Periprostatic local anesthesia with pudendal block for transperineal ultrasound-guided prostate biopsy: a randomized trial.

OBJECTIVES: To investigate the effectiveness of adding pudendal block to periprostatic anesthesia for transperineal ultrasound-guided needle prostate biopsy. METHODS: A total of 150 patients were randomized to receive periprostatic anesthesia (group 1, n = 75) or combination of periprostatic anesthesia and bilateral pudendal block (group 2, n = 75). Visual analog scale was used to evaluate discomfort at each of the following stages: anesthetic infiltration, probe insertion, biopsy punctures, and 1 hour after biopsy. RESULTS: The overall cancer detection rate was 34.7% for the entire cohort. Injection of the local anesthetic agent was significantly more painful in group 2 (combined periprostatic and pudendal block). However, this group showed statistically significantly better pain control throughout the probe insertion, biopsy punctures, and at 1 hour after biopsy. The mean pain score of the whole procedure, calculated by averaging the pain scores at all 4 steps, was 2.41 +/- 1.01 and 1.83 +/- 0.65 in group 1 and 2, respectively (P <.001). Minor and transient complications were observed in both groups with similar frequency with the exception of penile and scrotal numbness that was reported only by patients from group 2, and in all cases resolved without treatment within 8 hours. CONCLUSIONS: A combination of pudendal and periprostatic nerve block is a safe, effective, and useful technique that is well tolerated by the patients and improves pain reduction during transperineal prostate biopsy compared with the periprostatic anesthesia only, with no alteration in the severe complication rates.

A minority of men with spinal cord injury have normal semen quality--can we learn from them? A case-control study.

OBJECTIVES: To determine factors that may help predict normal semen quality in this unique population of male patients, we examined our large database of men with spinal cord injury (SCI). Most men with SCI have abnormal semen quality; however, a small minority retain normal semen parameters. METHODS: A retrospective analysis was performed on semen retrieval procedures administered between 1991 and 2009 in 500 men with SCI. From those men, we selected subjects who underwent at least 1 penile vibratory stimulation, electroejaculation, or masturbation procedure resulting in antegrade ejaculation (n = 400). Cases were defined as men who, according to World Health Organization criteria, had normal semen volume, sperm concentration, sperm motility. Control subjects (CR) were defined as all remaining subjects. Risk factors for normal semen parameters were evaluated by conditional logistic regression analysis. RESULTS: Of the 400 subjects evaluated, only 30 had normal semen parameters. These 30 CS subjects were matched to 120 CR subjects. Analysis of risk factors revealed that incomplete lesion of the spinal cord (ASIA B to D) was significantly associated with the presence of normal sperm parameters (odds ratio 2.6 [95% confidence interval 1.1-6.1], P = .028). CS subjects were also more likely to be able to collect their samples via masturbation (odds ratio 2.7 [95% confidence interval 1.1-7.1], P = .037). Other risk factors evaluated were not predictive of normal semen parameters. CONCLUSIONS: This retrospective, case-control study, performed on a large group of subjects, showed that completeness of SCI is an important risk factor influencing semen quality.