Prostatectomy and bladder stones

Abstract

CorrespondenceIncreased patient satisfaction from transrectal ultrasonography and biopsy under sedation Sir, We congratulate the authors on an excellent study [1]. We have recently reviewed our experience using a 'sedoanalgesia' protocol over 10 years for a multitude of urological procedures, including prostate biopsies. First, patient satisfaction for prostate biopsies was high (satisfied 95%, not satisfied 5%, 940 patients; adverse events, none). Importantly, the cost of sedoanalgesia is lower, as it can be administered without an anaesthetist, with the 'cocktail' given 30 min before the procedure, when the patient is most anxious. The cocktail consists of intramuscular midazolam (0.1 mg/kg or 0.01 mg/kg in the elderly) and gentamicin (120 mg), rectal metronidazole (1 g) and diclofenac (100 mg) plus intranasal oxygen [2] and ciprofloxacin (500 mg, three doses) on discharge, the same day. The authors stated in their discussion that an anaesthetist is not necessary, but in our experience any intravenous administration of sedative has more potential problems than the relatively lower doses given intramuscularly. As our health system is already overburdened, perhaps theatre time and the anaesthetist could be used for other tasks, as sedoanalgesia is clinically safe and cost-effective [2].