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Schmeusser B, Levin B, Lama D, Sidana A. Hundred years of transperineal prostate biopsy. Ther Adv Urol 2022; 14:17562872221100590. [PMID: 35620643 PMCID: PMC9128053 DOI: 10.1177/17562872221100590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
The earliest recorded efforts to biopsy prostate, in the early 20th century, were made through transperineal (TP) approach, with open perineal prostate biopsy (PBx) being considered the gold standard for prostate cancer (PCa) diagnosis in that era. Later, to minimize morbidity and increase diagnostic accuracy, several technical modifications and transrectal ultrasound (TRUS) assistance were incorporated. However, in the 1980s, the transrectal (TR) approach became the predominant PBx method following the introduction of TRUS-TR PBx with sextant sampling, providing a convenient and efficacious method for prostate sampling. With modernization of PCa diagnosis, a recent resurgence of the TP PBx has been observed, driven primarily by TR drawbacks of infectious complications and sampling limitations. TP PBx is rapidly emerging as the new PBx standard, being officially recommended as the initial approach for biopsy in Europe and is increasingly being conducted and studied in the United States. The modern era of TP PBx is based on the improvements in local anesthesia techniques, TP access systems, and robotic assistance. These modifications and advancements have improved the ease of use, patient comfort, and diagnostic outcomes with TP PBx. Herein, we present a history of the evolution of TP PBx spanning over 100 years and explore the basis of the technique that merits future utilization.
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Affiliation(s)
- Benjamin Schmeusser
- Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Brandon Levin
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel Lama
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Abhinav Sidana
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Zhou Z, Cui Y, Zhang X, Lu Y, Chen Z, Zhang Y. The efficacy and safety of antimuscarinics for the prevention or treatment of catheter-related bladder discomfort: a systematic review and meta-analysis of randomized controlled trials. Perioper Med (Lond) 2021; 10:46. [PMID: 34903279 PMCID: PMC8670223 DOI: 10.1186/s13741-021-00217-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This meta-analysis aimed to evaluate the efficacy and safety of antimuscarinics for the prevention or treatment of catheter related bladder discomfort (CRBD). METHODS The MEDLINE, EMBASE, and Cochrane Controlled Trials Register (from 1987 to July 2021) were used to search randomized controlled trials. The PRISMA checklists were followed. RevMan5.4.0 was used for statistical analysis. RESULTS Eleven studies involving 1165 patients were involved in the analysis. The study reported that the incidence of CRBD observed in the antimuscarinics group was significantly lower than that of the control group at 0-, 1-, 2-, and 6-h after drug therapy (P = 0.001, P < 0.0001, P = 0.0005, and P = 0.001, respectively). For side effects, there were not statistical differences between the antimuscarinics group and the control group, mainly including dry mouth (risk ratio (RR) = 1.31, 95% confidence interval (CI) = 0.95 to 1.80, P = 0.09), postoperative nausea and vomiting (RR = 1.02, 95% CI = 0.55 to 1.90, P = 0.87), facial flushing (RR = 1.06, 95% CI = 0.43 to 2.61, P = 0.90), and blurred vision (RR = 0.95, 95% CI = 0.35 to 2.58, P = 0.91). Besides, rescue analgesics were required less in the antimuscarinics group than in the control group (RR = 0.51, 95% CI = 0.32 to 0.80, P = 0.003). CONCLUSIONS Compared with the control group, the antimuscarinics group had a significant improvement on CRBD, the patients were well tolerated and the use rate of rescue analgesics was low.
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Affiliation(s)
- Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yuanshan Cui
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - Xiaoyi Zhang
- Department of Urology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinwai Street, Xicheng District, Beijing, 100088, China
| | - Youyi Lu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - Zhipeng Chen
- Department of Urology, Weifang People's Hospital, Weifang, 261000, Shandong, China.
| | - Yong Zhang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Göger YE, Özkent MS, Göger E, Kılınç MT, Ecer G, Pişkin MM, Erol A. A randomised-controlled, prospective study on the effect of dorsal penile nerve block after TURP on catheter-related bladder discomfort and pain. Int J Clin Pract 2021; 75:e13963. [PMID: 33368991 DOI: 10.1111/ijcp.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE In the present study, the impact of penile nerve block (PNB) on postoperative pain and Catheter-Related Bladder Discomfort (CRBD) in the transurethral resection of prostate(TURP) patients were evaluated. METHODS Participants of the present study were selected from patients who performed TURP under spinal anaesthesia for benign prostatic hyperplasia (BPH) between January 2018 and July 2020. The present study was planned as a single-centre, randomised-controlled prospective study in which the patients were divided into two groups. Group 1 was administered Control (n:40), and Group 2 ultrasonography(USG) guided PNB (n:40). The patients were included in the Groups, respectively. Visual analogue scale (VAS) scores were questioned and recorded in order to evaluate the postoperative pain complaints of the patients after the operation. In addition, in order to evaluate the CRBD, VAS scores were questioned and recorded as 0th, 0-1th hour, 1st-2nd hour, 2nd-4th hour, 4th-8th hour, 8th-12th hour, and 12th-24th hour. In addition, postoperative pain and need for analgesic drug were recorded. Tramadol was given to patients with moderate to severe CRBD. The findings were compared between the Groups. RESULTS There was no statistical difference demographic and per-operative data between Group 1 and Group 2. The CRBD and pain-related VAS scores were significantly higher in Group 1 between the 0 and 8th hours. There was no difference between VAS scores in the postoperative 8-24th hours. In total 24 hours, Group 2's need for tramadol was significantly less than Group 1. On examining the factors affecting CRBD in the multivariate analysis, age, body mass index(BMI), prostate volume, operation time do not affect CRBD statistically, and only PNB reduces CRBD (P: .029). While less drug-related complications were observed in Group 2, no serious complications related to PNB were observed. CONCLUSION Penile nerve block is an effective method for the decrease pain and CRBD after urological surgery. It will also reduce the need for analgesics, and provide painless patients in the postoperative period.
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Affiliation(s)
- Yunus Emre Göger
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | | | - Esra Göger
- Department of Anaesthesiology, Konya City Hospital, Konya, Turkey
| | - Muzaffer Tansel Kılınç
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Gökhan Ecer
- Department of Urology, Konya City Hospital, Konya, Turkey
| | - Mehmet Mesut Pişkin
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Atilla Erol
- Department of Anaesthesiology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Aslan R, Erbin A, Celik S, Ucpinar B, Eryilmaz R, Taken K. Periprostatic nerve block alone versus combined with perineal pudendal nerve block or intrarectal local anesthesia during transrectal ultrasound-guided prostate biopsy: A prospective randomized controlled trial. Int J Urol 2019; 26:833-838. [PMID: 31209957 DOI: 10.1111/iju.14036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/12/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the efficacy, safety and cost of combinations of perineal pudendal nerve block + periprostatic nerve block and intrarectal local anesthesia + periprostatic nerve block with the standard technique (periprostatic nerve block). METHODS The study was designed as a randomized prospective controlled trial. Patients with elevated serum prostate-specific antigen values (prostate-specific antigen ≥4 ng/mL) and/or abnormal digital rectal examination findings were included in the study. Patients with anorectal diseases, chronic prostatitis, previous history of prostate biopsy and anorectal surgery were excluded from the study. A total of 148 patients (group 1 [periprostatic nerve block], n = 48; group 2 [intrarectal local anesthesia + periprostatic nerve block], n = 51; group 3 [perineal pudendal nerve block + periprostatic nerve block], n = 49) were included in the final analysis. Pain during insertion and manipulation of the transrectal ultrasound probe was recorded as visual analog scale 1, pain during penetration of the biopsy needle into the prostate and sampling was recorded as visual analog scale 2, and pain during the entire procedure recorded as visual analog scale 3. RESULTS The mean visual analog scale 1 score was significantly lower in group 3, when compared with group 1 and group 2 (P < 0.001). There was no significant difference between the groups in terms of the mean visual analog scale 2 score. The mean visual analog scale 3 score was significantly lower in group 3 when compared with other groups (P < 0.001). The total cost for transrectal ultrasound-guided biopsy in the intrarectal local anesthesia + periprostatic nerve block group was significantly higher than the other two groups. CONCLUSIONS The combination of perineal pudendal nerve block and periprostatic nerve block provides more effective pain control than intrarectal local anesthesia plus periprostatic nerve block and periprostatic nerve block alone, with similar complication rates and without increasing cost.
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Affiliation(s)
- Rahmi Aslan
- Department of Urology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sebahattin Celik
- Department of General Surgery, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Burak Ucpinar
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Recep Eryilmaz
- Department of Urology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Kerem Taken
- Department of Urology, Yuzuncu Yil University Medical Faculty, Van, Turkey
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Kim DK, Lee JY, Jung JH, Hah YS, Koo KC, Lee KS, Chung BH, Cho KS. What is the most effective local anesthesia for transrectal ultrasonography-guided biopsy of the prostate? A systematic review and network meta-analysis of 47 randomized clinical trials. Sci Rep 2019; 9:4901. [PMID: 30894638 PMCID: PMC6426994 DOI: 10.1038/s41598-019-41412-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/08/2019] [Indexed: 11/09/2022] Open
Abstract
We aimed to compare the effectiveness of various local anesthetic methods for controlling prostate biopsy (PBx) related pain using network meta-analysis. Literature searches were performed on PubMed/Medline, Embase, and Cochrane Library up to March 2018. Forty-seven randomized controlled trials, in which the effectiveness of PBx-related pain was investigated using a visual analogue scale after various local anesthetic methods, were included. The local anesthetic methods included intraprostatic local anesthesia (IPLA), intrarectal local anesthesia (IRLA), intravenous sedation (IVS), periprostatic nerve block (PNB), pelvic plexus block (PPB), and spinal anesthesia (SPA). Eight pairwise meta-analyses and network meta-analyses with 21 comparisons were performed. All modalities, except single use of IPLA and IRLA, were more effective than placebo. Our results demonstrate that PNB + IVS (rank 1) and SPA (rank 2) were the most effective methods for pain control. The followings are in order of PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, IVS, and PNB. In conclusion, the most effective way to alleviate PBx-related pain appears to be PNB + IVS and SPA. However, a potential increase in medical cost and additional risk of morbidities should be considered. In the current outpatient setting, PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, and PNB methods are potentially more acceptable options.
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Affiliation(s)
- Do Kyung Kim
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hung Jung
- Department of Urology, Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yoon Soo Hah
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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O'Neill AGM, Jain S, Hounsell AR, O'Sullivan JM. Fiducial marker guided prostate radiotherapy: a review. Br J Radiol 2016; 89:20160296. [PMID: 27585736 PMCID: PMC5604907 DOI: 10.1259/bjr.20160296] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022] Open
Abstract
Image-guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogeneous whole-pelvic radiotherapy dose, but these surrogates are not reliable when using reduced margins, dose escalation or hypofractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990s. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aimed to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied, which resulted in 50 articles being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft-tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardization of all techniques and procedures in relation to the use of prostate FMs is required. Finally, a clinical trial investigating a non-surgical alternative to prostate FMs is introduced.
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Affiliation(s)
- Angela G M O'Neill
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Suneil Jain
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Alan R Hounsell
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Joe M O'Sullivan
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
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Yan P, Wang XY, Huang W, Zhang Y. Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis. J Pain Res 2016; 9:787-796. [PMID: 27785093 PMCID: PMC5067058 DOI: 10.2147/jpr.s117451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS A literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale. RESULTS A total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: -0.22, 95% CI: -0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: -1.32, 95% CI: -1.68 to -0.95, P<0.00001), placebo injection (WMD: -2.62, 95% CI: -3.16 to -2.07, P<0.00001), or IRLA (WMD: -1.31, 95% CI: -1.40 to -1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.45, 95% CI: -0.62 to -0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.73, 95% CI: -0.92 to -0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia. CONCLUSION This meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed to validate this result.
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Affiliation(s)
- Pu Yan
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Xiao-Yan Wang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Wei Huang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Yong Zhang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
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Luan Y, Huang TB, Gu X, Zhou GC, Lu SM, Tao HZ, Liu BD, Ding XF. Effect of prostate volume on the peripheral nerve block anesthesia in the prostate biopsy: A strobe-compliant study. Medicine (Baltimore) 2016; 95:e4184. [PMID: 27428215 PMCID: PMC4956809 DOI: 10.1097/md.0000000000004184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the anesthetic efficacy of periprostatic nerve block (PNB) in transrectal ultrasound (TRUS)-guided biopsy on different prostate volume. METHODS A total of 568 patients received prostate biopsy in our hospital from May 2013 to September 2015 and were retrospectively studied. All patients were divided into local anesthesia group (LAG) and nerve block group (NBG). Then each group was subdivided into 4 subgroups (20-40, 40-60, 60-100, and >100 mL groups) according to different prostate volume range. Visual analogue scale (VAS) and visual numeric scale (VNS) were used to assess the patient's pain and quantify their satisfaction. The scores and complications were compared between the groups. RESULTS The age and serum prostate-specific antigen (PSA) level before biopsy had no significant differences at intergroup or intragroup level. The VAS scores were significantly lower in the NBG than those in the LAG in terms of prostate volume (1 (1-2) versus 2 (1-3), 2 (1-3) versus 2 (2-4), 2 (2-3) versus 3 (2-5), 4 (3-5) versus 5 (4-7), all P < 0.05). Conversely, the VNS scores were higher in the NBG (4 (3-4) versus 3.5 (3-4), 3 (3-4) versus 3 (3-3), 3 (2-4) versus 3 (2-3), 2 (2-2) versus 1 (1-2), all P < 0.05). Patients with smaller prostate volume undergoing PNB or local anesthesia experienced significantly lower pain and higher satisfaction scores than those with large prostate. Whether in PNB or local anesthesia group, patients with large prostate volume had more chance to have hematuria, hemospermia, urinary retention than smaller one except infection (P < 0.05). Those complications had no significant differences between LAG and NBG (P > 0.05). CONCLUSION Compared with local anesthesia, ultrasound-guided PNB has superior analgesic effect and equal safety, but for patients with a large prostate volume, the analgesic effect is inefficient.
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Affiliation(s)
| | | | | | | | | | | | | | - Xue-Fei Ding
- Department of Urology, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu Province, China
- Correspondence: Xue-fei Ding, No. 98 West Nantong Road, Yangzhou, 225001, Jiangsu Province, China (e-mail: )
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Haroon N, Ather MH, Khan S, Kumar P, Salam B. Diclofenac Suppository as a Preemptive Analgesia in Ultrasound-guided Biopsy of Prostate: Randomized Controlled Trial. Urology 2015; 86:682-5. [DOI: 10.1016/j.urology.2015.04.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/17/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Bai Y, Wang X, Li X, Pu C, Yuan H, Tang Y, Li J, Wei Q, Han P. Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. J Endourol 2014; 29:640-9. [PMID: 25335575 DOI: 10.1089/end.2014.0670] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Despite the various treatment and prevention options for catheter-related bladder discomfort (CRBD), many uncertainties persist in clinical practice. To systematically review the literature on the management of CRBD in patients who underwent surgery. MATERIALS AND METHODS Eligible, randomized controlled trials were identified from electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) without language restrictions. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent reviewers using Cochrane Collaboration's tools. RESULTS A total of 1441 patients from 14 articles published between 2005 and 2014 were included. Data heterogeneity precluded meta-analysis; therefore, data were synthesized narratively. Compared with nonurological surgery, CRBD is frequent and occurred immediately after urological surgery, especially after transurethral resection of the bladder tumor (TURBT). Data from included studies suggested that muscarinic antagonists, anesthetics, antiepileptics, and analgesics were associated with significant improvement in symptoms and reducing the incidence of CRBD, compared with placebo. Anticholinergic agents and antiepileptics (gabapentin and pregabalin) administered 1 hour before surgery reduced the incidence and severity of CRBD in the immediate postoperative period. Tramadol and ketamine are centrally acting opioid analgesics with antimuscarinic actions, which effectively prevent CRBD when administered intravenously. Paracetamol administered was also effective for the management of CRBD. Additionally, we perceived that TURBT is the surgical procedure that is the most refractory to treatment. CONCLUSIONS Muscarinic antagonists, anesthetics, antiepileptics, and paracetamol appear to achieve the greatest improvement in the clinical symptoms and a significant reduction in the incidence of CRBD compared with placebo. Although these studies observed a high incidence of intervention-related side effects, in general, patients tolerated these treatments well.
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Affiliation(s)
- Yunjin Bai
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Xianding Wang
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Xiaoqiang Li
- 2 Department of Anesthesiology, West China Hospital, Sichuan University , Chengdu, China
| | - Chunxiao Pu
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Haichao Yuan
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Yin Tang
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Jinhong Li
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Qiang Wei
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Ping Han
- 1 Department of Urology, West China Hospital, Sichuan University , Chengdu, China
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