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Urology and male health

Learn about urology and male health topics such as prostate, testis, cancer, aging, and treatment options. Understand the role of a urologist in managing conditions like benign prostatic hyperplasia, erectile dysfunction, and urinary incontinence. Explore the reasons behind prostate diseases and the importance of early detection. Discover different treatments like Radical Retropubic Prostatectomy and Robotic Prostatectomy, along with potential complications and outcomes. Stay informed about the latest advancements in urological care.

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Urology and male health

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  1. Urology and male health Eamonn Rogers Mercy University Hospital Cork

  2. Role of Urologist • Cancer • Prostate • Testis • Benign Prostatic Hyperplasia • Erectile Dysfunction • Urinary Incontinence

  3. The Prostate – Why does it become diseased so often? • Only male organ to enlarge with age • Enlargement impedes urine emptying from bladder • May inhibit ejaculation • Commonest cause of cancer in males

  4. Aging and the Prostate • Only 2 known risk factors for developing Prostate Hyperplasia / Neoplasia • Aging • Functional testicular tissue (Testosterone)

  5. Ageing Male • The Irish LongtituDinal Ageing Study • 1999 = 11% > 65 YEARS • 2011 = 15% > 65 YEARS • 2031 = 19% > 65 YEARS • 2035 = 66% > 80 YEARS

  6. Benign Prostatic Hyperplasia (BPH) develops deep within the prostate and is more likely to “squeeze” the water passage and cause symptoms • It is much more common than cancer (90%) • It starts in men from the age of 40 and progressively grows • Cancer develops in the outside of the gland and rarely causes symptoms in its early stages until the tumour becomes advanced

  7. Structure of the Bladder

  8. Prostate cancer • Slow growing but eventually lethal • Most prevalent male cancer • 2nd commonest cause of male cancer deaths • 85% PSA detetcted cancers will eventually progress (7-10 years)

  9. Therefore the only way one can detect early prostate cancer is with • A) a blood test (PSA) • B) feeling the surface of the prostate by means of an internal examination

  10. Histological Differentiation – Gleason Grade /Score • In multivariate analysis the most important clinical parameter predicting the NATURAL HISTORY OF PROSTATE CANCER i.e. • Rate of progression • Prognosis

  11. Histology – Gleason Grade 3

  12. Histology – Gleason Grade 5

  13. Histological Differentiation – Gleason Grade /Score • 5 Gleason grades (1-5) based on histological aggression of tissue • Architecture • Cytology • Gleason score estimates the 2 most prevalent patterns (e.g. 3+4 = 7; 2+2 = 4)

  14. Histological Differentiation – Gleason Grade /Score

  15. Histological Differentiation – Gleason Grade /Score • Well differentiated = Gleason score(2,3,4) • Mod. differentiated = Gleason score(5,6,7) • Poor differentiation = Gleason score(8,9,10)

  16. Natural History - Histology • Well differentiated / Gleason score(2,3,4) • 10% metastases at 10 years • Mod. differentiated = Gleason score(5,6,7) • 42% metastases at 10 years • Poor differentiation = Gleason score(8,9,10) • 74% metastases at 10 years

  17. Radical Retropubic Prostatectomy 1

  18. Radical Retropubic Prostatectomy 2

  19. Radical Retropubic Prostatectomy 3

  20. Radical Retropubic Prostatectomy 4

  21. Complications - Longterm • Bladder neck contracture • Impotence • Urinary Incontinence • Sphincter =Stress • Bladder

  22. Robotic Prostatectomy 1

  23. Robotic Prostatectomy 2

  24. Robotic Prostatectomy 3

  25. Robotic Prostatectomy 4

  26. Robotic Prostatectomy 5

  27. Laparoscopic or Open • Very user dependent • Robotic promising but extremely expensive • No prospective trial comparing modalities with longterm cancer specific survival • Potency better ? • Positive margin rates • Open = 9% • Lap = 14%

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