














































Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
Chabert in Urology, and my experiences and knowledge attained have been reflected in this book, which I hope will serve as a tool for all medical students.
Typology: Lecture notes
1 / 54
This page cannot be seen from the preview
Don't miss anything!
On special offer
Dr Chabert is a urological surgeon with an interest in minimally invasive surgery and diseases of the prostate gland. His practice is located at John Flynn Hospital, St Vincent’s Hospital and Lismore Base Hospital. He is also an assistant professor at Bond University.
Assistant Professor Charles Chabert
As a final year medical student at Bond University, it was a pleasure working with Dr Chabert in Urology, and my experiences and knowledge attained have been reflected in this book, which I hope will serve as a tool for all medical students. It contains the essential Urology facts that a student must know in a clear and concise format, so enjoy reading.
Nishanth Krishnananthan
Acute Scrotal Pain
Acute Scrotal Pain is the presenting symptom for a wide spectrum of surgical conditions which may present in adolescents to adults. The aim of evaluation is to identify testicular torsion due to the threat of irreversible testicular ischemia and subsequent infarction.
Differential Diagnoses
1. Testicular Torsion (16.0–39.5%)^1 **2. Torsion of Testicular Appendages
IMPORTANT Acute scrotal swelling in children indicates torsion of the testis until proven otherwise^2. Definition:
- Twisting or rotation of the testis on the axis of the spermatic cord. - Surgical emergency as it causes strangulation of the gonadal blood supply with subsequent testicular necrosis and atrophy - Torsion can be partial or complete (vary from 180-720°) Incidence: - Neonates/young adolescents (12-18, with a peak at 14), but can occur at any age. The prevalence is 1 in 4000 males less than 25 yrs old^3. Types:
Presentation:
Definition:
Acute Scrotum Condition Age Cause Onset Tenderness Cremasteric Reflex
Treatment
Testicular Torsion
12 - 18 Bell-Clapper deformity
Acute Diffuse Negative Surgical de-torsion
TTA 7 - 14 Structural predisposition
Acute/ Subacute
Localised (upper pole)
Positive Bed rest + Scrotal elevation
Epididym o-orchitis
18 - 50 C.Trachomatis, E-coli, Viral
Insidious Epididymal Positive Antibiotics
Burgher LCDR SW, Acute scrotal pain , Emerg Med Clinics of North America 1998;16(4):781-809.
J.David, S.Yale, I.Goldman, Urology: Scrotal Pain , PubMed, April 2003; 1(2): 159–160, last viewed June 2010.
S.Young, M.South, Acute Scrotal Pain or Swelling, The Royal Children’s Hospital Melbourne, April 2010, last viewed June 2010. http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5196
Siegel MJ. The acute scrotum. Radiol Clin North Am. 1997;35:959– 976
L.Galejs, E.Kass, Diagnosis and Treatment of the Acute Scrotum, American Family Physician, Feb 1999,
J.Brenner, A.Ojo, A.Middleman, G.Fleisher, M.Torchia, Evaluation of scrotal pain or swelling in children and adolescents, UpToDate, Sept 2008
Dugani S., Lam D, Toronto Notes 2009, Mcgraw Hill Professional; Canada, 2009
Prostate Specific Antigen (PSA)
Prostate specific antigen is a serine protease produced specifically by the prostate. It can be increased by inflammation, benign prostatic hyperplasia (BPH), or by cancer of the prostate.
PSA liquefies the seminal fluid.
PSA is a blood test used to detect early prostate cancer (increased in 25-92% of people^1 ); however elevation of PSA is not specific for cancer; it can also be increased due to inflammation or BPH. Causes for an elevated PSA include: BPH (increased in 30-50% of people^2 ) Recent rectal examination, prostate massage, prostatitis, UTI, urinary catherization, Acute urinary retention, ejaculation and acute renal failure. Evaluation of different aspects of PSA allows improvements in the utility of the test. These include: Age specific value Median value Free-total ratio Velocity, increase the utility of the test PSA density
Age Median PSA Normal Range 40-49 0.7ng/ml 0-2.5ng/ml 50-59 0.9ng/ml 0-3.5ng/ml 60-69 1.4ng/ml 0-4.5ng/ml 70+ 0-6.5ng/ml
(1,2) D.Provan, A.Krentz, Oxford Handbook of Clinical and Laboratory Investigation, 2002, UK, p 90.
(3,4) The Cancer Council Queensland, The Early Detection Of Prostate Cancer in General Practice: Supporting Patient Choice , 2007, last viewed on March 2010.
(5) S.Brosman, Prostate Specific Antigen , E-medicine Urology, April 2009, last viewed on March 24 2010.
(6) S.Parpart, A.Rudis, A. Schreck, N.Dewan, P.Warren, Sensitivity and Specificity in Prostate Cancer Screening Methods and Strategies , Georgia Institute of Technology, April 2007. Agabegi, E. Agabegi, Step up to medicine: Second edition, Lippincott Williams & Wilkins, USA, 2008, p. 289.
(7) M. Longmore, I.Wilkinsons, T. Turmezei, C.Chueng, Oxford Handbook of Clinical Medicine: Seventh Edition , 2007, New York, p. 607,681.
(8) J. Reynard, S.Brewster, S.Biers, Oxford Handbook of Urology: 1st^ edition, 2006, UK, p. 194-198.
(Table) C.Chabert, Laparoscopic Urology Australia, 2010. <http://www.laparoscopicurology.org/Default.aspx?ContentPageName=BPH Enlarged Prostate>
S.Freedland, M.O’Leary, D.Rind, Measurement of prostate specific antigen , UpToDate, Oct 2008, last viewed on March 24 2010.
National Cancer Institute of Health, Prostate-Specific Antigen (PSA) Test, U.S. National Institutes of Health, March 2009, last viewed on March 2010. http://www.cancer.gov/cancertopics/factsheet/Detection/PSA
Bladder calculi The presence of these complications requires to bladder outlet surgery.
The prognostic features for BPH progression are:
Clinical assessment includes an abdominal examination and a digital rectal examination (DRE). A DRE should be done to assess prostate size and consistency, to detect nodules, indurations, and asymmetry. The prostate is usually smooth, rubbery and symmetrically enlarged in patients with BPH (median sulcus remains palpable).
Investigating BPH includes combining History and DRE with Urinalysis, Blood tests, Imaging and occasionally a cystoscopy.
Treatment for BPH involves conservative measures, pharmacological treatments or surgical interventions depending on the severity of symptoms and degree of bother.
medical treatment and has greater efficacy when combined with Alpha-1 blockers.^9 SEs: Impotence, decreased libido. 3 Surgical Treatments Green Light Laser Prostatectomy : Minimally invasive option with lower incidence of complications when compared to TURP. TURP (Transurethral resection of the prostate). Open Prostatectomy
(1) Andrology Australia URL: <www.andrologyaustralia.org>
(2) McNeal JE, Redwine EA, Freiha FS, Stamey TA. Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol. Dec 1988;12(12):897-
(3,4) R. Leveillee, V.Patel, V.Bird, C.Moore, Prostate Hyperplasia, Benign , in E-medicine, June 2009, last viewed March 2010. http://emedicine.medscape.com/article/437359-overview
(5) Dugani S., Lam D, Toronto Notes 2009, Mcgraw Hill Professional; Canada, 2009 G.Cunningham, D.Kadmon, M.O’Leary, D.Rind, Epidemiology and pathogenesis of benign prostatic hyperplasia, UpToDate, Oct 2008.
(6) Barry, MJ, Fowler, FJ Jr, O'Leary, MP, et al. The American Urological Association Symptom Index for Benign Prostatic Hyperplasia. J Urol 1992; 148:1549. Lippincott Williams and Wilkins
(7) URL: http://www.nutrition2000.com/Q&A_BPH.cfm
(8) G.Cunningham, D.Kadmon, M.O’Leary, D.Rind, Medical treatment of benign prostatic hyperplasia, UpToDate, Oct 2008.
(9) American Urological Association Education and Research, Inc., 2003, last viewed March 2010. <http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/bph- management/chapt_1_appendix.pdf>
(Image) C.Chabert, Laparoscopic Urology Australia, 2010. <http://www.laparoscopicurology.org/Default.aspx?ContentPageName=BPH Enlarged Prostate>
McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia , N Engl J Med. Dec 18 2003;349(25):2387-
G.Gerber, Enlarged Prostate, in E-medicine Health, March 2009, last viewed March 2010. http://www.emedicinehealth.com/enlarged_prostate
McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. Feb 26 1998;338(9):557-
F.Gardiner, Prostate Enlargement Fact Sheet, Andrology Australia, March 2006. http://www.andrologyaustralia.org/docs/Factsheet_ProstateEnlargement.pdf
G.Cunningham, D.Kadmon, M.O’Leary, D.Rind, Clinical manifestations and diagnosis of benign prostatic hyperplasia, UpToDate, Aug 2008.
Madersbacher S, Marszalek M, Lackner J, Berger P, Schatzl G. The long-term outcome of medical therapy for BPH. Eur Urol. Jun 2007; 51(6):1522-33.
P. Kumar, M. Clark, Kumar and Clark: Clinical Medicine Sixth edition, Elsevier Saunders, United Kingdom, 2006, p. 685.
G.Cunningham, D.Kadmon, M.O’Leary, D.Rind, Surgical and other invasive therapies of benign prostatic hyperplasia , UpToDate, March 2008.
(1) C.Chabert, Laparoscopic Urology Australia