A comparison of 1.5% glycine and 2.7% sorbitol-0.5% mannitol irrigants during transurethral prostate resection.

PURPOSE: We performed a prospective randomized trial comparing glycine 1.5% with 2.7% sorbitol-0.5% mannitol irrigating solution. We evaluated blood loss, fluid absorption, temperature change, cardiac effects and postoperative symptoms. MATERIALS AND METHODS: Between April 1998 and July 1999, 205 treated patients were included in the statistical analysis. Intraoperative irrigating fluid absorption was measured with the patient on the operating table. Serum cardiac troponin I was used as a marker of perioperative myocardial damage. Operative details were recorded, including the type of anesthesia, resection time and the weight of resected tissue. Postoperative symptoms were documented prospectively. RESULTS: Mean patient age was not significantly different in the glycine and sorbitol-mannitol groups. (72.1 versus 73.7 years). American Society of Anesthesiologists grade was also comparable. Median resection time was 27 minutes and resected tissue weighed a mean of 21 gm. The median resection rate was 0.8 gm. per minute. Blood loss and temperature changes during resection were similar in the 2 groups. Overall median blood loss was 216 ml. and irrigant absorption was 140 ml. In the sorbitol-mannitol group significantly less fluid was apparently absorbed during resection (median 88.2 versus 184.4 ml.). Analysis of the incidence of symptoms of the transurethral prostate resection syndrome did not show any differences in the irrigant groups. Cardiac damage measured using troponin I also showed no significant difference in the 2 groups, although there was a high overall incidence of 7.5%. CONCLUSIONS: We noted no significant differences in 1.5% glycine and 2.7% sorbitol-0.5% mannitol as an irrigating solution for transurethral prostate resection.

Use of glyceryl trinitrate patches in patients with ureteral stones: a randomized, double-blind, placebo-controlled study.

OBJECTIVES: To report a randomized, double-blind, placebo-controlled trial of glyceryl trinitrate (GTN) patches. The primary outcome measure was stone passage at 6 weeks. GTN is a potent smooth muscle relaxant that may offer benefit by both reducing pain and facilitating ureteral stone passage. METHODS: Fifty consecutive patients, with a single radiopaque calculus less than 10 mm, were randomized to receive a 6-week course of patches containing either 5 mg GTN or placebo. Patients used a diary to record pain episodes during the 6-week study period and were reviewed weekly with x-ray imaging. Analysis was by intention to treat. RESULTS: Twenty-six patients were randomized to the GTN group and 24 to the placebo group. Seven patients in the GTN group discontinued therapy because of headaches. One patient in the placebo group discontinued because of a skin reaction to the patches. No serious adverse events were recorded. No difference was observed in the stone-free rate at 6 weeks (18 patients in each group), interval to stone passage (median GTN 11.5 days versus placebo 13 days), or interventions performed (5 patients each). Although the GTN group reported fewer pain episodes (median 3.5 versus 6.0), this did not achieve statistical significance. CONCLUSIONS: Our preliminary results did not demonstrate a significant advantage in using GTN compared with placebo, with regard to the stone-free rate at 6 weeks, interval to stone passage, or number of episodes of pain experienced.

Early observations of the effect of extracorporeal shockwave lithotripsy on blood pressure: a prospective randomized control clinical trial.

OBJECTIVE: To determine, in a randomized controlled clinical trial, the effect of extracorporeal shock wave lithotripsy (ESWL) on blood pressure. PATIENTS AND METHODS: The trial included 228 patients with small (< 15 mm) asymptomatic calyceal stones who were randomised to undergo ESWL (113 patients) or to an untreated (observed) control group (115 patients). Blood pressure was recorded at randomization using a standardized protocol. Patients undergoing ESWL received a mean (SD) of 5281 (3462) shocks over a mean of 1.75 sessions on one of two lithotripters. Patients were then followed annually, assessing blood pressure and changes in medication. Data were analysed on an intention-to-treat basis. RESULTS: At randomization, 43% of patients in the control group and 53% in the ESWL group were hypertensive. Of the 228 randomized, 200 patients completed at least one annual follow-up, of whom 192 (93 in the control and 99 in the ESWL group) had their blood pressure recorded. The mean follow-up was 2.2 years; 35 (37%) patients in the control and 46 (46%) in the ESWL group were hypertensive (P = 0.19). Seven (7%) patients in the control group and 11 (11%) in the ESWL group were newly diagnosed to be hypertensive (P = 0.35). CONCLUSIONS: In this randomized controlled clinical trial there was no evidence that ESWL causes changes in blood pressure.

Using the Internet for postgraduate medical education.

Obtaining information from the Internet can be fun. As the Internet is unregulated, the quality of this information can vary enormously and time can be wasted searching poor quality websites. Despite this, use of the Internet for postgraduate medical education is increasing.

Computer-assisted learning; experience at the Bristol Urological Institute in the teaching of urology.

OBJECTIVE: To report the use of a computer-assisted learning (CAL) program in the teaching of urology to medical students. SUBJECTS AND METHODS: Four CAL tutorials were developed, covering the examination of the urological patient, prostate cancer, impotence and lower urinary tract symptoms, for an initial evaluation of the use of CAL. Twenty-six third-year medical students seconded to the department for one week of urology teaching were randomized to two equal groups. One group used the CAL programs in addition to daily formal teaching, while the other group only received daily teaching. Teaching was of a standardized format, covering all aspects of urology, including the four areas covered by the CAL tutorials. Students were assessed using standardized multiple-choice questions (MCQ) at the start and end of the week's teaching. Incorrect responses were marked negatively. The content and ease of use of the CAL programs were also evaluated by a questionnaire. RESULTS: There was no difference between the groups in MCQ scores at the start of the week. The mean (SD) change in score over the week for those using the CAL tutorials was 6.0 (7.0), and for the control group was 0.9 (6.0), a significant difference (P < 0.005). Students reported the tutorials to be easy to use and of satisfactory content. CONCLUSION: The results of this study suggest that CAL programs are of benefit to students learning urology.