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Rohan Hall
Goldfields Urology
Bendigo
Full Steam Ahead
Full Stream Ahead
LUTS
Age <45 – 20%
Age 65-79 – 48%
Age 80> - 70%
OAB (urgency, frequency, nocturia, UUI)
BOO (hesitancy,poor flow, incomplete emptying)
BPH
Aetiology
?
Testosterone
DHT
Oestrogen
Family history
Pathophysiology
Smooth muscle
Glandular tissue
Prostatic capsule
Intravesical extension / middle lobe
Clinical Sequelae
OAB – Urgency and urge incontinence
Urinary retention
Detrusor failure
UTI
High pressure storage or voiding – renal failure
Ejaculatory dysfunction
Medical Management
Smooth muscle
Alpha blockade
- selective
Glandular tissue
Dutasteride/fina
steride
OAB / detrusor
irritability
Ditropan
Vesicare
Betmiga
Diet
Surgical Management
Divide high bladder neck
Resect intravesical middle lobe
Dilemma:
Retrograde ejaculation
Urethral stricture
Urgency/Urge Urinary Incontinence
Risk of anaesthetic
Open Prostatectomy
Traditional approach prior to endoscopy
Large prostates
Pro’s – tissue for examination, less risk to
urethra
Con’s – surgical risk, incontinence risk,
TURP
“Re-bore”
“ Coring out an apple”
“Gold Standard”
Pro’s – physically remove obstruction, tissue for pathology
Con’s – issues with large glands, retrograde ejaculation, anticoagulation, stricture
Laser Ablation
Vaporisation
Pro’s – anticoagulation, 19Fr sheath
Con’s – anticoagulation, length of operation,
urethral strictures, no tissue for pathology,
depth of ablation, need for second procedure
Urolift
“0% sexual side effects”
Better for smaller gland
Less bleeding
In reality…….
HOLEP
Established as safe in trials
Pro’s – tissue for pathology, large volume
removed
Con’s - retrograde ejaculation, morcellation,
urethral stricture
Hydrodissection
New
Aquablation
Dissection versus ablation
Embolisation
Controversial
Proven for menorrhagia
Erectile dysfunction
CBI
Why?
Virchow’s triad
Solution
2 bags – why
Counting bags
Titration
Recovery – tips
Bladder spasm – ditropan (2.5-5mg prn)
Traction
Manual washout
Questions?
