You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-14 RANDOMIZED, SINGLE CENTER TRIAL OF THE EFFECT OF EXTENDING TIME FROM PERI-PROSTATIC LIDOCAINE INJECTION TO ONSET OF TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY ON PATIENT-REPORTED PAIN SCORES Ram Pathak, Alexander Parker, Andrea Tavlarides, Julia Crook, Nancy Diehl, Scott Alford, Michael Heckman, and Todd Igel Ram PathakRam Pathak More articles by this author , Alexander ParkerAlexander Parker More articles by this author , Andrea TavlaridesAndrea Tavlarides More articles by this author , Julia CrookJulia Crook More articles by this author , Nancy DiehlNancy Diehl More articles by this author , Scott AlfordScott Alford More articles by this author , Michael HeckmanMichael Heckman More articles by this author , and Todd IgelTodd Igel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.241AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although the efficacy of peri-prostatic lidocaine injection in terms of site, dosage and method of administration has been previously described in prospective randomized control trials elsewhere, the time from lidocaine injection to prostate biopsy has not been thoroughly investigated. The primary aim was to compare Visual Analog Scale (VAS) pain scores between patients with a 2-minute delay of lidocaine injection to onset of prostate biopsy and patients with a 10-minute delay. Secondary aims compared VAS scores with 2 injections versus 3 injections. METHODS A total of 80 prostate-biopsy naive males underwent standard 12 core transrectal ultrasound-guided prostate biopsy by a single surgeon in this prospective, single-blinded randomized study between September 2011 and July 2014. Patients were randomized into four treatment arms: bibasilar injection at 2 minutes, bibasilar and single apical injection at 2 minutes, bibasilar injection at 10 minutes, and bibasilar and single apical injection at 10 minutes. Patients were asked to report their level of pain on the VAS (1–10, with 10 indicating unbearable pain). All analyses were performed on the basis of intention-to-treat principle. RESULTS The mean age of the 80 patients was 65.0 years (41.9-90.3) with a median BMI of 29.5 (22.3-52.1). 92.4% of patients were Caucasian. All groups were comparable with respect to age, BMI and prostatic volume. In general, VAS scores were fairly low with a mean of 1.7. Only 16% of patients reported a VAS score greater than 4 for any one core. VAS scores were significantly higher for the 2-minute delay group compared to the 10-minute delay group when subtracted from the baseline VAS score (mean: -0.7 vs. -1.6, p=0.025). Subset analysis of mean VAS scores during biopsies 1–3, 4–6, 7–9 and 10–12 minus baseline VAS score also demonstrated statistical significance when comparing 2-minute to 10-minute delay (p=0.023, p=0.020, p=0.021 and p=0.043, respectively). Secondary aims comparing mean VAS scores subtracted from baseline VAS scores of 2-injection vs. 3-injection groups demonstrated a trend toward significance with a mean of -0.8 vs. -1.4, p=0.11. CONCLUSIONS Extending the time from lidocaine injection to prostate biopsy results in lower VAS scores. Although this may lengthen the time of each individual prostate biopsy session, patients experience less pain, thereby reducing anxiety. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e50 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ram Pathak More articles by this author Alexander Parker More articles by this author Andrea Tavlarides More articles by this author Julia Crook More articles by this author Nancy Diehl More articles by this author Scott Alford More articles by this author Michael Heckman More articles by this author Todd Igel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

To investigate the relationship between sleep disturbance, fatigue, and urinary incontinence (UI) and overactive bladder (OAB) symptoms among patients with OAB.Patients who were diagnosed with OAB and age-matched control subjects without OAB were enrolled. Sleep disturbance and fatigue symptoms were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. UI and OAB symptoms were assessed using the International Consultation on Incontinence Questionnaire—Urinary Incontinence (ICIQ-UI), the International Consultation on Incontinence Questionnaire—Overactive Bladder (ICIQ-OAB), the Overactive Bladder Questionnaire (OAB-q), the Urogenital Distress Inventory Short Form (UDI-6), and the Incontinence Impact Questionnaire Short Form (IIQ-7). Psychosocial health (depression, anxiety, and perceived stress level) was also assessed.Patients with OAB reported a significantly greater sleep disturbance compared with controls (PROMIS 8b T-scores: 54.3 ± 10.3 vs 43.8 ± 9.2). Patients with OAB also reported a significantly greater fatigue compared with controls (PROMIS 7a T-scores: 54.7 ± 9.6 vs 46.0 ± 6.4). After adjusting for nocturia, the differences in sleep disturbance between OAB and controls became insignificant (P = .21), whereas the differences in fatigue between OAB and controls remained significant (P = .014). Among patients with OAB, there were positive correlations between sleep disturbance and the severity of OAB symptoms (ICIQ-OAB), poorer health-related quality of life (OAB-q QOL), the severity of UI symptoms (ICIQ-UI), greater incontinence impact (IIQ-7), and urinary bother (UDI-6). Positive correlations were also observed between fatigue and worse UI and OAB symptoms and quality of life. Both sleep disturbance and fatigue were associated with poor psychosocial health (depression, anxiety, and higher stress level) among patients with OAB.Sleep disturbance and fatigue are present in substantial percentages of patients with OAB. Among patients with OAB, sleep disturbance and fatigue were associated with more severe UI and OAB symptoms, worse health-related quality of life, and poorer psychosocial health.