Varicoceles

 

InfoDiagnosisTreatmentMicroscopic VaricocelectomyProcedurePost Operative InstructionsResults
varicocele out side

  • It is a condition of dilated testicular vein.
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  • It happens in 15-20% of adults.
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  • It may cause testicular discomfort or pain.
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  • It can cause impairment of semen quality in 40-80% of the cases.
varicocele ultrasoundInvestigations of Varioceles

  • Usually done by clinical examination.
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  • Patient needs to be standing for better assessment.
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  • Scrotal ultrasound with Doppler is helpful.
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  • Semen test is important
Me in mic varic

  • If patient has no pain and testicular volume is normal especially in children, and if semen quality is normal then treatment is not indicated.
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  • If the patient has testicular pain and his semen test is normal then conservative treatment with scrotal support and analgesics is helpful.
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  • The treatment of choice in our view and based on different studies is microscopic varicocelectomy.
Me in mic varic

  • Usually done under general anesthesia.
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  • Patient needs to be fasting for at least 8 hours.
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  • Patient needs to be in the hospital at least 4 hours before operation time.

  • Patient lies on his back.
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  • A small incision is done in lower abdomen
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  • The veins are ligated and cut and they shrink
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  • We preserve the arteries and lymphatics.
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  • The wound is injected with local anesthetic which helps relieve pain for 6 hours.
  • Keep the adhesive dressing for 1 week without using water on the wound.
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  • Put scrotal support for three days.
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  • Put cold compresses on the wound for 3 days
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  • You can do regular activities like walking and sitting.
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  • Avoid excessive activities and exercises and sexual activities until 2-3 weeks after operation.
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  • Usually patients can take 1-2 weeks leave. But if patient feels better he can work.
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  • First follow up visit is after 1 week.
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  • Second visit after 1 month.
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  • 3rd visit after 3 months with semen test.
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  • Then every 3 months with semen test until 1 yr or if pregnancy happens.
Technically the operation is successful with very minor complications like wound or scrotal hematoma in less than 1 % of the cases.
 
The advantage of varicocelectomy is 70% improvement in semen parameters, in cases of oligospermia. But in cases of azoospermia improvement is 40-50%.

Benign Prostatic Hyperplasia

 

InfoEvaluationTreatment - MedicalTreatment - SurgicalSurgical Techniques
BPH
It is a condition where the prostate gets bigger usually it may start at age 40 and commonly at 50-60 years.
 
This can cause urinary symptoms including weak urine stream, frequency of urination at day and night time.
1) We ask about the symptoms.
 
2) Urine test , urine flow test and bladder ultrasound, PSA are done.
 
3)Urodynamic test and cystoscopy can be done in some cases.
meds2
1) Watchful waiting and behavioral modifications. including decreasing fluid intake especially caffeinated drinks.
 
2) Medical therapy: A group called alfa blockers which relax the prostatic urethra. They are effective in 60-70% OF cases. Side effects include dizziness , retrograde ejaculation. Commonly needs to be taken life long.
meds
surgical1

  • Is a common procedure where scraping obstructive prostate tissues from the urethra is done under anesthesia.
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  • Can mainly be done for glands less than 80 cc
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  • A catheter with irrigation is put in urethra for 1-3 days.
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  • Patients should drink fluids.
  • surgical2

  • Patient should refrain from sexual activity for 1 month.
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  • Patient should avoid heavy lifting and constipation.
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  • Within the first week to 6 weeks postoperatively patient may get burning and frequency of urination with mild blood in the urine. This will usually subside.
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  • If severe bleeding with urine, fever or inability to urinate then come to emergency department.
Resection and Vaporization
 
This technique uses a device which has good effect to decrease bleeding and no absorption problems that can happen with standard TURP technique.
 
It useful for prostates less than 80 ml.
 
Laser Enucleation of Prostate
 

  • It was invented by Dr.Gilling ( New Zealand).
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  • It is a technique that uses high power holmium laser to enucleate most of the prostate.
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  • It is done through the urethra under anesthesia.
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  • It has no size limitation
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  • Patient stay in the hospital for 1-2 days with a urethral catheter.
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  • Long term follow up proved this technique to be the best specially for large prostates over 100 ml.
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    Dr.Al-Kandari and Dr.Gilling the inventor of HOLEP In OR during workshop

    Dr.Al-Kandari and Dr.Gilling the inventor of HOLEP In OR during workshop

    HOLEP

    HOLEP

 

Women Recurrent Urinary Tract Infections

 

InfoDiagnosisPredisposing FactorsTreatment

  • It can occur in different age groups.
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  • More common after marriage ( honey moon cystitis).
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  • Symptoms : painful and frequent urination, occasional blood in the urine. Pain in the lower abdomen.
1) Clinical.
 
2) Urine analysis and culture.
 
3) Less commonly abdominal ultrasound may be helpful especially to check the residual urine in the bladder.
1) Genetic.
 
2) Constipation.
 
3) Sexual intercourse.
 
4) Infrequent voiding.
     

  • Antibiotics for 3-7 days.
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  • Treat constipation.
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  • Treat that enhances immunity : Urovaxom.
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  • Cranberry is helpful.
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  • Post intercourse antibiotics ( Nitrofurantoin).
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  • To drink plenty of fluids.
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  • Avoid vaginal douches.
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  • Vaginal estrogen in postmenopausal women.
 

Urinary Stones

 

Info
Urinary stones is a condition that occurs due to precipitation of some salt crystals usually in the kidney and then gets bigger and can move down the urinary system.

by Bliss Drive Review