ABSTRACT
To analyze the testicular cancer [TCa] incidence, diagnosis aspects, pathologic grade, stage, and survival in Tunisian men. we studied all patients who had histopathologically confirmed TCa treated in La Rabta University-Hospital between 1991 and 2010. Baseline demographic data included age at diagnosis, year of diagnosis, clinical symptoms, stage at diagnosis, histologic type, management strategies and survival were analyzed. The incidence of TCa among Tunisians in very low; we collected only 41 cases over a period of 20 years with an average incidence of 2 new cases per year. Peak age incidence was 30-49 years. testicular swelling was the principal complaint in 25 patients. 58.5% of tumours were right-sided and 39% were left-sided. There was bilateral involvement in only one case. The mean interval between onset of symptoms and presentation was 16.5 months [1-120]. Most patients presented at stages T2 and T3 [63.4% and 26.8% respectively]. Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in respectively 11 and 12 patients [association in 5 patients]. One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminomas [n=20] and mixed germ cell [n=8]. Three patients died within 48 months, while half were lost to follow-up. The incidence of TCas in Tunisia remains low. Late presentation and treatment are major challenges to management. Better health funding and education regarding testicular self-examination is essential
ABSTRACT
Intrarectal lidocaine application and apical periprostatic nerve block are a safe technique that significantly reduces pain during transrectal prostate biopsy. We compare prospectively the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound -guided prostate biopsy. From June 2005 to February 2006, 100 consecutive patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in endorectally [Group I], 10 cc of 1% lidocaine solution injected into the prostate apex to induce bilateral periprostatic nerve block [Group II], or intrarectal 10 cc of ultrasound gel as placebo [Groupe III]. Pain was evaluated by a 10- point linear visual analogue pain scale [VAS], and a 5-point digital visual scale [DVS]. The side effects of the drugs and complications were also evaluated. The three groups counted respectively: 33, 33 and 34 patients and were statically comparable as the age, prostate volume, PS A level and the number of biopsies. The mean pain score on the VAS was respectively 4,1; 4,6 and 3,5 for the three groups. The DVS score was 2,5; 2,8 and 2,15 [p < 0.001]. Pain scores were significantly lower in Group 3 and equivalent between Groups 1 and 2. There is no difference in complication rate between the three groups. Compared to intrarectal lidocaine application, apical periprostatic nerve block is a safe technique that significantly reduces pain during transrectal prostate biopsy, with no increase in the complication rate