T. Anagnostou

Ultrasound-Guided Transrectal Placement of a Drainage Tube as Therapeutic Management of Patients with Prostatic Abscess

BACKGROUND AND PURPOSEnA novel approach for continuous drainage of prostatic abscesses is presented and discussed.nnnPATIENTS AND METHODSnWe present seven cases diagnosed with prostatic abscess during 2001-2007. The diagnosis was based on either clinical or transrectal ultrasound (TRUS) findings. All patients were initially treated as prostatitis cases by intravenous antibiotics, a1 blockers, and a suprapubic catheter. Those diagnosed with an abscess had a drainage tube placed transrectally under TRUS guidance, and it was left in place for 24-36 hours.nnnRESULTSnPast medical history most often included previous urinary infection (n = 4), bladder outlet obstruction (n = 1), and diabetes mellitus (n = 4). In all patients, prostatic abscess was greater than 1.5 cm, and in two patients the abscess was multifocal. All abscesses were completely resolved by transrectal continuous drainage, and the average hospitalization period was 10 days. No patient required a second intervention. All patients received antibiotics for 1 month following the procedure.nnnCONCLUSIONnAlthough rare, prostatic abscess is a serious condition that needs quick diagnosis and treatment. In our experience, TRUS-guided transrectal placement of a drainage tube is a feasible and safe treatment alternative for prostatic abscess; it is also easy to perform and well tolerated by the patients.

European Study of Radical Prostatectomy: time trends in Europe, 1993-2005.

European Study of Radical Prostatectomy: time trends in Europe, 1993–2005 Bob Djavan, Vincent Ravery 1 , Bernardo Rocco 2 , Alexandre Zlotta 3 , Maurizio Brausi 4 , Markus Margreiter, Peter Hammerer 5 , Amir Kaisary 6 , Theodore Anagnostou 7 , Imre Romics 8 , Pitor Dobronski 9 , Ottavio De Cobelli 2 and Michael Marberger Departments of Urology, University of Vienna, Vienna, Austria, 1 University of Paris, Paris, France; 2 European Institute of Oncology, Milan, Italy; and Departments of Urology, 3 University of Brussels, Brussels, Belgium, 4 University of Modena, Modena, Italy, 5 University of Hamburg, Hamburg, Germany, 6 University of London, London, UK, 7 University of Athens, Athens, Greece, 8 University of Budapest, Budapest, Hungary and 9 University of Warsaw, Warsaw, Poland

Analgesia during Extracorporeal Shockwave Lithotripsy: Fentanyl Citrate versus Parecoxib Sodium

BACKGROUND AND PURPOSEnShockwave-induced pain may become an important issue during extracorporeal shockwave lithotripsy (SWL), although the new generation of lithotriptors generally produces less pain than previous models. The aim of the study was to compare the analgesic effect of a cyclooxygenase-2-specific inhibitor (parecoxib sodium) with that of our standard method of analgesia (fentanyl citrate) in patients who needed pain relief when undergoing SWL.nnnPATIENTS AND METHODSnFifty-eight patients who were undergoing SWL for renal calculi were randomized to receive intravenously either fentanyl citrate (group A, n = 30) or parecoxib sodium (group B, n = 28) when they felt that their pain during the session became intolerable. Lithotripsy was recommenced 10 minutes after administration of analgesia. The severity of pain before and after administration of the analgesic regimens was evaluated using a five-level verbal scale. The effectiveness of each drug was evaluated with respect to degree of pain relief and ensuing tolerance of the procedure to completion, as well as the need for supplementary analgesia (half the standard dose of fentanyl citrate).nnnRESULTSnThe patients in the two groups were comparable with regard to age, sex, body mass index, and stone size. There was no statistically significant difference in the maximum energy level achieved as well as in the total number of shock waves given in the two groups. Administration of fentanyl citrate resulted in alleviation of pain and completion of SWL in 27 patients (90%), whereas parecoxib sodium was effective in five patients (17.8%) (P < 0.01). The remaining 23 patients in group B received supplementary analgesia, and 22 completed the lithotripsy session.nnnCONCLUSIONSnParecoxib sodium was not as effective as fentanyl citrate in alleviating pain during SWL. Its use, however, may lower the dose of opioid-based analgesia in this group of patients.

Value of Immediate Anastomotic Biopsy following Biochemical Failure after Radical Prostatectomy

Aims: To study the value, in diagnostic terms, of performing transrectal ultrasound (TRUS)-guided anastomotic biopsy immediately following the diagnosis of biochemical failure in patients treated by radical retropubic prostatectomy. Methods: We report on 50 sessions of TRUS-guided biopsy obtained during post-radical retropubic prostatectomy follow-up, immediately after the diagnosis of biochemical failure. No patient had received either adjuvant or further treatment due to biochemical failure status prior to the biopsy session. In each case, tissue sampling involved cores taken by a standard protocol (random) as well as TRUS-guided biopsy to sonographically suspicious areas. Statistical analysis focused on identifying the statistical importance of various pre- and post-treatment variables in predicting biopsy outcome. Results: 10/50 cases with local evidence of malignancy (1 case harboring both benign and malignant glands) were identified and in another 10/50 cases benign prostatic tissue was diagnosed. The remaining (30) cases have shown fibromuscular tissue only. Statistical analysis of various parameters has demonstrated a significant correlation between local evidence of cancer and the finding of sonographically remarkable areas. Conclusion: Performing TRUS-guided anastomotic biopsy close to the onset of biochemical failure can frequently identify but also may easily miss the suspected local presence of prostate tissue. We believe that, with minimal risks of morbidity, there is merit in exploring its possibilities to trace local prostatic tissue, since it may provide useful information for further treatment actions also in an earlier time.