Does using alprazolam during outpatient flexible cystoscopy decrease anxiety and pain?

OBJECTIVES: To evaluate the effect of pre-operative alprazolam medication on anxiety and pain in flexible cystoscopy for bladder cancer follow-up. METHODS: A total of 86 male patients who had flexible cystoscopy for bladder cancer follow-up at 6th and 9th months were included in the study. A visual analog scale (VAS) pain score and the State-Trait Anxiety Inventory (STAI) were used. The 6th (VAS-1)and 9th (VAS-2) month pain scores and 6th month STAI score (STAI-1) and, 9th month STAI score before (STAI-2a) and after alprazolam (0.5 mg) intake (STAI-2b) were compared. RESULTS: The mean age was 66.49±12.45 years. Patients were grouped by age≤65 (Group-1) and age≥66 (Group-2). Mean VAS score for VAS-1 and VAS-2 were 2.66±0.96 and 2.44±1.05, respectively (p=0.007). The mean VAS-1 and VAS-2 scores in Group 1 were 3.0±1.05 and 2.73±1.18, respectively (p=0.009). The mean VAS-1 and VAS-2 scores in Group 2 were 2.36±0.77 and 2.17±0.86 respectively (p=0.031). The differences between mean anxiety scores were all statistically significant. All STAI (1, 2a, and 2b) and VAS (1 and 2) scores in Group-1 were statistically significantly higher than Group-2. Increasing STAI score is associated with a statistically significant increase in the VAS scores in the 0.50 and 0.75 quantiles (p=0.021 and p=0.039, respectively). CONCLUSIONS: Using alprazolam before flexible cystoscopy reduces both anxiety (STAI-1 vs STAI-2b) and pain (VAS-1 vs VAS-2). Previous cystoscopy experience reduces anxiety (STAI-2a vs. STAI-2b). Elderly patients have less anxiety and pain scores than younger patients in flexible cystoscopy.

Does using alprazolam during outpatient flexible cystoscopy decrease anxiety and pain? / ¿Disminuye el Alprazolam la ansiedad y el dolor durante la cistoscopia flexible ambulatoria?

OBJECTIVES: To evaluate the effect of pre-operative alprazolam medication on anxiety and pain in flexible cystoscopy for bladder cancer follow-up. METHODS: A total of 86 male patients who had flexible cystoscopy for bladder cancer follow-up at 6th and 9th months were included in the study. A visual analog scale (VAS) pain score and the State-Trait Anxiety Inventory (STAI) were used. The 6th (VAS-1) and 9th (VAS-2) month pain scores and 6th month STAI score (STAI-1) and, 9th month STAI score before (STAI-2a) and after alprazolam (0.5 mg) intake (STAI-2b) were compared. RESULTS: The mean age was 66.49±12.45 years. Patients were grouped by age≤65 (Group-1) and age≥66 (Group-2). Mean VAS score for VAS-1 and VAS-2 were 2.66±0.96 and 2.44±1.05, respectively (p = 0.007). The mean VAS-1 and VAS-2 scores in Group 1 were 3.0±1.05 and 2.73±1.18, respectively (p = 0.009). The mean VAS-1 and VAS-2 scores in Group 2 were 2.36±0.77 and 2.17±0.86 respectively (p = 0.031). The differences between mean anxiety scores were all statistically significant. All STAI (1, 2a, and 2b) and VAS (1 and 2) scores in Group-1 were statistically significantly higher than Group-2. Increasing STAI score is associated with a statistically significant increase in the VAS scores in the 0.50 and 0.75 quantiles (p = 0.021 and p = 0.039, respectively). CONCLUSIONS: Using alprazolam before flexible cystoscopy reduces both anxiety (STAI-1 vs STAI-2b) and pain (VAS-1 vs VAS-2). Previous cystoscopy experience reduces anxiety (STAI-2a vs. STAI-2b). Elderly patients have less anxiety and pain scores than younger patients in flexible cystoscopy

OBJETIVOS: Evaluar el efecto del alprazolam preoperatorio sobre la ansiedad y el dolor durante la cistoscopia flexible en el seguimiento del cáncer vesical. Métodos Se incluyeron 86 pacientes varones en seguimiento con cistoscopia flexible por cáncer vesical a los 6 y 9 meses. Se utilizaron una escala visual analógica (EVA) para el dolor y el Formulario STAI (State-trait anxiety Inventory) de ansiedad. Se compararon los resultados de dolor al 6º (EVA1) y 9º mes (EVA2) y los resultados del formulario STAI al 6º (STAI 1) y 9º mes, antes (STAI 2a) y después de la toma de alprazolam (STAI 2b). RESULTADOS: La edad media fue de 66,49±12,45 años. Los pacientes se agruparon por edad ≤ 65 años (Grupo 1) y ≥ 66 (Grupo 2). Las puntuaciones de la EVA 1 y EVA 2 fueron 2,66±0,96 y 2,44±1,05, respectivamente (p = 0,007). La media de las puntuaciones EVA 1 y EVA 2 en el grupo 1 fueron 3,0±1,05 y 2,73±1,18, respectivamente (p = 0,009). La media de las puntuaciones EVA 1 y EVA 2 en el grupo 2 fueron 2,36±0,77 y 2,17±0,86, respectivamente (p = 0,031). Las diferencias entre las puntuaciones medias de ansiedad fueron todas significativas. Todas las STAI (1, 2a y 2b) y EVA (1 y 2) en el grupo 1 fueron superiores a las del grupo 2, con diferencias estadísticamente significativas.Una puntuación del STAI creciente se asocia con un aumento significativo de las puntuaciones de la EVA en los cuartiles 0,50 y 0,75 (p = 0,021 y p = 0,039, respectivamente). CONCLUSIONES: La utilización de alprazolam antes de la cistoscopia flexible reduce tanto la ansiedad (STAI-1 vs STAI-2b) como el dolor (EVA-1 vs EVA-2). La experiencia de cistoscopia previa reduce la ansiedad (STAI-2a vs. STAI-2b). Los pacientes ancianos tienen valores más bajos de ansiedad y dolor en la cistoscopia flexible que los pacientes jóvenes

The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients.

BACKGROUND AND PURPOSE: Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (>65 years) has not ever been studied before. PATIENTS AND METHODS: A retrospective analysis of patients' medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic™ (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed. RESULTS: Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11-38), 22.1 ± 11.2 (R: 11-59) months, respectively (p < 0.001). When compared with SP, mean catheter removal time (p < 0.001) and median hospitalization time (p < 0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p < 0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p < 0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p > 0.05). Thirty-three patients had perioperative complications according to the modified Clavien-Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy. CONCLUSIONS: BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month's results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.

Size of the transrectal ultrasound probe makes no difference in pain perception during TRUS-Bx under adequate local anesthesia.

INTRODUCTION AND OBJECTIVES: In the great majority of the cases, transrectal ultrasound guided prostate biopsy (TRUS-Bx) is the definitive step in the diagnosis of prostate cancer (CaP). Although this procedure is well tolerated by most patients, it can result in considerable discomfort that can effectively be overcome with local injection anesthesia. In this study, we evaluated the effect of the size (i.e., circumference) of the transrectal probe on pain during TRUS-Bx. MATERIAL AND METHODS: One hundred and seventy eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included in this study. Patients (pts.) were divided into three TRUS-Bx groups; Group I: 60 pts. underwent TRUS-Bx with newer B-K Type 8808 probe (circumference 58 mm) under injectable periprostatic anesthesia, Group II: 60 pts. underwent TRUS-Bx with B-K Type 8551 probe (circumference 74 mm) under injectable periprostatic anesthesia, and Group III: 50 pts. underwent TRUS-Bx with B-K Type 8551 probe (circumference 74 mm) without local anesthesia. Periprostatic injection anesthesia was performed with 10 cc, 1% lidocaine (5 cc on each side) 10 min before TRUS-Bx. Pain was assessed using a 10-point modified visual analog scale (VAS) 15 min after the biopsy procedure. RESULTS: Three groups were homogeneous with respect to age and tPSA, and no statistically significant difference was observed in terms of mean biopsy duration between the 3 groups. Most of the patients experienced no pain to slight pain in Groups I and II, but 66% of the patients had more than moderate pain (VAS ≥ 5) in Group III with mean VAS score statistically higher than the other two groups (Group I vs. III, P = 0.0001; Group II vs. III, P = 0.0001). Mean VAS score was not statistically different between Group I and II (P = 0.126). No statistically significant difference in VAS pain perception was observed between different age categories within the Group I, II, and III. CONCLUSION: In the absence of injectable local anesthesia, larger probe (74 mm) results in much higher VAS pain perception than same size and smaller (58 mm) probe used under injectable local anesthesia. However, under injectable local anesthesia, the size (circumference) of the transrectal probe (58 mm vs. 74 mm) does not result in any different pain perception during TRUS-Bx.