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Urology Men’s Health

Urology Men’s Health. GPVTS Mr Rob Brierly Consultant Urologist Ipswich Hospital. Urology for GPVTS. Frank Haematuria Microscopic Haematuria Lower Urinary Tract symptoms BPH and medical treatments Overactive bladder Nocturia PSA Prostate cancer ED medical treatments

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Urology Men’s Health

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  1. Urology Men’s Health GPVTS Mr Rob Brierly Consultant Urologist Ipswich Hospital

  2. Urology for GPVTS • Frank Haematuria • Microscopic Haematuria • Lower Urinary Tract symptoms • BPH and medical treatments • Overactive bladder • Nocturia • PSA • Prostate cancer • ED medical treatments • Testis lumps and chronic pain

  3. Haematuria • 65 year old recently retired Solicitor, reports 2 episodes of passing blood in his urine while on a golfing holiday last month. He has not had any further problems, but his wife insisted that he should come and see you for a check up.

  4. Dipstix Haematuria • 50year old man, a new patient to the practice. Previously fit and well. 2+blood on urine Dipstix • What if he is 25 years old?

  5. Lower Urinary Tract Symptoms • 65 year old man complains of gradually worsening urinary symptoms over the last couple of years. Gets up to pass urine at least 2X per night. He has noticed that his flow is weak and slow to start. He seems extremely anxious.

  6. International Prostate Symptom Score (IPSS) • If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that ? “Delighted, Pleased, Satisfied, Mixed, Dissatisfied, Unhappy, Terrible”

  7. BAUS gudelines for management in Primary care

  8. LUTS • 60 Year old man with 1year history of hourly daytime frequency with urgency and 1X nocturia.

  9. LUTS 2 • 80 year Old man history of worsening Nocturia 6 or 7 times at night.

  10. PSA • 45 year old patient requests PSA test. He saw a poster for Prostate cancer Awareness in your waiting room.

  11. PSA • 63 year old fit and well man has longstanding mild lower urinary tract symptoms (LUTS). • DRE moderately enlarged (25cc) smooth benign feeling prostate. • PSA 6.7

  12. Age-related PSA Age (years)Reference range (ng/ml) 40-49 0-2.5 50-59 0-3.5 60-69 0-4.5 70+ 0-6.5

  13. PSA The Diagnostic Triad in Prostate Cancer

  14. Albertsen P et al, JAMA 1998Connecticut

  15. Risk stratification for localised disease

  16. Prostate Cancer • 80 Year old man presents with new onset back pain and some difficulty passing Urine. Rectal exam shows a hard craggy mass in the prostate and PSA is 350.

  17. Erectile Dysfunction • A 60 year old business man has been unable to get a sustainable erection for last 6 months. He is concerned because he has a much younger wife and he feels that it is affecting their marriage.

  18. Investigations • Essential • Glucose • Guided • Testosterone • Other endocrine • Lipid and cholesterol • Cardiovascular

  19. Side-effects • Flushing • Headache • Visual disturbance • Stuffy nose • Dyspepsia • Back pain and myalgia

  20. Usage • Caution • IHD • Nitrates inc. Nicorandil • Retinitis pigmentosa • Risk of priapism: Sickle cell, myeloma, leukaemia • Significant Peyronie’s

  21. Ischaemic Heart Disease • Marginal increased risk 2 hours following sex • No exercise ischaemia= No sex ischaemia • Golden Mile • After recent Stroke • Recent MI • Unstable angina • Congestive cardiac failure / Severe valve disease • Complex arrythmia

  22. Chronic Testis pain • A 30 year old body builder and gym enthusiast. Has noticed an ache in his left testicle on and off for the last year. He is especially anxious because when he examined himself in the bath last night, he thought he could feel a lump.

  23. THE END THANK YOU

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