The importance of anatomical region of local anesthesia for prostate biopsy; a randomized clinical trial.

INTRODUCTION: In our study, the efficiency and reliability of lidocaine (1 cc/1%) application during transrectal ultrasound-guided (TRUS) prostate biopsy to levatores prostate was studied. Levatores prostate was visualized on a cadaver dissection previously. PATIENTS AND METHODS: Eighty outpatients with lower urinary tract complaints or were suspected clinically to have prostate cancer were submitted to TRUS-guided prostate biopsy. The ages of outpatients were ranging from 45 to 81. Patients were randomized in 2 groups: Group-I, with 40 patients submitted to local anesthesia by periprostatic injection of 1 cc 1% lidocaine before biopsy; and group-II, with 40 controls the biopsy was performed without local anesthesia. The anatomical region for anesthesia was determined via dissection. The name of this anatomical region is levatores prostatae and it has got high nerve density. The process was explained to the patients and their approvals were obtained. Levatores prostatae was detected with TRUS before biopsy. Pain; related to digital rectal examination (DRE), probe insertion or biopsy, was scored via visual analog scale (VAS). The patients were evaluated about side effects of lidocaine and early and late complications of biopsy as well. RESULTS: Both groups were similar in terms of mean age, PSA levels, prostate volume and VAS scores (p > 0.05). As for VAS score, on the group submitted to anesthesia was determined 2.34 ± 1.08, while for VAS score on the group submitted conventional biopsy was determined 5.8 ± 1.6. Between two groups, there was a statistical difference in terms of VSA score (p < 0.05); but there was no statistical difference about early and late complications of biopsy. CONCLUSIONS: The periprostatic blockage use is clearly associated with more tolerance and patient comfort during TRUS-guided biopsy. Owing to the local anesthesia introduced to the periprostatic nerve bundle localization in levatores prostate area, the patients could tolerate the pain better.

The effect of Amifostine (Ethyol) on intestinal anastomosis in rats with radiation enteritis.

BACKGROUND: Preoperative radiotherapy in colorectal cancers is being used as an adjuvant therapy with increasing frequency. Postoperative complications in early and late periods in various ratios are reported. It has also been shown that radiation has a delaying effect on wound healing and this effect is dose-dependent. AIM: This study investigated the effects of the Amifostine on healing of the irradiated colonic anastomosis. MATERIALS AND METHODS: 30 female Wistar rats were divided randomly into three groups equally (n=10). Colonic anastomosis were performed to all rats. Group I served as a control. 800 rad abdominopelvic irradiation on the 5th day of preoperation was given to group II and III. Rats in the group III, prior to radiation, were given Amifostine at a dose of 200 mg/kg. On the 5th postoperative day all the rats were sacrificed and the healing of anastomosis was measured with bursting pressure, hydroxyproline levels and histopathological evaluations. Statistical analyses were expressed by analysis of variance (ANOVA) test and p < 0.05 was regarded as significant. RESULTS: In group II, all parameters were found lower compared with control group and Amifostine+Radiation group. As compared with hydroxyproline values and the anastomotic wound healing scores, except group II, no significantly difference were determined between the two other groups. In bursting pressure levels, Group I and III were higher than group II, but not statistically significant (p > 0.05). In group III (Amifostine+Radiation group), the hydroxyproline levels and anastomotic wound healing scores were found significantly higher than group II (p < 0.05), and no significant difference were found between the control group. CONCLUSIONS: It is determined that radiation given on the 5th preoperative day has a negative effect on anastomotic wound healing and administered Amifostine prevent this negative effect. In the light of these data, the Amifostine may have a positive effect on preoperative irradiated colonic anastomosis and may play an important role in future on the supporting of the colonic anastomosis.

Could ureteral wall thickness have an impact on the operative and post-operative parameters in ureteroscopic management of proximal ureteral stones? / ¿Podría el espesor de la pared ureteral afectar a los parámetros intra y postoperatorios de la ureteroscopia para el tratamiento de piedras ureterales proximales?

AIM: To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. PATIENTS AND METHODS: 82 patients with proximal ureteric stones were included and were divided into 2subgroups where UWT was> 5mm in 38 cases; and <5mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. RESULTS: Mean patient age and stone size values were 47.55±1.78 years and 8.17±0.29mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P=.0243). CONCLUSIONS: UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made.

The protective effects of Ginkgo biloba EGb761 extract against renal ischemia-reperfusion injury in rats.

OBJECTIVE: The aim of the study was to investigate the protective effects of Ginkgo biloba EGb761 extract on renal ischemia-reperfusion (I/R) injury in rats. MATERIALS AND METHODS: 26 male Wistar albino rats were divided into four groups: First group (n=6), which served as control received only standard pellet; second group (IR) (n=6) was subjected to renal I/R injury; a third group (Gb) (n=7) was given additional EGb761 extract; and rats in the fourth group (IR-Gb) (n=7) had been treated with EGb761 extract before they were subjected to I/R injury. After rats were euthanized, renal tissues were analyzed microscopically, and tissue malondyaldehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) levels were determined. RESULTS: MDA values were significantly high in the IR group when compared with the other groups. No significant difference in MDA values between the Control and Gb groups was observed. SOD enzyme activity was significantly lower in the IR group when compared with other groups. Furthermore, SOD values were found to be comparable in control, Gb and IR-Gb groups. The CAT enzymatic activity was significantly low in the IR group when compared with the other groups. Moreover, although no statistical significance was identified between control group and Gb group, CAT levels in these groups were higher compared to IR-Gb group. Microscopic examination showed no histopathological differences between the control and Gb groups. Cast formation and tubular necrosis in the IR group have been determined to be significantly high when compared with IR-Gb group. We further observed that the histopathological changes in the IR-Gb group were lesser in the advanced levels when compared with the IR group. CONCLUSIONS: Ginkgo biloba Egb761 extract applied before renal ischemia-reperfusion decreases the tissue damage.