Junaid Masood

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

PURPOSEnWe 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.nnnMATERIALS AND METHODSnPatients 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.nnnRESULTSnA 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.nnnCONCLUSIONSnOur 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.

Hydroxyurea therapy: a rare cause of reversible azoospermia

BackgroundEssential thrombocythaemia (ET) is an uncommon chronic myeloproliferative disorder characterized by a marked increase in the number of platelets. Hydroxyurea is effective in preventing thrombosis in high-risk patients with essential thrombocythaemia. In previous studies different side effects of Hydroxyurea have been pointed out, but attention has not really been focused on the possible side effects on spermatogenesis.CaseA 35-year-old man under investigation for haematospermia and complaining of erythromyalgia was found to have a thrombocytosis with a platelet count of 1130xa0×xa0109/l. Bone marrow aspiration confirmed a diagnosis of essential thrombocythaemia. He was commenced on hydroxyurea (2xa0g daily) in order to lower his platelet count and relieve the erythromyalgia. The patient represented to the Urologists, 3xa0years later with infertility and a semen analysis done by his doctor had shown azoospermia. Monthly sperm counts after the withdrawal of hydroxyurea showed a gradual return of the spermatogenesis to normal over a period of around 6xa0months. The patient’s wife had conceived within 4xa0months of him stopping hydroxyurea.ConclusionThis case highlights a very rare but nonetheless important side effect of treatment with hydroxyurea. Hydroxyurea can cause reversible inhibition of spermatogenesis and result in primary infertility. We believe that all patients being commenced on such treatment should be warned of this possibility and that they should be given the necessary follow-up investigations.

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).

Definitive identification of a patent processus vaginalis by intraoperative injection of methylene blue into the hydrocoele sac

OBJECTIVEnSeven percent of patent processus vaginalis (PPVs) are obliterated at exploration. This potentially increases the risk of cord injury with a subsequent increased risk of testicular atrophy or reduced fertility. We report a modification of a technique to improve identification of the PPV and thus potentially minimise the risk to the cord.nnnMETHODSnFifteen consecutive boys were operated on via a standard inguinal approach. The testicle was delivered and 0.2-0.5 ml of a 50% methylene blue/normal saline solution was injected into the hydrocoele sac. A PPV is identified as a blue line.nnnRESULTSnMethylene blue injection identified all PPV. In a case with an encrusted hydrocoele of the cord and a hydrocoele this anatomy was clearly delineated. Dissection in a recurrent case was better facilitated. No testicular atrophy was recorded and there were no significant complications.nnnCONCLUSIONSnIntraoperative injection of a methylene blue solution into a hydrocoele sac will aid identification of a difficult PPV, thus minimising the risk of cord damage. This is especially helpful in cases of recurrent hydrocoele.

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.

Colposcopy in the diagnosis of infrasphincteric ureteric ectopia.

The diagnosis of infrasphincteric ureteric ectopia remains controversial. Laparoscopy [2], CT [3] and 99m Tc-DMSA scintigraphy [4] have all been recommended to confirm the suspected diagnosis, because vaginal examination frequently fails to reveal any abnormality. Colposcopy, with its magnifying effect, offers a viable alternative to an oftenprotracted series of imaging techniques which may ultimately prove fruitless. We suggest that in the absence of diagnostic IVU and a history consistent with ureteric ectopia, colposcopy is used, as it both establishes the diagnosis and allows for further imaging to delineate the aberrant anatomy before embarking on definitive surgery. This case highlights the need for clinicians to embrace and adapt techniques from other specialist fields to improve the management of patients in their chosen areas of expertise.