This document describes uroflowmetry - a noninvasive test used to evaluate urine flow. It discusses the normal and abnormal flow patterns seen in uroflowmetry and their clinical significance. Uroflowmetry provides parameters like maximum flow rate, average flow rate and voided volume. It can detect bladder outlet obstruction, detrusor underactivity or overactivity. However, pressure-flow studies are needed to precisely define lower urinary tract function. Uroflowmetry is useful for screening and monitoring treatment response, though invasive therapy should not be based on uroflowmetry alone per AUA guidelines.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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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
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?
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- Prix Galien International Awards Ceremony
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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.
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.
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
2. Moderators:
Professors:
➢ Prof. Dr. G. Sivasankar, M.S., M.Ch.,
➢ Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
➢ Dr. J. Sivabalan, M.S., M.Ch.,
➢ Dr. R. Bhargavi, M.S., M.Ch.,
➢ Dr. S. Raju, M.S., M.Ch.,
➢ Dr. K. Muthurathinam, M.S., M.Ch.,
➢ Dr. D. Tamilselvan, M.S., M.Ch.,
➢ Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC,
Chennai. 2
3. ➢ Urine flow studies are the simplest of
urodynamic techniques – noninvasive
➢ Equipment is simple and relatively
inexpensive
3
Dept of Urology, GRH and KMC,
Chennai.
4. Definitions
➢ Urine flow - described in terms of flow rate
and flow pattern (continuous or
intermittent)
➢ Flow rate - volume of fluid expelled via the
urethra per unit time and is expressed
in ml/s
4
Dept of Urology, GRH and KMC,
Chennai.
5. ➢ Maximum flow rate (Qmax) - Maximum measured value
of the flow rate
➢ Voided volume (VV) - Total volume expelled via the
urethra
➢ Flow time - Time over which measurable flow occurs
➢ Average flow rate (Qave) - Voided volume divided by
flow time
➢ Time to maximum flow - Elapsed time from onset of flow
to maximum flow
➢ Voiding time - total duration of micturition, including the
interruptions
5
Dept of Urology, GRH and KMC,
Chennai.
6. Intermittent flow - same measurements
are used as for continuous flow curve
➢ However, flow time must be measured
carefully, as the time intervals between
flow episodes are disregarded
6
Dept of Urology, GRH and KMC,
Chennai.
10. Weight transducer flowmeter involves
weighing the urine voided
➢ Calculates the urine flow rate by
differentiation with respect to time
10
Dept of Urology, GRH and KMC,
Chennai.
11. Rotating-disc flow meter
➢ Spinning disc on which the urine falls
➢ The disc is kept rotating at the same speed by a
servomotor, in spite of changes in the urine flow rate
(weight of the urine tends to slow the rotation of the disc)
➢ The differing power needed to keep disc rotation
constant is proportional to the urine flow rate
11
Dept of Urology, GRH and KMC,
Chennai.
13. Normal Flow Patterns
➢ When considering the normal flow rates
⚫ Age and Sex
⚫ Voided volume
should be taken into account
➢ In addition to numerical data , shape of
the trace - important
13
Dept of Urology, GRH and KMC,
Chennai.
14. Normal flow
➢ “Bell” shape
➢ Maximum flow is reached in the first 30% of any trace
and within 5 seconds from the start of flow
➢ Flow rate varies according to the volume voided
➢ The final phase of a normal flow trace shows a rapid fall
from high flow, sharp cutoff at the termination of flow
14
Dept of Urology, GRH and KMC,
Chennai.
15. ➢ Urine flow rate is highly dependent on the volume voided
➢ Detrusor muscle when stretched achieves an optimal
performance, but if stretched further it becomes
inefficient
➢ At more than 400 ml, the efficiency of the detrusor
begins to decrease and Qmax is lower
➢ Flow rates are highest and most predictable in the
volume range between 200 ml and 400 ml
➢ Minimum voided volume of 150 ml is necessary for
accurate assesment
15
Dept of Urology, GRH and KMC,
Chennai.
16. Qmax Vs Voided Volume
16
Dept of Urology, GRH and KMC,
Chennai.
18. Flow rate nomograms
➢ nomograms have been developed to
define normal flow rates for a specified
population and correct flow rate for voided
volume
1.Siroky nomogram for men
2.Liverpool nomogram for men and women
18
Dept of Urology, GRH and KMC,
Chennai.
19. Abnormal Flow Patterns
➢ Urine flow results from the interaction
between the detrusor contraction /
abdominal straining and urethral
resistance
➢ urine flow rates have limitations
which must be appreciated
19
Dept of Urology, GRH and KMC,
Chennai.
20. ➢ Information from urine flow traces, without simultaneous
pressure recording must be interpreted with care
Misleading situations
➢ Patients showing normal flow can have bladder outlet
obstruction when a normal Q max is maintained by
abnormally high voiding pressures
➢ Patients whose low flow rates are due to detrusor
underactivity rather than to bladder outlet obstruction
20
Dept of Urology, GRH and KMC,
Chennai.
22. Bladder Outlet Obstruction (BOO)
➢ Low Qmax and reduced average flow, with the
average flow greater than half the Qmax
➢ Qmax- obtained quickly (3–10 secs), but the flow
rate then decreases slowly
➢ Terminal dribble
22
Dept of Urology, GRH and KMC,
Chennai.
23. ➢ Obstruction may be
⚫ Compressive - Benign Prostatic Obstruction
⚫ Constrictive - Urethral Stricture
➢ Constrictive obstruction - “plateau”-shaped trace with
little change in flow rate and little difference between
Qmax and Qave
➢ Compressive obstruction - first third of the flow trace
may appear relatively normal, Qmax will be reduced,
latter part is elongated into a pronounced “tail” of
reducing flow rate
23
Dept of Urology, GRH and KMC,
Chennai.
26. Detrusor Underactivity (DUA)
➢ Symmetrical trace with a low maximum flow
rate is seen
➢ Time to reach Qmax is variable , may occur in the
second half of the trace
➢ Considerable overlap between - obstructed and
underactive detrusor group – proof comes from a
pressure-flow study
26
Dept of Urology, GRH and KMC,
Chennai.
28. Detrusor Overactivity
➢ Very high maximum flow rates in abnormally short time
(1 s - 3 s)
➢ Reduction in time to Qmax is achieved because the
detrusor contraction has already opened the bladder
neck widely, hence reducing the urethral resistance.
28
Dept of Urology, GRH and KMC,
Chennai.
30. Interrupted Flow Patterns
➢ Irregular Trace
Secondary to
Straining
⚫ Habitual
⚫ Obstruction
⚫ Detrussor over activity
⚫ Urethral overactivity
⚫ Artefacts
30
Dept of Urology, GRH and KMC,
Chennai.
31. Artefacts
“Cruising”
➢ Caused by men moving their stream in relation to the
central exit from the collecting funnel
➢ “Peaks” occur when the point of impact of the stream is
moving down the side of the funnel towards the central
exit
➢ “Valleys” occur when the impact point is moving
away from the exit
31
Dept of Urology, GRH and KMC,
Chennai.
33. “Squeezing”
➢ In an effort to deny the onset of age (and reducing urine
flow), some men have the habit of squeezing the tip of
their penis or foreskin during voiding
➢ This leads to a series of peaks
➢ When the patient is asked to stop this , the flow trace
usually becomes classically obstructed, and the flow rate
is no longer within the normal range
33
Dept of Urology, GRH and KMC,
Chennai.
35. Indications
➢ Urine flow studies are an excellent screening study in a
wide variety of patients
➢ But they must be followed by pressure-flow studies -
precise definition of bladder and urethral function
➢ Uroflow is used to investigate possible bladder
outlet obstruction and can also give a guide to detrusor
contractility
➢ It can be used for patients of all ages and both sexes
35
Dept of Urology, GRH and KMC,
Chennai.
36. Indications
➢ Uroflow is the screening test of choice in men of
all ages with symptoms suggestive of outlet
obstruction
➢ Uroflow should be measured before and after
any procedure designed to modify the function
of the outflow tract
36
Dept of Urology, GRH and KMC,
Chennai.
37. QMAX
➢ Qmax is below 10 ml/s then the chance of the
patient having BOO is 90%
➢ If the Qmax is 10 ml/s to 15 ml/s then the
incidence of BOO is 71% or less
➢ Because 29% of these patients will not have
BOO, patients with a Qmax of 10 ml/s or more
should have PRESSURE FLOW STUDIES
before invasive therapy
37
Dept of Urology, GRH and KMC,
Chennai.
39. AUA Guidelines
➢ Urinary flow rate measurement is optional
➢ It is useful in the initial diagnostic assessment and during
or after treatment to confirm response
➢ Despite the noninvasive nature of the test and its clinical
value, it is an optional test before embarking on any
invasive therapy
39
Dept of Urology, GRH and KMC,
Chennai.
40. AUA Guidelines
➢ Peak urinary flow (Qmax) is the best single measure to
estimate the probability of a patient to be urodynamically
obstructed
➢ But a low Qmax does not distinguish between
obstruction and decreased detrusor contractility
➢ Because of the intra‐individual variability and the volume
dependency of the Qmax, at least 2 flow rates should be
obtained, ideally both with a volume greater than 150 mL
voided urine.
40
Dept of Urology, GRH and KMC,
Chennai.
42. ICS NOMOGRAM
BOOI = PdetQmax
− 2(Qmax)
Men are considered
obstructed if BOOI is
greater than
40, unobstructed if
BOO is less than 20,
and equivocal if
BOOI is 20 to 40.
42
Dept of Urology, GRH and KMC,
Chennai.
43. BCI NOMOGRAM
the bladder contractility index (BCI), is
➢ given by the formula: PdetQmax + 5(Qmax)
➢ Strong contractility is a BCI greater than 150
➢ Normal contractility a BCI of 100 to 150
➢ weak contractility a BCI of less than 100
43
Dept of Urology, GRH and KMC,
Chennai.