Comparison of pain control between lidocaine and prilocaine spray (TEMPE) versus lidocaine gel in the treatment of premature ejaculation: a prospective randomized controlled trial in a tertiary care centre

Background: Premature ejaculation is the most common cause of sexual dysfunction. There is no consensus on the treatment protocol due to poor understanding of the underlying mechanisms. Therefore, the present pilot study was conducted to compare the efficacy of topical eutectic mixture for premature ejaculation (TEMPE) spray with lidocaine gel for the treatment of premature ejaculation. Methods: After obtaining ethics approval and written informed consent, 100 patients meeting the inclusion and exclusion criteria were included. Baseline values of intravaginal ejaculation time (IELT) and international index of erectile function (IIEF) were recorded. Patients were randomly assigned into group A (lidocaine plus prilocaine spray) and group B (lidocaine gel). After 4 weeks of treatment IELT and IIEF score were recorded. The findings were noted and analysed. Results: Both the groups were similar in terms of demographic and baseline characteristics. There was a significantly higher improvement in IELT and IIEF score following treatment in group A as compared to group B. The incidence of side effects was lower in group A as compared to group B. Conclusions: We recommend that the use of TEMPE spray for the treatment of premature ejaculation as it is better than lidocaine gel.

Comparison of pain control between lignocaine and prilocaine spray versus oral analgesia in post-circumcision patients: a prospective randomized controlled trial in a tertiary care center

Background: Pain in the postoperative period is of particular concern. It is a major barrier in the uptake of circumcision. There are various systemic and local analgesics for the management of postoperative pain. However, data regarding efficacy is scarce. Therefore, the present pilot study was conducted to compare the efficacy of lidocaine and prilocaine spray with oral analgesics for the relief of pain. Methods: After obtaining ethics approval and written informed consent, 100 patients meeting the inclusion and exclusion criteria were included. After circumcision, patients were randomized into group A (Lidocaine and prilocaine spray) and group B (Oral analgesics). Pain was assessed by visual analogue scale (VAS) score and patient reported comfort levels were assessed in the postoperative period till 72 hours. Findings were noted and analysed. Results: Both the groups were similar in terms of demographic characteristics and baseline characteristics. The VAS score was significantly lower in group A and the patient-reported comfort level was significantly more in group A. Conclusions: We recommend that the lidocaine and prilocaine spray is better in relieving pain in the postoperative period following circumcision as compared to oral analgesics.

Comparison of tamsulosin hydrochloride versus tamsulosin hydrochloride and deflazacort in relieving postoperative urinary retention in patients undergoing transurethral resection of prostate: a prospective randomized controlled trial in a tertiary care centre

Background: Benign prostatic hyperplasia (BPH) is common amongst the elderly. Even after transurethral resection of prostate (TURP), retention of urine may persist in some leading to significant morbidity adversely affecting the quality of life. The role of alpha blockers in this situation as a combination is unclear. The present study was conducted to evaluate and compare the efficacy of tamsulosin versus tamsulosin and deflazacort in relieving the postoperative retention of urine following TURP. Methods: After obtaining ethics approval and written informed consent, 72 patients satisfying the eligibility criteria were included. After TURP, patients with urinary retention following catheter removal were randomized into group A (tamsulosin hydrochloride) and group B (tamsulosin hydrochloride and deflazocort). baseline international prostate symptom score (IPSS) score was done to assess quality of life and findings of radiological investigations were noted. Thereafter, medical therapy was done as per assigned group and postoperative findings were documented and analyzed. Results: Both the groups were similar in terms of demographic characteristics and baseline characteristics. The relief of symptoms was significantly more in group B along with lower IPSS score and residual volume. Conclusions: We recommend addition of deflazacort to tamsulosin hydrochloride as medical therapy for the management of postoperative retention of urine (POUR), especially following TURP.

Comparison of stent-related symptoms, passive ureter dilatation and stone clearance rate using 4.5 French versus 6 French double J stenting of unfavourable ureter: a prospective randomized controlled trial in a tertiary care centre

Background: Retrograde intrarenal surgery (RIRS) is the standard of care for renal stones of less than 1.5 cm and less than 1000 Hounsfield units (HU). Most virgin ureters do not allow the flexible ureteroscope in the first setting. Placement of a D-J stent in the ureter dilates the ureter. Therefore, our study aimed to compare stone clearance rates and symptom complex of passive ureteral dilation following 4.5 French/Fr versus 6 French/Fr double J (DJ) stent placement. Methods: After obtaining ethics approval and written informed consent, 100 patients satisfying the inclusion and exclusion criteria were included and data recorded. patients were randomized into group A (4.5 Fr) and group B (6 Fr). Stent was placed. After 4 weeks, symptoms were assessed by the ureteral stent symptom questionnaire (USSQ). Following retrograde intrarenal surgery (RIRS) successful passage of ureteric access sheath (UAS) and stone clearance rates were assessed. Results: The surgical success rate, stone clearance rate was similar in the two groups (p value: more than 0.05). The USSQ score was significantly lower in group A (p value: 0.001). Conclusions: Stent of smaller diameter (4.5 Fr) is associated with less patient discomfort with similar surgical completion rates and stone clearance.

Diagnostic dilemma in histopathology report following robot assisted laparoscopic prostatectomy: Tumour 'hide and seek'.

INTRODUCTION: Widespread PSA (prostate specific antigen) screening has resulted in stage migration of prostate cancer. Smaller tumor volumes are being detected in radical prostatectomy specimens. This has coincided with increasing reports about the ‘vanishing cancer phenomenon.’ AIMS: To analyse the cases of robot assisted laparoscopic prostatectomy (RALP) at our institute in which the pre operative prostate biopsy was positive for adenocarcinoma but no tumor could be identified in the final histopathology, and to review the literature for possible reasons for such a phenomenon. MATERIALS AND METHODS: Nine patients were identified out of a total of 184 cases of RALP in which the final histopathology did not correlate with the initial biopsy report. The initial biopsy slides as well as the final histopathology slides were reviewed by a second pathologist. The specimens were processed in entirety and additional sections were taken until no tissue was left. RESULTS: Two patients had cancer diagnosed on TURP (transurethral resection of prostate) chips, while the remaining patients had undergone TRUS biopsy for elevated PSA. The final histopathological diagnosis was benign prostatic hyperplasia in two patients, chronic prostatitis in four patients, and acute florid prostatitis in one patient, granulomatous prostatitis with glandulostromal hyperplasia in one patient and TCC (transitional cell carcinoma) of prostate in one patient. CONCLUSION: Most cases of pT0 are due to inability of routine histopathological analysis to identify minute tumor focus. Urologists need to be aware of this in view of the potential medico legal implications.

Correlation between the preoperative serum prostate specific antigen, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy: An Indian experience.

Objectives: To correlate the preoperative serum prostate specific antigen (PSA), Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy (RARP) in Indian men with clinically localized cancer prostate. Materials and Methods: A prospective study analysis was done for 166 consecutive patients of prostate cancer who underwent RARP at our center from June 2006 to October 2009. Preoperative workup included serum PSA, biopsy Gleason score, and clinical staging. The preoperative parameters were correlated with final Gleason score, capsular penetration, seminal vesicle involvement, and lymph node status on final histopathology. Results: The mean age was 64 years (range: 50-76 years) with mean and median PSA of 17.98 ng/ml (range: 0.3-68.3 ng/ml) and 12.1 ng/ml, respectively. With increase in preoperative Gleason score, chance of organ confinement decreases (P=0.002) and capsular penetration increases (P=0.004) linearly. With increasing serum PSA, there is linear decrease in trend of organ-confined disease (P=0.03) and increased chances of seminal vesicle involvement (P=0.02). Patients with higher clinical stage have less probability of localized disease (P=0.007) and more chances of capsular penetration (P=0.04) and seminal vesicle involvement (P=0.004). Conclusion: Our data suggest that patients with higher preoperative serum PSA, Gleason score, and clinical stage have more chances of advanced pathological stage following RARP.