Pain modulation by audiovisual distraction during cystoscopy.

INTRODUCTION: Cystoscopy is one of the most common urological procedures used for either diagnostics, therapeutics, or for surveillance. It may be performed under local or general anesthesia. The procedure is associated with pain and discomfort. AIMS: The aim of the study was to compare the levels of perceived pain during local cystoscopy with and without audiovisual distraction (AVD). METHODOLOGY: A randomized control study was performed at our academic hospital local cystoscopy theater of the urology division. Approximately half the patients already booked for the local rigid cystoscopy procedure were exposed to a distracting musical video during the procedure (study group), while the control group was not. STATISTICAL ANALYSIS: Descriptive statistics were used to determine percentage, mean, and standard deviation (SD) for categorical data. The Mann-Whitney U-test for nonparametric data was used for comparing pain levels. RESULTS: A total of 91 patients participated in the study with 48 patients in the study group and 43 patients in the control group. The visual analog scale (VAS) ranged between 1 and 5/10 in the study group and 1-8/10 in the control group, while the mean VAS was 2.52 ± 1.2 SD in the study group and 4.97 ± 1.35 SD in the control group. The AVD intervention was statistically significant (P < 0.0001). CONCLUSION: AVD during local rigid cystoscopy is highly recommended, especially in patients undergoing the procedure for the first time.

Enuresis in South African children: prevalence, associated factors and parental perception of treatment.

UNLABELLED: Study Type--Symptom Prevalence (prospective cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Nocturnal enuresis is a common childhood problem. Although its prevalence is known in many countries, no data are available from South Africa and it is difficult to extrapolate data from developed countries to a population with such diverse conditions and resource-poor settings. This study is the first to report on the 16% prevalence rate and the low level of parental knowledge of enuresis in South African children aged between 5 and 10 years. OBJECTIVES: • To establish the prevalence of NE in 5-10 year old South African children in a cross-sectional study using a parent-completed questionnaire. • To establish the parental perception and associated factors of mono-symptomatic nocturnal enuresis (MNE) treatment and treatment success rates in 5-10 year old children from South Africa. PATIENTS AND METHODS: • A total of 4700 questionnaires were distributed to children at 37 selected schools willing to participate from South Africa. Parents anonymously filled out the questionnaire. • Data were reported as frequencies and percentages of NE in tables according to different gender and age groups. • The Chi-square test compared proportions between groups and Fisher's Exact test corrected for small numbers of observations (n ≤ 5). Age differences were determined using Student's t-test. A P-value ≤ 0.5 was considered to be statistically significant. RESULTS: • The questionnaire's response rate was 72.1%, with 3389 children included in the study. • The overall prevalence of NE was 16.0%-14.4% of children suffered from mono-symptomatic NE (MNE). The prevalence of NE in boys was double that in that in girls. • Only 28.3% had received some form of treatment, whereas 13.5% had been medically treated by a doctor. Parents' awareness of treatment modalities available is outdated and most of the management of MNE was done by parents themselves, albeit with low success rates. • A positive family history was found in 50.5% of children suffering from MNE. • Constipation was a problem in 15.8% of children with enuresis. CONCLUSIONS: • This is the first study to estimate the prevalence of NE and report on the parental perception and possible associated factors of enuresis in children from South Africa. The study showed that South African children have a similar prevalence rate of NE (16%) when compared with other countries. • The possible associated factors with MNE in South Africa include constipation and a family history of enuresis. • Finally, there are low levels of parental knowledge of treatment modalities of MNE, leaving many children untreated.

Testosterone depot injection in male hypogonadism: a critical appraisal.

Testosterone compounds have been available for almost 70 years, but the pharmaceutical formulations have been less than ideal. Traditionally, injectable testosterone esters have been used for treatment, but they generate supranormal testosterone levels shortly after the 2- to 3-weekly injection interval and then testosterone levels decline very rapidly, becoming subnormal in the days before the next injection. The rapid fluctuations in plasma testosterone are subjectively experienced as disagreeable. Testosterone undecanoate is a new injectable testosterone preparation with a considerably better pharmacokinetic profile. After 2 initial injections with a 6-week interval, the following intervals between two injections are almost always 12-weeks, amounting eventually to a total of 4 injections per year. Plasma testosterone levels with this preparation are nearly always in the range of normal men, so are its metabolic products estradiol and dihydrotestosterone. The "roller coaster" effects of traditional parenteral testosterone injections are not apparent. It reverses the effects of hypogonadism on bone and muscle and metabolic parameters and on sexual functions. Its safety profile is excellent due to the continuous normalcy of plasma testosterone levels. No polycythemia has been observed, and no adverse effects on lipid profiles. Prostate safety parameters are well within reference limits. There was no impairment of uroflow. Testosterone undecanoate is a valuable contribution to the treatment options of androgen deficiency.