Does waiting after peri-prostatic nerve block reduce pain during transrectal ultrasound-guided prostate biopsy? A randomized controlled trial.

BACKGROUND: To determine if a short, clinically sufficient and manageable time delay after peri-prostatic nerve block (PNB) reduces pain during transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS: This was a prospective, randomized controlled trial. All patients who underwent TRUS-guided prostate biopsy between February and June 2014 were randomized into waiting or control groups. All biopsies were performed by senior registrars with the same PNB technique. Patients in the waiting group waited 5 min after PNB prior to biopsies. Those in the control group did not. Patients were then asked to complete a questionnaire regarding pain associated with different parts of the procedure and their degree of anxiety using a 10-cm, validated visual analogue scale. Mann-Whitney U tests were performed on the pain and anxiety scores and analysis of variance was conducted using the Statistical Package for the Social Sciences software. RESULTS: A total of 92 patients were randomized to 39 in the waiting group and 53 in the control group. Mean overall pain scores were 2.85 and 2.66 (P = 0.626) for the waiting and control groups, respectively. The mean pain scores from probe insertion, biopsy, before leaving the department and mean anxiety scores were similar between the two groups and did not reach statistical significance. Analysis of variance showed that irrespective of group and age, increasing anxiety is associated with an increase in overall pain score (P < 0.0005). CONCLUSION: Waiting 5 min after PNB did not reduce pain in men undergoing TRUS-guided prostate biopsy.

Prospective, multicentre, randomized controlled trial of bladder filling prior to trial of void on the timing of discharge.

BACKGROUND: The objective of this study was to investigate whether bladder filling with saline prior to trial of void (TOV) was safe and whether it reduced time to discharge compared with standard TOV in the urology inpatient setting for patients post-transurethral resection of prostate, bladder neck incision or an admission with urinary retention. METHODS: Prospective, multicentre, randomized controlled trial at Hawkes Bay and Waikato hospitals with local ethics committee approval. All consecutive, consented patients requiring TOV were randomized into filling and control groups. The filling groups were filled with normal saline prior to TOV (up to 500 mL or first sensation of fullness). The control group had their catheter removed at 06.00 hours without filling. Time taken between catheter removal and discharge was recorded in minutes. Complications were recorded. RESULTS: Fifty-two patients were recruited and randomized with 27 and 25 patients in the filling and control groups, respectively. The mean time taken from catheter removal to discharge was 300.6 min in the filling group and 340.1 min in the control group. The filling group reduced the time to discharge by 39.5 min (P = 0.304). Furthermore, 2/27 and 2/25 patients in the filling and control groups, respectively, developed urinary retention after TOV and required re-catheterization prior to discharge. CONCLUSION: Bladder filling prior to TOV showed a non-statistically significant reduction in the time to discharge of 39.5 min. Despite the fact that bladder filling is a safe and cheap procedure, it cannot be recommended for use in an attempt to reduce time to discharge in an inpatient setting.

Comparison of kidney-ureter-bladder abdominal radiography and computed tomography scout films for identifying renal calculi.

OBJECTIVE: To assess the sensitivity of computed tomography (CT) scout topograms and kidney-ureter-bladder abdominal radiography (KUB) in detecting urinary tract stones. PATIENTS AND METHODS: We assessed films taken on presentation for 163 consecutive patients referred to our service for stone follow-up. Only those with both CT and KUB imaging on the same day were studied further. Two urology registrars examined the films independently. Location, size and length of stone were recorded. Where there was discordance, the films were examined by an independent radiologist. RESULTS: In all, 108 of 163 patients had both CT and KUB imaging on the same day. Stones were identified in 63% (68/108) of patients with KUB, with a mean length of 4.93 mm. There were 40/108 radiolucent stones subsequently measured on CT, with a mean length of 4.90 mm. Stones were seen on 47% (51/108) of the CT scouts, with a mean length of 5.22 mm. Importantly, all stones visible on CT scout were also visible on KUB. There was no correlation between stone location and visibility on KUB or CT scout films. CONCLUSION: KUB could be used for follow-up in 63% of cases. All stones seen on CT scout were also visible on KUB. Scout detected 75% of stones visible on KUB. We suggest CT scout film should be reported before proceeding to KUB. If the stone is visible on CT scout film, then the decision to use KUB for follow-up can be made. This minimizes radiation exposure and other costs.

Temporal trends of acute nephrolithiasis in Auckland, New Zealand.

AIM: An increasing amount of evidence suggests that the occurrence of kidney stone disease has increased over the last 50 years. No data analysis on temporal trends in Auckland, New Zealand has ever been performed. The aim of this study was to investigate the changing pattern by age, ethnicity, and gender on stone incidence over a 10-year period. METHODS: Demographic data was collected on all patients who presented with renal colic. Population numbers were provided by the New Zealand ministry of statistics using regular census data. The analysis was performed using Pearson's correlation coefficients and a Poisson regression model. RESULTS: From 1997 to 2007, 17,532 new stones were coded as nephrolithiasis with an age range of 1-97. Disease incidence amongst Auckland residents was greater in 2007 than 1997 (0.131% or 131 per 100,000 population vs 0.102% or 102 per 100,000 population. p=0.012). The male to female ratio changed over time with a greater proportion of females presenting in 2007 than 1997 (0.47 vs 0.41, p<0.05). Pacific, Asian, and Maori incidence increased faster compared to European whilst those from the Middle East were the only group to have a stable rate (0.26% or 260/100,000 per year) over the 10-year period. CONCLUSIONS: Incidence of kidney stone disease in the Auckland region has increased significantly from 1997 to 2007. Different ethnic groups had different rates of change, but all groups showed an increasing incidence over time, with the exception of those from the Middle East. A greater proportion of patients are female than 10 years ago.

A surgical career for New Zealand junior doctors? Factors influencing this choice.

AIMS: To discover the level of interest in a surgical career amongst junior doctors and trainee interns in the Auckland region. Secondary aims are to identify the factors that influence career choice as well as the timing of career choice. METHODS: An anonymous and structured questionnaire was distributed to all trainee interns and junior doctors in their first to fifth postgraduate years in the Auckland region. Questions were based on basic demographics, level of training, career preference and factors from previous experiences in surgery that may have influenced their career choice. RESULTS: Total of 87 replies with 36% expressed interest in surgery whereas 64% were interested in non-surgical specialties. Top three factors influencing career choice were similar in both groups: Lifestyle, career ambitions and family. Personal interest, practical hands-on and positive previous experiences were the top reasons why junior doctors chose surgery. Poor lifestyle, lacking of interest, limited future part-time work and previous negative experiences were the top reasons why junior doctors did not choose surgery. A significantly (p<0.05) larger number of junior doctors in the surgical group had positive previous experiences on their surgical runs, with their consultants and registrars compared with the non-surgical group. Those interested in surgery decided on their careers earlier. CONCLUSION: Career aspirations of New Zealand junior doctors were similar to findings reported overseas. To promote surgery amongst junior doctors and medical students, attention should be paid to the key factors which may influence career choice. By improving working conditions and have better surgical education with good mentoring, team atmosphere and opportunities for early exposure will hopefully allow better recruitment and training of future surgeons.