Effect of Listening to Music on Patient Anxiety and Pain Perception during Urodynamic Study: Randomized Controlled Trial.

OBJECTIVE: Urodynamic studies (UDS) include assessments of the physics and physiology of the lower urinary tract (LUT). It is an invasive test and patients can feel fear and anxiety, especially at the beginning of the test. The aim of this study was to determine whether listening to music during urodynamic study decreases patient anxiety and pain. METHODS: Sixty-two patients who underwent urodynamic study were randomized into the following groups: no music (group 1, n = 30) or classical music (group 2, n = 32) during the procedure. Patient anxiety levels were quantified using the State-Trait Anxiety Inventory (STAI) and Beck's Anxiety Inventory (BAI). A visual analog scale (VAS) was used for self-assessment of discomfort and willingness among patients to have a repeat urodynamic study. RESULTS: Demographic characteristics, mean age, duration of procedure, systolic and diastolic blood pressure (SBP and DBP) and heart rate before procedure were statistically significantly similar between the two groups. Statistically significant differences were detected between the two groups in the mean pain score on VAS (4.1 ± 1.4 vs 2.6 ± 1.8), mean post-procedural STAI score (46 ± 5.8 vs 37.3 ± 5) and mean BAI score (14.2 ± 1.7 vs 3.5 ± 0.7). SBP and DBP and heart rate were similar between the groups. CONCLUSION: Music is a cheap, safe and effective intervention that has gained increasing recognition as an effective tool to reduce pain and anxiety. Listening to music during urodynamic study reduced patient pain and anxiety.

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.

Novel approach for pain control in patients undergoing prostate biopsy: iliohypogastric nerve block with or without topical application of prilocaine-lidocaine: a randomized controlled trial.

PURPOSE: To investigate the efficacy of a novel anesthetic technique called iliohypogastric nerve block (INB) for pain control in patients undergoing prostate biopsy. MATERIALS AND METHODS: A total of 59 consecutive patients who underwent transrectal ultrasound guided prostates biopsies were included in the study. Patients were randomized into four groups: (1) control, no method of anesthesia was administered, (2) intrarectal prilocaine-lidocaine cream application, (3) INB and (4) INB + intrarectal prilocaine-lidocaine cream application (combined group). Patients were asked to use a scale of 0-10 in a Visual Analogue Scale (VAS) questionnaire about pain during probe insertion (VAS 1) and prostate biopsy (VAS 2). RESULTS: The mean VAS 1 and VAS 2 scores were 0.7 and 4.9 for controls, 0.5 and 1.8 for INB, 0.5 and 2.6 for the intrarectal cream group, and 0.4 and 1.8 for the combined group. The mean VAS 1 scores were not different between groups. However, the mean VAS 2 scores were significantly lower in INB, prilocaine-lidocaine cream and combined groups compared to the control group (P < .001). In addition, the INB group had significantly lower VAS 2 scores compared to the cream application group (P = .03). On the other hand, there was no difference between the INB and combined groups (P = .8). CONCLUSION: Any form of anesthesia was superior to none. However, INB alone seemed to be superior to prilocaine-lidocaine cream application in patients undergoing prostate biopsy. Addition of prilocaine-lidocaine cream application to INB may not provide better analgesia. 

Apoptosis in testicular tissue of rats after vasectomy: evaluation of eNOS, iNOS immunoreactivities and the effects of ozone therapy.

OBJECTIVE: We aimed to investigate the changes in endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expression and apoptotic index in rat testicular tissue, as well as serum and seminal plasma sex hormone levels after vasectomy, and the effect of ozone therapy (OT). MATERIAL AND METHODS: Adult male Wistar rats were used (n=6 per group). Control (G1), sham for 4 weeks (G2) or 6 weeks (G3), orchiectomy at the 4(th) (G4) or 6(th) (G5) week after left vasectomy, orchiectomy at the 4(th) (G6) or 6(th) (G7) week after bilateral vasectomy, orchiectomy after 6 weeks OT following left (G8) or bilateral (G9) vasectomy, orchiectomy after 6 weeks OT (G10). RESULTS: In the left testes, while there were increases in eNOS and iNOS immunoreactivity and apoptotic indexes in G4 and G5, no changes were observed in contralateral testis. These values increased in G6 and G7, while OT inhibited these parameters in the left testis of G8 and both testes of G9. Sex hormone levels did not show any changes after vasectomy and ozone therapy. CONCLUSION: While OT was found to be protective against some parameters mentioned above under stress conditions, it seemed to cause some harmful effects when used in healthy conditions.

Local anesthesia in transrectal ultrasound-guided prostate biopsy: EMLA cream as a new alternative technique.

OBJECTIVES: The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics (EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures. MATERIAL AND METHODS: Eighty male patients with prostate-specific antigen (PSA) levels > 4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 (controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min. RESULTS: Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p = 0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p2-3 = 0.126, p2-4 = 0.303, p3-4 = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (pMAP = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05). CONCLUSION: Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.

Prevalence and treatment of Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis in patients with non-gonococcal urethritis.

The aim of present study was to evaluate the occurrence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in non-gonococcal urethritis (NGU) and to determine the bacterial resistance to six antibiotics in order to determine the most suitable treatment strategy. A total of 50 patients were enrolled into the study. Urethral samples were taken with a dacron swab placed into urethra 2 - 3 cm in males, and vaginal samples were taken from the endocervical region in women. The patient samples that did not grow Neisseria gonorrhoeae were accepted as NGU. Direct immunofluorescence technique was used for the investigation of C. trachomatis. Mycoplasma IST was used for the isolation of M. hominis and U. urealyticum. U. urealyticum was isolated from 24 patients. Thirteen of them had only U. urealyticum, and the rest had mixed pathogen organisms (7 U. urealyticum + M. hominis; 3 U. urealyticum + C. trachomatis, and 1 U. urealyticum + M. hominis + C. trachomatis). C. trachomatis was detected in 12 patients. While 8 patients had C. trachomatis only, the rest had a mixture of the pathogen organisms listed above. Partner examinations could be performed for only 22 patients' partners. In the evaluation of antibiotic susceptibility, higher resistance was obtained against ofloxacin in U. urealyticum, and against erythromycin with M. hominis. Our results indicated that doxycycline or ofloxacin should be the first choice when empirical treatment is necessary.