A double-blind, randomized, placebo-controlled trial of prilocaine and felypressin (Citanest and Octapressin) for the relief of pain associated with cervical biopsy and treatment with the Semm coagulator.

OBJECTIVE: To quantify the anticipated and actual pain experienced in association with preliminary cervical punch biopsies and subsequent ablative treatment with the Semm coagulator, and to test the hypothesis that the intracervical injection of prilocaine with felypressin reduces the intensity of the pain experienced. MATERIALS AND METHODS: One hundred consecutive women referred with abnormal cervical smears for colposcopic assessment and considered suitable for treatment with the Semm coagulator were recruited to a double-blind, randomized, prospective, placebo-controlled trial conducted in a colposcopy clinic in a university teaching hospital. Personal particulars were taken and anticipated pain scored. The patients were injected with randomized externally identical vials of prilocaine and felypressin (Citanest and Octapressin) or placebo. After biopsy and treatment, patients scored their actual pain experienced. Pain scores were compared as the main outcome measure. Relative risks with 95% CIs were calculated and compared using the CI Analysis computer programme (Professor Martin J Gardner and the British Medical Journal Version 1.1, copyright 1991). RESULTS: Anticipated pain was greater than the actual pain experienced in both groups. Women receiving the local anesthesia experienced a significantly greater reduction in pain (p < .05) with only 4.3% and 6.7% experiencing moderate pain during biopsy and treatment, respectively. The active drug abolished severe pain. In the placebo group, 44.7% felt mild pain at the most. CONCLUSIONS: Intracervical injection of prilocaine and felypressin reduces the intensity of pain experienced in women undergoing cervical biopsy and treatment with the Semm coagulator. Its use is commendable but is not absolutely necessary in all cases.

Tension free vaginal tape: a procedure for all ages.

OBJECTIVE: To assess the success and complications of the tension free vaginal tape (TVT) procedure in different age groups. PATIENTS AND METHODS: This prospective long-term study of 179 consecutive cases of urodynamically confirmed urinary incontinence that had had the TVT procedure was conducted from March 1999 to December 2002 at a District General Hospital. To assess whether outcome was influenced by the patient's age, the patients were divided into three age groups: group A (30-49 years old), group B (50-69 years old) and group C (70-90 years old). Operative details and early and late complications were recorded, and patients were followed up with clinic visits at 6 weeks and 6 months and a quality of life questionnaire was completed at 1 year. RESULTS: Of the 179 patients included in the study, 53 (29.6%) were in group A, 91 (50.8%) in group B and 35 (19.5%) in group C. The subjective cure rate for the patients was 84.9%, 81.3% and 85.3% in groups A, B and C, respectively. A significant improvement in symptoms was reported by 3.8%, 14.3% and 8.6% women, respectively. The failure rate was 11.3%, 4.4% and 5.7%, respectively. The intraoperative complication rate was 5.6%. The overall postoperative complication rate was 29.6%. A total of 86.2% of the patients were treated as day cases. Patients who had intraoperative complications or initial voiding difficulties (i.e. those patients requiring "in/out" catheterization before spontaneous voiding was established) were in hospital for 1-2 days. CONCLUSIONS: Our data showed better subjective cure rates and substantial improvement rates without any significant increase in intraoperative complications with increasing age. Postoperative complications of urgency and vaginal wall erosion were more common in the older aged patients but were easily resolved. Hospital stay and recovery period were short, making TVT a suitable procedure for all ages.