Sunday, April 16, 2017

Summary of uro-oncology by Dr.Ahmed Emam

This is comprehensive summary of urogenital tumors

Prepared and revised by Dr. Ahmed Emam

Wednesday, June 29, 2016

Prostate Cancer After Radiotherapy: Initial Results From the Cryo On-Line Data Registry

The outcomes from this observational study indicate that salvage focal cryoablation can be an effective treatment with encouraging potency preservation for patients with locally recurrent PCa after radiotherapy. However, other morbidity including rectoure- thral fistula and incontinence are not clearly lower than for patients treated with salvage whole gland cryoablation. Studies with longer follow-up, more patients, and direct comparison to salvage whole gland cryoablation are needed before recommending salvage focal cryoablation as a standard treatment option for these patients. Prostate 75: 17, 2015. 

Approximately 25% patients with prostate cancer (PCa) undergo radiotherapy as a primary treatment option according to SEER (Surveillance, Epidemiology and End Results) data [1]. Biochemical failure after radiotherapy for localized PCa can occur in approxi- mately 1060% [24]. The most common salvage treatment for these patients is androgen-deprivation therapy [3]. However, this is not a curative treatment. Furthermore, it can have an impact on quality of life and increase the risk of cardiovascular mortality and skeletal fracture [5]. Many patients with biopsy-proven locally recurrent PCa may be suitable for local salvage therapy with curative intent. Local salvage treatment options include radical prostatectomy (RP), cryo- ablation, high-intensity focused ultrasonography, and brachytherapy.
Since salvage RP is limited in clinical practice due to much higher morbidity than primary RP [6], salvage whole gland cryoablation has emerged as an option with acceptable long-term oncological outcomes and lower side effects. However, significant side effects are possible, including urinary retention (3.08.5%), incontinence (4.413.0%), rectourethral fistula (03.3%), and erectile dysfunction (61.5100%) [7,8,9].
In order to decrease complications of salvage cryoablation, several investigators have tried to apply salvage focal cryoablation to small numbers of patients with biopsy-proven unilateral recurrent PCa after radiotherapy. Salvage focal cryoablation of the prostate for locally recurrent PCa after radiotherapy failure was first reported by Eisenberg and Shinohara in 2008 [10]. Several recent publica- tions also showed encouraging outcomes of salvage focal cryoablation for locally recurrent PCa after radiotherapy failure. However, all these studies had small patientsnumbers (the biggest number is 44 patients) [9,11,12].
In this study, we report the outcomes of salvage focal cryoablation at a large number of academic and community centers that have participated in the COLD Registry. To our knowledge, this is the largest data set assembled for salvage focal cryoablation for the treatment of localized PCa recurrence after radio- therapy. 

Ramadan Kareem

Sunday, August 23, 2015

Voiding dysfunction A Simple Approach Towards Understanding and Management

Voiding dysfunction
A Simple Approach Towards Understanding and Management
by Prof.Dr.Tarek Osman

Tuesday, August 4, 2015

Sexual Intercourse May Clear Distal Ureteral Stones

Yes, it is not a joke. The abstract from pubmed at the end of the page

 Having sex 3-4 times a week was associated with a significantly greater stone passage rate than tamsulosin or standard medical therapy.

    Having sex 3-4 times a week was associated with a significantly greater stone passage rate than tamsulosin or standard medical therapy
Sexual intercourse may be an effective way to clear distal ureteral stones, researchers have concluded.
Omer Gohhan Doluoglu, MD, and colleagues at the Clinic of Ankara Training and Research Hospital in Ankara, Turkey, randomly assigned 90 male patients with distal ureteral stones to 1 of 3 treatment arms: sexual intercourse 3–4 times a week (group 1); tamsulosin 0.4 mg/day (group 2); and standard medical therapy (controls, group 3). The mean stone size was similar among the groups: 4.7, 5.0, and 4.9 mm in groups 1, 2, and 3, respectively. Of the 90 patients, 15 were excluded because of loss to follow-up.
After 2 weeks, 26 (83.9%) of 31 patients in the sexual intercourse group passed their stones compared with 10 (47.6%) of patients in the tamulosin group and 8 (34.8%) of patients in the control arm, according to a report in Urology (2015;86:19-24). The difference in stone passage rate was significantly greater in group 1 versus the other groups.
The mean stone expulsion time was significantly shorter in group 1 compared with the other groups: 10 days in group 1 versus 16.6 days in group 2, and 18 days in group 3.
The investigators postulate that nitric oxide released during erection and sexual intercourse may affect the distal ureters, causing relaxation of ureteral muscle.
"Today, MET [medical expulsive therapy] is recommended as the first-line treatment in ureteral stones that do not necessitate surgery," the authors concluded. "In our opinion, if the patient has a sexual partner, having sexual intercourse at least 3 times a week may be beneficial to increase the probability of spontaneous stone expulsion in patients with distal ureteral stones ≤6 mm in size."
In an accompanying editorial (p.24), Jeffrey J. Tosoian, MD, MPH, of Johns Hopkins Medical Institutions in Baltimore, commented that the study by Dr. Doluoglu's group "has great value in again bringing to light the potential role of the nitric oxide pathway in treatment of stone disease."
Dr. Tosoian cited previous studies that have identified nitrergic fibers in the distal ureter and demonstrated a relaxant effect of nitric oxide on ureteral smooth muscle.

The abstract from Pubmed

 2015 Jul;86(1):19-24. doi: 10.1016/j.urology.2015.03.037.

Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study.



To investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones.


The patients were randomly divided into 3 groups with random number table envelope method. Patients in group 1 were asked to have sexual intercourse at least 3-4 times a week. Patients in group 2 were administered tamsulosin 0.4 mg/d. Patients in group 3 received standard medical therapy alone and acted as the controls. The expulsion rate was controlled after 2 and 4 weeks. Differences in the expulsion rate between groups were compared with the chi-square test for 3 × 2 tables. P <.05 was considered as statistically significant.


The mean stone size was 4.7 ± 0.8 mm in group 1, 5 ± 1 mm group 2, and 4.9 ± 0.8 mm group 3 (P = .4). Two weeks later, 26 of 31 patients (83.9%) in the sexual intercourse group, and 10 of 21 patients (47.6%) in tamsulosin group passed their stones, whereas 8 of 23 patients (34.8%) in the control group passed their stones (P = .001). The mean stone expulsion time was 10 ± 5.8 days in group 1, 16.6 ± 8.5 days in group 2, and 18 ± 5.5 days in group 3 (P = .0001).


Our results have indicated that patients who have distal ureteral stones ≤6 mm and a sexual partner may be advised to have sexual intercourse 3-4 times a week to increase the probability of spontaneous passage of the stones.
Copyright © 2015 Elsevier Inc. All rights reserved.

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