Penectomy with simultaneous compared to deferred bilateral inguinal lymph node dissection for squamous cell carcinoma of the penis - evaluation of surgical complications

In men with advanced squamous cell carcinoma of the penis, inguinal lymph node dissection is usually deferred for 6 weeks after primary penectomy. The rationale is that the penile lesion is usually infected and immediate lymphadenectomy may lead to a higher surgical complication rate. However, some patients do not return for deferred node dissection and then present much later with incurable metastatic disease. The main of this study was to compare the complication rates of simultaneous versus deferred bilateral inguinal lymph node dissection. From October 1999 to September 2006, 29 men with histologically confirmed squamous cell carcinoma of the penis were treated. Penectomy with simultaneous bilateral inguinal lymph node dissection was performed in 18 patients with locally advanced primary lesions [cT2 in 8, cT3 in 10] and palpable inguinal nodes. The complications were compared with a previous study of 34 men who underwent bilateral inguinal lymph node dissection at a mean of 72 days after penectomy at Tygerberg Hospital during the period November 1983 to April 1995. Post-operative complications occurred in 11 of 18 patients [61.1%]: lymphocele formation in 8, lymph leak in 1, wound dehiscence and skin edge necrosis in 5, wound sepsis in 1, lymphedema of the legs in 2, scrotal edema in 1 and cellulitis in 2 patients [more than one complication occurred in some patients]. In the previously reported comparison group who had undergone deferred inguinal lymph node dissection at a mean of 72 days after penectomy, complications occurred in 26 of 34 [76.5%] patients: wound sepsis in 12, wound dehiscence in 7, lymphocele in 7, lymph leak in 4, wound abscess in 3, necrosis of wound edges in 2 and hematoma formation in 1. Penectomy with simultaneous bilateral inguinal lymph node dissection in men with squamous cell carcinoma of the penis does not lead to a higher complication rate compared with primary penectomy and deferred inguinal lymph node dissection performed at a mean of 10 weeks after the primary procedure

prospective, randomized study of periprostatic lignocaine injection versus intrarectal lignocaine or placebo gel for pain relief during transrectal ultrasound [TRUS] guided needle biopsy of the prostate

Objective: The aim of our study was to compare the efficacy and complications of periprostatic lignocaine injection with transrectal instillation of lignocaine gel or placebo for the relief of pain associated with transrectat ultrasound [TRUS] guided needle biopsy of the prostate

Patients and Methods: Between March 2003 and January 2004, 210 patients were prospectively randomized to recieve periprostatic injection of 10m12% lignocaine [Group 1, n = 83], intrarectal instilation of 15ml 2% lignocaine gel [Group 2, n = 64] or intrarectal instilation of l0mI water-souluble gel [placebo] [Group 3, n = 63]. The degree of pain experienced during and 15 minutes after completion of the biopsy was recorded by the patient himself, using a visual pain score [VPS] with a scale from 0 [no pain] to 10 [the most severe pain possible]. Statistical evaluation was performed using analysis of variance [ANOVA] with post-hoc analyses using the Bonferroni correction

Results: There were no statistically significant differences between the groups with regard to the mean number of biopsy cores, serum PSA or prostate volume. The mean VPS during biopsy was 2.02, 3.05 and 5.16 in Groups 1, 2 and 3, respectively [all differences statistically significant]. The mean VPS 15 minutes after biopsy was significantly lower in Group 1 [1.43] compared to Group 3 [3.28, p<0.001] but not Group 2 [2.17, p = 0.086], and it was significantly lower in Group 2 compared to Group 3 [p=0.006]. With regard to complications, there were no statistically significant differences between the groups, except for rectal bleeding which occurred more frequently in Group 3 [23.2%] than in Groups 1 [7.9%, p 0.033] and 2 [11.5%, p=0.l86]. There was no significant difference with regard to the percentage of patients who would be willing to return for a repeat biopsy [95.7%, 87% and 91.7% in Groups 1, 2 and 3 respectively]

Conclusions: For pain relief during and after TRUS guided needle biopsy of the prostate, periprostatic injection of 10 ml 2% lignocaine was significantly more effective than intrarectal instillation of 15 ml 2% lignocaine gel, which in turn was more effective than intrarectal lubricant [placebo] gel. The incidence of complications was not increased after periprostatic lignocaine injection. Although the greater pain experienced by the patient during biopsy without anesthesia did not result in a significantly greater unwillingness to return for repeat biopsy, considerations of human compassion dictate that all patients undergoing TRUS guided prostate biopsy should routinely be offered local anesthesia