Urology in Primary Care Mr Shiv Bhanot Consultant Urological
Surgeon
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Advances in Urology Practice, a historical perspective 1995
TRUS biopsies and open radical prostatectomy 1996 Urodynamics 1997
Uro-Gynecology service 1997 Laser Prostatectomy (Neodymium Yag)
1998 Smiley Incision open radical prostatectomy 1999 TVT
colposuspension 2000 PCNL service for kidney stones 2002 Model for
Evaluation of Dynamics of Prostate Cancer 2003 Specialist MDT 2004
Laparoscopic Nephrectomy 2004 Laparoscopic Radical Prostatectomy
2005Laparoscopic Pyeloplasty 2006 Robotic Arm LRP 2007 Laparoscopic
Partial Nephrectomy 2008 PCA3 Urine Test for early diagnosis of
Prostate Cancer 2009 Holmium Laser for stones 2010 Single 1 cm
technique of LRP 2011 Template prostatic biopsies 2011 Zero
ischaemia partial nephrectomy 2011 HOLEP for BPH 2013 Hand Assisted
Laparoscopic Radical Prostatectomy( under evaluation)
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Why Urology in primary care Ageing population Dignity,
aesthetics and quality of life Urological cancers Cost of pads and
appliances Cost of falls and orthopaedics operations
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Urology Service at BHRT Comprehensive Service Based at KGH,
Cancer centre Clinics at Queens and in the community 6 Consultants
8 middle grade urologists 3 CNSs Acute Receiving Unit
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What will be covered ? What is LUTS Assessment and treatment of
LUTS When to refer for LUTS When to do a PSA When to refer for
raised PSA Early Prostate Cancer Treatment Kidney Stones Urinary
Incontinence
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LUTS Lower urinary tract symptoms Frequency, urgency and
nocturia Hesitancy Weak or interrupted flow of urine Incomplete
bladder emptying Post micturition dribbling * Dysuria and pain are
not LUTS
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The urological basis of LUTS Two special muscles of urinary
tract Detrusor (always resting except) Sphincter (always active
except) Bladder Prostate Urethra
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What can you do for LUTS General medical history Physical
examination, DRE Urine test Frequency volume chart Reassurance,
life style advice Offer serum creatinine Offer IPSS Offer PSA Offer
drug treatment Offer specialist referal
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Drug Treatment IndicationTreatmentReview LUTSAlpha bockerat 4-6
weeks then 6-12 m OABAnticholinergicat 4-6 weeks then 6-12 m
>30gm, PSA>1.45 alpha reductase inhibitorat 3-6 m then 6-12 m
High IPSS, >30gm, PSA>1.45 ARI + alpha blockerat 4-6 weeks
then 6-12 m Symptoms despite treatment with alpha blocker Add
anticholinergicat 4-6 weeks then 6-12 m
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LUTS Indications for referal to hospital Bothersome symptoms
UTIs Retention Renal impairment Suspected urological cancer
haematuria, sterile pyuria and raised PSA Stress urinary
incontinence
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Who is fit for surgery (TURP) for LUTS Good head Good legs The
vast majority can tolerate TURP, selection is the key to success
for surgery
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An alternative to surgery for Retention Done under local
anaesthetic, can be easily reversed
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PSA Test Very good tumour marker No positive or negatives for
diagnosis Marker of prostatic size in BPH Truly speaking not a test
but a measure Measure of probability and not diagnostic of Ca
Allows diagnosis of early prostate cancer 20% of all prostate
cancers have normal PSA
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When to offer a PSA Test offer information, advice and time to
decide ( Pre Test PSA info sheet ) Suspect benign prostatic
enlargement or BPH Prostate feels abnormal Patient concern
regarding prostate cancer
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Pre PSA Test Information
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PSA Video
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Diagnosis of Prostate Cancer PSA Rectal Examination Free PSA*
pCA3 gene test* MRI, MRI Spectroscopy and diffusion weighted
imaging* Transrectal ultrasound guided biopsies Transperineal
biopsies* * Not routinely available yet
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Early Prostate Cancer PSA
Surgical Experience, 20 years > 1200 major cases of kidney,
bladder and prostate cancer Other interests, Female Urology, TVT,
Stones Since 2004 all kidney and prostate cancer operations done
laparoscopically
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Urology, when to refer ? Follow the guidelines When in doubt
please call or email NHS 0208 970 8138 Private 07711335083
[email protected]