This document provides an overview of benign prostatic hyperplasia (BPH) presented by Prof. Dr. Sherine Ragy. It discusses the gross anatomy of the prostate, zonal anatomy, vascular supply, pathophysiology including the role of androgens. It also covers the natural history, definitions, complications and diagnosis of BPH including history, IPSS scoring, examination, PSA, and additional investigations. Non-surgical and medical therapy options are summarized including watchful waiting, alpha-blockers, 5-alpha reductase inhibitors and plant extracts. Common alpha-blockers and their dosing are listed.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control.
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
Find the powerpoint (PPt.) on Benign hyperplasia of Prostate with proper explanation and references were taken from the well known Books (Bailey and Love textbook of Surgery and others).
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
basic lecture on literature types, importance of primary literature (papers,article) , study designs, and organization of scientific paper. p value and assessment of a new test is additional topic.
“If you fail to plan, you plan to fail” Benjamin Franklin.
Do you have a clear view about what you want to do in the future? Did you write down a plan? Is this plan detailed? Do you know how to set goals, put an action plan, make a to-do list and organize your time schedule?
We all have dreams and plans but many “plans” stay just in our dreams.
In this presentation i will try to give you tips and techniques on “How to make a PDP (Personal Development Plan) that really works?”
TURP step by step operative urology series
for more resources:
www.uronotes2012.blogspot.com
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Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
for more urology resources visit:
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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32. Open prostatectomy
Now rarely used.
Indicated in
• Patients with symptomatic bladder outlet
obstruction due to BPH and markedly enlarged
prostate gland,
• Patients with a concomitant bladder condition,
such as a bladder diverticulum or large bladder
calculi
• Patients who cannot be placed in the dorsal
lithotomy position for TURP
36. Nesbit technique for TURP (1943)
• resection from proximal to distal
If large middle lobe, start by it first
1st stage: resect BN (superiorly to inferiorly) 12
to 3 O’clock
2nd stage: resect lat. & median lobes (superiorly
to inferiorly)
3rd stage: resect apical lobes (inferiorly to
superiorly )
37. TURP (Nesbit technique)
1st stage: resect BN (superiorly to inferiorly)
• Resect BN from 12 to 9 o'clock (until see circular fibers of BN)
38. 2nd stage: resect adenoma in quadrants, (superiorly to inferiorly)
(until see fibers of prostatic capsule)
(a): Rt lobe (12 to 9 o’clock)
39. 2nd stage: resect adenoma in quadrants, (superiorly to
inferiorly) (until see fibers of prostatic capsule)
(b): Lt lobe (12 to 3 o’clock)
40. 2nd stage: resect adenoma in quadrants, (superiorly to inferiorly)
(until see fibers of prostatic capsule)
(c): Floor(9 to 6 o’clock)
41. 3rd stage: Apical adenoma removed immediately proximal to EUS,
preserving veru (inferiorly to superiorly)
(a): begin next to the veru → toward the 12 o'clock position
42. 3rd stage: Apical adenoma removed immediately proximal to EUS,
preserving veru (inferiorly to superiorly)
(a): Residual tissue is carefully cleared on the patient's right side
43. 3rd stage: Apical adenoma removed immediately proximal to EUS,
preserving veru (inferiorly to superiorly)
(c): remaining residual tissue is cleared from the patient's left side
44. Another technique
• Resection begins at the proximal portion of the middle lobe at the 6-
o’clock position.
• The resectoscope is placed just proximal to the verumontanum and
the resection performed always controlling the end point of each cut.
• be aware of the position of the verumontanum to avoid extending
below this level or otherwise damage to the sphincter mechanism
may occur.
45. Another technique (cont.):
• Resection in smaller adenomas is now carried directly to the side
lobe.
• It depends on the preference of the surgeon whether to begin on
the left and then to resect the other side or vice versa. .
50. Transurethral radiofrequency needle
ablation of the prostate (TUNA)
• Low-level radiofrequency is
transmitted to the prostate
via a transurethral needle
delivery system
• The resultant heat causes
localized necrosis of the
prostate.
51. Transurethral radiofrequency needle
ablation of the prostate (TUNA)
Side-effects
• bleeding in 1/3 of patients
• Short-term urinary retention in 10-40%.
• UTI in 10% and urethral stricture in 2%.
• Irritative urinary symptoms can last for a
month or more.
• No adverse effects on sexual function
have been reported.
52. Transurethral radiofrequency needle
ablation of the prostate (TUNA)
Efficacy
• TUNA is a successful minimally invasive
treatment option for symptoms associated
with prostatic enlargement.
• However, Concerns remain with regard to
long-term effectiveness.
53. Transurethral microwave
thermotherapy (TUMT)
• Microwave energy is delivered
to the prostate via an
intraurethral catheter which
incorporates a microwave
generator (antenna), a
temperature measurement
system, and a cooling system to
prevent damage to the adjacent
urethra.
54. Transurethral microwave
thermotherapy (TUMT)
• The microwave energy produces prostatic
heating and coagulative necrosis.
• Subsequent shrinkage of the prostate and
thermal damage to adrenergic neurons (i.e.
heat-induced adrenergic nerve block) relieves
obstruction
• Cavities can be demonstrated 3 months post-
treatment by TRUS.
• Low-energy, high-energy, and high-intensity
protocols are available.
55. Transurethral microwave
thermotherapy (TUMT)
Side effects
• Perineal discomfort is common after TUMT, as is
urgency, but these symptoms usually resolve in
a few days.
• Sexual side-effects after TUMT (e.g. impotence,
retrograde ejaculation) are less frequent that
after TURP,
• a catheter may be required for 1-2 week
because of urinary retention in up to 25% of
patients especially with higher-energy protocols.
56. HIFU
• A focused ultrasound beam can
be used to induce a rise in
temperature in the prostate, or
indeed in any other tissue to
which it is applied.
• A transrectal probe is used for
HIFU treatment of the prostate
• There are no randomized trials
comparing its effectiveness
against other treatment
modalities.
57. TUVP
• This technique vaporizes and
dessicates the prostate.
Advantages
• TUVP is as effective as TURP for
symptom control and relief of
bladder outlet obstruction.
• Requirement for blood transfusion
may be slightly less after TUVP
than after TURP.
•
58. TUVP
Side effects
• Retrograde ejaculation occurs 70-100% of
patients and impotence in 0-15%.
• Irritative symptoms seem to be more
troublesome than after TURP and can last
for 4-6 weeks.
• TUVP does not provide tissue for
histological examination, and so prostate
cancers cannot be detected.
60. LASER
• Penetration depends
on wavelength.
• Shorter wavelengths
(600nm-700nm) are
absorbed within a couple
of mm by hemoglobin.
• Longer wavelengths
(1,000nm + ) are
absorbed by fat and
water.
61. Laser Therapy
Mechanism of action of Laser in prostatectomy:
• Ablation (coagulation necrosis).
• Resection.
• Vaporization.
These mechanisms are employed through
1) Visual laser ablation of the prostate.
2) Laser vaporization of the prostate.
3) Laser resection of the prostate.
4) Laser enucleation of the prostate (with tissue morcellation).
5) Laser incision of the prostate.
6) Interstitial laser coagulation of the prostate.
63. Laser Therapy
There are four types of laser for the prostate:
1) Neodymium: Yttrium-Aluminum-Garnet (Nd:YAG)
laser: utilizes wavelengths of 1064 nm causing
coagulative necrosis of the prostate.
2) Potassium Titanyl Phosphate (KTP) laser:
Doubling the frequency of pulsed (Nd:YAG) laser energy with a KTP
crystal has led to the creation of a 532 nm wavelength selectively
absorbed by Hb.
The 60-W KTP laser has proved that a higher-power laser beam could
speed up vaporization.
So, the 80-W KTP laser was introduced (Green light photoselective
vaporization laser system).
64. Laser Therapy
3) Holmium: Yttrium-Aluminum-Garnet (Ho:YAG) laser:
• The Ho:YAG utilises wavelength of 2140 nm.
• It causes vaporization rather than coagulation.
• can be used for resection (HoLRP) or enucleation
(HoLEP).
4) Diode laser:
has 3 components:
1. portable diode laser unit,
2. specialized fiber optic delivery system that allows optical
monitoring of tissue temperatures,
3. laser.
65. Visual laser ablation of the
prostate
It is based on the principle of laser coagulation.
Surgical technique:
The laser energy is delivered to the prostate gland with a side-firing,
noncontact, free-beam laser.
The most widely used laser energy is the Nd:YAG.
The obstructive tissue then starts to slough during the next 4 to 8
postoperative weeks, leading to a patent prostatic urethra.
Adverse effects:
Prolonged irritative voiding
symptoms which may last for
weeks and sometimes months.
66. Laser vaporization of the prostate
The Green Light company improved the power of the 532
nm laser up to 80 W KTP and 120 W high-performance
system (HPS) with lithium triborate (LBO).
Photoselective vaporization of the prostate (PVP) is
considered an easy technique creating prostatic fossa
resembling TURP.
Indications of PVP:
1) Prostates larger than 80 ml can be done.
2) Patients with a high risk.
3) Elderly aged 80 years or more.
4) Anticoagulant users .
67. Laser vaporization of the
prostate
Surgical technique:
Vaporization is started at the 6 o'clock position or at one
of the two lateral lobes of the prostate.
Effective lasing makes many air bubbles.
A Foley catheter is placed for less than 24 hours before a
voiding trial is done.
Advantages
No significant blood loss or fluid absorption was noted
during or immediately after PVP.
Side effects transient hematuria (8.6%), dysuria (9.3%)
and urinary retention (5%).
68. Laser resection of the prostate
It is based on the principle of laser vaporization.
Holmium: YAG is the most widely used laser for this
technique.
Surgical technique
the laser fiber cuts the prostatic lobes into pieces small
enough to be evacuated through the resectoscope
sheath to create a TUR-like cavity.
69. Laser enucleation of the prostate
(with tissue morcellation)
Indication:
Alternative to open prostatectomy in large prostates.
Surgical technique
Bilateral bladder neck incisions from orifices to veru.
The median lobe is enucleated then the lateral lobes.
Prostate tissues in the bladder are fragmented and
aspirated with the morcellator.
Adverse effects:
Recatheterization (2.9%), UTI (2.3%), urethral stricture or
bladder-neck contracture (3.2%) and reoperation (2.8%).
70. Laser incision of the prostate
• based on the principle of tissue vaporization
• a contact-tip laser fiber is used to deliver high
energy along the prostatic urethra, causing a linear
tract of tissue vaporization.
• It is performed on relatively small glands (< 30 g).
71. INTERSTITIAL LASER COAGULATION
A standard cystoscope is used to insert
the laser fiber transurethrally into the
prostate gland.
The intraprostatic temperature reaches
100°C within a few seconds and is
maintained for150 seconds resulting in
tissue coagulation.
Adverse Effects
Retreatment rate in 16% and UTI in 20%
of patients.
72. Plasmakinetic vaporesection of the
prostate (PKVP)
A new technique based on creating a
plasma arc, vaporizing tissue and achieving
hemostasis to a predictable depth.
73. Plasmakinetic vaporesection of the
prostate (PKVP)
• current is passed through the active electrode of the
device that approaches boiling point and a plasma
corona is formed, creating very high resistance between
the active and return electrodes.
• Tissue entering the corona (lower resistance) is
vaporized and adjacent tissue is sealed up to 0.5 mm.
74. Plasmakinetic vaporesection of the
prostate (PKVP)
Advantages of PKVP
1) The bipolar current and the use of saline irrigation
eliminates the risk of TUR syndrome.
2) Hemostasis is achieved to a predictable depth.
3) The working element is the return electrode , thus,
eliminating the risk of skin burns and obturator jerk.
4) Safe to be used in patients with cardiac pacemakers.
5) used in high risk patients, patients with bleeding disorder
and patients receiving anticoagulative therapy.
Disadvantages of PKVP
It does not provide histopathological specimens which
may miss incidental cancers.
75. Trans-urethral resection in saline
(TURis)
• Using a bipolar electrode this technique
allows working with saline medium.
• The technique offers familial technique
with minimal bleeding and use in high risk
patients with cardiac pacemakers and
arrhythmias.