A Prospective Randomized Study Comparing Effectiveness of Local Anesthesia Techniques in Patients undergoing Transrectal Ultrasound-guided Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during TRUS-guided biopsies. MATERIALS AND METHODS: From April 2003 to September 2003, 90 men undergoing a transrectal prostate biopsy were randomized into three groups. In group 1, 30 patients intrarectally received 20ml of 2% lidocaine gel; and group 2, 30 patients received 5ml(2.5ml per side) of 2% lidocaine solution injected along each side of the prostate, near the junction of the seminal vesicle and the base of the prostate(along the neurovascular bundles); in group 3, 30 patients received 5ml(2.5ml per side) of normal saline injected along the neurovascular bundles. The pain level after the biopsy was assessed using a 10-point linear visual analog pain scale(VAS). A statistical analysis was performed using the Wilcoxon Rank Sum test, and the results compared. RESULTS: Patient who received lidocaine solution injections along the neurovascular bundles (Group 2) had significantly lower VAS scores compared to the control group(mean score 3.56+/-2.13 versus 5.83+/-1.94, p<0.0001), but patients who received intrarectal lidocaine gel did not (mean score 5.46+/-2.70 versus 5.83+/-1.94, p=0.671). Gross hematuria, rectal bleeding and hemospermia occurred in 36(40.0%), 6(6.7%) and 5(5.6%) subjects, respectively. One patient had a vasovagal syncope. No patient reported febrile UTI or urinary retention. CONCLUSIONS: Bilateral nerve blockade with local anesthetic is a safe technique that significantly reduces pain during a prostate biopsy. However, in this study, intrarectal lidocaine injection did not reduce the pain compared to the control group during the prostate biopsy.

Correlation between Calculated Bioavailable Testosterone and Free Testosterone by Direct Immunoassay / 대한남성과학회지

PURPOSE: We investigated whether free testosterone measured by direct immunoassay(aFT) reflects aging as well as bioavailable testosterone(free testosterone index; cBT) calculated from serum testosterone(T) and sex hormone-binding globulin(SHBG). MATERIALS AND METHODS: Serum T, SHBG, and aFT were measured in sera of 414 patients who presented with erectile dysfunction and partial androgen deficiency symptoms but no serious medical comorbidities. Their mean age was 52.5 years(or=50: 262). The cBT was obtained by calculation from T and SHBG. The mean values of T, aFT, SHBG, and cBT were compared according to the age range. We analyzed the correlation between cBT and aFT and calculated the correlation coefficient. RESULTS: The mean values of T(ng/mL), aFT(pg/mL), SHBG(nmol/L), and cBT(nmol/L) were 3.39, 13.08, 24.3, and 6.04, respectively, in the 3rd and 4th decades; 4.34, 14.72, 23.36, and 7.74 in the 5th and 6th decades; and 4.05, 13.83, 27.32, and 5.96 in the 7th and 8th decades. The SHBG increased and T/aFT/cBT declined as age increased from the 5th and 6th to the 7th and 8th decades. The change was statistically insignificant only for aFT. The correlation between cBT and aFT was weak, with a correlation coefficient of 0.391. CONCLUSIONS: Because free testosterone measured by direct immunoassay did not reflect the age-related changes of SHBG, a single measurement is not a reliable index of bioavailable testosterone.

Three-year Outcome of the Tension-free Vaginal Tape Procedure for Treatment of Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To evaluate the 3 year results of the tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence. MATERIALS AND METHODS: Of 41 women that underwent the TVT procedure, between March 1999 and December 1999, for stress urinary incontinence, 30 were followed up for at least 3 years following surgery. The preoperative evaluations included a comprehensive medical history, a through physical examination, urinalysis, urine culture, voiding diary, 1-hour pad test and a complete multichannel urodynamic study, including valsalva leak point pressure (VLPP) and maximal urethral closing pressure (MUCP). Long-term evaluations were performed by questionnaires on the durability of surgical outcome and the patients' satisfaction of the procedure. RESULTS: Of the 30 patients followed-up, the tension-free vaginal tape procedure remained successful in 93.3% (cured 80%, improved 13.3%) 3 years after the procedure. Two patients, with a VLPP lower than 60cmH2O and a MUCP lower than 40cmH2O, failed to gain continence after the procedure. There were no serious or long-term complications related to the procedure. The satisfaction rates 1 and 3 years after the surgery were 90 and 86.6%, respectively. CONCLUSIONS: We consider the TVT procedure to be an effective treatment for stress urinary incontinence, with long-term durability of continence and minimal complications related to the surgery.