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Purpose To assess the frequency of complications specifically related to local anesthetic infiltration prior to transrectal ultrasound (TRUS)-guided prostate biopsy. Methods A total of 200 patients receiving 10 cm3 (5 cm3 on each side) of 2% lidocaine injected around the periprostatic nerve plexus under TRUS guidance before prostate biopsy were included. Various complications presumed to be associated with local anesthesia were noted during and after the biopsy procedure. Two weeks later, periprostatic tissue integrity and vascularization were re-examined with TRUS Doppler examination to assess for fibrosis or infection. Results The most common finding was pain due to puncture with the needle used for local anesthesia (27%). Also recorded were the need for repeated injections during the biopsy procedure (4.5%), symptoms associated with systemic lidocaine toxicity (2%), urinary incontinence (1.5%), and degradation of the image resolution due to anesthetic injection (1%). Increased vascularization within the periprostatic region was uncommon (2%) on the 2-week follow-up examination. No TRUS finding consistent with rectal wall hematoma or other periprostatic change and no erectile dysfunction associated with the procedure occurred. There was a significant difference in overall pain scores between the subgroups of patients (p < 0.001). Conclusion TRUS-guided periprostatic nerve blockade is an effective method for relieving discomfort from prostate biopsy with very few complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008

OBJECTIVE The purpose of this study was to assess the role of spectral Doppler ultrasonographic parameters of the feeding arteries of the prostate for the detection of prostate cancer. METHODS A total of 55 patients referred for prostate biopsy with a mean age of 66.4 years (range, 46-82 years) were included. In each patient, Doppler indices from bilateral capsular and urethral arteries were obtained. The indices were compared with regard to malignant (group A) and benign (group B) subgroups of histopathologic outcomes of transrectal ultrasonographically guided prostate biopsy for each side (n = 19 and n = 91 for groups A and B, respectively) and to assess whether the indices were significantly altered on the side with cancer compared with the contralateral side. RESULTS The mean pulsatility index value for the capsular artery of group A (1.49 +/- 0.57) was significantly lower than that of group B (1.71 +/- 0.52; P = .048). The mean resistive index and systolic/diastolic ratio for the capsular artery of group A (0.78 +/- 0.10 and 5.40 +/- 2.74, respectively) were lower than those of group B (0.82 +/- 0.08 and 7.40 +/- 4.91) despite being statistically insignificant (P = .075 and .119, respectively). CONCLUSIONS Spectral waveform measurements by power Doppler transrectal ultrasonography may be useful in differentiating prostate cancer from benign hypertrophy. Further research is needed to elucidate the potential of spectral Doppler indices of the capsular and urethral arteries.

Purpose. To evaluate the effect of clinical varicocele on testicular microcirculation using spectral Doppler analysis. Methods. Forty-nine young and healthy volunteers were enrolled in this prospective study. Varicocele grades were determined according to sonographic parameters. Patients with left-sided clinical varicocele were classified as the patient group (n = 15), while the remaining patients served as controls (n = 34). Spectral Doppler measurements of testicular arteries (peak systolic/end diastolic velocity, resistance index, pulsatility index) were measured from capsular and intratesticular branches. Results. No statistically significant difference was found between the Doppler parameters obtained from the intratesticular branches of both testes and the capsular branches of the right testis. On the other hand, in left-sided clinical varicocele cases, the average resistance index (RI) and pulsatility index (PI) of capsular branches of the left testes (RI, 0.68 ± 0.04; PI, 1.22 ± 0.15) were significantly greater than in the control group (RI, 0.64 ± 0.06; PI, 1.07 ± 0.18) (p < 0.05 and p < 0.01, respectively). Conclusions. Increased RI and PI of capsular branches of testicular arteries on spectral Doppler examination may be an indicator of impaired testicular microcirculation in patients with clinical varicocele. Further studies addressing the correlations with sperm counts are needed to determine the cut-off values for these indices. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007

Objective. The purpose of this study was to evaluate the effect of premicturitional bladder volume (V 1 ) on postvoid residual urine volume (V 2 ) measurements and to assess the ideal V 1 for an accurate V 2 determination. Methods. Twenty-five healthy men without any urinary symptoms constituted the study group. Measurements by transabdominal ultrasonography for V 1 and V 2 were performed for each subject at 3 different phases, each of which was preceded by oral intake of 1000 mL of water and accompanied by "mild," "moderate," and "severe" sensations of micturition, respectively. Results. Mean ± SD V 1 and V 2 during the first, second, and third phases were 117.7 ± 70.3 and 1 ± 1, 356.2 ± 112.3 and 11.5 ± 12 and 639.6 ± 171.8 and 58.8 ± 35.2 mL, respectively. With 50 mL as the cutoff value for a pathologic V 2 , 15 (60%) men had V 2 in the third phase exceeding this value, whereas the same rate was calculated as 0% for either of the first 2 phases. No patient with V 1 of less than 540 mL had V 2 of greater than 50 mL. Conclusions. Postvoid residual urine volume measurements with an uncomfortably full bladder result in high false-positive postmicturitional residue values even in healthy young men. We strongly advise that V 1 measurements of the bladder be performed before V 2 measurements and that V 2 not be measured if V 1 is greater than 540 mL.

Objective. The purpose of this study was to evaluate the transrectal ultrasonographic features of the prostate after biopsy and to find out whether any ultrasonographically detectable lesion forms secondary to biopsy. Methods. Prebiopsy transrectal ultrasonographic findings in 60 consecutive patients who underwent repeated biopsies were evaluated. Detected lesions that were not defined before the first biopsy were considered postbiopsy-formed lesions and were sampled during the second biopsy. All transrectal ultrasonographically detected lesions were correlated with histopathologic results in the same locations. Results. There were 7 (11.6%) patients with new hypoechoic lesions formed after the first biopsy. Histopathologic analysis of postbiopsy-detected lesions showed that 38.5% were cancer; 62.5% of the detected benign lesions were prostatitis foci. Conclusions. Prostate biopsy does not give rise to formation of fibrotic scar tissue in the peripheral zone. Most postbiopsy-detected lesions are prostatitis foci, but all hypoechoic lesions must be sampled during repeated prostate biopsies because of the 38.5% cancer detection rate. Key words: biopsy; prostate; transrectal ultrasonography.

Kaplan, Suleyman/0000-0003-1477-5002; Guvenc, Tolga/0000-0003-1468-3415 WOS: 000232389300009 PubMed: 16207295 Considerable evidence supports the hypothesis that melatonin plays an important role in osteogenesis. We carried out an experiment to investigate histological and radiological changes in the cervical vertebrae of pinealectomized chickens. Thirty new-hatched chicks were divided into two groups: pinealectomized group (n = 15) and nonpinealectomized control (n = 15). Surgical pinealectomies were performed in Hybro broiler chickens at the age of 3 days. At 8 wk, one animal from each group was examined using computed tomography scanner to obtain density histograms of four consecutive vertebrae between the 4th and 7th cervical vertebral segments of chickens. At the end of the study, all animals were killed for subsequent measurement of bone mineral density (BMD) and macroscopic, radiographic and histopathological evaluation of specimens. We found that the profile of the density histogram in nonpinealectomized control group showed a spike profile for the vertebral body, indicating an increase in the amount of higher density tissues in this region, while a plateau-shaped profile was obtained for the vertebral body in pinealectomy group, indicating the presence of heterogenous bone tissue. Accordingly, the mean value of BMD in pinealectomy group was significantly lower at the vertebral body in chickens compared with control subjects (P < 0.001). At the end of the experiment, almost all of the chickens in pinealectomy group developed a scoliotic curvature and the mean weight and length of the cervical vertebral bodies of the pinealectomized chickens were significantly lower than those of control group (P < 0.001). Although the numerical density of osteocytes and osteoblasts in pinealectomy group was significantly higher than that from the control group, total number of osteocytes but not osteoblasts in cervical vetrebrae from pinealectomized animals was significantly lower than that from nonpinealectomized control animals (P < 0.05). In conclusion, the results of the current study demonstrated for the first time pinealectomy-induced histomorphometrical changes in chicken vertebral column using stereological methods, suggesting that pineal gland/melatonin may have an osteoinductive effect on bone formation, but further studies are needed to elucidate the relationship of our findings with some disorders such as postmenopausal and/or senile osteoporosis.