Surgical management of bone metastases from urological malignancies: an analysis of 70 cases.

OBJECTIVE: The purpose of this study was to evaluate symptomatic bone metastases from urological malignancies and the efficacy of surgical treatment of bone metastases in achieving local tumor control. METHODS: This was a retrospective observational study of patients diagnosed with bone metastases from urological malignancies who died from their diseases between 2002 and 2013. Data on clinicopathology, number and sites of bone metastasis, time to first and subsequent metastasis, survival after metastasis, nature of metastasis (blastic, mixed, lytic), type of surgical reconstruction, systemic affections, and visceral organ metastasis for 70 bone metastases from deceased urological malignancies patients (55 male, 15 female) with evidence of bone metastasis were statistically analyzed. RESULTS: Forty-three patients (61.42%) had renal cell carcinoma (RCC), 15 patients (21.43%) had prostate cancer, and 12 patients (17.15%) had bladder carcinoma as primary diagnosis. Osteolytic lesions were most prevalent (n=61; 87%). The most common surgical modality for extremities was wide resection with prosthetic replacement (42 patients), followed by wide resection or wide resection with bone cement application with internal fixation (21 patients); 65 patients were treated with limb salvage procedures, and 2 patients were treated with amputation. Overall median survival was 13 months for RCC, 16 months for prostate carcinoma, and 11 months for bladder carcinoma patients. CONCLUSION: Detection of bone metastases in patients with urological malignancies influences the treatment strategy. Diagnosis of bone metastases may be delayed in urologic malignities; thus, these patients receive long-term clinical follow-up.

The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety.

INTRODUCTION: Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. MATERIALS AND METHODS: Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p < 0.05 was considered statistically significant. RESULTS: Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS [mean 1 (0-8); p = 0.011], BAI (6.0 vs 2.0; p < 0.001), and HAS (11.0 vs 6.0; p < 0.001). CONCLUSION: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety, and therefore pain, in patients awaiting diagnostic prostate cancer surgery.

Novel approach for pain control in patients undergoing prostate biopsy: iliohypogastric nerve block with or without topical application of prilocaine-lidocaine: a randomized controlled trial.

PURPOSE: To investigate the efficacy of a novel anesthetic technique called iliohypogastric nerve block (INB) for pain control in patients undergoing prostate biopsy. MATERIALS AND METHODS: A total of 59 consecutive patients who underwent transrectal ultrasound guided prostates biopsies were included in the study. Patients were randomized into four groups: (1) control, no method of anesthesia was administered, (2) intrarectal prilocaine-lidocaine cream application, (3) INB and (4) INB + intrarectal prilocaine-lidocaine cream application (combined group). Patients were asked to use a scale of 0-10 in a Visual Analogue Scale (VAS) questionnaire about pain during probe insertion (VAS 1) and prostate biopsy (VAS 2). RESULTS: The mean VAS 1 and VAS 2 scores were 0.7 and 4.9 for controls, 0.5 and 1.8 for INB, 0.5 and 2.6 for the intrarectal cream group, and 0.4 and 1.8 for the combined group. The mean VAS 1 scores were not different between groups. However, the mean VAS 2 scores were significantly lower in INB, prilocaine-lidocaine cream and combined groups compared to the control group (P < .001). In addition, the INB group had significantly lower VAS 2 scores compared to the cream application group (P = .03). On the other hand, there was no difference between the INB and combined groups (P = .8). CONCLUSION: Any form of anesthesia was superior to none. However, INB alone seemed to be superior to prilocaine-lidocaine cream application in patients undergoing prostate biopsy. Addition of prilocaine-lidocaine cream application to INB may not provide better analgesia. 

Is type 2 diabetes mellitus a predictive factor for incontinence after laparoscopic radical prostatectomy? A matched pair and multivariate analysis.

PURPOSE: We evaluated the effect of diabetes mellitus on incontinence after laparoscopic radical prostatectomy. MATERIALS AND METHODS: From a series of 2,071 patients 135 with type 2 diabetes mellitus undergoing laparoscopic radical prostatectomy without radiotherapy and with a minimum followup of 24 months were identified. These patients were randomly matched with 135 nondiabetic controls for age, body mass index, preoperative prostate specific antigen, clinical stage, neoadjuvant hormonal therapy, prostate volume, previous surgery, surgeon skills, surgical approach, presence of bladder neck sparing, lymphadenectomy, technique of urethrovesical anastomosis and attempted nerve sparing surgery. RESULTS: Using multivariate analysis age, diabetes mellitus and duration of diabetes mellitus were independent factors for post-prostatectomy incontinence in the whole group. Early continence (0 to 3 months) was observed in 43.7% of patients with diabetes and in 57.8% of nondiabetic controls which was statistically significant (p = 0.02). The rates of continence in patients with diabetes mellitus for 5 or more years at 3, 12 and 24-month evaluations were less than those in patients with diabetes mellitus for less than 5 years, and the difference was statistically significant (36% vs 50%, p = 0.001; 63.9% vs 82.4%, p = 0.02; 91.8% vs 98.6%, p = 0.03, respectively). CONCLUSIONS: Patients with type 2 diabetes mellitus need longer to recover continence than nondiabetics after laparoscopic radical prostatectomy. However, type II diabetes mellitus did not affect overall return to continence. Patients with diabetes mellitus for 5 or more years have an almost 5 times increased risk of post-prostatectomy incontinence compared to those with diabetes mellitus for less than 5 years. Diabetic patients should be counseled for the potential negative impact of diabetes mellitus on the recovery of continence after laparoscopic radical prostatectomy.

Frequency of metabolic syndrome among hemodialysis patients according to NCEP-ATP III and IDF definitions.

Objective. Patients with chronic renal failure (CRF) have an increased risk of death from cardiovascular diseases. The metabolic syndrome is a common risk factor for cardiovascular diseases. In the present study, it was aimed to evaluate the frequency of metabolic syndrome using the National Cholesterol Education Program Adults Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF) definitions in patients with end-stage CRF undergoing hemodialysis (HD). Materials and Methods. A total of 222 cases undergoing HD were enrolled in the study. After obtaining medical history and physical examination, blood samples were collected from each patient for the measurements of fasting blood glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. Results. Among HD patients evaluated according to both IDF and NCEP-ATP III definitions, the diagnosis of metabolic syndrome was confirmed by IDF in 56.5% of those fulfilling the criteria for NCEP-ATP III. Similarly, 86% of the undiagnosed patients according to NCEP-ATP III were confirmed by IDF definitions. The sensitivity and positive predictive value of NCEP-ATP III for metabolic syndrome were 81.25% and 64.8%, respectively. The area under the Receiver Operating Characteristic (ROC) curve for NECP-ATP III and IDF was 0.730. False-positive rate and probability ratio for NECP-ATP III were 0.352 and 2.49, respectively. In other words, among the patients who were diagnosed with metabolic syndrome according to NCEP-ATP III definitions, the proportion of subjects whose diagnosis was confirmed by IDF definitions was 2.49-fold higher than those with unconfirmed diagnosis. Conclusion. It is logical to evaluate patients with CRF for metabolic syndrome and cardiovascular risk factors at the time of diagnosis and regularly thereafter due to the high ratio of metabolic syndrome in this population.

EEG abnormalities during treatment with tadalafil, a phosphodiesterase type 5 inhibitor.

OBJECTIVE: Tadalafil is a selective phosphodiesterase type 5 (PDE-5) inhibitor approved for the treatment of erectile dysfunction. Less is known about the electroencephalography (EEG) effects of PDE-5 inhibitors, and the present study, therefore, examined the risk of EEG abnormalities associated with tadalafil. METHOD: EEG recordings from 35 erectile dysfunction patients taking tadalafil (20 mg) were graded for severity of EEG abnormalities (at admission, 2 and 48 hours after tadalafil administration). RESULTS: At admission, there were no EEG abnormalities. At second EEG, abnormalities occurred in 12 (34.3%) of the 35 patients. Eight (22.9%) patients had mild and four (11.4%) patients had moderate EEG abnormalities. At third EEG, one (2.9%) patient had mild and one (2.9%) patient had moderate EEG abnormalities. CONCLUSION: PDE-5 inhibitors may produce EEG abnormalities. Although the exact role of PDE in altering susceptibility to seizure remains unclear, epileptic seizures may occur during treatment with PDE inhibitors.

The effect of rectal Foley catheterization on rectal bleeding rates after transrectal ultrasound-guided prostate biopsy.

PURPOSE: To assess whether Foley catheterization of the rectum after transrectal ultrasound (TRUS)-guided prostate biopsy decreases complication rates. MATERIALS AND METHODS: Between June 2000 and September 2006, 275 consecutive patients were evaluated after undergoing TRUS-guided prostate biopsy. All procedures were performed on an outpatient basis. Patients were divided into two groups. In the first group (n = 134), a Foley catheter was inserted into the rectum and inflated to 50 cm(3) after TRUS-guided biopsy. In the second group (n = 141), catheterization was performed without balloon placement. Rectal bleeding, hematuria, hematospermia, infection, and acute urinary retention rates were compared between groups. RESULTS: The mean ages of the patients were 63.3 years +/- 5.6 and 62.1 years +/- 7.2 years in the Foley catheter group and control group, respectively (P = .112). Hematuria, hematospermia, infection, and rectal bleeding occurred in 31 (23.1%), 30 (22.4), nine (6.7%), and two patients (1.5%), respectively, in the Foley catheter group; and in 36 (25.5%), 36 (25.5%), 11 (7.8%), and 25 patients (17.7%), respectively, in the control group. The incidences of infection, hematuria, and hematospermia were not significantly different between groups (P > .05). In contrast, the rectal bleeding rate was significantly lower in the Foley catheter group (1.5%) than in the control group (17.7%; P = .001). CONCLUSIONS: Although it has no effect on other complications, TRUS-guided prostate biopsy with rectal Foley catheterization is a useful, practical method to decrease or prevent rectal bleeding.

The analgesic efficacy of preoperative versus postoperative lornoxicam in varicocele repair.

STUDY OBJECTIVE: To determine whether intravenous injection of lornoxicam 30 minutes before skin incision provides better pain relief after varicocelectomy than postoperative administration of lornoxicam. DESIGN: Prospective, double-blind, randomized clinical investigation. SETTING: Operating room and postoperative recovery area. PATIENTS: 44 ASA physical status I and II adult male patients undergoing varicocelectomy. INTERVENTIONS: Patients were randomized either to receive 8 mg lornoxicam infusion 30 minutes before skin incision, followed by saline infusion immediately after skin closure (group 1), or to receive the identical injections but in reverse order (group 2). All patients received local anesthesia with bupivacaine. MEASUREMENTS: Postoperative pain scores were evaluated hourly for the first 8 hours after surgery, then at 12, 16, 20, and 24 hours after surgery, using a 10-cm visual analog scale. Time to first analgesic request and patients' global assessments also were recorded. MAIN RESULTS: Patients in group 1 reported significantly lower pain scores (P < 0.05) at all time intervals except at 24 hours and better global assessment (P = 0.001) than did group 2. There were significantly fewer patients in the preemptive group than group 2 who required rescue analgesic within the first 24 hours (0% vs 22.7%; P = 0.024). Mean time to first analgesic request was also significantly longer in the preemptive group (P = 0.001). CONCLUSION: Intravenous lornoxicam administered before surgery has a better analgesic effect for varicocelectomy than when administered postoperatively.

Spontaneous ureteral stent fragmentation: a case report and review of the literature.

Ureteral stents have been widely used for more than two decades with different indications. Due to the widespread usage of ureteral stents, the number of possible complications of ureteral stents has increased, including stent migration, encrustation, stone formation, and fragmentation. Among these complications, ureteral stent fragmentation is rare. Herein, we present a case of spontaneous ureteral stent fragmentation and review the relevant literature.