Articles

Day Case Prostate Operation- “the Weight is Lifted!”

Enlarged Prostate Treatment

Prostatic enlargement is one of the most common problems encountered in men. Around 50% of men in their 50s will have a prostate Enlargement. Half of those require medical treatment. If medicine fails then surgery is the solution.

However, men would be keen to avoid the most common side effects of prostate surgery. These are Mainly dry orgasm and urinary incontinence. Of course, men would be very keen to go back to their normal activities as soon as possible.

What are the side effects of prostate surgery?

There are several types of surgery for prostate enlargement. All have side effects including hospital stay and urinary catheterization, and the above-mentioned side effects.

What Is UroLift?

A few years back a new method has emerged. The concept of which included simply pinning the prostate lobes to the side, hence, opening the occlusion created by the prostate Enlargement. This is called prostatic urethral lift, or UroLift.

What are the Benefits of UroLift?

The whole process would take up to 15 minutes. The patient is hardly in need of a urinary catheter afterward. Most would go home on the same day. They would return to their daily activities almost immediately.

However, When first introduced, the UroLift Procedure was largely rejected, because of a lack of knowledge for the long-term effects.

Since then, several trials were carried out and the results were outstanding. The procedure proved its efficacy, safety, and tolerability.

Patient satisfaction was phenomenal. The objective results of the operation including the IPSS score and the flow rate were significant.

UroLift procedure has proven to be even safer for men who are high-risk surgical candidates.

This procedure is simply revolutionary. Intermediate-term results are very encouraging. Long-term effects are still awaited

For Enlarged Prostate Treatment and more information, book an Appointment with Dr. Ali Thwaini on +971 50 435 4853. 

Li-ESWT with Regenerative Medicine in ED

English


Erectile dysfunction (ED) is a very common health problem that affects a large proportion of men. The word “40 over 40” stands true. Various causes leading to various treatments for ED have been highlighted and adopted respectively. Most, if not all, are situational and not permanent ( apart from modifying lifestyle and care about Men’s health). 

Regenerative therapies for ED


Therefore, additional treatments are being investigated, including regenerative therapies. Regenerative therapies aim to restore function via replacement or regeneration of human cells, tissues, or organs. Regenerative therapies for the treatment of ED include low-intensity extracorporeal shockwave therapy (Li-ESWT).

Benefits of Li-ESWT


Li-ESWT began to be explored as an alternative means of treating ED,33 with the first randomized controlled trial (RCT) published in 2012. The benefits of Li-ESWT stems from its ability to induce microtrauma. A shockwave is a type of longitudinal acoustic wave that is composed of three sequential parts: a short pulse, a rapid increase to max positive acoustic pressure (the “shock”), and a prolonged period of negative pressure.

Stem Cell Therapies (SCT)


On the other hand, stem cell therapies (SCT) seek to harness the regenerative potential of stem cells for the repair of injured or damaged tissues. The utilization of adult stem cells has allowed for easier access to stem cells, leading to a higher likelihood of utility in regenerative medicine.


Since the causes of ED are numerous and include damage to the neurovascular bundle or neuropraxia during radical prostatectomy nerve damage, endothelial dysfunction, and oxidative stress in the setting of diabetes mellitus, SCT has gained a lot of interest in this field.


As opposed to PRP, several studies have evaluated the efficacy of SCT for the treatment of ED in humans, with promising results.


The combination of Li-ESWT and SCT in ED is an emerging concept. For stem cells to reach the affected tissues, and to accept their actions via paracellular and intercellular signals, they have to be “led” to the affected tissues. One method is to induce an acute micro-trauma to the targeted tissues allowing them to release their attractive signals for the relating cells, of more importantly here, the stem cells, to accumulate in that particular area and exceed their restorative tasks. Animal studies have already proven this concept. Human trials are awaited. Food for thought..

Reference : journals.sagepub


Arabic

Li-ESWT مع الطب التجديدي في الضعف الجنسي

ضعف الانتصاب (ED) هو مشكلة صحية شائعة جدًا تؤثر على نسبة كبيرة من الرجال. كلمة “40 فوق 40” صحيحة. تم تسليط الضوء على الأسباب المختلفة التي أدت إلى علاجات مختلفة للضعف الجنسي واعتمادها على الاسباب. معظمها ، إن لم يكن كلها ، ظرفية وليست دائمة (بصرف النظر عن تعديل نمط الحياة والاهتمام بصحة الرجل).

لذلك ، يتم التحقيق في علاجات إضافية ومستديمة ، بما في ذلك العلاجات التجديدية. تهدف العلاجات التجديدية إلى استعادة الوظيفة عن طريق استبدال أو تجديد الخلايا أو الأنسجة أو الأعضاء البشرية. تشمل العلاجات التجديدية لعلاج الضعف الجنسي علاجًا منخفض الكثافة بالموجات الصدمية خارج الجسم (Li-ESWT).

بدأ استكشاف Li-ESWT كوسيلة بديلة لعلاج الضعف الجنسي ، مع أول تجربة ذات ادله (RCT) نُشرت في عام 2012. تنبع فوائد Li-ESWT من قدرته على إحداث الصدمات الدقيقة. موجة الصدمة هي نوع من الموجات الصوتية الطولية التي تتكون من ثلاثة أجزاء متتالية: نبضة قصيرة ، وزيادة سريعة إلى أقصى ضغط صوتي إيجابي (“الصدمة”) ، وفترة طويلة من الضغط السلبي.

من ناحية أخرى ، تسعى علاجات الخلايا الجذعية (SCT) إلى تسخير الإمكانات المتجددة للخلايا الجذعية لإصلاح الأنسجة المصابة أو التالفة. توجيه استخدام الخلايا الجذعية البالغة بالوصول السهل إلى الخلايا الجذعية ، يؤدي إلى زيادة احتمالية الاستفادة منها في الطب التجديدي.

نظرًا لأن أسباب الضعف الجنسي عديدة وتشمل تلف الحزمة الوعائية العصبية أو الأعصاب أثناء تلف الأعصاب الجذري للبروستاتا ، والخلل البطاني ، والإجهاد التأكسدي في حالة مرض السكري ، اكتسبت SCT الكثير من الاهتمام في هذا المجال.

على عكس PRP ، قيمت العديد من الدراسات لفعالية SCT في علاج الضعف الجنسي لدى البشر ، مع نتائج واعدة.

يعتبر الجمع بين Li-ESWT و SCT في ED مفهومًا ناشئًا. لكي تصل الخلايا الجذعية إلى الأنسجة المصابة ، وباستثناء أفعالها عبر الإشارات بين الخلايا والداخلية ، يجب “توجيهها” إلى الأنسجة المصابة. تتمثل إحدى الطرق في إحداث صدمة صغيرة حادة للأنسجة المستهدفة مما يسمح لها بإطلاق إشاراتها الجذابة للخلايا ذات الصلة ، والأهم من ذلك ، الخلايا الجذعية ، لتتراكم في تلك المنطقة بالذات وتتجاوز مهامها التصالحية. لقد أثبتت الدراسات التي أجريت على الحيوانات بالفعل هذا المفهوم.

UTI in Pregnancy Dr.Ali Thwaini Urologist Dubai

UTIs during pregnancy are not uncommon and increase the risk of developing pyelonephritis, which is associated with an increased risk of fetal loss, premature delivery, and low birth weight babies. Screening can reduce the risk of this.

All women should be screened for asymptomatic bacteriuria at the 1st antenatal appointment

Symptomatic bacteriuria occurs in 17-20% of pregnancies. There are pathophysiological grounds to support a link to pre-labour,

premature rupture of membranes (PROM) and pre-term labour. Untreated upper UTI in pregnancy also carries risks of morbidity and rarely mortality to the pregnant women 

Physiological changes in the pregnant woman make her more likely to suffer both asymptomatic bacteriuria (AB), and urinary infection (cystitis, pyelonephritis).

2-9% of women are bacteriuric in the first trimester. 10-30% of women with bacteriuria in the first trimester develop upper urinary tract infection in the second or third trimester

High fever, whether caused by UTI or other infection, is associated with foetal loss, at any stage in pregnancy.

Benefits of screening for asymptomatic bacteriuria:

Early screening for and treatment of asymptomatic bacteriuria in pregnancy has maternal and foetal benefits.

A Cochrane review of 14 randomized trials of asymptomatic bacteriuria in pregnant women compared the antibacterial therapy to that with placebo or no treatment. The Cochrane review showed that antibacterial therapy was significantly more likely to clear asymptomatic bacteriuria, to lower the incidence of pyelonephritis, and to reduce the rate of preterm delivery or low birth weight babies.

Screening for asymptomatic bacteriuria in pregnancy

All women should be screened once for asymptomatic bacteriuria at the

1st antenatal (booking) appointment (NICE recommendation).

Do this by sending an MSU. DO NOT USE DIPSTICKS: they are not sufficiently sensitive.

If positive result, repeat as indicated in the flow chart over the page to ensure first test is reliable , as contamination can occur.

Managing symptomatic bacteriuria

Symptomatic bacteriuria in pregnancy should be treated (see over page for guidance on antimicrobials).

Use near-patient testing with dipsticks to assess the likelihood of UTI. Send urine for culture before starting empirical therapy. Send a repeat sample 7 days after completing treatment as a test of cure.

Antimicrobials for bacteriuria in pregnancy

The choice of antibacterial and the duration of therapy depend on a number of considerations:

  1. The relative contraindications to some antimicrobials in pregnant women (always refer to the BNF)
  2. Resistance of the organisms;
  3. Adverse effect profiles (including propensity to cause C. difficile-
  4. infection).
  5. Use MSU results, when available, to guide therapy even if this entails a change of empirical therapy.
  6. Since most antimicrobials are concentrated in urine, oral therapy is sufficient in most patients

Managing incidentally-found group B streptococcus infection in urine

The antenatal care service should be informed when a group B streptococcus (GBS), Streptococcus agalactiae, is isolated in urine. Women with GBS bacteriuria identified during the current pregnancy should be offered IV antimicrobial prophylaxis during delivery .

GBS bacteriuria, is associated with a higher risk of choriamnitis and neonatal disease. However, it is currently not possible to accurately quantify these increased risks.

Women with GBS urinary tract infection during pregnancy should also receive appropriate treatment at the time of diagnosis as well as IV prophylactic antimicrobials as the time of delivery. Treatment of GBS UTI during pregnancy should be treated as per culture sensitivities. Refer to BNF for further advice on appropriate antimicrobials during pregnancy.

Urine Sampling

The specimen should be mid-stream. Cleansing with water and holding the labia apart are not essential. Use of antiseptics for cleaning the perineum is not

recommended as this can cause false negative culture results. Refrigerate specimens to prevent bacterial overgrowth.

Interpreting a culture result:

The following usually indicates UTI in a patient with urinary symptoms. Higher counts have even higher positive predictive values:

  1. Single organisms ≥ 104 colony forming units (CFUs)/ mL
  2. Mixed growths’ indicates perineal contamination which reduces the significance of the culture. If a culture is still required, an MSU should be repeated with patient counselled on correct sampling technique
  3. Culture results should be interpreted in the light of near-patient dipstick testing.

Microscopy:

Microscopy is not available for the diagnosis of UTI except in children <3years to comply with NICE guidelines. Use near-patient testing with dipsticks to assess the likelihood of UTI, they are as sensitive and specific as microscopy for predicting the presence of infection. Urine microscopy is only performed for? glomerulonephritis, SLE, endocarditis, haematuria, casts, crystals, candiduria and Schistosomiasis and must be specifically requested with the relevant clinical details.

Treatment: please refer to the following chart: