Have a question of medical issues click here:

 Being an expert in several urological and urologysurgery web site including my association the most frequent questions received are the following

  •  Urinary infection
  • STD

  • IMPOTENCE AND ERECTION ISSUES

  • BPH

      •                       

                        HOPING YOU WILL FIND SOME ANSWER IN THESE NOTES AND LECTURES

                      Some of the notes are more board oriented , for the USMLE AND SPECIALIZATION, meaning more detailed in the treatment and pathology as pictures.

                      In this web site I mixed the upper part and lower part of the urinary systyem, since it is the urinary system [urology, nephrology].

Danil Hammoudi.MD
Sinoe Medical Association.
The medical information for all. This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider

Should Men With Serum PSA Levels of 4.0 ng/mL or Less Undergo a Prostate Biopsy?
Recent reassessment of the utility of PSA levels in diagnosing prostate cancer has changed the way many urologists advise their patients. But PSA, however imperfect, is still the best marker we have.

 

About 30 million men are estimated to have some form of erectile dysfunction, according to the Sexual Function Health Council of the American Foundation for Urologic Disease. Medscape's Erectile Dysfunction Resource Center brings together the latest news and clinical information on the diagnosis and treatment of sexual dysfunction in men

Erectile Dysfunction: Lesson From the 11th World Congress of the International Society for Sexual Impotence Research
Physicians can share in the latest research and developments presented at ISSIR's 11th World Conference held October 17 - 21, 2004 in Buenos Aires, Argentina

Sex, Sexuality, and Serotonin
Read about the impact of mood disorders and their treatment on love, sex, and sexuality from a variety of perspectives, including biologic, psychosocial, and cultural factors.

Oct 25, 2004 - In a phase 1 trial, a subtherapeutic dose of the human recombinant Maxi-K gene was not associated with adverse events.
From Reuters Health and Medscape Medical News
Experiences with the The LifeSite Hemodialysis System, a subcutaneous access.
Vascular. 2004;12:256-262.
Terlipressin has been shown to be effective for treatment of hepatorenal syndrome; there is also evidence for the combination of midodrine and octreotide when terlipressin is not available.
Medscape General Medicine. 2004;6(4).
Feb 17, 2004 - The investigators of this longitudinal study suggest monitoring patients with mildly depressed glomerular filtration rate for progression to kidney disease.

Anatomy , physiology review

Urology lab

Acute urological emergencies

Infection

  • Urinary infection
  • STD's

 

Lithiasis

  • Physiopathology
  • Urinary Lithiasis
  • Renal Lithiasis

Testes Pathology

  • ANATOMY PHYSIOLOGY REVIEW
  • INFECTION
  • TUMOR
  • TORSION

 

Prostate ProblemsMost men don't know about it, or don't want to know about it until     it's too late RAY ALCORN

  • ANATOMY REVIEW
  • BPH
  • CANCER
  • PROTATITS

 

Bladder  Problems

  • hematuria
  • tumor of the bladder
  • diverticules of the bladder
  • bladder atony

 

 

kidney problems:

  • kidney pathology
  • kidney tumors

 

 

MANNEKEN PISMale Issues [female issues see my gyn page]

  • Impotence

 

 

 

 

Do not use drag and drop.Do not use drag and drop.

Prostate cancer is the most common cancer affecting men in the United States. As life expectancy increases, so will the incidence of this disease, creating what will become an epidemic male health problem. The common histology is adenocarcinoma. Digital rectal examination is considered the standard of reference for detection of prostate cancer. About 50% of all palpable nodules are carcinomas. Neither prostatic acid phosphatase (PAP) nor prostate-specific antigen (PSA) is useful for screening prostate cancer, although elevated serum levels of these substances are usually suggestive of locally advanced or metastatic disease. The commonly used Gleason score, which ranges from a minimum of 2 to a maximum of 10, is based on both the tumor's glandular differentiation as well as its growth pattern, and has been shown to be associated with the clinical stage of disease

 

Fear of prostate cancer recurrence imposes a substantial burden in patients before and after treatment. Understanding the fear of cancer recurrence associated with different treatments can help physicians better counsel patients and promote psychological well-being.

 

There are several known risk factors for prostate cancer. These include increasing age, race, family history, and dietary intake of fats (Presti, 2004). A man age 60 to 79 has a probability of 1 in 8 of being diagnosed with prostate cancer, a significant increase compared to a younger man age 40 to 59 who has a 1 in 103 chance of a prostate cancer diagnosis (Presti, 2004). African-American men are at increased risk, although the reason for the phenomena is unknown. Relatives diagnosed with prostate cancer put a man at increased risk. The number of relatives and their age at diagnosis increases the risk; the younger the age of the relative at the time of diagnosis, the higher the relative risk for the male relative (Presti, 2004). A diet high in fat is a possible risk factor. Cadmium exposure (cigarette smoke, alkaline batteries, and working in the welding industry) may increase the risk, although this is a weak risk factor (Presti, 2004).

Published studies do not prove a cause-effect association for vasectomy as a risk factor (Presti, 2004). The underlying reason for the possible relationship is unknown. Elevations in antispermatozoa antibodies, decreases in seminal hormone concentrations, and decreases in prostatic secretion have been reported in men who have undergone vasectomy. How these effects might relate to the development of Ca P is unknown (Platz, Kantoff, & Giovannucci, 2000). There is also speculation that men who have undergone vasectomy may seek medical care more frequently, leading to earlier diagnosis of Ca P (Presti, 2004).

The etiology of Ca P is unknown. Many theories have been proposed through the years, but none has ultimately been proven. Increased male hormones and infections are two theories that continue to be discussed. What is currently known is that the gene responsible for familial Ca P resides on the long arm of chromosome 1 and PCAP and CAPB genes. In addition, there are tumor-suppression genes in several areas of the human genome that have been identified as possible areas involved in developing Ca P (Presti, 2004). As scientific knowledge of Ca P increases, the cause and natural course of the disease may be discovered

The history of urology and perhaps more specifically the treatment of urinary tract stone disease is recognised as one of the first surgical specialties.

The term "cutting for the stone" is even included in the Hippocratic oath where he extols medical practitioners to "... not covet persons labouring under the stone but will leave this to be done by men who are practitioners of this work" recognising that treatment of stone disease is in the realm of a specialist. The oldest bladder stone discovered was in the body of a boy in Egypt dated about 4800 BC.

A significant number of patients died from bleeding or infection. If they did survive they were often incontinent. Since those times, the treatment of stones in the urinary tract has developed considerably to the use of endoscopic surgery and extracorporeal lithotripsy

Urology through the ages

http://www.uroweb.org/index.php?structure_id=289
Diseases of the uro-genital tract are as old as the human species itself. Archaeological findings, as well as the very first writings, indicate that our ancestors were plagued by the same kind of discomforts routinely encountered in modern urological practice. For example, in a 5,000-year-old mummy of a child, a huge bladder stone was found. Circumcision and removal of the penile foreskin was probably the first operation ever performed on a routine basis. The importance of urinary stone disease and the dangers of treating bladder stones were already fully recognised by Hippocrates, `The Father of Medicine`. Hippocrates recognised the importance of the analysis and judgment of human excreta. This started a tradition of many ages of urine-analysis by inspection (uroscopy) and tasting.

In the seventeenth century, Frérè Jacques gained great fame as a `stone-cutter` or `lithotomist`. He travelled through Europe, practising a bladder-stone removal technique that became the golden standard for a long time. Modern urology started off with the development of sophisticated instruments that offered the ability to illuminate the inside of the body. The arrival in the mid-nineteenth century of anaesthesia and surgical techniques, based on thorough knowledge of human anatomy, enabled the treatment of all urological diseases, whether these were afflictions of the kidney, the bladder or the genitalia.

Urology as a distinct specialty dates from 1890, when it became a separate course of study from General Surgery and Felix Guyon became the first Professor of Urology in Paris (France).

At present, urology has developed into a field of medicine in which science, technical developments, diagnostic procedures and invasive as well as non-invasive therapeutic measures have reached the highest level.

The challenges of the future lie in many fields: improvement of the understanding of the development of micturition disorders in apparently healthy patients, or of the causes for urological cancers of the kidney, bladder and prostate; development of techniques to treat urological disease with minimal damage to healthy tissues (the so-called `minimal invasive surgery`); better treatment of common urological diseases, such as benign prostatic enlargement (a disease that affects all men at a certain age) or better treatment of less common but highly impacting malignant diseases, such as kidney, prostate and bladder cancer. For all these reasons, it is good to know that urology is enjoying increasing interest on the part of the general public.

Indeed, urology compasses 8% of all diseases and abnormalities occurring in mankind. Within the course of a lifetime, there is a great chance that everyone will need a urologist and his expertise for advice, treatment and hopefully for the curing of urological diseases. The facts are overwhelming:

* Urological abnormalities comprise close to 50% of all congenital abnormalities, the majority of which are today discovered before birth.
* Urinary tract infection is still the most frequently encountered infectious disease.
* Urinary lithiasis is still an common disease in both industrialised and non-industrialised countries.
* Most of the systemic diseases related to the aging population have direct or indirect urological consequences; these include diabetes, Alzheimer`s disease, Parkinson`s disease, arteriosclerosis, etc.
* Prostate disease today affects 75% of the male population over the age of 50, while benign prostatic hyperplasia is the most common disease in this age group.
* Urological cancers are the leading cause of cancer deaths in the male population, and prostate cancer is the most common malignant disease.


Urological admissions and surgical procedures are among the most frequently performed interventions in current hospital care.

shows the surgeon about to operate with his assistants and of course no anaesthetic.http://www.cairns-urology.com.au/history.htm

Urology journals:

Scandinavian Journal of Urology and Nephrology

A Peer-Reviewed Online Journal of Adult and Pediatric Urology

American Journal of Hypertension  
American Journal of Kidney Diseases  
American Journal of Nephrology  
American Journal of Physiology: Renal Physiology  
Andrologia  
Archives of Andrology  
BJU International  
BMC Urology  
Chronicle of Urology & Sexual Medicine  
Clinical and Experimental Nephrology  
Contemporary Urology  
Contraception  
Current Opinion in Nephrology & Hypertension  
Current Opinion in Urology  
Current Sexual Health Reports  
Current Urology Reports  
Digital Urology Journal  
European Urology  
European Urology Today  
Fertility and Sterility  
Geriatric Nephrology and Urology  
Hong Kong Journal of Nephrology  
Hypertension  
Hypertension, Dialysis & Clinical Nephrology  
Indian Journal of Nephrology  
International Journal of Andrology  
International Journal of Impotence Research  
International Journal of Urology  
International Urogynecology Journal  
International Urology and Nephrology  
Internet Journal of Urology  
Journal of Endourology  
Journal of Lower Genital Tract Disease  
Journal of Renal Nutrition  
Journal of the American Society of Nephrology  
Journal of Urology  
Kidney  
Kidney & Blood Pressure Research  
Kidney International  
Nephrology  
Nephrology Dialysis Transplantation  
Nephrology News & Issues  
Nephron  
Neurourology and Urodynamics  
Pediatric Nephrology  
Peritoneal Dialysis International  
Philippine Journal of Urology  
Prostate  
Prostate Cancer and Prostatic Diseases  
Renal Failure  
Scandinavian Journal of Urology and Nephrology  
Seminars in Dialysis  
Seminars in Nephrology  
Sexually Transmitted Infections  
Transplant International  
Transplantation  
Transplantation Proceedings  
Transplantation Reviews  
Urologe A  
Urologe B  
Urologia Internationalis  
Urologic Clinics of North America  
Urologic Nursing Journal  
Urologic Oncology  
Urological Research  
Urology  
Urology & Nephrology  
Urology Nurses Online  
Urology Times  
Uroloji  
UroOncology  
Uroreviews  
World Journal of Urology  
zz---Updated 09/14/2004 

CYSTOSCOPY.

Blood Press. 1999;8(1):29-36.  
    Clinical, anthropometric, metabolic and insulin profile of men with fast annual growth rates of benign prostatic hyperplasia.

    Hammarsten J, Hogstedt B.

    Urological Section, Department of Surgery, Varberg Hospital, Sweden.

    The purpose of this study was to test the hypothesis of a causal relationship between high insulin levels and the development of benign prostatic hyperplasia (BPH) and to determine the clinical, anthropometric, metabolic and insulin profile in men with fast-growing BPH compared with men with slow-growing BPH. The present study was designed as a risk factor analysis of BPH in which the estimated annual BPH growth rate was related to components of the metabolic syndrome. Two hundred and fifty patients referred to the Urological Section, Department of Surgery, Central Hospital, Varberg, Sweden, with lower urinary tract symptoms with or without manifestations of the metabolic syndrome were consecutively included. The prevalences of atherosclerotic disease manifestations, non-insulin-dependent diabetes mellitus (NIDDM) and treated hypertension were obtained. Data on blood pressure, waist and hip measurement, body height and weight were collected and body mass index (BMI) and waist/hip ratio (WHR) were calculated. Blood samples were drawn from fasting patients to determine insulin, total cholesterol, triglycerides, HDL and LDL cholesterol, uric acid, alanine aminotransferase (ALAT) and prostate-specific antigen (PSA). The prostate gland volume was determined using ultrasound. The median annual BPH growth rate was 1.04 ml/year. Men with fast-growing BPH had a higher prevalence of NIDDM (p = 0.023) and treated hypertension (p = 0.049). These patients were also taller (p=0.004) and more obese as measured by body weight (p<0.001), BMI (p=0.026), waist measurement (p <0.001), hip measurement (p = 0.006) and WHR (p=0.029). Moreover, they had elevated fasting plasma insulin levels (p = 0.018) and lower HDL cholesterol levels (p = 0.021) than men with slow-growing BPH. The annual BPH growth rate correlated positively with diastolic blood pressure (rs = 0.14; p = 0.009), BMI (rs = 0.24; p < 0.001) and four other expressions of obesity and fasting plasma insulin level (rs = 0.18; p = 0.008), and negatively with the HDL cholesterol level (rs = -0.22; p = 0.001). In conclusion, the data suggest that NIDDM, hypertension, tallness, obesity, high insulin and low HDL cholesterol levels constitute risk factors for the development of BPH. The results also suggest that BPH is a component of the metabolic syndrome and that BPH patients may share the same metabolic abnormality of a defective insulin-mediated glucose uptake and secondary hyperinsulinaemia, as patients with the metabolic syndrome. The findings support the hypothesis of a causal relationship between high insulin levels and the development of BPH, and give rise to a hypothesis of increased sympathetic nerve activity in men with BPH.

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