Intravenous paracetamol for relief of pain during transrectal-ultrasound-guided biopsy of the prostate: A prospective, randomized, double-blind, placebo-controlled study.

Transrectal-ultrasound-guided prostate biopsy (TRUS-PBx) is the standard procedure for diagnosing prostate cancer. The procedure does cause some pain and discomfort; therefore, an adequate analgesia is necessary to ensure patient comfort, which can also facilitate good-quality results. This prospective, randomized, double-blinded, placebo-controlled study aimed to determine if intravenous (IV) paracetamol can reduce the severity of pain associated with TRUS-PBx. The study included 104 patients, scheduled to undergo TRUS-PBx with a suspicion of prostate cancer, that were prospectively randomized to receive either IV paracetamol (paracetamol group) or placebo (placebo group) 30 minutes prior to TRUS-PBx. All patients had 12 standardized biopsy samples taken. Pain was measured using a 10-point visual analog pain scale during probe insertion, during the biopsy procedure, and 1 hour postbiopsy. All biopsies were performed by the same urologist, whereas a different urologist administered the visual analog pain scale. There were not any significant differences in age, prostate-specific antigen level, or prostate volume between the two groups. The pain scores were significantly lower during probe insertion, biopsy procedure, and 1 hour postbiopsy in the paracetamol group than in the placebo group. In conclusion, the IV administration of paracetamol significantly reduced the severity of pain associated with TRUS-PBx.

On-demand tramadol hydrochloride use in premature ejaculation treatment.

OBJECTIVES: To determine the efficacy of tramadol in premature ejaculation (PE) treatment compared with placebo. METHODS: A single-blind, placebo-controlled, crossover study was conducted with 60 lifelong (primary) patients with PE. The patients were randomized into 2 groups, each consisting of 30 patients, who took tramadol or placebo on demand. PE was defined as an intravaginal ejaculation latency time of ≤60 seconds in 90% of intercourse episodes. The efficacy of the drugs was assessed using the intravaginal ejaculation latency time, ability of ejaculation control, and sexual satisfaction scores after an 8-week treatment period. RESULTS: All participants completed the study voluntarily. Two groups were similar in terms of the patient demographics. Increases in the intravaginal ejaculation latency time, ability of ejaculation control, and sexual satisfaction score between the placebo and tramadol groups were compared with the baseline values in both groups. At the end of study period, the tramadol group had significantly (P<.001) greater values for all 3 parameters compared with those in the placebo group. CONCLUSIONS: On-demand use of low-dose tramadol is effective for lifelong PE. Currently, selective seratonin reuptake inhibitors such as dapoxetine, are a more popular treatment option for PE. However, tramadol might be considered an alternative agent for primary PE treatment.

Haemostatic role and histopathological effects of a new haemostatic agent in a rat bladder haemorrhage model: an experimental trial.

OBJECTIVE: To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, Ankaferd BloodStopper (ABS; Ankaferd Drug Cosmetic Co., Istanbul, Turkey) in a rat bladder haemorrhage model. ABS is a unique combination of five plant extracts that has been used in Turkish traditional medicine as a haemostatic agent for external traumatic bleeds. MATERIALS AND METHODS: In all, 20 male Sprague-Dawley rats were divided into two equal groups. In both groups, the mucosa was damaged on the posterior wall (PW) of the bladder. The liquid form of ABS was applied to the bleeding area of one group (group 1) and 0.9% NaCl to the bleeding area of the other group (group 2, controls). The solutions were applied drop by drop with a 2 mL injector until the bleeding stopped and the bleeding times recorded. For histopathological examination, two tissue samples were taken from all rats in each group; one from the damaged mucosa in the PW and one from undamaged mucosa in the lateral wall (LW). Two sections were prepared from all samples. One section was stained with haematoxylin and eosin (H&E), and the rest was used for immunohistochemical staining for fibronectin. RESULTS: The mean bleeding times were 65 s and 147 s for groups 1 and 2, respectively (P < 0.001). In the pathological specimens stained with H&E, fibrosis and other studied pathological features were similar in the LW samples in groups 1 and 2. Similarly, there were no differences between the PW samples of groups 1 and 2. In the pathological specimens stained for fibronectin, the number of attenuated cells was similar in the LWs of group 1 and 2 (P = 0.21) as well as in the PWs of each group (P = 0.066). CONCLUSIONS: ABS decreased bleeding time and did not increase fibrotic reactions in rat bladder tissue.

Combination antioxidant effect of α-tocoferol and erdosteine in ischemia-reperfusion injury in rat model.

INTRODUCTION: Renal ischemia/reperfusion (I/R) which is an important cause of renal dysfunction is inevitable in renal transplantation, surgical revascularization of the renal artery, partial nephrectomy and treatment of suprarenal aortic aneurysms. AIM: The purpose of this study was to investigate the efficacy of α-tocopherol and erdosteine combination in the reduction in injury induced by ROS in a rat model of renal ischemia-reperfusion. MATERIALS AND METHODS: Thirty-six- male Wistar albino rats weighing 200-250 g were utilized for this study. Rats were divided into six groups, and each group was consistent of six rats: (1) sham-operated (control), (2) ischemia group (3) I/R group, (4) I/R/α-tocoferol group (5) I/erdosteine group (6). I/R/α-tocoferol and erdosteine group. Biochemically tissue MDA, XO and SOD activities, light and electron microscopic findings were evaluated. RESULTS: The erdosteine and α-tocoferol significantly reversed the effect of protein oxidation and lipid peroxidation induced by I/R shown by the decreased levels of MDA and XO activities. Both MDA and XO levels were found to be lower in group 6 compared to single agent treatment groups, and this was significantly different. All treatment groups showed increased SOD activity, which accounts for their oxidative properties. The mean Paller score of the combination treatment group (group 6) was lower than all groups except the sham group (3.67 ± 1.2), and this finding was statistically significant (0.05). Our results showed that the antioxidant pretreatment with α-tocopherol and erdosteine combination reduced lipid peroxidation of renal cellular membranes in a model of normothermic renal ischemia-reperfusion in rats. Combination of erdosteine and α-tocopherol has a synergistic effect of protection against oxidative processes. Long-term use of α-tocopherol seems to have a greater effect on the prevention of IR injury. However, further investigations are needed for the clinical applications of our findings.

Topical and long-acting local anesthetic for prostate biopsy: a prospective randomized placebo-controlled study.

OBJECTIVE: To determine the efficacy of intrarectal lidocaine gel alone and a combination of lidocaine gel with 2 different longer-acting local anesthetic (LA) agents that were injected into the periprostatic area before transrectal ultrasound-guided prostate biopsy. PATIENTS AND METHODS: One hundred patients undergoing transrectal prostate biopsy were randomized into 4 groups of 25 patients each. Before the biopsy, group 1 received no local anesthesia, group 2 received 2% lidocaine gel intrarectally, group 3 received intrarectal lidocaine gel and 5 ml bupivacaine (0.25%) injected into periprostatic area, and group 4 received lidocaine gel intrarectally and a 5-ml ropivacaine injection (0.25%) in the same location as group 3. Pain levels during and after the biopsy were assessed by using a 10-point linear visual analog scale (VAS). RESULTS: Patients in groups 3 and 4 had significantly lower VAS scores than those in groups 1 and 2, both during and 1 h after biopsy. There were no differences in the pain scores between groups 1 and 2. CONCLUSION: The combination of intrarectal lidocaine gel and periprostatic longer-acting LA agents significantly reduces the pain related to prostate biopsy, whereas intrarectal lidocaine gel administration alone does not reduce pain. Thus, administration of the periprostatic longer-acting LA agents alone is adequate.

Transurethral resection of ejaculatory ducts in the treatment of complete ejaculatory duct obstruction.

OBJECTIVES: To evaluate the value of transurethral resection of the ejaculatory duct (TURED) in the treatment of complete ejaculatory duct obstruction (EDO) as a treatable cause of male factor infertility. MATERIALS AND METHODS: We retrospectively evaluated 12 azoospermic infertile men who were diagnosed as having complete EDO. The mean age of the patients was 32 years (range 24-40). Inclusion criteria were EDO in patients with azoospermia, normal serum levels of gonadotropins and testosterone and evidence of obstruction on transrectal ultrasonographic (TRUS) images. The definitive diagnosis was based on the absence of an efflux of methylene blue injected through the seminal vesicles during cystoscopy. All patients were treated by TURED. RESULTS: Before TURED, all patients were azoospermic and had been considered as candidates for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Following the operation, sperms were seen in the ejaculates of 11/12 patients. After a mean follow-up period of 12 (range 4-36) months, five (41.6%) pregnancies were noted (three spontaneous, one with intrauterine insemination and one with IVF/ICSI). CONCLUSION: Transurethral resection was found to be a safe and somewhat effective approach for the treatment of EDO. After TURED, a significant improvement was achieved in semen parameters, and spontaneous pregnancy resulted in three cases. In addition, TURED can reduce the need for expensive procedures such as IVF/ICSI as this modality allows IVF/ICSI to be performed with ejaculated instead of surgically retrieved sperm.

Pure squamous cell carcinoma after intravesical BCG treatment. A case report.

Besides the commonly seen side effects of intravesical BCG instillations, very rare complications have been reported including new tumor formation other than transitional cell carcinoma of the bladder. Here we report the first case of pure squamous cell carcinoma formation in a BCG-treated patient with pure transitional cell carcinoma.

Prevention of renal damage by alpha tocopherol in ischemia and reperfusion models of rats.

Ischemia-reperfusion injury in rat kidneys most probably comes from oxidative stress, but the possible preventive effect of alpha-tocopherol (AT) treatment on this injury has not yet been established. Forty male Wistar rats were randomly divided into four groups. The left renal arteries of all rats except the controls were clamped to induce renal ischemia. The left kidneys of the rats in the ischemia group were removed following 40 min ischemia. The rats in the ischemia-reperfusion and ischemia-reperfusion-AT groups were treated similarly, but in these groups the renal arteries were re-perfused for 1 h following ischemia. The rats in the ischemia-reperfusion-AT group also received 10 mg/kg AT 3 h prior to ischemia. The specimens were examined histopathologically and ultrastructurally, and the tissue calcium levels were measured. Light microscope and ultrastructural examination showed that the greatest damage occurred in the ischemia-reperfusion group. The highest level of tissue calcium was also found in this group. In the ischemia-reperfusion-AT-treated group, less tissue damage and a lower tissue calcium concentration was found compared to both the ischemia and ischemia-reperfusion groups. Our results indicate that AT can reduce tissue damage after ischemia-reperfusion injury.