Effects of 8-Year Treatment of Long-Acting Testosterone Undecanoate on Metabolic Parameters, Urinary Symptoms, Bone Mineral Density, and Sexual Function in Men With Late-Onset Hypogonadism.

INTRODUCTION: The long-term effects of long-acting testosterone undecanoate (TU) and androgen receptor CAG repeat lengths in Thai men with late-onset hypogonadism (LOH) have not been reported. AIM: To analyze the 8-year follow-up effects of intramuscular TU therapy on metabolic parameters, urinary symptoms, bone mineral density, and sexual function and investigate CAG repeat lengths in men with LOH. METHODS: We reviewed the medical records of 428 men with LOH who had been treated with TU and 5 patients were diagnosed with prostate cancer during TU therapy. There were 120 patients (mean age = 65.6 ± 8.9 years) who had 5 to 8 years of continuous TU supplementation and sufficiently completed records for analysis. Genomic DNA was extracted from peripheral blood and the CAG repeat region was amplified by polymerase chain reaction. Fragment analysis, sequencing, electropherography, and chromatography were performed. MAIN OUTCOME MEASURES: The main outcome measure was dynamic parameter changes during testosterone supplementation. RESULTS: TU did not improve all obesity parameters. A statistically significant decrease was found in waist circumference, percentage of body fat, glycated hemoglobin, cholesterol, low-density lipoprotein, and International Prostate Symptom Score (P < .05). TU did not produce differences in body mass index, high-density lipoprotein, triglyceride, or the Aging Male Symptoms score from baseline. However, a statistically significant increase was found in the level of testosterone, prostate-specific antigen, hematocrit, International Index of Erectile Function score, and vertebral and femoral bone mineral density (P < .05). No major adverse cardiovascular events or prostate cancer occurred during this study. The CAG repeat length was 14 to 28 and the median CAG length was 22. There was no association between CAG repeat length and any of the anthropometric measurements. CONCLUSION: Long-term TU treatment in men with LOH for up to 8 years appears to be safe, tolerable, and effective in correcting obesity parameters.

Percutaneous computerized tomography guided renal cryoablation using local anesthesia: pain assessment.

PURPOSE: The administration of intravenous sedation during prone computerized tomography guided, percutaneous procedures has the potential for complications. We assessed the pain associated with computerized tomography guided, percutaneous renal cryoablation using straight local anesthesia. MATERIALS AND METHODS: Patients were treated with cryoablation probes inserted into the renal tumor under computerized tomography guidance with local anesthesia. Patients were asked to rate the pain experienced during needle placement and cryoablation using a visual 10-degree pain score scale. Sedation was given when pain was greater than 7 or when requested by the patient. Parameters assessed were cardiopulmonary complications, the need for intravenous supplementation, the pain score during the procedure and the postoperative score. RESULTS: A total of 25 patients (30 tumors) underwent a total of 26 cryoablation sessions with only local anesthesia. Mean patient age +/- SD was 67 +/- 13 years (range 33 to 88). Average tumor and ice ball size was 2.1 +/- 0.7 (range 1.1 to 4.3) and 4.1 +/- 1.0 cm (range 2.6 to 5.9), respectively. The mean dose of 1% lidocaine was 43.89 +/- 24.97 ml (range 10 to 110). All procedures were completed in an average of 68.78 +/- 20.7 minutes (range 40 to 120). Vital signs were not significantly changed during the procedure. Successful completion of percutaneous computerized tomography guided cryoablation using local anesthesia was accomplished in 22 of the 26 sessions (84.62%) without sedation. Four patients required intravenous supplementation. CONCLUSIONS: Percutaneous computerized tomography guided cryoablation for renal tumors can be performed using local anesthesia with minimal discomfort in most patients.