascular event. Aspirin induces an irreversible inactivation of cyclooxygenase in blood platelets, which lasts for the entire period that the platelets remain within circulation (7–10 days).

Radiommunotherapy and prostate cancer: a promising new therapy in the management of metastatic disease.

The mainstay of treatment for metastatic prostate cancer is androgen deprivation, but unfortunately all patients eventually become resistant to this treatment, developing androgen-independent cancer, with a median time to death of ≈1 year. In addition, taxanebased chemotherapy has met with limited success and is usually associated with significant toxicity. Recent research has suggested that radioimmunotherapy (RIT) using radiolabelled monoclonal antibodies (mAbs) could emerge as a novel and potentially successful treatment for metastatic prostate cancer.

Current trends in the management of Wilms' tumour.

The current management of Wilms’ tumour has resulted in long-term survival rates of > 90% for localized cancers and of ≈ 70% for metastatic disease. Large randomized controlled trials have been designed, managed and published by various collaborative groups, including the National Wilms’ Tumour Study Group (NWTSG), The Société Internationale d’Oncologie Pédiatrique (SIOP) and the United Kingdom Children’s Cancer Study Group (UKCCSG), and emphasis has now been diverted from successful treatment to reducing treatmentassociated morbidity, without loss of efficacy. Collectively, these studies have enabled the treatment of Wilms’ tumour to be modified to minimize morbidity for low-risk disease and to maximize the prognosis for high-stage high-risk patients.

Urethral Catheter: A Pain in the Neck!

Long-term urinary catheterization is well recognized in the literature as being associated with significant morbidity and mortality. We present a rare and previously unreported complication of a cervical spine abscess resulting from methicillin-resistant Staphylococcus aureus septicaemia originating from the urinary tract in a patient with a urinary catheter.

The case for probiotics in urology.

The spiralling costs of antibiotic therapy, the appearance of multi-resistant bacteria, and more importantly for patients and clinicians, unsatisfactory therapeutic options in recurrent UTI (RUTI) calls for alternative and advanced medical solutions. Long-term oral antibiotic treatment has been used with some success as a therapeutic option, but this is no longer secure due to the development of bacterial resistance. One promising alternative is the use of live microorganisms (probiotics) to prevent and treat recurrent complicated and uncomplicated UTI.

Dutasteride: 21st Century medical therapy for symptomatic benign prostatic hyperplasia

Dutasteride is the latest addition to medical therapy for symptomatic benign prostatic hyperplasia. The safety and efficacy of dutasteride has been firmly established in high-quality, randomized, clinical trials, and in this article we discuss these key studies, along with current thoughts on its use in combination with other benign prostatic hyperplasia drugs. The role of dutasteride in chemoprevention of prostate cancer will also be discussed.