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Platelet-rich plasma cells with Low-Intensity Shock Wave for the Treatment of Male Erectile Dysfunction

Posted on by Dr. Ali Thwaini

Background

Male erectile disorder is becoming an endemic entity with more than 40% of men at the age of 40 being affected by this condition.

There are several aspects that led to this abundance. Mainly, the adoption of a sedentary lifestyle and associated medical conditions like diabetes and hypertension. This is obviously associated with bad social, habits such as smoking, and excessive drinking.

Thankfully, medical treatment has evolved in the past three decades to solve this problem, largely, however, many men feel stigmatized by their dependence on these tablets to maintain, and potentially improve their sexual function, and increasingly men are seeking natural and more durable solutions to cure the current problem and restore their manhood.

The human body is a dynamic entity with cells ever regenerating and replacing the dead ones. Different parts of the body regenerate at different rates, and the fuel for that process is normally the stem cells and other associated factors.

While these are mainly of embryonic origin. Recent evidence, however, showed the abundance of the cells and adults as well, mainly from the fat cells, and the bone marrow.

The utilization of cells in various aspects of the body is a novel field with very promising results.

One of the aspects of regenerative medicine is the utilization of platelet-rich plasma, cells to treat various clinical conditions.

Please let rich plasma contains mainly the liquid portion of the blood that contains various growth factors in addition to an important component of the blood cell. Platelets. For their clotting abilities, however, they contain a significant amount of growth factors that will help repair and regeneration. Of various injured organs.

To increase the concentration of the cells we tend to centrifuge the body at various speeds. This leads to the separation of the important components that can be utilized later for treating various conditions of which erectile dysfunction is one.

Since this is an oval technology, there has been a lot of skepticism us to the scientific application and the success of this procedure.

However, recent, emerging evidence, published and a midline journal, provided a good demonstration to the success of this procedure. Researchers did a prospective trial on 60 patients equally randomize between two groups.

 Those who received PRP showed significant improvement of their sexual function as opposed to the placebo group.

Low-Intensity Shock Wave Therapy (Li-ESWT)

This relatively new modality of treatment is gaining acceptance with encouraging intermediate-term results, as proven by their approval as part of the urology guidelines.

Shock waves appear to induce micro trauma to the tethered tissue hence, stimulating vascular flow and erectile function and one possible mechanism of action is through an endogenous stem cell-mediated regenerative effect. This microtrauma not only stimulates the local regenerative process, but the resultant signals act as a lighthouse for the ADCs to reach and synergistically enhance the local regenerative and repair process in the penile corpora.

Future studies are needed in the form of placebo-randomized trials to establish better the effects of platelet-rich plasma, cells combined with shock waves on ED.

References:

Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial

Evangelos Poulios et al. J Sex Med. 2021 May.

Renal cancer The silent killer

Posted on by Dr. Ali Thwaini

Renal Cancer is one of the come in urological counters affecting people are different stages of their lives. There are about 75,000 renal cancer new cases diagnose every year the United States Constitution saying about 5% of all other cancers and women are equally affected. While there are no definite predisposing factors to the development of renal cancers, There is a weak link between obesity and hypertension and, of course, smoking, to the development of real Cancers.

Most are diagnosed Anecdotally, however, some Are hereditary. Such as VHL disease. Before the advancements in medicine and surgery, kidney cancers were diagnosed rather late and patients were beyond the stage of cure. Due to the rightfully low thresholds and imaging, most of these cancers tend to be diagnosed incidentally and in early stages, Hence the name “incidentalomas”.

The benefits of early diagnosis of kidney cancer Are multifactorial; With early diagnosis, Tumors tend to be at a very early stage And patients are being offered kidney Sparing operations. This type of treatment has the potential of preventing The development of chronic kidney disease. Also, when the tumors are diagnosed at an early stage, especially in people who are high-risk surgical candidates, there is the option of minimally invasive treatment, in the form of the use of high or low temperatures to remove the cancer cells; this is in the form of radiofrequency ablation, Microwave ablation, And cryoablation. These methods have safe, proving their efficacy and safety.

The third benefit of diagnosing early kidney cancer is having a chance to follow them up closely In order to understand the biology of the disease. Several studies have shown that small kidney cancers tend to grow at a very slow pace the elderly and there is an option of active surveillance in this particular cohort of patients. Having said all the above, nephron-sparing surgery remains the gold standard in early localized kidney cancers, especially when technically feasible and safe. Surgery, on par with Medicine, has significantly progressed, and we have moved from open surgery to laparoscopic and then robotic surgery. While all options have proven their Efficacy in curing kidney cancer, the latter two surgical options have proven their safety and efficacy in providing an early return to normal function with less perioperative complications.

At Mediclinic and City Hospital, all the above modalities are available in treating kidney cancers and Patient’s are well managed by the multidisciplinary team to make their journey through illness and recovery as short and smooth as possible.

Fasten your Belt

Posted on by Dr. Ali Thwaini

Health is becoming more of a common topic with the vast majority of people being more involved and interested in promoting thief own health and well-being.

So many dietary regimes have been practiced and many have quickly risen and similarly faded away.

Few have remained, and lesser are now gaining popularity to almost becoming the lifestyle for many.

I’m going to talk about two types

Intermittent fasting

Intermittent fasting is one of the most popular programs being adopted by people all over the world.

There are several forms of intermittent fasting (IF). The principle is adopting fasting periods beyond the duration of an overnight fast and restricting feeding time windows, with or without caloric restriction.

A few examples are below:

Time-restricted feeding/eating (TRF), eating is limited to a certain number of hours each day.

Alternate-day fasting (ADF) as the name applies, consists of alternating days of feasting and fasting —feasting is compatible with liberal energy intake during 24 h and fasting implicates a restricted caloric intake ≤ 25% of daily needs ( less than 600 kcal during 24 h)

intermittent energy restriction (IER): It includes periods of energy restriction alternated with periods of habitual intake or minimally restricted dietary intake, allowing wider food choices. This approach helps “cheating” our metabolic rate to avoid going into starvation mode and keep burning calories.

continuous energy restriction (CER) for improving body composition. This has the potential of steering our metabolism to a slow energy-conserving mode. Thus, after an initial satisfactory weight loss, it becomes challenging to shed off more weight. Hence, this method is better avoided.

The ultimate goal of most IF regimens is to improve body composition. For this reason, they are suggested to maximize the loss of fat mass (FM), while attempting to preserve fat-free mass (FFM).

There is compelling evidence that IF elicits reductions in body weight and FM of ~3–8%, Improvements in blood lipid profile, blood pressure and insulin sensitivity.

Whist IF has recently emerged and increasingly gained popularity, its possible predecessor has been around for about 1400 years.

Ramadan fasting

During the 9th month (Ramadan) of the Islamic calendar (Hijra) many millions of adult Muslims all over the world fast during the daylight hours. Since Hijri calendar is 11 days shorter, Ramadan occurs at different times in the seasonal year over a 33-year cycle.

During Ramadan, Muslims abstain from ingesting food and liquids between sunrise and sunset throughout a month-long period. Thus, food and liquid intake become exclusively nocturnal.

Ramadan fasting (RF) can last ~12–18 h/day, depending on the geographic location and season of the year. Reductions in body weight, relative FM, and resting metabolic rate are common consequences of RF. It has also been shown that RF decreases total cholesterol, low-density lipoprotein (LDL), and fasting blood glucose levels. In parallel, RF seems to improve body composition, possibly through enhancements in the ability to mobilize saturated fatty acids for metabolic processes.

In the general population, weight loss subsequent to RF is largely caused by the unconscious restriction of food intake.

In addition, there is a metabolic shift toward the predominant use of fatty acids as fuel for adenosine triphosphate (ATP) synthesis during RF and this lowers body fat.

However, despite representing an important opportunity for some people to lose bodyweight and FM, the adaptations inherent to RF are typically transient and largely reversible within a small amount of time.

Thus, the prescription of maintenance strategies at the termination of Ramadan is of extreme value for the long-term preservation of healthy body composition.

Fluid intake during Ramadan

Water, which makes up around 70% of our bodies, is the most important fluid that replenishes our thirst and energy, especially during the month of Ramadan. Studies have shown that reduced intake of water affects our bodies on a cellular level and causes problems in their proper functioning because dehydration has many adverse side effects such as constipation, headaches, dizziness, tiredness, and dry skin.

During the daylight hours of RF, practicing Muslims are undoubtedly dehydrating, but it is not clear whether they are chronically hypohydrated during the month of Ramadan. No detrimental effects on health have as yet been directly attributed to negative water balance at the levels that may be produced during Ramadan.

Not only is water important for weight loss and maintenance, it also helps to get rid of harmful toxins and reduce the feeling of hunger. Due to these and various other reasons, it is imperative that we keep ourselves properly hydrated throughout the day.


Here are a few pointers to help you out:

Increase water intake
Drink at least eight glasses of water every day. If you are exercising or are outdoors in hot weather, you’ll sweat more and lose more fluids. So, ensure you increase your water intake to make up for this excessive loss.

Avoid salty food
Reduce the amount of salt in your food, as foods containing high volumes of sodium trigger thirst throughout the fasting hours of the day.

Add fruits and vegetables to your meals
Eat fresh fruits and vegetables instead of salty foods because they are rich in water and fiber. They stay in the intestines for long, retaining water and hence suppressing your thirst.

Avoid drinking large quantities in one go
Refrain from drinking large quantities of water all at once or a lot during a meal. Instead, have small sips during the meal and drink water in between your meals between sehr and iftar.

Avoid juices and sugary fluids
Do not drink juices to break your fast as it contains high amounts of sugar leading to weight gain. Instead, try and stick with just water.

Add dates to your Iftar menu
Break the fast with dates. Not only is this a tradition because that’s how the Prophet Muhammad (PBUH) broke his fast; dates also help with hydration since they are a natural source of glucose, which encourages your cells to store fluid and fuel for energy.

Ramadan Mubarak!

References:

Frontiersin

Nature

islamicfinder

Invasive treatment of symptomatic prostatic enlargement. Many ways to skin a cat

Posted on by Dr. Ali Thwaini

All men have prostate. Half would develop a prostate enlargement in their fifties. Half of those will develop symptoms. Divide those by two, and the resultant number would represent those who need medical treatment. It goes on, with half of those in whom medical treatment fails, necessitating an intervention.

Treatment of Symptomatic Prostate Enlargement

Surgery has progressed in the past century, from open, to endoscopic, to laparoscopic and now the robotically performed operations.

To manage a benign prostate enlargement, and for the past few decades, transurethral resection (TURP) has always been the gold standard and the benchmark against which other modalities are compared to.

If you imagine a timeline for the evolution of benign prostate interventions, you’d see not infrequently, many have evolved across the decades, most of which disappeared for a variety of reasons; some from lack of producing similar ( let alone better!) results than the gold standard TURP, others failed due to inferior long term results. Others were simply non financially viable.

Some of the examples are the transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA), etc.

LASERs have entered this race, some as strong contenders, such as the Holmium laser (HOLEP, HOLERP), Greenlight laser ( stumbled initially but managed to pull through after enhancing its technology rendering better results). Thulium laser is another appealing technology.

Then came the vaporization (RESUM); it is a promising technology and it stands head and shoulder above the rest with its claims to preserve the ejaculatory function, being safe and bloodless. It can be carried out as a day case, which makes it very attractive in healthcare systems that struggle for hospital beds. The caveat is the severe storage symptoms that men suffer from in the first few days-weeks, during the shedding of the dead prostate tissues from the vaporization. Men would have to stay with a catheter for some time, which many, would find unacceptable.

However, for any problem, there is a potential solution. The EXIME short-term urethral stent would indeed sort out the severe storage symptoms ( in principle) by keeping the prostatic urethra patent during the sloughing period. However, while mechanically offering to keep the urethra patent, will it dampen the severe storage symptoms arising from the inflammatory response to the treatment? This needs to be prospectively assessed.

Last but indeed not least, is the UroLift. This one differs from all the other modalities (even including the gold standard) is the mere reliance on mechanically squeezing the prostatic lines thus creating a wider urethral channel for men to pass urine. No chipping, frying or freezing of any tissue, hence, one can assume that any inflammatory response ( if occurred after this procedure) should be trivial. It also preserves the ejaculatory function.

Now the challenges.. it is good for moderate-sized prostate and preferably with no median lobe. Other prostate sizes or shapes could impose a challenge.

It’s not cheap!

The learning curve is short, and its intermediate results are encouraging, awaiting long-term results. It per se does not preclude other modalities if it didn’t serve the purpose or if the symptoms recurred after some time.

Objective

In conclusion, there are several ways indeed “to skin the cat” none is perfect. One treatment can’t fit all conditions.

At the age of 51, and that’s my own personal opinion, if ( or should I say when!!) I need a prostate intervention, I’d probably go for the UroLift, knowing that it would, at least, buy me time until I’m less interested in preserving other functions, then I would go for other modalities ( possibly newer ones yet to be invented!).

Reference:

Soum Lokeshwar, David Valancy, Thiago, Fernandes Negris Lima, Ranjith Ramasamy. A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH. Current Urology Reports

Sparing the Nephron and Sparing Life

Posted on by Dr. Ali Thwaini

Nephron sparing surgery

Nephron sparing surgery has gained wide acceptance in the past decade or so. After being considered mainly for absolute and some relative indications ( single anatomical or functioning kidney or bilateral renal disease that renders the patient with long-term effects from chronic kidney disease), partial nephrectomy has now topped up the radical nephrectomy in many situations.

Nowadays the most common indication for partial nephrectomy is an elective one ( in the presence of a normal contralateral kidney and a normal overall kidney function.

What are the complications of nephrectomy?

However, there are risks associated with this procedure. Being a very vascular structure, cutting through kidney tissue would inevitably result in bleeding that could be excessive at times. To minimize it, the blood supply is cut during excising the tumour, which should not take more than 30 minutes ( some say 25 min), longer ischemia would result in damage to the remaining kidney tissue.

The other complication is a urine leak. This mainly occurs with complex kidney tumours that are too close to the renal collecting system. This would be at risk of being breached during the time-limited resection and despite an operative repair, still, urine leak might still happen, which would potentially take a longer time to heal and potentially need other procedures. Thirdly, cancer control; tumours should be removed with a clear margin. This traditionally was “estimated” to be 1 cm. Evidently, these large clear margins are not indicated, and wasteful of normal precious kidney tissue. This has now decreased to as little as 1mm.

On the other hand, as much as 20-30% of small renal masses could have a benign nature to them, and active surveillance is now becoming a strong contender to partial nephrectomy, especially in relatively older people who aren’t or are unwilling to go for major surgery. One should not be deceived by the word “partial” here! In this context, partial means major.

Partial-Nephrectomy-Ali-Thwaini

Lastly, the dark horse in the race of kidney cancer treatment is the minimally invasive ablative treatment for small renal masses (radiofrequency ablation, cryoablation, microwave).

In summary

Partial nephrectomy is now becoming the gold standard for treating organ confined kidney cancers, when it is technically feasible, and safe to do so.

Having performed over 200 of these procedures, and having harvested the success in most and endured failure of some, along with my patients, I conclude

When offering any kind of treatment, one has to think not only of the organ being treated but health and the quality of life of the human bearing this organ Do No Harm

Penis Enlargement

Posted on by Dr. Ali Thwaini

Penoplasty (male enhancement)

The penile enlargement procedure is seldom discussed. Men in general are private about their privates at the best of times, and when it comes to such an intimate matter, they are even more introvert.

However, the amount of men going for penis enlargement procedures is up. 

A recent UK based study, a general questionnaire was sent to community men of various ages, They found that almost 50% would like a larger penis.

For the last five years, members of the International Society of Aesthetic Plastic Surgery carried out almost 50 000 enhancements worldwide.

There are several procedures that would increase the apparent length and the actual girth of the penis. These, however, are to be tailored to the anatomy of the patient, and also to patient expectations.

It is important to realise that there is no procedure that actually increases the real length of the penis. Penoplasty makes the penis appear longer by repositioning it in relation to the tissues around it.

Penoplasty (Penis Enlargement)

Although there are medical indications for penoplasty. However, these are rare indications, and surprisingly, the majority of men seeking penile enlargement have normal sized genital organs. The reasons for wanting a larger penis are often nothing to do with sexual performance. Most men seek this procedure mainly to enhance the appearances of their flaccid penis size, especially when going to the gym and using communal showers because.

There is a range of procedures. They can be generally split between those increase the length of flaccid penises, or more girth.

One thing you can do is use liposuction on the fat around the base of the penis — if you’ve got four inches of fat there, your penis will look four inches bigger when the fat is surgically sucked out.

The lengthening procedure, however, mainly involves making an incision at the base of the penis in an area that can be easily covered by the hairline, and dividing a ligament which is called the ‘suspensory ligament’ which connects the penis to the pubic bone.”

Once the ligament is cut, the penis will permanently come further out of the body.

Penis Enlargement Surgery

Cutting the ligament means the angle of erection will change so it’s not as upright, and there is a thing balance between cutting too much and too little of this ligament, and a skilled surgeon can keep this change to a minimum so you don’t end up with a downward-pointing erection.

Increasing the penile girth usually involves injecting material into the soft tissue underneath the skin on the penis. The most commonly used material is the patient’s own fat, usually from the abdominal area. There surgeons use a synthetic filler like hyaluronic acid, which is what women use to enhance the lips or fill gaps in cosmetic surgery. Each has its own pros and cons.

Post operatively, me are advised to refrain from having sex for at least about four weeks.

Although these procedures do not actually increase the surest penis length, as they significantly enhance the girth of the flaccid and erect penis, there will be an improvement in overall outcome, with more pleasurable for both partners.

Non-surgical methods for Penile Enhancement

penile enhancement

Non surgical methods for penile enhancement There are several conservative measures that if used properly, might help in gaining some length and possibly strength during erection.

Visit Dr. Ali Thwaini for Penis Enlargement Dubai, Complicated surgery often calls for expert surgeons

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