RESUMEN
AIM: The aim of this study was to evaluate the anal discomfort and pain level, during transrectal ultrasound probe insertion and before the periprostatic anesthesia in young patients (<65 years of age). METHODS: This study enrolled 147 patients, who underwent prostate biopsy and were divided in two groups: 74 patients received perianal local anesthesia with lidocaine cream 2% (first group), while 73 received only lubricant gel as perianal local anesthesia (second group) prior the insertion of ultrasound probe. Patients in both groups received periprostatic anesthesia. Pain and discomfort due to the probe and due to the biopsy were estimated with visual analogue scale. Patients' characteristics, complications, and surgical data were analyzed for both groups. RESULTS: No serious intraoperative and postoperative complications were noted in both groups. The mean pain score for pain and anal discomfort was 1.7 and 5.7 for the first and second group, respectively. During biopsy, patients in the first group reported also less pain but there was no significant difference. CONCLUSIONS: The intrarectal introduction of lidocaine cream 2% can significantly reduce anal discomfort and pain before the probe insertion for ultrasound guided biopsies in young patients. Considering that these patients could undergo repeated biopsies, a higher level of local anesthesia is desired.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/uso terapéutico , Biopsia , Lidocaína/uso terapéutico , Dolor/prevención & control , Neoplasias de la Próstata/diagnóstico por imagen , Ultrasonido Enfocado Transrectal de Alta Intensidad , Administración Rectal , Anciano , Anestesia Local/efectos adversos , Anestésicos Locales/administración & dosificación , Enfermedades del Ano/prevención & control , Biopsia/efectos adversos , Biopsia/métodos , Humanos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Pomadas , Dimensión del Dolor , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía , Ultrasonido Enfocado Transrectal de Alta Intensidad/efectos adversosRESUMEN
OBJECTIVE: To compare the efficacy of three different doses of intravesical interferon alpha-2b (IFN alpha-2b) in reducing recurrence and progression rates in superficial grade II, transitional cell carcinoma (TCC). PATIENTS AND METHODS: Eighty-nine patients with primary or recurrent TCC stage Ta/T1, grade II, were randomly allocated into four groups after transurethral resection (TUR) of the tumour. Group A (20 patients) received no further treatment, serving as the control group; group B (22 patients) received 40 MU of IFN alpha-2b, group C (24 patients) 60 MU and group D (23 patients) 80 MU. The instillations started within 48-72 h after TUR and were performed weekly for 2 months, bimonthly for the next 4 months and thereafter monthly for 6 months. The patients were followed for 36 months. The four groups were compared for the number of recurrences (simple recurrence rate), progression in stage, disease-free interval and recurrence rate per 100 patient-months. RESULTS: During the follow-up, 33 patients had recurrence (13, eight, seven and five in groups A to D, respectively). The simple recurrence rate was 65% for group A, compared with 36% (P = 0.06), 29% (P < 0.05) and 22% (P < 0.01) for groups B, C and D, respectively. The differences in simple recurrence rates between the groups treated with IFN alpha-2b were not statistically significant. Eleven patients experienced progression in stage, with six, there, one and one in groups A to D, respectively. The differences were statistically significant only between groups A and C (P < 0.05) and groups A and D (P < 0.05). The disease-free interval was 15 months for group A, compared with 21.4 (P < 0.05), 26.1 (P < 0.001) and 30 months (P < 0.001) for groups C to D, respectively. The disease-free intervals of the groups treated with IFN alpha-2b were significantly different between all patients in groups B and D (P < 0.01) and only for those with stage T1 between groups C and D (P < 0.01). Finally the recurrence rate per 100 patient-months was 2.91, 1.19, 0.88 and 0.63 for groups A to D, respectively (all P < 0.001). The results were always in favour of the patients treated with the high dose, the only exception being the difference between groups C and D (P = 0.026). No side-effects of the drug were noted, nor was any adverse reaction reported from any patient. CONCLUSION: These results show a significant advantage for adjuvant intravesical IFN alpha-2b treatment over TUR alone for the 36 months of follow up and indicate that IFN alpha-2b can modify the clinical course of superficial TCC at least in the short term. The appropriate dose was apparently 80 MU, for although 40 MU was better than TUR alone, it was less effective than 60 MU and 80 MU; the 80 MU dose was slightly better than 60 MU and thus this regimen is recommended.