Choi H, Kim DW, Jung E, et al. Impact of intravesical administration of tranexamic acid on gross hematuria in the emergency department: a before-and-after study. Am J Emerg Med. 2023;68:68-72.

Special thanks to Dr Saturnino Luján at Hospital Universitari I Politécnic La Fe, Valencia, Spain.

There are a few concepts that have stuck with me throughout my residency and career as a urologist. One of them that I used to hear from my senior colleagues is: “Never use tranexamic acid for hematuria—it’s useless.” This Korean study may change that. The authors compared patients who came to the emergency room with macroscopic hematuria and needed a 3-way urethral catheter. One gram of tranexamic acid diluted with 100 mL of normal saline was administered through the Foley catheter. The median length of stay in the emergency department and the duration of Foley catheter placement were shorter in the intervention group than in the group not treated with tranexamic acid. The number of return visits after discharge from the emergency department was lower in the postintervention group than in the preintervention group without tranexamic acid.

Of course, more robust trials are needed before this can be systematically recommended. In the meantime, you can try tranexamic acid the next time you have a case with gross hematuria. But be careful, don’t tell my senior faculty—especially if it was good.

Escobar AJ, Krishna S, Flowers KM, et al. Practical use of self-adjusted nitrous oxide during transrectal prostate biopsy: a double-blind randomized controlled trial. J Urol. 2024;211(2):214-222.

Special thanks to Drs Rabun Jones and Mahmoud Mima at the University of Illinois at Chicago

Prostate biopsy evokes patient anxiety and discomfort but is an unavoidable part of diagnosing and managing prostate cancer. Aside from injecting local anesthesia, data are mixed on pain control measures both during and after the procedure. These authors collaborated with their anesthesia colleagues to investigate the effectiveness of low-dose self-adjusted nitrous oxide in decreasing anxiety and pain during and after transrectal ultrasound-guided prostate biopsies.

Nitrous oxide is common in ambulatory procedures and has a very quick onset and offset time of about 3 minutes. There is no requirement for anesthesia personnel, patients are able to communicate and follow commands during the procedure, and there is no need for an escort home. In this double-blind study, participants were randomized to either receive via mask 100% oxygen or a combination of nitrous oxide and oxygen during their procedure. A low dose of 20% to 45% of nitrous oxide was used to minimize potential adverse effects such as headache and nausea. Patients could request that their level of gas be adjusted throughout the procedure.

Those receiving nitrous oxide experienced significantly decreased pain after biopsy by validated patient-reported outcome measures. Urologists felt that the procedure was easier to perform with patients receiving nitrous oxide, no difference in procedure duration was noted, and there were no serious adverse events in either group. The bottom line is that self-adjusted nitrous oxide is an alternative and safe approach for alleviating pain after transrectal prostate biopsies.

Piedras P, Cumpanas AD, McCormac A, et al. Alkaline water: help or hype for uric acid and cystine urolithiasis?. J Urol. 2024;211(2):276-284.

Special thanks to Drs Rabun Jones and Mahmoud Mima at the University of Illinois at Chicago.

Alkaline water grew in popularity during the past decade, likely due to its touted anti-aging and free radical–scavenging benefits. Ask any urologist how to manage uric acid and cystine stones and their answer will include alkalinization of urine. These authors investigated the composition of 5 popular commercially available alkaline waters and compared the results to other urinary alkalinization agents, including potassium citrate and baking soda.

The authors quantified the amount of urine alkalinizing agents with ion chromatography and direct chemical measurement in 5 brands of alkaline water. None of the waters demonstrated greater than 1 mEq of physiological alkali content per serving. For reference, both UroCitK and Simply Orange Juice with pulp have 15 mEq per serving. For stone formers, fluid consumption is key, so if drinking alkaline water helps stone formers to increase their overall water intake, then sure, drink away! However, if the goal is urinary alkalinization, money is better spent on a nice chilled glass of orange juice.