Urethral stricture is an abnormal narrowing of the urethra caused by fibrosis and scarring from injury, infection, or inflammation. It occurs more often in males due to their longer urethra. Clinical features include dysuria, weak urine stream, urinary retention, and urinary tract infections. Management involves temporary measures like catheterization or definitive treatments like dilation, urethrotomy, or open urethroplasty depending on the location and severity of the stricture. Complications can include recurrent strictures, infections, fistulas, and renal impairment if left untreated.
Please find the power point on Urinary Tract Injury (Kidney Injury). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
URETHRAL STRICTURE is the narrowing of urethra that is often due to the scarring as result of infections like STDs, inflammatory processes such as prostate enlargement, trauma, surgical operations like circumcision, kidney stone removal, intermittent or long term catheterization and lichen sclerosis.
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.
Please find the power point on Urinary Tract Injury (Kidney Injury). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
URETHRAL STRICTURE is the narrowing of urethra that is often due to the scarring as result of infections like STDs, inflammatory processes such as prostate enlargement, trauma, surgical operations like circumcision, kidney stone removal, intermittent or long term catheterization and lichen sclerosis.
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.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
Urinary diversion procedures are performed to divert urine from the bladder to a new exit site, usually through a surgically created opening (stoma) in the skin.
These procedures are primarily performed when a bladder tumor necessitates removal of the entire bladder (cystectomy).
Urinary diversion has also been used in managing pelvic malignancy, birth defects, strictures, trauma to ureters and urethra, neurogenic bladder, chronic infection causing severe ureteral and renal damage, and intractable interstitial cystitis and as a last resort in managing incontinence.
There are two categories of urinary diversion:
1. Cutaneous urinary diversion : in which urine drains through an opening created in the abdominal wall and skin.
2. Continent urinary diversion : in which a portion of the intestine is used to create a new reservoir for urine.
easy description of common lut disorders. improvements on the slides accepted. text includes congenital and acquired disorders. more so the causes of bladder outlet obstructions. also management of the disorders are breifly described.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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
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2. Outline
• Introduction
• Anatomy of the urethra
• Aetiology
• Pathogenesis
• Clinical features
• Investigations
• Differential diagnosis
• Management
• Complications
• Conclusion
• References
3. Introduction
• Urethral stricture is an abnormal narrowing or loss of
distensibility of any part of the urethra due to fibrosis
(scar formation) in or around the urethra which can
lead to partial or total obstruction to the flow of urine
through the urethra.
• Urethral stricture could be a result of injury, infection
or inflammation of the urethra.
• Urethral stricture occurs when the urethra heals by
proliferation of fibroblasts which later contract to form
a scar.
4. Introduction
• Urethral strictures are seen more often in males
than females because the males have longer
urethras which are thus more susceptible to injury .
• Urethral stricture is the commonest cause of
urinary retention in tropical Africa.
• Urethral stricture can be seen in any part of the
urethra
5. Anatomy of the Urethra
• The urethra is a vessel transporting urine from the
bladder to external environment during micturition.
• The urethra originates from the neck of the bladder to
the external urethral meatus and has 2 sphincters
• Internal urethral sphincer (smooth muscle)
• External urethral sphincter (skeletal muscle)
• The course of the male and female urethras are different:
• Male Urethra: It is 15-20cm long and also provides an exit
for semen. It has 2 angles:
• Prepubic angle
• Infrapubic angle
6. Anatomy of the Urethra
• The male urethra is divided into 4 parts
i. Pre-prostatic (intramural)
ii. Prostatic
iii. Membranous
iv. Spongy- subdivided into
• Bulbous and
• Pendulous
• Female Urethra: Relatively short (4cm) hence it is
more prone to infection.
• It is located anteriorly to the vagina and posteriorly to
the clitoris.
10. Aetiology
• Urethral stritcure can be caused by the following:
a. Congenital:
Pin-hole meatus
Non-meatal stricture
b. Traumatic:
External trauma
Urethral instrumentation
Foreign body or urethral calculus
Douching in women
c. Postoperative:
Transurethral surgical procedures
Vaginal repair
12. Pathogenesis
• Urethral stricture is due to fibrosis of the urethra or its
surrounding structures.
• When the urethra gets injured due to any of the
factors previously listed, the fibroblasts proliferate
laying down scar tissue and eventually contract to
form scars.
• These scars are what are known as strictures and may
partially or totally obstruct the urethra.
• Most strictures (60-70%) occur in the bulbous urethra
followed by the pendulous urethra and the glandular
urethra.
13. Pathogenesis
• Urethral stricture can result in:
• Dilatation of urethra proximal to the stricture
• Compensatory hypertrophy of the bladder musculature
• Vesicoureteral reflux resulting in hydroureters and
hydronephrosis
• Urine retention increasing risk of infections such as
periurethral abscess (rupture of which can lead to
urinary fistulas), prostatitis, cystitis and pyelonephritis.
14. Clinical features
• Dysuria
• Spraying of urine stream
• Increased frequency of micturition
• Abdominal pain
• Urethral discharge
• Hesitancy
• Dribbling
• Acute or chronic urinary retention
• Extravasation of urine
• Uraemia
15. Clinical features
• On examination, the following may be found
• Periurethral induration
• Periurethral abscess
• Perineal urinary fistula
• Visible/palpable bladder
23. Management
• Temporary measures: These are done as emergency
treatments and also when definitive surgery can't be
done at that moment
i. Urinary retention: Suprapubic cystostomy
ii. Extravasation of urine: Suprapubic cystostomy
iii. Watering can scrotum (perineal urinary fistula):
Suprapubic cystostomy
iv. Uraemia: Suprapubic cystostomy
24. Management
• Specific measures:
Dilatation: Often palliative and can also be curative.
It is done using a bougie at intervals e.g 2 weeks, 1
month, 3 months or 6 months. It is indicated for
passable incomplete strictures.
• Complications include bleeding, clot retention,
urethral rupture, infections, endotoxic shock and
rupture of prostate in patients with prostatic
enlargement.
25. Management
Endoscopic direct vision internal urethrotomy:
Involves incision of the stricture under direct vision
using a urethrotome.
• Indicated for uncomplicated impassable strictures
and not used in cases complicated by fistulae,
extensive fibrosis or calculi
• It is advisable to splint the urethra using a catheter
for 2-7 days or more for difficult cases
• Complications include bleeding, clot retention,
extravasation of irrigation fluid and infections
26. Management
Urethroplasty: This is an open plastic repair of the
urethra.
• Indicated for patients with failed conservative
measures, urethral stricture with extensive
spongiofibrosis, periurethral abscess, very long
complete strictures.
• The urethroplasty done depends on the location of the
stricture within the urethra:
• External meatus-
• meatotomy
• meatoplasty
28. Conclusion
• Urethral stricture develops as result of injury to the
urethra leading to fibrosis and obstruction to flow
of urine through the ureter
• It is commoner in males than in females
• Urethral stricture can result in urinary retention,
infection, periurethral abscess, perineal urinary
fistula, extravasation of urine
