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Tag: Consultant Urologist

The Shortest Distance Between two Points in a Straight Line

Posted on by Dr. Ali Thwaini

Peyronie’s disease is a rather common and potentially debilitating condition for sexually Active men.

What is Peyronie’s disease?

It must be quite unnerving in to wake up on a random morning to see one’s erect penis has “taken a turn”.

While the mainly this condition is idiopathic, some are attributed to various other clinical conditions such as Dupuytren’s contracture.

Painful erections with penile deviation to start with, however, with time, the pain settles leaving behind the penile deviation while erect, which sometimes interferes with sexual activity causing dissatisfaction for the patient and the partner

Treatment

There have been several attempts to treat this condition conservatively and most of these conservative treatments were, at best, equal to placebo.

These have ranged from a variety of supplements like vitamin E, Paraamino Benzoic Acid (Potaba) calcium channel blockers, and even local injection of steroids, with no beneficial effects

Surgical interventions on the other hand provide a definite alternative, however, they come with their inherent side effects.

These are generally divided into penile shortening and penile lengthening procedures;

While the former concentrates on shortening the healthy side of the penis to make it as short as this affected side, this inevitably results in losing some of the erect penis’s length, which all men find unsatisfactory..

Penile lengthening procedures, although seemingly appealing, they have the potential side effect of causing erectile dysfunction as it involves cutting the affected segment that’s responsible for the disease, thus causing the potentially venous leak, which will hinder the erectile process

Recently, there has been some treatment which was initially effective. Collagenase clostridium histolyticum (Xiapex) has been tried with initially promising results, however, due to its significantly high price and the potential side effects of corporal rupture, its use has faded, as with other treatments

Other physical treatments such as external shockwave treatment on Penile remodeling have been attempted with modest results

Regenerative medicine has become a viable alternative in a variety of clinical conditions, and Peyronie’s disease is no different.

Several researchers have attempted the injection of platelet-rich plasma cells (PRP) (with or without hyaluronic acid) into the area of the plaque, in addition to exposing the affected area to shockwave treatment and the results are thus far, promising

It takes one or more sessions depending on the severity of the condition and it is carried out as an outpatient procedure with minimal side effects

The immediate results are encouraging, however, we are still waiting for the intermediate long-term results

Watch the space!

References

Comparison between TRUS and TP: The patient perspective

Posted on by admin

Authors: S.Mustafa, W.Elabroni, A.McAdam,S. Elamin A.Thwaini

Urology Department, Belfast Health and Social Care Trust. United Kingdom

Accepted at the ANNUAL MEETING OF THE IRISH SOCIETY of UROLOGY (ISU)
Friday 23 and Saturday 24 September 2022

Introduction

Prostate cancer is the most common cancer in men with around 47,500 men in the UK diagnosed every year. Diagnostic approaches have evolved throughout the years, with a shift from transrectal (TRUS) biopsies to transperineal (TP) for various reasons. This study focuses on the patient experience of these procedures.

Method

We evaluated men who underwent prostatic biopsies between January 2019 and April 2020. 110 underwent local TP biopsy with a previous history of local TRUS biopsy. We used a modified validated patient-related outcome measure for our questionnaire for our cohort.

Results

The response rate was 78% (N=86). Overall, the majority of respondents (77%) prefer TP over TRUS biopsy. A large proportion, 86%, found TP to be a “minor- moderate procedure” with only 14% viewing it as a “major but tolerable under local anesthetic”. In terms of pain with TP biopsy, 22% of the respondents found the procedure to be completely painless, 43% experienced a little amount of pain, 29% found it to be somewhat painful, and 6% experienced a lot of pain during the procedure. 50% would not have a problem with undergoing a further TP biopsy in the future. Only 9% felt that it would be a major problem for them to undergo further procedures.

Conclusion

Our study demonstrates, that Transperineal Prostate biopsy appears to be preferable with patients having undergone both procedures; with the majority experiencing little or no pain with TP biopsies and a large proportion describing it as a “minor- moderate procedure” that they would not mind undergoing again if needed.

Festive Seasons and their Effects on your Urinary System

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Christmas has just passed and we are still in the partying mode, preparing for the new year. It’s been tough couple of years with yet another wave, albeit less virulent, of COVID’s new disguise; Omicron.

We are on the verge of winning our war against it. It’s indeed worth the celebration. One has to be careful though with the effects of alcohol on our urinary system. The Celebration should not be at the expense of our health and the safety of people around us. Here are some facts about alcohol and its effects on our urinary system.

The effect of Alcohol on the kidneys:

Alcohol alters the filtration function of the kidneys adversely resulting in the reduction of its efficacy, thus rendering them less able to filter the blood.

Alcohol also affects the ability to regulate fluid and electrolytes in the body. It has a natural diuretic effect leading to frequent visits to the toilet after many drinks. This, however, leads to intracellular dehydration, resulting in loss of excess fluid and an Increase in electrolyte concentration in the body.

Regular heavy drinking has been found to double the risk of chronic kidney disease, which does not go away over time. Even a higher risk of kidney problems has been found for heavy drinkers who also smoke.

The Centers for Disease Control estimates that most American adults (two out of three) drink alcohol. Too often, some of these regular drinkers have more than five drinks at one time. In fact, about a quarter of drinkers reported they had done this on at least one day in the past year. “Binge” drinking is even worse. It has harmful effects on the kidney that can even lead to acute kidney failure. A sudden drop in kidney function is called acute kidney failure. This often goes away after a time, but it can occasionally lead to lasting kidney damage.

Added to that is the effect of chronic drinking on the increase in blood pressure resulting in different levels of kidney damage with protein loss in the urine.

Studies have demonstrated the effects of chronic alcohol intake on the cellular structure of the building brick of the kidney; The nephron. It’s been shown that the basement membrane of various aspects of the nephron develops an increase in its thickness, therefore hindering its ability to perform its filtration and concentration functions properly.

The effects of alcohol on the urinary bladder:

Alcohol has a double adverse effect on the urinary bladder: It has a strong diuretic affect leading to excessive frequency and urgency.

It will also lead to dehydration resulting in more concentrated urine, which causes burning of micturition by the concentrated urine.

It has been shown previously by various experiments when the bladder gets distended, the intravesical pressure increases to a peek after which (especially in situations not permitting paying visits to the toilet) the pressure drops down simply due to the thinning of the bladder muscle. This results and the reduction and pressure necessary to generate in order to empty the urinary bladder (law of Laplas).

Also, chronic alcohol intake leads to nerve damage resulting in “alcoholic cystopathy”. This would potentially lead to the current urinary retention.

In summary:

Drinking can be fun in certain cultures, let’s be honest. Excessive alcohol intake can lead to injury, accidents, serious embarrassment and long-term health problems. Even drinking small amounts of alcohol increases your cancer risk.

There are a few tips for those who would enjoy having a drink with their family and friends.

  • Eat before drinking to minimize the direct effect of alcohol on your body.
  • Drink plenty of water.
  • Don’t mix alcohol with sugary or energy drinks.
  • Avoid salty snacks – they will make you thirsty and likely to drink more.
  • Be in control of the number of drinks you take: Set yourself a drinks limit and stick to it. Avoid drinking in rounds (especially with friends who drink too much). Try to finish your drink before you start another, rather than topping up your glass.
  • Slow down when you drink: To keep safe, slow down your drinking to 1 drink per hour. You can do this by:
  • drinking non-alcoholic drinks as well as alcoholic drinks
  • drinking water to quench your thirst before you start drinking alcohol
  • opting for low-alcohol drinks. sipping rather than gulping

Wish you a Happy New Year

References:

Consultant Urologist in Dubai

Posted on by Dr. Ali Thwaini

After graduating from medical school, Baghdad University in 1994, Dr Thwaini relocated to Jordan where he started his career in Urology at the Royal Medical Services, which is a national tertiary referral center.

He acquired FRCS (Ireland) in 1999 and the Jordanian Board in Urology in 2000. He then moved to Abu Dhabi where he worked for three years as a specialist at SKMC. He acquired the Arab Board in Urology in 2001.

In 2004 he moved to the UK, where he finished his MD degree from Queen Mary University of London. His thesis was on prostate cancer.

In 2007 he entered the UK national higher training scheme in urology. This took place in Northern Ireland, where he worked in Belfast City Hospital, Altnagelvin Hospital and Craigavon Hospital, working with regional and national experts in the field. During his training, Dr Thwaini developed specialist interest in urological cancers. He completed his training in 2012 by acquiring the Intercollegiate Specialty Board Certificate in Urology (FRCS-Urology) and he acquired the CCT UK-wide accreditation. Work

Urologist in Dubai

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Dr Thwaini has been working as a consultant urological surgeon with specialist interest in urological cancers, namely in renal cancers. He became the lead for renal cancers in the Belfast Health and Social Care Trust (Belfast City Hospital). This is a tertiary regional referral centre for complex cancer and benign cases.

His main skills are in advanced laparoscopy and renal cancer and renal reconstruction procedures.

Dr Thwaini has travelled on charity trips to west Africa and East Asia along with other Urology colleagues, where they have carried out laparoscopic Urology workshops in those countries.

Recently, Dr Thwaini acquired the International Academy if Penoplasty fellowship from Milan, Italy and he’s certified for penile enhancement procedures. Dr Thwaini is has developed a vested interest in regenerative medicine with its applications in Urology.

Dr Thwaini is also an Honorary Clinical Lecturer at Queens University, Belfast. He is known for his academic contributions throughout his career with over 40 Medline publications in the field, in addition to his contributions in Urology book chapters.

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