Combination of pregabalin and Amitriptyline in management of chronic idiopathic pain following penile prosthesis implantation: a pilot study.

BACKGROUND: Chronic post-penile prosthesis pain is de novo pain persisting > 2 months post-operatively. This pain is inadequately reported, poorly understood and undermanaged. The purpose of this current pilot study was to improvise a medical approach to alleviate the condition and assess the combination of Pregabalin and Amitriptyline in its management. RESULTS: The study enrolled 9 patients complaining of idiopathic penile, pelvic, or scrotal pain persisting > 2 months after penile prosthesis implantation. Patients were prescribed pregabalin 75mg/12h (escalated after 1 week to 150mg/12h upon demand) and Amitriptyline 25mg once daily for 3 months. The pain was reassessed after 10, 30 and 100 days. The dose of pregabalin required and the side effects of the medication were noted. Findings revealed a significant decrease in pain duration (p = 0.007), frequency (p < 0.001), and intensity (p < 0.001); in glanular (p = 0.008), shaft pain (p = 0.046) but not scrotal (p = 0.112). Moreover, a significant decrease was found in sharp pain (p = 0.003) and pain aggravated by touch (p = 0.008) but not aching pain (p = 0.277). Additionally, significant improvement was reported in QoL (p < 0.001) and dose escalation of pregabalin to 150mg/12h was required in only 1 case (11%). CONCLUSION: The combination of pregabalin and amitriptyline is very effective in the management of chronic idiopathic pain following penile prosthesis implantation. However, due to the ambiguity and lack of reporting of the condition, we recommend a multicentric contribution to acknowledge the condition, and weigh its prevalence accurately, whilst evaluating the efficacy of our approach. This study received ethical approval from Ain Shams University Research Ethics Committee (REC) FWA 000017585, on 04/13/2023 (REC-FMASU@med.asu.edu.eg). TRIAL REGISTRATION: no FMASU R98/2023.

RéSUMé: CONTEXTE: La douleur chronique survenant après l'implantation d'une prothèse pénienne est une douleur de novo qui persiste plus de 2 mois après la chirurgie. Cette douleur est mal rapportée, mal comprise et mal gérée. L'objectif de cette étude pilote était d'improviser une approche médicale pour soulager cette douleur, et d'évaluer l'association de la prégabaline et de l'amitriptyline dans sa prise en charge. RéSULTATS: L'étude a inclut 9 patients se plaignant de douleurs idiopathiques au pénis, au bassin ou au scrotum, persistantes depuis plus de 2 mois après l'implantation d'une prothèse pénienne. Les patients se sont vu prescrire 75 mg/12 h de prégabaline (augmenté après 1 semaine à 150 mg/12 h sur demande) et 25 mg d'amitriptyline une fois par jour, pendant 3 mois. La douleur a été réévaluée après 10, 30 et 100 jours. La dose de prégabaline requise et les effets secondaires du médicament ont été notés. Les résultats ont montré une diminution significative de la durée de la douleur (p = 0,007), de sa fréquence (p < 0,001) et de son intensité (p < 0,001), au niveau du gland (p = 0,008), de la verge (p = 0,046) mais pas du scrotum (p = 0,112). De plus, une diminution significative a été observée en ce qui concerne la douleur vive (p = 0,003) et la douleur aggravée par le toucher (p = 0,008), mais pas la douleur aigüe (p = 0,277). Enfin, une amélioration significative de la qualité de vie (p < 0,001) a été rapportée et l'augmentation de la dose de prégabaline à 150 mg/12 h ne s'est avéré nécessaire que dans 1 cas (11 %). CONCLUSION: L'association de la prégabaline et de l'amitriptyline est très efficace dans la prise en charge de la douleur chronique idiopathique suite à l'implantation d'une prothèse pénienne. Cependant, en raison de l'ambiguïté et de l'absence de déclaration de la maladie, nous recommandons la mise en place d'une contribution multicentrique pour reconnaître la maladie et évaluer sa prévalence avec précision, tout en évaluant l'efficacité de notre approche. Cette étude a reçu l'approbation éthique du Comité d'éthique de la recherche (CER) de l'Université Ain Shams 44 FWA 000017585, le 13/04/2023 (REC46 FMASU@med.asu.edu.eg). N° D'ENREGISTREMENT DE L'ESSAI: FMASU R98/2023.

Evaluation of Tamsulosin 0.4 mg versus 0.8 mg in management of lower urinary tract symptoms due to benign prostatic enlargement.

PURPOSE: To compare the efficacy and the safety of Tamsulosin 0.4 mg/day and 0.8 mg/day in patients suffering from lower urinary tract symptoms due to benign prostatic obstruction. PATIENTS AND METHODS: A prospective interventional, double-blinded, controlled study was carried out on 93 patients who met the criteria and divided randomly into two groups: group A for Tamsulosin 0.4 mg/day and group B for Tamsulosin 0.8 mg/day. International prostate symptom score, post void residual urine volume, and maximum flow rate of urine were assessed before and after 4 weeks of treatment. RESULTS: Both study groups showed a significant reduction in storage sub-score but only frequency was significantly reduced in group B (P < 0.001). On the other hand, Tamsulosin 0.8 mg was superior to Tamsulosin 0.4 mg regarding voiding sub-score except for straining (P = 0.325). Accordingly, the total international prostate symptom score was significantly improved in group B versus group A (P < 0.001). Furthermore, maximum flow rate and post-void residual urine volume were notably improved in Group B as compared to Group A (P < 0.001). Of all adverse events only dizziness was noted to be statistically significant in Group B versus Group A (P < 0.001). CONCLUSION: Tamsulosin 0.8 mg has shown better outcomes in treating patients who suffer from lower urinary tract symptoms due to benign prostatic enlargement than Tamsulosin 0.4 mg, and besides that, it is well tolerated. TRIAL REGISTRATION NUMBER: M S 292/2020, SID: 373, date: 22/4/2020.

Comparison Between Mini-Percutaneous Nephrolithotomy and Standard Percutaneous Nephrolithotomy in Management of Large Renal Stones: A Randomized, Controlled Clinical Trial.

Objectives: The aim of this study was to compare mini-percutaneous nephrolithotomy (PNL) and standard PNL in management of renal stones (20-40 mm) with regard to the operative time, fluoroscopy time, blood loss, stone-free rate, and postoperative complications. Subjects and Methods: This prospective, randomized comparative study was carried out on 93 patients divided into two groups: Group A included 44 patients who underwent standard PNL, whereas Group B included 49 patients who underwent mini-PNL. Results: Standard PNL showed shorter operative time, yet longer hospitalization and nephrostomy and catheterization time. The mean drop in hemoglobin level was significantly lower in the mini-PNL group. In the 1st postoperative week, the stone-free rate was higher in the standard PNL group, but this was statistically insignificant. However, 4 weeks postoperatively, the stone-free rate was significantly higher in Group A. Postoperative pain and the need for postoperative analgesia were significantly higher in standard PNL patients. Conclusions: Standard PNL achieved a higher stone-free rate and shorter operative time, while mini-PNL had the advantage of shorter hospitalization time and lower incidence of pain and postoperative complications.

Breaking the ritual metabolic cycle in order to save acetyl CoA: A potential role for mitochondrial humanin in T2 bladder cancer aggressiveness.

INTRODUCTION: Cancer cells may exhibit outsourcing of their high energy need in order to avoid the intrinsic mitochondrial apoptosis. Reduced mitochondrial respiration and accumulation of mitochondrial genome mutations are among metabolic transformations in this regard. Mitochondrial humanin (MT-RNR2) is a small peptide with anti-apoptotic activities attributed to binding some pro-apoptotic proteins. AIM OF THE WORK: The current study aims at investigating the expression of mitochondrial humanin in bladder tumor cells and the possible casting of humanin anti-apoptotic action through orchestrating some of the mitochondrial metabolic enzymes. MATERIAL AND METHODS: Here messenger RNA of humanin, succinate dehydrogenase, glutaminase, isocitrate dehydrogenase were compared in tissues from patients with T2 bladder carcinoma in comparison to tumor associated normal tissues from the same patients. Levels of lactate and mitochondrial pyruvate carrier (MPC1) mRNA were determined to scrutinize the prevalence of aerobic glycolysis. RESULTS: The present study found that tumor cells had suppressed aerobic glycolysis, augmented mitochondrial respiration and interrupted tricarboxylic acid cycle, all of which were suggested to serve tumor aggressiveness. MT-RNR2 was found closely related to the alterations in mitochondrial activity. CONCLUSION: MT-RNR2 plays its anti-apoptotic role partly by avoiding deploying energy from complete oxidation of organic compounds to inorganic wastes. Thus MT-RNR2 can potentially serve as a new biomarker in the diagnosis of bladder carcinoma especially that it is present in blood circulation.

Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria.

OBJECTIVES: To determine the preoperative, intraoperative and postoperative risk factors that influence the development of persistent post-transurethral resection of the prostate (TURP) urinary tract infection (UTI) defined as pyuria and/or bacteriuria remaining for 3 weeks after surgery. PATIENTS AND METHODS: This is a prospective study including 100 patients scheduled for TURP. Urine analysis and culture was performed immediately after catheter removal, then at 1 and 3 weeks postoperatively, and the results were correlated to various preoperative, intraoperative and postoperative potential risk factors to detect any significant relation to persistent UTI. RESULTS: There was a statistically significant relationship between bacteriuria and the following risk factors: old age, past history of diabetes mellitus, large prostatic size, positive preoperative urine analysis and culture, preoperative catheter use, previous urological interventions, large size of sheath, long duration of operation, postoperative catheter events and postoperative manual wash. CONCLUSIONS: Many risk factors have been found to contribute to the development of post-TURP UTI and avoiding these factors can enhance recovery of patients undergoing TURP.