The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety.

INTRODUCTION: Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. MATERIALS AND METHODS: Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p < 0.05 was considered statistically significant. RESULTS: Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS [mean 1 (0-8); p = 0.011], BAI (6.0 vs 2.0; p < 0.001), and HAS (11.0 vs 6.0; p < 0.001). CONCLUSION: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety, and therefore pain, in patients awaiting diagnostic prostate cancer surgery.

The impact of metabolic syndrome on the outcomes of transurethral resection of the prostate.

PURPOSE: To investigate the effect of metabolic syndrome (MS) and its components on the outcomes of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Fifty patients with MS and 50 without MS were enrolled for the study. Patients without MS were assigned to Group 1 and patients with MS were in Group 2. Patients were evaluated by the International Prostate Symptom Score (IPSS), Quality of Life index (QoL), maximum urine flow rate (Qmax), prostate-specific antigen level, and urinary ultrasonography. Six months after surgery, patients were again evaluated by IPSS and uroflowmetry; then comparison was made between the groups with respect to IPSS, QoL, and Qmax. RESULTS: Postoperative IPSS was determined as 11.2±0.87 in Group 1 and 12.9±0.88 in Group 2 (P<0.05). Postoperative Qmax values were determined as 18.2±0.81 and 13.9±1.12 for the two groups, respectively (P<0.05). After multivariate analyses, elevated fasting glucose (EFG) and dyslipidemia were determined to have a significant correlation with IPSS improvement. EFG and hypertension had a significant negative impact on Qmax, and hypertension and abdominal obesity had a significant correlation with QoL improvement. CONCLUSIONS: MS as a comorbidity seems to diminish the effects of TURP. Further well-designed prospective, randomized studies with larger cohorts are needed to confirm the findings of this study.

Can a four-session biofeedback regimen be used effectively for treating children with dysfunctional voiding?

OBJECTIVE: To compare the outcomes of the open-ended six to ten sessions of biofeedback against a novel regime of four sessions of biofeedback to treat children with dysfunctional voiding. MATERIALS AND METHODS: Patients from two centers using different methods were retrospectively analyzed. Group 1 comprised 20 patients treated with four sessions of biofeedback. Group 2 comprised 20 patients treated with six to ten sessions of biofeedback. Each group was evaluated with subjective and objective parameters pre-treatment, immediately post-treatment and 6 months post-treatment. RESULTS: All patients in Group 1 were treated with four sessions of biofeedback and in Group 2 the mean number of sessions was 7.35±1.30 (range 6-10). Normalized voiding flow curves after treatment were determined in 18 patients in Group 1 (90%) and 19 patients in Group 2 (95%) (p=0.553). There were seven patients (35%) in Group 1 and eight patients (40%) in Group 2 with reflux. When units were compared, there were 11 units (4 bilateral) in Group 1 and 13 units (5 bilateral) in Group 2 with reflux (p=0.747). At 6 months post-treatment, in Group 1, seven had resolved (63.6%), three had improved (27.2%) and one persisted (9.01%). In Group 2, ten had resolved (76.9%) and three had improved (23.1%) (p=0.553). CONCLUSIONS: Biofeedback therapy is one of the most widely used techniques in dysfunctional voiding in children. The regime of use has not been well defined, and the results of this study showed that a regime of four sessions of biofeedback therapy may be as safe and effective as the previously defined open-ended six to ten sessions.