PURPOSE: We evaluated the effectiveness of intrarectal lidocaine-gel and periprostatic nerve block, or the combined method, on the reduction of pain during repeated transrectal prostate biopsy. MATERIALS AND METHODS: 61 patients with a negative pathology after an initial sextant biopsy, with no sedatives or analgesia, were rebiopsied using the 12 extended biopsy technique. The patients scheduled for a repeat prostate biopsy were randomized to the combination method (group 1, 19 patients), periprostatic nerve block (group 2, 23 patients) or intrarectal lidocaine-gel (group 3, 19 patients). After the repeat biopsy, the rectal pain during probe insertion, pain intensity during prostate biopsy and complication rates were recorded. Pain was evaluated by a 10-point linear visual analogue scale (VAS). An ANOVA test was used as the statistical analysis for the assessment of VAS, with p<0.05 considered significant. RESULTS: No significant difference was found in mean patient age, prostate specific antigen level, prostate volume and complication rates between the groups. The VAS during probe insertion were significantly lower in group 1 and 3 (mean 1.74 and 1.84) than in group 2 (mean 3.96, p<0.001). The VAS during biopsy was significantly lower in group 1 (mean 3.05) than group 3 (mean 4.63, p<0.001). CONCLUSIONS: Periprostatic nerve block decreased pain during the repeated prostate biopsy, but had no effect on the pain felt during transrectal probe insertion. Intrarectal lidocaine-gel decreased the pain only during probe insertion. However, the combination of intrarectal lidocaine-gel and periprostatic nerve block was effective in reducing the pain, both at biopsy and during probe insertion, in the repeated 12 core biopsy.
Analgesia ; Anesthesia ; Biopsy* ; Humans ; Hypnotics and Sedatives ; Lidocaine* ; Nerve Block ; Pathology ; Prostate* ; Prostate-Specific Antigen

PURPOSE: To evaluated the effects of transrectal ultrasonography (TRUS) and a digital rectal examination (DRE) on the serum level and percentage of free prostate-specific antigen (PSA). MATERIALS AND METHODS: Out of 200 patients, aged over 50, with lower urinary tract symptoms, 24 men were excluded from the study due to a past history of severe pain, with prostatitis, a prostate operation, neurologic symptoms, acute obstructive symptoms and finasteride medication, and those showing signs suspicious of prostate cancer on a DRE. Of the remaining 176 patients, only 48 men (mean age 68.9+/-7 years) were willing to participate in the study. Therefore, the level of total PSA, free PSA and percentage of free PSA were determined in this group. RESULTS: There was no significant difference between the serum total PSA levels before, and 30 minutes after the DRE and TRUS (p>0.05). However, the mean percentage of free PSA (35.3+/-15.3%) after the DRE and TRUS was significantly elevated compared to that before (p<0.01). The mean percentage of free PSA (30.66+/-9.3%) after the DRE and TRUS was significantly elevated compared to that before (20.18+/-8.1%) in the patients with serum PSA levels between 4 and 10ng/ml (p<0.01). CONCLUSIONS: In our study, the serum free PSA and the percentage of free PSA were significantly elevated by prostate maneuvers, such as DRE and TRUS, however the level of total PSA was unaltered by these maneuvers. Therefore, the collection of blood samples prior to a DRE and TRUS will aid in the diagnosis of prostate cancer. In those with serum PSA levels between 4 and 10ng/ml, the collection of blood samples before a DRE and TRUS are even more important for useful results.
Diagnosis ; Digital Rectal Examination* ; Finasteride ; Humans ; Lower Urinary Tract Symptoms ; Male ; Neurologic Manifestations ; Prostate ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Prostatitis ; Ultrasonography*

PURPOSE: The aim of this study was to evaluate the results of multiplex polymerase chain reaction (PCR) in patients with chronic pelvic pain syndrome (CPPS) and the significance of microorganisms as the causative factor of CPPS. MATERIALS AND METHODS: We evaluated the frequency of 19 possible causative microorganisms of prostatitis in 849 patients who had prostatitis symptoms from April 2007 to March 2009 by using multiplex PCR. All of the enrolled patients were category III by the definition of the NIH Chronic Prostatitis Workshop. RESULTS: Of the 849 patients, 414 (49%) and 435 (51%) were categories IIIa (inflammatory CPPS) and IIIb (noninflammatory CPPS). On multiplex PCR, using the third voided urine specimen (VB3), 369 (89%) of the 414 category IIIa and 367 (84%) of the 435 category IIIb cases were found to have positive PCR results for causative microorganisms. The common microorganisms were Enterococcus, Ureaplasma urealyticum, Lactobacillus, Streptococcus agalactiae, and Chlamydia trachomatis in 173 (18%), 144 (15%), 129 (13%), 78 (8%), and 69 cases (7%), respectively. CONCLUSIONS: There were too many positive PCR results for causative microorganisms in the CPPS patients despite negative urine culture examination. Therefore, it is necessary to rule out contamination of the specimen to achieve reliable results with multiplex PCR. However, multiplex PCR can detect various unknown microorganisms suggestive of the etiology of CPPS, particularly those that are difficult to cultivate. PCR is expected to play an important role in the diagnosis of CPPS, but further studies will be required to define the usefulness of molecular tests.
Chlamydia trachomatis ; Enterococcus ; Humans ; Lactobacillus ; Multiplex Polymerase Chain Reaction ; Pelvic Pain ; Polymerase Chain Reaction ; Prostatitis ; Streptococcus agalactiae ; Ureaplasma urealyticum

Adenomatoid tumors arising in the tunica vaginalis are relative rare neoplasms, and usually benign in nature. An appropriate treatment of an adenomatoid tumor is local excision. Herein, a case of an adenomatoid tumor of the tunica vaginalis, in a 40-year-old man, is described. An orchiectomy was performed to excise the mass, and pathologic evaluation revealed an adenomatoid tumor of the tunica vaginalis.
Adenomatoid Tumor* ; Adult ; Humans ; Orchiectomy ; Scrotum ; Testis*

Adenomatoid tumors arising in the tunica vaginalis are relative rare neoplasms, and usually benign in nature. An appropriate treatment of an adenomatoid tumor is local excision. Herein, a case of an adenomatoid tumor of the tunica vaginalis, in a 40-year-old man, is described. An orchiectomy was performed to excise the mass, and pathologic evaluation revealed an adenomatoid tumor of the tunica vaginalis.
Adenomatoid Tumor* ; Adult ; Humans ; Orchiectomy ; Scrotum ; Testis*

We present an unusual case of a penile cavernosal abscess. This patient did not improve clinically despite repeat percutaneous aspiration of the abscess and administration of oral fluoroquinolone. Surgical drainage was required. Culture of pus and infected tissues were negative. Three months postoperatively, penile deviation to the left side and erectile dysfunction occurred but the patient was able to have sexual intercourse by using the medication of oral vardenafil. Colchicine was administered orally to the patient for 9 months and the penile curvature was improved.
Abscess* ; Coitus ; Colchicine ; Drainage ; Erectile Dysfunction ; Humans ; Male ; Penis ; Suppuration ; Vardenafil Dihydrochloride

Adenocarcinoma arising in an augmented bladder is a relative rare neoplasm. We report here on 2 cases of adenocarcinoma that developed in augmented bladders 23 and 30 years after ileocystoplasty, and both tumors were associated with contracted bladder due to tuberculosis. We also reviewed the literatures related to neoplasms occurring after urinary diversion procedures.
Adenocarcinoma* ; Tuberculosis ; Urinary Bladder* ; Urinary Diversion