A comparative study on the operative outcomes of a novel technique of continuous versus interrupted vesicourethral anastomosis in open radical retropubic prostatectomy

OBJECTIVE: Vesicourethral anastomosis (VUA) is the most technically challenging part in open radical retropubic prostatectomy (ORRP). Traditionally, it is accomplished using interrupted anastomotic sutures. The objective of this study is to describe our surgical technique of continuous VUA and compare its outcomes with that of interrupted VUA as performed by a single surgeon. MATERIALS AND METHODS: A total of 235 patients with clinically localized prostate cancer who underwent ORRP since February 2000 to June 2013 were included. They were divided into Group 1 (n=121) using interrupted VUA and Group 2 (n=114) using our technique of continuous VUA. Primary outcome measures to be evaluated include several operative parameters with respect to operative time, blood loss, anastomotic integrity, hospital stay, continence, potency and occurrence of VUA stenosis. Analysis was done using Welch's t-test and Fisher's exact test. All the statistical tests were performed using SPSS 20.0. P-values less than 0.05 indicate statistically significant difference. RESULTS: Patients who underwent continuous VUA (Group 2) had significantly less operative time (210.05 ± 1.91 vs 251.37 ± 2.74 mins, P CONCLUSIONS: Our technique of continuous VUA for ORRP provides better outcome compared to standard interrupted VUA.

A prospective, double blind, placebo controlled, clinical trial comparing the effect of intrarectally applied and periprostatically injected lidocaine on the pain scores of patients undergoing transrectal ultrasound guided prostate biopsy

Background: Transrectal ultrasound guided prostate biopsy has placed a role in the urologist armamentarium. Considered as a minor procedure, TRUS guided prostate biopsies has currently been performed without any anesthesia. Recent studies have observed that prostate biopsy is perceived as painfulObjective: A. To compare the effect of intrarectal lubricant gel application, intrarectal lidocaine gel application and periprostatic lidocaine injection on the pain scores of patients undergoing transrectal ultrasound guided prostate biopsy. B. To determine the differences in morbidity after the procedureMaterials and Methods: From January 2004 to August 2004, 100 men underwent prostate biopsy at a tertiary hospital. Patients were distributed into 3 groups (control, lidocaine gel, lidocaine injection). A visual analog scale was used to assess the pain score. The Shapiro-Wilk test was performed on all epidemiologic data as well as on the patients pain scores. Statistical analysis used includes analysis of variance for age and Kruskal-Wallis test for PSA level, prostate volume and pain score. Tukey and Mann Whitney U test were subsequently doneResults: Ultrasound guided prostate biopsy was done in 100 cases. There were no statistical difference as to age, PSA level and prostate volume between the 3 groups. There was no statistical difference in the pain scores of patients after intrarectal lubricant gel application and intrarectal lidocaine application. (4.933 versus 4.250, p 0.1375). However, there was a statistical difference in the pain scores of patients after intrarectal lidocaine gel application and periprostatic injection (4.250 versus 2.158, p 0.0001) and intrarectal lubricant gel application and periprostatic injection (4.933 versus 2.158, p 0.0001)Conclusions: Periprostatic lidocaine injection effectively lowers the pain scores of prostate biopsy than those who received lidocaine gel or lubricant gel. Improvement in patient tolerance permits the number of biopsy cores to be increased as necessary without increasing patient distress. Routine use of local anesthesia in the formed of periprostatic lidocaine injection is highly recommended in future biopsies