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.

Monday, August 3, 2015

Top 10 Best Android Medical Apps

Article posted originally in
Personally i use Medscape application extensively.... but this is detailed list of other apps...
I will spotlight Medscape app. in separate post... till then enjoy studying on your smartphone

Medical Main
Look in the Google Play Store and you will see that there are hundreds of Android Apps in the Medical category – some Medical Apps are useful for students and professionals in the field and others provide useful information for any individual.  Some Apps are more for educational purposes, others offer how-to-videos, and still others are for first aid – from Babies to Adults. Medical Apps have increased in quality the past couple of years and the ones we suggest here can really provide the user with some quality and helpful information.

My PillBox

My PillBox(Meds&Pill Reminder) Collage
My PillBox – is an application designed for those of us that need to keep track of taking their daily pills.  If you are only taking a couple of pills it is no big problem, but if you are trying to juggling a bunch of pills every day, a pill reminder can be a big help.  This App can also track multiple pill takers, so the entire family can be tracked on just one App.  There are twelve different types of medicine you can categorize, such as: Pills, Capsules, Drops, Injections, Packs and Patches.  You can even choose from nine different colors so it looks like the medicine you are taking.  When you setup a medicine you can add information such as the reason you take it, the date you began taking a medicine, and the doctor that prescribed the medicine.

Home Remedies (Lite)

Home Remedies (Lite) Collage
This is the number one FREE App in Google Play for Home Remedies and is recommended by top U.S. licensed doctors on Health Tap.  The Lite version of this App takes up less memory and has fewer features – if you want the more robust version of the App then purchase the Plus version.  This is the complete guide for home remedies and natural cures for your ailments…they are natural and safe and made from common herbs, spices, fruits and vegetables.

GoodRx Drug Prices and Coupons

GoodRx Drug Prices and Coupons Collage
GoodRx Drug Prices and Coupons – allows you to find the best price for your medicine, offers up coupons, and even gives you directions on Google Maps – you can save 20-80-percent in drug costs.  GoodRx allows you to compare drug prices just as you would plane tickets and covers more than 6,000 drugs at virtually every pharmacy in the U.S. – they only display licensed, legitimate U.S. pharmacies.  GoodRx is completely free and there are no obligations or other hidden costs.
GRAB IT HERE ON GOOGLE PLAY! Medication Guide Medication Guide Collage Medication Guide – easily allows you to look up drug information – you can identify pills, check drug interactions, and keep up your own personal record of medicines that you take.  This App will store a ‘My Drug List’ so you can have instant access to all relevant medical information.  The App contains a Pill Identifier, Interactions Checker, and many more tools that are helpful. is a leader in drug information with over nine million unique visitors each month providing free and informed information.

Visual Anatomy Free

Visual Anatomy Free Collage
Visual Anatomy Free – is an interactive reference and educational tool that now includes a 3D rotational organ model.  There are 58 high-resolution images with more than 300 feature points and the full version has 1247 images.  This App is used primarily as a learning tool but is also useful for physicians to show their patients or students…a great all around general anatomy guide.  You can use Tap and Zoom feature to enlarge any image, use Quick Navigation to jump to other organs, and the App even allows you to take a quiz.

Doctor on Demand

Doctor on Demand Collage
Doctor on Demand – gives you the opportunity to speak to a real doctor or do a video chat online about whatever problem that you are having – all for a $40 fee.  While $40 may be higher than your co-pay, the nice part is you never have to leave your house for a visit and that is certainly worth some money.  You do not have to take time off work, fight through the traffic or sit in a waiting room…definitely a waste of your precious time.  It is designed for more common type of aliments – Cold, Flu, Cough, Fever, Allergies, Prescription Refills, Urinary Tract Infections, STDs and many more.  This service is available where State Laws Permit.

WebMD for Android

WebMD for Android Collage
WebMD for Android – gives you 24/7 access to health information and if you have no internet you can still have access to first aid information.  The App gives you all the decision-making tools and support of WebMD’s Symptom Checker, Drugs and Treatments, First Aid Information, Health Listings, Pill Identification Tool, and Local Health Listings.


CPR•Choking Collage
CPR•Choking – is an App offers instant videos on how to perform CPR and how to help a choking victim.  The App was developed by leading educators and doctors and follows the latest recommendations…From the AHA Executive Summary:
“The newest development in the 2010 AHA Guidelines for CPR and ECC is a change in the basic life support (BLS) sequence of steps from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, Breathing) for adults and pediatric patients (children and infants, excluding newly borns).  Although the experts agreed that it is important to reduce time to first chest compressions, they were aware that a change in something as established as the A-B-C sequence would require re-education of everyone who has ever learned CPR.”

Baby and Child First Aid

Baby and Child First Aid Collage
Baby and Child First Aid – this is the official Red Cross (from Britain) for Infants and Children.  It has useful videos, easy advice, and even a test section – all this free.  As a parent, you need to learn the skills and information that is taught you, prepare yourself for possible emergencies, and test your knowledge.  A must have App if you have any babies or children living with you.

First Aid – American Red Cross

First Aid - American Red Cross Collage
First Aid – American Red Cross – is the definitive App for first aid and a whole lot more.  This App has been reviewed by almost 3900 users and received a 4.7 out of 5 rating, one of the highest I have ever seen and comes with top ratings and has won several awards.  You never know when an accident will happen, but having the ‘Red Cross’ with you can be a big help.  Comes with videos, interactive quizzes, and simple to follow step-by-step instructions.  The App is fully integrated with 9-1-1 so you can call for an EMS from within the App any time.  The App is ad-free and spam-free but does require a SD card with 40MB of free space.

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