The importance of prostate volume in prostate needle biopsy.

OBJECTIVE: Although ultrasound-guided prostate needle biopsy is the gold standard method in the diagnosis of prostate cancer, biopsy schemes and the number of repeated biopsies are still controversial today. It is known that the rate of prostate cancer decreases with increasing prostate volume. In this study, we evaluated the effects of prostate volume on cancer detection in our patient series. MATERIAL AND METHODS: In our clinic, data for 992 patients who had gray zone PSA levels (2.5-10 ng/mL) and whose 10 core biopsies were taken between 2004 and 2010 were evaluated. Among them, 500 patients from whom 6 to 8 biopsies were taken, whose information was lacking and who had suspicious cancer findings after digital rectal examination were excluded from the study. Patient ages, free/total PSA levels (f/TPSA), PSA densities (PSAD), Gleason scores, and prostate volumes were compared between patients with (Group 1) or without biopsy-proven prostate cancer (Group 2). Student's t-test was used for statistical analysis. RESULTS: According to biopsy findings, prostate cancer was detected in 74 patients while no cancer was detected in 418 patients. The mean age of Groups 1, and 2 were 65±8.6, and 64±8.1 years, respectively The mean prostate volume in Groups 1, and 2 were 45±23 cc, and 58±26 cc, respectively. CONCLUSION: In line with the literature, the average prostate volume of the prostate cancer group was significantly lower. This supports the notion that cancer detection is more probable in small prostates than in high-volume prostates.

The effect of diabetes mellitus on α1-adrenergic receptor subtypes in the bladder of rats.

OBJECTIVE: To detect the possible alterations on density or sensitivity of α1-adrenergic subtypes in diabetic bladder by reverse transcriptase-polymerase chain reaction technology and in vitro studies. METHODS: Experimental diabetes was induced by administration of streptozotocin with a single injection through the tail vein. Rats were divided into control and diabetic groups. Contractile responses of bladder strips from each group were obtained for postassium chloride, adenosine triphosphate, and electrical field stimulation (0.5-32 Hz) in organ bath. Electrical field stimulation responses of strips were evaluated in the presence of PPADS (nonselective P2 antagonist), atropine (cholinergic antagonist), 5 MU (α-1a-adrenergic antagonist), BMY-7378 (α-1d-adrenergic antagonist), and finally CED (α-1b-adrenergic antagonist). mRNA expression of α1-adrenergic subtypes was determined for each group. RESULTS: The difference between contractile responses related to electrical field stimulation with incubation with PPADS, atropine, 5 MU, BMY-7378, and CED, respectively, was not significant in the control and diabetic groups (P > .05). The electrical field stimulation responses of strips at 0.5-2 Hz without incubation were significantly different between the control and diabetic groups (P < .05). The contractile responses of strips with PPADS + atropine + 5 MU and BMY-7378 incubations in the diabetic group were significantly lower than in the control group in all doses (P < .05), The mRNA expression of α-1a-adrenergic in the diabetic group was significantly lower than in the control group (P < .05). No change was found in the expression of mRNA of α-1b-adrenergic. CONCLUSION: These results support the probability of changes in presynaptic and autonomic receptor sensitivity. We believe that α-1a-adrenergic and α-1d-adrenergic subtypes should be kept in mind in the treatment of diabetic cystopathy.

Incomplete recovery of erectile function in rat after discontinuation of dual 5-alpha reductase inhibitor therapy.

AIM: The association of 5-alpha reductase inhibitor (5ARI) therapy and sexual dysfunction has been reported. Some patients claim persistent erectile dysfunction despite long-term discontinuation of 5ARI treatment. The aim of this study was to assess erectile function after cessation of 5ARI therapy using a rat model. METHODS: Twenty-six adult male Sprague-Dawley rats were randomized into three groups: (i) control (N = 10); (ii) 8-week dutasteride treatment (0.5 mg/rat/day, in drinking water, N = 8); and (iii) 6-week dutasteride treatment followed by a 2-week washout period (N = 8). The experiments were performed after 8 weeks from the initiation of treatment in all groups. In vivo erectile activity and in vitro contractile and relaxant responses of cavernosal smooth muscle were investigated. RESULTS: In vivo erectile activity (intracavernosal pressure [ICP]/mean arterial pressure [MAP] and total ICP) in treatment groups were significantly decreased compared with controls (ICP/MAP: P < 0.001 for 2.5 v, 5 v, and 7.5 v; total ICP: P < 0.001 for 5 v and P < 0.01 for 7.5 v). Acetylcholine-induced relaxations were diminished in treatment groups (P < 0.05). Relaxant responses to electrical field stimulation (EFS) were decreased in the 8-week treatment group (P < 0.05) but were similar to controls in the washout group. Sodium nitroprusside (SNP)-induced endothelium-independent relaxations were reduced in the 8-week dutasteride treatment group (P < 0.01), while these responses were restored in the washout group. The contractile responses to the alpha1-adrenergic agonist phenylephrine were decreased in treatment groups compared with controls (P < 0.01). Direct neurogenic contractile responses in the dutasteride groups were significantly lower than controls between 1 and 15 Hz frequencies (but not at 20 Hz) and washout partially restored the responses at 10 and 15 Hz. CONCLUSION: Discontinuation of dutasteride improved the relaxant responses to EFS and SNP, while cholinergic and adrenergic responses remained depressed. Our findings suggest a time-dependent detriment of dutasteride on erectile function. The withdrawal/washout effect of 5ARIs on parameters of human sexual function warrants further investigation.

The effects of transurethral resection of the prostate on morbidity and mortality in patients with nondialysis-requiring renal insufficiency.

OBJECTIVES: To compare the prevalence of preoperative co-morbid factors and complications of transurethral resection of prostate (TUR-P) in patients with normal and non-dialysis requiring elevated serum creatinine levels. METHODS: The records of 357 consecutive patients with IPSS≥20, serum creatinine level ≤ 3 mg/dl, residual urine volume ≤ 300 ml and with no upper urinary tract dilatation or evidence of prostate cancer that underwent TUR-P were retrospectively evaluated. 60 patients who did not fulfill the inclusion criteria were excluded. The preoperative Na, K, creatinine levels and the early changes observed in these parameters after TUR-P of the patients with normal (Group1, n = 272) and elevated (Group2, n = 25) serum creatinine levels, as well as the preoperative baseline data and postoperative complications were compared. RESULTS: Preoperative PSA, serum urea, creatinine and K levels were significantly higher in group2. No significant differences were observed between early and late postoperative complications of the two groups. Co-morbid diseases were significantly more common in group2. No progression in renal failure or de novo need for hemodialysis was observed in group2. CONCLUSIONS: TUR-P can be safely performed in BPH patients with mild serum creatinine elevations (1.6-3 mg/dl) and moderately increased prostate volumes without additional morbidity and mortality.

Impact of asymptomatic prostatitis on re-operations due to urethral stricture or bladder neck contracture developed after TUR-P.

PURPOSE: To evaluate the relationship between pathologically proven prostatic inflammation (PI) and re-operation rates due to urethral stricture (US) or bladder neck contracture (BNC) after transurethral resection of prostate (TUR-P). MATERIALS AND METHODS: We have retrospectively reviewed the data of 917 consecutive TUR-P cases. Eligible patients (n = 276) were grouped with respect to presence of PI on TUR-P pathology; Group1: PI (+) (n = 67, 24.3%), and Group2: PI (-) (n = 209, 75.7%). The "re-operation" was defined as internal urethrotomy or bladder neck resection performed for BNC or US. Groups were compared with respect to descriptive data and need for re-operation. Logistic regression analysis was performed to estimate the independent risk factors for the development of BNC and US. P values under 0.05 were considered significant. RESULTS: Of the patients, 38 (13.8%) needed re-operation while 238 (86.2%) did not. The re-operation rate in Group1 was significantly higher than Group2 (29.8 vs. 8.6%, P < 0.001). In logistic regression analysis, duration of initial TUR-P and PI were found to be independent risk factors for development of BNC or US after TUR-P. CONCLUSIONS: Prostatic inflammation on TUR-P pathology is an independent variable affecting the development of US or BNC. Our results should be supported by prospective studies including higher number of patients.

Imatinib mesylate (Gleevec) as protein-tyrosine kinase inhibitor elicits smooth muscle relaxation in isolated human prostatic tissue.

OBJECTIVE: To evaluate the mechanism of action of imatinib mesylate (Gleevec), a protein tyrosine kinase inhibitor on the human prostate with benign prostatic hyperplasia. METHODS: Prostate samples were obtained from 16 patients with benign prostatic hyperplasia (mean age 68.3 ± 1.9 years), who had undergone transurethral prostatectomy. In tissue bath studies, cumulative concentration-response curves were constructed for imatinib after precontraction with 120 mM KCl. Imatinib-induced relaxation was quantitated in tissues treated with l-N(G)-Nitroarginine Methyl Ester (l-NAME) (an inhibitor of nitric oxide synthase) or 1H-[1,2,4]-oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) (a soluble guanylyl cyclase inhibitor). Two K+ channel blockers (adenosine triphosphate [K(ATP)] and Large-conductance Ca(2+)-activated K(+) channels [BK(Ca2+)] channels) were also evaluated as antagonists of imatinib-induced relaxation and repeated in the presence of the α-adrenergic receptor blocker alfuzosin. An electrical field stimulation (1-20 Hz, 5 ms, 5 seconds, 60 V)-induced contractile response was performed on strips incubated with imatinib (10(-3) M). RESULTS: KCl-induced contractions in human prostatic tissue were significantly inhibited by imatinib (maximal response 84.9 ± 4.5%) and were attenuated by l-NAME (42%, P < .001) and ODQ (43%, P < .001). This relaxant effect was also suppressed by glibenclamide (adenosine triphosphate-sensitive K+ channel blocker, 41%, P < .001) and tetraethylammonium (BK(Ca2+) channel blocker, 24%, P < .05). CONCLUSION: Imatinib induced prostatic smooth muscle relaxation in vitro. This effect was suppressed by l-NAME and ODQ, showing a dependence on the nitric oxide-cyclic guanosine monophosphate pathway and modulated by the K(ATP) and BK(Ca2+) K+ channels. Our findings suggest that imatinib can augment relaxation of human prostatic tissues by way of a novel ligand-protein tyrosine kinase signaling pathway.

Stage-by-stage effects of surgical margin status on biochemical failure after radical prostatectomy in patients with clinically localized prostate cancer.

PURPOSE: To evaluate the effects of pathological stage and surgical margin status on biochemical failure rates after radical prostatectomy (RP). MATERIALS AND METHODS: The records of 205 patients who underwent RP for clinically localized prostate cancer (CaP) were evaluated. Known risk factors for biochemical failure (BF) were analyzed using univariate and multivariate logistic regression analysis. The effects of surgical margin status together with pathological stage on BF were evaluated. p values lower than 0.05 were accepted to be statistically significant. RESULTS: Pathological stage, positive surgical margin (PSM), seminal vesicle invasion, lymph node involvement, biopsy Gleason score and postoperative Gleason score were the factors associated with BF in univariate analysis. Logistic regression analysis revealed that pT3a patients with PSM had a significant BF rate when compared to pT2 patients with a negative surgical margin (NSM) (OR 7.46, p = 0.002). pT3a patients with a NSM had a similar BF rate to that of pT2 patients with PSM. CONCLUSIONS: pT2 patients with PSM had a similar biochemical prognosis to that of pT3a patients without PSM, implicating that a PSM may have a negative effect on prognosis similar to that of extracapsular invasion.

Impacts of antibiotic and anti-inflammatory therapies on serum prostate-specific antigen levels in the presence of prostatic inflammation: a prospective randomized controlled trial.

INTRODUCTION: The aim of this study was to determine if antibiotic or anti-inflammatory medications lower serum prostate-specific antigen (PSA) in the presence or absence of inflammation in the prostatic secretions of patients with PSA levels between 2.5 and 10 ng/ml and normal digital rectal examinations (DRE). MATERIALS AND METHODS: Patients with PSA levels between 2.5 and 10 ng/ml and normal DRE were candidates for the study. One hundred and eight patients with positive expressed prostate secretion (EPS) were randomized into antibiotics, anti-inflammatory and control groups (groups 1, 2 and 3, respectively), and 108 patients with negative EPS were randomized into similar groups (groups 4, 5 and 6, respectively). Repeat PSA levels of all patients were obtained 6 weeks after randomization and 10 core prostate biopsies were performed. RESULTS: Median PSA levels in group 1 before and after treatment were 5.2 (4.3-6.4) and 4.0 ng/ml (3.1-4.9), respectively (p < 0.001). The only significant decrease in PSA was observed in group 1. The percent change in PSA levels in group 1 was significantly greater than both in its control group (group 3; p < 0.001) and the EPS- antibiotics group (group 4; p < 0.001). CONCLUSIONS: Antibiotherapy significantly reduces serum PSA only in EPS+ patients, which justifies limiting the use of prebiopsy antibiotics to EPS+ patients with a normal DRE and PSA level between 2.5 and 10 ng/ml, minimizing the major drawbacks of empirical antibiotics usage.

Alteration in contractile responses in human detrusor smooth muscle from obstructed bladders with overactivity.

INTRODUCTION: In this study, we aimed to evaluate changes in contractile responses under in vitro conditions in detrusor overactivity (DO) in patients with bladder outflow obstruction (BOO). MATERIALS AND METHODS: Detrusor strips obtained during open prostatectomy procedure from 16 patients with BOO related to benign prostate hyperplasia were evaluated under in vitro conditions. Patients were assigned to two groups as patients with (DO) and without (no DO) DO. Four detrusor strips were prepared from each bladder in dimensions of 2 x 10 mm, and were suspended in organ bath. Responses to carbachol (10(-8) to 10(-3)M), electrical field stimulation (EFS) (0.5-32 Hz), single-dose adenosine 5'-triphosphate (ATP) (10(-3)M) and KCl (120 mM) were recorded to evaluate the contractile responses. EFS responses were repeated in the presence of NG-nitro-L-arginine methyl ester (L-NAME; 10 muM) and L-NAME + indomethacin. All responses were expressed as mg tension developed per mg of bladder tissue. Data obtained were compared using independent t test and one-way ANOVA test. Values of p < 0.05 were accepted as statistically significant. RESULTS: Of the 16 patients on whom open prostatectomy was performed because of BOO, 8 of the patients were determined as no DO and 8 as DO. There were no differences between groups regarding age and residual urine. We found statistically significant differences between groups regarding dimensions of prostate, maximum bladder capacity and maximum bladder pressure. In the comparison of cumulative dose of carbachol, it was seen that responses were higher in the DO group, but the differences were not statistically significant. In EFS application, contractile responses were found to increase significantly in the DO group. No changes were observed between groups for ATP and KCl. EFS responses were found to be significantly higher in presence of L-NAME + indomethacin in the no DO group; however, no difference was seen in the DO group. CONCLUSIONS: Detrusor contractile responses to EFS increased in patients with BOO in presence of overactivity. These changes in contractile responses are observed possibly as a result of deterioration in neuromodulation, rather than as a result of changes in purinergic or cholinergic receptor sensation or level. We suggest that a noncholinergic-nonpurinergic mechanism can have some effect on these changes.

Tissue reactions of suture materials (polyglactine 910, chromed catgut and polydioxanone) on rat bladder wall and their role in bladder stone formation.

Suture materials are widely used in urological surgery especially in regions that are in contact with urine. In this study, we aimed to compare polyglactine 910, chromed catgut and polydioxanone sutures according to stone formation and inflammation, congestion and foreign body reaction that occur on bladder mucosa. Cystotomy procedure was performed, in three groups of Wistar female rats, with 4/0 polyglactine 910, 4/0 chromed catgut and 4/0 polydioxanone sutures. All groups were divided into two sub-groups with 4 and 8-week follow up periods. Rats were treated with 20 mg kg(-1) day(-1) Ofloxacin (i.p.) daily until the seventh post-operative day. Urinary pH, leucocyte esterase and nitrite levels were determined. All rats were killed at the end of the follow-up period and stone formation on sutures and degrees of tissue reactions (inflammation, congestion and foreign body reaction) on bladder mucosa were compared. Tissue reactions were evaluated by the same pathologist (S. K.). Chi-square and Student's t test were used in statistical analysis (p<0.05). There was no significant difference between the mean weights of the groups. Leucocyte esterase and nitrite were negative in urine analyses. There was no significant difference between urinary pH levels of the groups with 4 and 8 weeks follow-up (p>0.05). Although the difference between the degrees of congestion in groups was not statistically significant (p>0.05), there were statistically significant differences between the degrees of inflammation and foreign body reaction in groups. Although the duration of urinary contact of suture is the main factor in stone formation on suture material, tissue reaction on mucosa and the physical structure of suture also affect this formation. We observed lower degrees of inflammation and foreign body reaction with 4/0 polydioxanone and no stone formation. We believe that polydioxanone may be useful and reliable in urological surgery due to these properties.

Comparison of four different anesthesia methods for relief of all pain during transrectal ultrasound-guided prostate biopsy.

INTRODUCTION: To find the most beneficial method, we assessed patient comfort and morbidity rates during prostate biopsy procedures performed using periprostatic nerve blockade, unilateral pudendal nerve blockade, intrarectal lidocaine gel, and a combination of periprostatic nerve blockade and intrarectal lidocaine gel. MATERIALS AND METHODS: A total of 159 patients were included in this study. Pain evaluation results were retrospectively assessed and retrieved from the patient charts. Patients in group 1 (n = 64) received no anesthesia, group 2 (n = 34) received periprostatic nerve blockade, group 3 (n = 26) received unilateral pudendal nerve blockade, group 4 (n = 20) received intrarectal lidocaine gel, and group 5 (n = 15) received a combination of periprostatic nerve blockade and intrarectal lidocaine gel. A visual analog scale (VAS) was used for pain evaluations. RESULTS: According to pain scores (VAS) during probe insertion, only group 2 did not show a statistically significant difference (P > 0.05), while the other groups were found to be significantly different when compared to group 1. Groups 2, 3, and 5 were found to be significantly different when compared to group 1 according to pain scores (VAS) during insertion of needles. Groups 3 and 5 displayed statistically significant differences when compared to group 1 as regards pain scores during both the insertion of the probe and biopsy. CONCLUSIONS: Our data suggests that using either a combination of intrarectal lidocaine gel and periprostatic block or solely unilateral pudendal nerve block for prostate biopsy procedures provides efficient patient comfort by reducing pain both during probe insertion and needle passing through the prostate gland.

Effects of simultaneous transurethral resection of prostate and solitary bladder tumors smaller than 3 cm on oncologic results.

OBJECTIVES: To investigate the effect on the oncologic outcomes of treatment with transurethral resection of patients with a solitary bladder tumor smaller than 3 cm with a superficial appearance and benign prostatic hyperplasia. METHODS: The follow-up data from 34 men (group 1) who had undergone transurethral bladder tumor resection alone and 31 men who had undergone both transurethral prostate resection and transurethral bladder tumor resection at the same operation (group 2) in our clinic from 1996 to 2004 were retrospectively examined. The groups were also compared with each other. The recurrence and progression rates, elapsed time to recurrence, and the recurrence rates in the bladder neck and prostatic urethra were determined and compared. Statistical analysis was performed using the Mann-Whitney U and chi-square tests. RESULTS: The patients were followed up for at least 12 months (mean 28.9, range 12 to 98). The average follow-up period for group 1 was 27.4 months (range 12 to 91) and was 30.5 months (range 12 to 98) for group 2. The recurrence and progression rates for groups 1 and 2 were 41.2% and 8.8% and 35.5% and 9.7%, respectively. Recurrence in the bladder neck and/or prostatic urethra developed in 1 patient in each group. No statistically significant differences were found between groups in terms of follow-up time, recurrence, progression, recurrence in the prostatic urethra and/or bladder neck, and elapsed time to recurrence. CONCLUSIONS: According to our results, transurethral prostate resection can be safely performed with transurethral bladder tumor resection simultaneously in selected patients with severe lower urinary tract symptoms and a superficial solitary tumor smaller than 3 cm.

Comparison of transurethral resection and plasmakinetic transurethral resection applications with regard to fluid absorption amounts in benign prostate hyperplasia.

INTRODUCTION: We compare the absorption of irrigant fluid during gyrus plasmakinetic transurethral prostatectomy (PK-TURP) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS: 42 patients with clinical benign prostatic hyperplasia were randomly assigned to undergo PK-TURP or TURP. In the PK-TURP group 0.9% NaCl was used as an irrigation fluid and 1.5% glycine in the TURP group. By adding ethanol to the irrigation fluids 1% ethanol-containing solutions were formed. All operations were carried out under spinal anesthesia and alcohol concentration of the ventilated air measurements were made just at the beginning of the operation, every 10 min peroperatively and at the end of the operation by using an alcoholmeter. RESULTS: There was no difference in age, prostate volume and the length of operation time in either group. In both groups, the estimated absorbed fluid volume increased with the duration of surgery (p < 0.05). The difference between mean fluid absorption during PK-TURP and during TURP was the statistically significant (p < 0.01). CONCLUSION: PK-TURP operation causes lesser absorption of the irrigation fluid than the TURP operation. The lesser absorption of irrigation fluid and using saline instead of glycine decreases the risk of TUR syndrome.

Value of frozen sections of lymph nodes in pelvic lymphadenectomy in patients with invasive bladder tumor.

AIM: We examined the reliability of classical lymph node evaluation methods. We compared the results of preoperative computed tomography (CT) and perioperative frozen section examination of lymph nodes in patients on whom radical cystectomy was performed because of invasive bladder tumors. METHODS: A total of 142 patients, in whom radical cystectomy was performed because of invasive bladder tumors between the years 1994 and 2005 in our clinic, and 284 pelvic lymph node regions were evaluated retrospectively. For each of the pelvic lymph node region, the conditions of the lymph nodes according to CT and in frozen sections were compared with the final pathology reports of the surgical specimens. RESULTS: Lymph node involvement was found in 36 pelvic regions out of 284 in the final pathology. It had been possible to show only two of the 36 positive lymph nodes in preoperative CT. Frozen section results of the 29 pelvic lymph node regions out of 36 that were involved according to the final pathology were positive also according to frozen section results. On the other hand, in all the 29 lymph node regions those that were positive according to frozen section had lymph node involvement in the final pathology. CONCLUSIONS: We recommend the performance of frozen section examination on obturator plus internal iliac lymph nodes when deciding extended lymph node dissection, and the performance of extended lymph node dissection only if the result is positive.

How do patients with familial benign prostatic hyperplasia differ clinically from those with sporadic benign prostatic hyperplasia?

INTRODUCTION: The aim of this study was to compare age, prostatic volume, International Prostate Symptom Score (IPSS), maximal flow rate, serum total prostate-specific antigen (PSA), serum free PSA, free/total PSA ratio and PSA density values of familial and sporadic benign prostatic hyperplasia (BPH) patients suffering moderate or severe lower urinary tract symptoms. MATERIALS AND METHODS: Between September 1999 and August 2004, 511 patients with moderate or severe lower urinary tract symptoms (IPSS > or =8) due to BPH were included in the study. Patients with at least 2 first-degree relatives who had undergone surgery or received medication for BPH were classified as having the familial form of the disease, while the remaining patients were taken as sporadic cases. Mean age, prostatic volume, symptom score, maximal flow rate, PSA, free PSA, free/total PSA ratio and PSA density values of the familial and sporadic groups were compared using student's t test. RESULTS: Thirty-eight patients had a positive family history and formed the familial group, while the remaining 473 made up the sporadic group. No significant difference was observed in the parameters studied, except that mean prostate volume of the familial group was found to be greater and the mean age to be lower than those of sporadic patients in accordance with the literature. CONCLUSIONS: Patients with familial BPH need treatment significantly earlier and have larger prostates than those with sporadic BPH.

Effect of urothelium on bladder contractility in diabetic rats.

AIM: It is known that physiopathological changes in diabetes affect the function of the bladder. In this study, we aimed to demonstrate the possible effects of diabetes on the urothelium during this physiopathological process. METHODS: Diabetes was induced in rats by tail vein injection of 35 mg/kg streptozotocin. Eight weeks later, intact and denuded bladder strips were prepared from these rats. Electrical field stimulation (EFS; 0.5-32 Hz), carbachol (10(-8)-10(-3) mol/L; cumulative dosage-response curves) and KCl (120 mmol/L) were used for the evaluation of the contractile responses. All responses were expressed as mg tension developed per mg of bladder tissue. Weights of rats and of their bladders, blood glucose levels, and frequency- and concentration-response curves were compared using anova, the paired t-test and the independent t-test. Differences were considered significant at P<0.05. RESULTS: Although no differences related to the weight of bladders of the control and diabetic groups were observed, there were differences in blood glucose levels and body weights between the two groups. Similarly, although there were no differences between the data obtained with EFS and KCl from tissues with intact and denuded strips in the control group, carbachol responses significantly differed between intact and denuded strips in the non-diabetic group. These differences were not observed in the diabetic group. In the control groups, in the presence of additional strips with intact urothelium placed in the medium containing denuded tissue, the differences in contractile responses between the intact control strip and the denuded strip disappeared. CONCLUSIONS: Diabetes possibly changes the interaction between the relaxant factors that are released from urothelium and muscarinic stimulation, but these interactions are not completely understood yet. Consequently, the response of the bladder to contractile stimulants is also affected. Further studies are required to reveal the mechanism by which diabetes influences the urothelium.

Unilateral pudendal nerve blockade for relief of all pain during transrectal ultrasound-guided biopsy of the prostate: a randomized, double-blind, placebo-controlled study.

OBJECTIVES: To investigate the efficacy of unilateral pudendal nerve block for the relief of all pain during transrectal ultrasound (TRUS)-guided prostate biopsy. TRUS-guided prostate biopsy is the standard procedure to diagnose or rule out prostate cancer. The pain, attributed to ultrasound probe insertion and the needle punctures into the prostate, inflicted by TRUS-guided prostate biopsy limits its effectiveness. METHODS: We performed a prospective, randomized, double-blind, placebo-controlled study of 65 consecutive men suspected of having prostate cancer who were undergoing TRUS-guided prostate biopsy, 51 of whom fulfilled the inclusion criteria. Before the biopsy, each patient was randomized to one of two groups. Both the patient and the physician who performed the TRUS-guided biopsy were unaware of the contents of the injection for the pudendal nerve block. Unilateral pudendal nerve blockade was performed transperineally with digital rectal examination guidance using 10 mg of 1% prilocaine (group 1 [n = 26]) or 10 mL of a 0.9 NaCl solution (group 2 [n = 25]) by way of a 22-gauge spinal needle by the same anesthetist. Pain was evaluated using an 11-point visual analog scale questionnaire. RESULTS: No statistically significant differences were found in the visual analog scale score for pain during the pudendal nerve blockade or digital rectal examination between the groups. A statistically significant difference was found in the visual analog scale score for the biopsy procedure (P < 0.01) and probe discomfort (P < 0.05) between the two groups. CONCLUSIONS: Unilateral pudendal nerve blockade was effective in reducing the pain at both biopsy and probe manipulation in our study.

Effect of periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy on patient comfort: a randomized placebo controlled study.

BACKGROUND: In the present study, we assessed the efficacy and morbidity of periprostatic local anesthesia before transrectal ultrasound (TRUS)-guided biopsy of the prostate. METHODS: From August 2001 to February 2002, 98 patients underwent TRUS-guided prostate biopsy at the Department of 2nd Urology, Ankara Numune Education and Research Hospital, Ankara, Turkey. Ninety patients who fulfilled the inclusion criteria were randomized into three groups of 30 patients each. Group 1 received no local anesthesia, while group 2 received a periprostatic saline injection 5 min before the biopsy and group 3 received periprostatic local anesthesia with 1% lidocaine. Pain-scale responses were analyzed for each aspect of the biopsy procedure using a visual analog scale. RESULTS: There were no differences in pain scores between the three groups during digital rectal examination, intramuscular injection and probe insertion. Mean pain scores during needle insertion in groups 1, 2 and 3 were 5.65 +/- 2.35, 6.25 +/- 2.04 and 3.16 +/- 2.14, respectively. There was no significant difference between the pain scores of groups 1 and 2, whereas pain scores decreased significantly in group 3. CONCLUSION: Periprostatic local anesthesia before prostate biopsy is a safe and easy method to increase patient comfort during the procedure.

Detection of prostate cancer and changes in prostate-specific antigen (PSA) six months after surgery for benign prostatic hyperplasia in patients with elevated PSA.

OBJECTIVE: To evaluate early postoperative results of patients with elevated prostate-specific antigen (PSA) levels who underwent surgery due to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: 64 patients who had lower urinary tract symptoms (LUTS), normal digital rectal examinations (DRE), elevated PSA levels and prostate biopsies reported as being benign pathologically in specimens obtained by transrectal ultrasound (TRUS)-guided biopsies, were included in the study. Patients were assessed in accordance with PSA density, free/total PSA ratio and uroflowmetric studies. Patients had no cancer pre- and postoperatively (according to operative specimens). Six months postoperatively, 32 patients were accepted for re-evaluation for all PSA parameters, routine tests and prostatic biopsies. RESULTS: 64 patients with a mean age of 66.8 (SD 6.72) were included in the study. Total PSA average value was 14.38 (SD 7.49) ng/ml. Free PSA average value was 2.11 (SD 1.43) ng/ml. Average PSA density and free/total PSA ratio were 25.19 SD (14.12) ng/ml/cm(3) and 14.53% (SD 5.35%) respectively. 56 patients had BPH, 7 had chronic prostatitis and 1 had prostatic intraepithelial neoplasia (PIN) preoperatively with biopsies. Re-biopsy of the patient with PIN was reported as BPH. In pathologic examination with resected tissues postoperatively, 49 patients had BPH, 14 had chronic prostatitis and 1 had PIN. In the sixth month, average values of free/total PSA were 0.45 (SD 0.26) and 3.71 (SD 4.96) ng/ml respectively. Average PSA density and free/total PSA ratio were 12.41 (SD 13.8) ng/ml/cm(3) and 19.59% (SD 10.33%) respectively. There were significant decreases in PSA densities (p < 0.001) and increases in free/total PSA ratios (p = 0.004). Seven patients still had elevated PSA levels 6 months postoperatively. Three of 7 patients were reported as chronic prostatitis. One of them was indicated as prostatic carcinoma who was reported as PIN preoperatively. All other patients were stated as BPH at re-biopsies. CONCLUSION: If pretreatment biopsies are negative and operative specimens are also benign in patients with high PSA values, these patients can be followed up like usual BPH patients, but long-term follow-up is still unclear.

Periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy: the Ankara Numune experience.

OBJECTIVES: To assess the efficacy and morbidity of periprostatic local anesthesia before transrectal ultrasound-guided biopsy of the prostate. METHODS: From August 2001 to December 2001, 58 patients underwent transrectal ultrasound-guided prostate biopsy at the 2nd Department of Urology, Ankara Numune Education and Research Hospital. Fifty patients who fulfilled the inclusion criteria were randomized into 2 groups of 25 patients each. Group 1 received periprostatic local anesthesia with 1% lidocaine while group 2 received no local anesthesia. Pain scale responses were analyzed for each aspect of the biopsy procedure with a visual analog scale. RESULTS: There was no difference between the 2 groups in pain scores during digital rectal examination, intramuscular injection and probe insertion. The mean pain scores during needle insertion in group 1 receiving periprostatic nerve block and in group 2 receiving no local anesthesia were 3.00 +/- 2.22 and 6.16 +/- 2.85, respectively, and were found to be significantly different (p < 0.001), but morbidity after the biopsy was not statistically different between the 2 groups. CONCLUSION: Periprostatic local anesthesia before prostate biopsy is a safe and easy method to increase patient comfort during the procedure.