Although the top-down approach and repeat voiding cystourethrography cause less anxiety for caregivers, these values do not correlate to pain scale in children. This finding might be due to lack of appropriate evaluation tools of pediatric pain and anxiety. However, the theory that the top-down approach is less invasive, and thus less stressful, requires further research. The Child-Adult Medical Procedure Interaction Scale-Revised data indicate that influences in adult-child interaction are bidirectional.
Objective: Open prostatectomy (OP) is a valid option for the surgical treatment of large prostates in the absence of holmium laser enucleation. The most frequent complication of OP is intra-and perioperative bleeding. Preoperative use of dutasteride has been shown to reduce vascularity and perioperative bleeding in transurethral resection of the prostate (TUR-P). However, there has been no study addresing this effect in OP. The aim of this study was to evaluate whether pretreatment with dutasteride for 6 weeks before OP can reduce surgical blood loss.
Material and methods:Data of 218 patients with benign prostatic hyperplasia (BPH) who underwent OP was investigated retrospectively. Of the 218 patients, 46 were treated with dutasteride for at least 6 weeks and the rest were dutasteride naïve. Age, prostate volume, prostate-specific antigen (PSA) levels, coagulation tests, platelet counts, pre-and postoperative hemoglobin (Hb) levels, and transfusion history were recorded. Blood loss was estimated as follows: preoperative Hb (-) postoperative Hb (+) amount of transfusion. The 2 groups were compared by independent samples t-test and a p value of 0.05 was considered significant.
Results:The groups were similar in terms of age, prostate volume, platelet counts, coagulation tests, and postoperative Hb levels. Preoperative Hb levels were lower in the dutasteride group (13.4 vs. 14.3, p=0.002) and amount of bleeding (-2.72 g/dL vs. -1.93 g/dL, p= 0.01) was shown to be significantly lower in dutasteride group.
Conclusion:Our results showed that pretreatment with dutasteride for 6 weeks before OP considerably reduces perioperative surgical bleeding. Further prospective randomized trials should be conducted to confirm the effectiveness of such treatment.
Patients with testicular tumors who received cisplatin based chemotherapy showed a significant decrease in the estimated glomerular filtration rate and a significant increase in new onset stage 3 chronic kidney disease compared to patients who received no cycle. However, in patients at high risk with stage I nonseminomatous germ cell tumor who elected 2 cycles of cisplatin, etoposide and bleomycin the chemotherapy had no statistically significant effect on these parameters compared to those in patients who received no chemotherapy.
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