INTRODUCTION: Prostate biopsy is an uncomfortable procedure, and attempts are therefore being constantly made to try and decrease biopsy-related pain. MATERIALS AND METHODS: A randomized, prospective study including 160 procedures was designed. Inclusion criteria were: first biopsy, PSA < 15 ng/mL, and age under 75 years. Patients were randomized into 4 groups. Group A was the control group, while group B received intracapsular anesthesia (8 mL of 2% lidocaine), group C 5 mg of oral clorazepate dipotassium one hour before biopsy, and group D both local anesthesia and clorazepate. Each patient completed a questionnaire including three 10-point visual analog scales for pain immediately after the procedure and 30 minutes later. RESULTS: Mean pain scores were 5.17 (group A), 1.72 (group B), 2.43 (group C), and 0.88 (group D) in the first questionnaire, and 1.71, 0.25, 0.75 and 0.35 respectively in the second questionnaire. Statistically significant differences were found in the ANOVA test. Group comparisons showed the following: 1. A vs B: statistically significant differences in both questionnaires (p = 0.006 and 0.011). 2. A vs C: a significant difference was found in the first questionnaire (0.051), but not in the second (0.012). 3. A vs D: significant differences in both questionnaires (0.001 and 0.010). No statistically significant differences were seen in both questionnaires (0.825 and 0.685) when benzodiazepines where added to local anesthesia (B vs D). CONCLUSION: Use of benzodiazepines as a single method to decrease biopsy-related pain is not warranted.
Anesthesia, Local , Anti-Anxiety Agents/therapeutic use , Biopsy, Needle/psychology , Clorazepate Dipotassium/therapeutic use , Pain/prevention & control , Patient Acceptance of Health Care , Prostate/pathology , Administration, Topical , Adult , Aged , Anti-Anxiety Agents/administration & dosage , Benactyzine/administration & dosage , Benactyzine/analogs & derivatives , Biopsy, Needle/adverse effects , Biopsy, Needle/methods , Clorazepate Dipotassium/administration & dosage , Gels , Humans , Injections , Lidocaine/administration & dosage , Male , Middle Aged , Muscarinic Antagonists/administration & dosage , Pain/etiology , Pain Measurement , Prospective Studies , Prostate/diagnostic imaging , Surveys and Questionnaires , Ultrasonography, Interventional
Introducción: la biopsia prostática es un procedimiento molesto, lo que condiciona que constantemente intentemos disminuir el dolor durante su realización. Material y métodos: diseñamos un estudio prospectivo aleatorizado en el que incluimos 160 procedimientos. Criterios de inclusión: primera biopsia, antígeno prostático específico (PSA) < 15 ng/ml, edad menor de 75 años. Los pacientes fueron aleatorizados en 4 grupos. El primero (A) quedó como control, el B recibió anestesia intracapsular (8 ml de lidocaína 2%), el C 5 mg de clorazepato dipotásico vía oral una hora antes y en el D se aplicaron las dos medidas (anestesia local y clorazepato). Se entregó un cuestionario con tres medidas de dolor (valorándolo de 0 a 10) tras el procedimento y otro 30 minutos después. Resultados: las medias del dolor fueron 5,17 (A), 1,72 (B), 2,43 (C) y 0,88 (D) en el primer cuestionario. En el segundo fueron 1,71, 0,25, 0,75 y 0,35, respectivamente. La comparación de medias realizada mediante el test de ANOVA pone de manifiesto diferencias significativas. Al comparar los grupos entre sí encontramos: 1. A frente a B: diferencia significativa en ambos cuestionarios (p 0,006 y 0,011). 2. A frente a C: no significación en el primer cuestionario (0,051) y sí en el segundo (0,012). 3. A frente a D: diferencia en ambos cuestionarios (0,001 y 0,010). El uso de benzodiacepinas añadidas a la anestesia local (B frente a D) no mostró diferencias estadísticas en ambos cuestionarios (0,825 y 0,685). Conclusión: consideramos que el uso de benzodiacepinas no está justificado como método único de control del dolor para la realización de la biopsia prostática(AU)
Introduction: Prostate biopsy is an uncomfortable procedure, and attempts are therefore being constantly made to try and decrease biopsy-related pain. Materials and methods: A randomized, prospective study including 160 procedures was designed. Inclusion criteria were: first biopsy, PSA < 15 ng/mL, and age under 75 years. Patients were randomized into 4 groups. Group A was the control group, while group B received intracapsular anesthesia (8 mL of 2% lidocaine), group C 5 mg of oral clorazepate dipotassium one hour before biopsy, and group D both local anesthesia and clorazepate. Each patient completed a questionnaire including three 10-point visual analog scales for pain immediately after the procedure and 30 minutes later. Results: Mean pain scores were 5.17 (group A), 1.72 (group B), 2.43 (group C), and 0.88 (group D) in the first questionnaire, and 1.71, 0.25, 0.75 and 0.35 respectively in the second questionnaire. Statistically significant di fferences were found in the ANOVA test. Group comparisons showed the following: 1. A vs B: statistically significant di fferences in both questionnaires (p = 0.006 and 0.011). 2. A vs C: a significant di fference was found in the first questionnaire (0.051), but not in the second (0.012). 3. A vs D: significant di fferences in both questionnaires (0.001 and 0.010). No statistically significant differences were seen in both questionnaires (0.825 and 0.685) when benzodiazepines where added to local anesthesia (B vs D). Conclusion: Use of benzodiazepines as a single method to decrease biopsy-related pain is not warranted(AU)
Humans , Male , Biopsy/methods , Biopsy , Prostate-Specific Antigen/analysis , Lidocaine/therapeutic use , Analysis of Variance , Prospective Studies , Anesthesia , Clorazepate Dipotassium/therapeutic use , Anesthesia, Local , Surveys and Questionnaires , Benzodiazepines/therapeutic use , Pain/therapy
Cada vez son más frecuentes en nuestras consultas los pacientes diagnosticados de HBP en los que al indicar la intervención quirúrgica, se plantean limitaciones por la toma de medicación concomitante, edad, morbilidad asociada o condiciones psicosociales. La RTU de próstata, aun siendo el patrón quirúrgico de referencia, en este grupo de pacientes ancianos y de alto riesgo, no está exenta de complicaciones como la posibilidad de reabsorción, sangrado e incluso transfusión en un porcentaje de casos. La fotovaporización prostática mediante láser puede ser una alternativa válida en este subgrupo de pacientes. Revisamos nuestra experiencia en este procedimiento, así como lo publicado al respecto y describimos recomendaciones técnicas que consideramos útiles para evitar en lo posible complicaciones durante la cirugía o en el postoperatorio inmediato (AU)
It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period (AU)
Humans , Male , Lasers/therapeutic use , Laser Therapy/methods , Laser Therapy/trends , Morbidity , Urinary Retention/surgery , Urinary Retention , Cystoscopy/methods , Endoscopy/methods , Psychosocial Impact , Neovascularization, Physiologic/physiology , Angiogenesis Inhibitors/therapeutic use , Length of Stay/economics
Objetivos: Nos planteamos en este caso clínico mostrar el manejo de la rabdomiolisis secundaria a la cirugía laparoscópica y como el tratamiento médico puede ser suficiente para una correcta resolución del mismo. Métodos: La nefrectomía laparoscópica es una técnica de rutina, no exenta de morbilidad asociada. Presentamos un caso de rabdomiolisis que debutó como dolor glúteo e impotencia funcional, junto con alteraciones cutáneas, insuficiencia renal aguda y enzimas musculares elevadas. Resultados: En nuestro caso el paciente evolucionó satisfactoriamente con tratamiento médico. Hacemos una revisión de la literatura publicada, donde se identifican múltiples factores de riesgo, tales como el IMC (índice de masa corporal), tiempo quirúrgico, la posición durante el acto quirúrgico en decúbito lateral con flexión 40-60°. La prevención es el factor más importante para evitar la insuficiencia renal aguda por mioglobina. Conclusiones: La prevención, la detección precoz y la instauración inmediata de medidas terapeúticas son fundamentales para la buena resolución del cuadro de rabdomiolisis tras cirugía (AU)
Objective: To show the clinical management of rhabdomyolysis secondary to laparoscopic surgery and how clinical treatment may be enough for adequate resolution. Methods: Laparoscopic nephrectomy is a routine technique, which may have associated morbidity. We present one case of rhabdomyolysis which presented as gluteal pain and functional impotency, together with skin lesions, acute renal failure and elevated muscle enzymes. Results: In our case, the patient had a satisfactory outcome with medical treatment. We perform a bibliographic review in which we identify multiple risk factors, such as body mass index, surgical time, position during operation with lateral decubitus and 40-60° flexion. Prevention is the most important factor to avoid acute renal failure secondary to myoglobin. Conclusions: Prevention, early detection, and immediate start of therapeutic measures are essential for the good resolution of rhabdomyolysis after surgery (AU)
Humans , Male , Rhabdomyolysis/etiology , Rhabdomyolysis/diagnosis , Nephrectomy/adverse effects , Nephrectomy/methods , Laparoscopy/adverse effects
It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period.
Laser Therapy/methods , Prostatic Hyperplasia/surgery , Equipment Design , Humans , Laser Therapy/instrumentation , Male , Risk Factors
