[Value of nitrous oxide-oxygen mixture (Entonox) in transrectal prostate biopsies]. / Intérêt du mélange équimolaire d'oxygène et de protoxyde d'azote (Meopa) dans les biopsies transrectales de prostate.

OBJECTIVE: The objective of this study was to evaluate the analgesic and anxiolytic properties of an equimolar nitrous oxide-oxygen mixture (Entonox) for transrectal prostate biopsies compared with the use of intrarectal lidocaine gel. The authors evaluated the pain experienced by patients during the procedure and the correlation between pain and anxiety. MATERIAL AND METHODS: One hundred and two patients were included in the study and were divided into two groups. Patients of group 1 (47 patients) received 15 ml of intrarectal 2% lidocaine gel and patients of group 2 (55 patients) inhaled Entonox for three minutes before the procedure. A visual analogue scale (VAS), graduated from 0 to 10, was used to evaluate pain intensity. Patients completed the Spielberger State-Trait Anxiety Inventory (forms Y and A), scored from 20 to 80, before the procedure. RESULTS: No significant difference in anxiety scores was observed between the two groups (p=0.85). In contrast, pain intensity evaluated by the patient tended to be lower in the Entonox group (mean VAS: 2.9 versus 3.5; p=0.10). A linear correlation was observed between the anxiety score and pain intensity in the lidocaine group (p=0.01), but not in the Entonox group (p=0.92). CONCLUSION: The use of Entonox tended to improve the tolerability of prostate biopsies, which can be explained by attenuation of the anxiogenic component of pain.

[Management of ureteral injuries]. / Prise en charge des lésions urétérales iatrogènes.

Ureteral injury is a rare but potential serious complication that can occur during a variety of general surgical procedures. Knowledge of the course of the ureter is the first step toward preventing ureteral injuries. While some injuries are noticed intraoperatively, most are missed and present later with pain, sepsis, urinary drainage or renal loss. The choice of treatment is based on the location, type and extend of ureteral injury. For injuries recognized during open surgery, when involving the distal 5 cm of the ureter, an antireflux ureterocystostomy such as the Politano-Leadbetter procedure or a vesicopsoas hitch can be performed. For the middle ureter, an ureteroureterostomy is satisfactory and for the proximal ureter, most injuries can be managed by transureteroureterostomy. In complex situations intestinal interposition, autotransplantation or even nephrectomy can be considered. The majority of patients with delayed diagnosed ureteral injuries should be managed by an initial endo-urologic approach.