/
Mr  Rohan Hall Mr  Rohan Hall

Mr Rohan Hall - PowerPoint Presentation

lindy-dunigan
lindy-dunigan . @lindy-dunigan
Follow
379 views
Uploaded On 2016-03-08

Mr Rohan Hall - PPT Presentation

Goldfields Urology Managing the side effects of a radical prostatectomy Stages of diagnosis Receiving a result of an elevated PSA Referral to urologist Prostatic biopsy TRUS or transperineal ID: 247794

erectile penile urinary dysfunction penile erectile dysfunction urinary continence post piece inflatable implants pde5 patients position incontinence simple treatment

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Mr Rohan Hall" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Mr Rohan HallGoldfields Urology

Managing the side effects of a radical prostatectomySlide2

Stages of diagnosis

Receiving a result of an elevated PSA

Referral to urologist

Prostatic biopsy (TRUS or transperineal)Receiving the diagnosisStagingReceiving results Discussing management of localised prostate cancerDiscussing the side effects of each treatment optionAnxietyDepressionLoss of autonomyFutilityAngerSlide3

Managing the “trifecta”Oncology

Pre-op

Post-op

Review appointmentsContinencePre-op lower urinary tract symptomsPre-op preparationPost-op expectationsErectile FunctionPre-op erectile functionSocial circumstancesMedical comorbiditiesIntra-operative variationPost-op expectationsSlide4

Post-opWound

IDC

Pain

Scrotal oedemaDrivingCyclingSlide5

Urinary ContinenceMale continence mechanismSlide6

Urinary ContinencePre-op pelvic floor education benefits post-op return to continence

Post-op pelvic floor exercises – when to start

What level of continence is normal in the post-operative period

3/12 – 1 pad/day12/12 – 1 pad/day2% of patients will be wet, wet, wetOther factors affecting ability to be continent:Chronic coughObesityDiureticsWhat if continent, then new incontinence?Slide7

Behavioural modificationsDecrease fluid intake

Void frequently

Avoid caffeine, alcohol

Avoid activity that increases intraabdominal pressureSlide8

Urinary ContinenceWhat next – formal

urodynamics

to rule out over active bladder, also can assess ALPP.

Bulking agentsConsidered successful 17% of the time for post radical prostatectomy SUIPro’s - minor procedureCon’s – may need to be repeatedCan set up local chronic inflammatory response making further treatment difficultSlide9

Urinary incontinenceSlide10

AdVance™ Male Sling

Sling

restores

urethra to its proper anatomical position for optimal sphincter function, restoring urinary control

Procedure:

Spinal or general anesthesia

can be used

Three small incisions: 1 under the

scrotum, 2 over groin creases

Specially designed surgical tools

are used to position the sling

Sling is gently tensioned

Incision closedSlide11

Artificial Urinary Sphincter (AUS)

The Gold Standard for treatment

of moderate to severe

incontinence 60± minute outpatient procedure92% of patients would have the device placed again96% of patients would recommend it to a friendDevice is placed completely in the body, providing simple,

discreet control

- Requires dexterity for use of pum

pSlide12

Erectile Dysfunction“The inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance”

Prevalence of ED: 52% men older than 40 have some degree of erectile dysfunction

Mandropause” Age 60 – 20% EDAge 70 – 70% EDSet expectations“The best erection they will achieve post-op is 70% of there pre-op erection, and this may be with the aid of a PDE5-I”Slide13

Erectile dysfunctionAetiology

Vasculogenic

:

arteriogenic vs veno-occlusive dysfunctionNeurogenicPsychogenic – depression, stress, anxiety, psychiatric disorderEndocrinologic – hyperprolactinemia, thyroid disorder, hypogonadismMedications (b-blockers,antidepressants,spironolactone,sedatives, phenytoinSlide14

Erectile Dysfunction

PDE5-I

Penile Pump

Intra-urethral suppositoryIntracavernosal injectionSlide15

Erectile dysfunction

PDE5-inhibitors

How to use these tablets?

ContraindicationsSlide16

Erectile dysfunctionPenile Rehabilitation

- Daily

cialis

Aim to achieve 3 erections per weekHigh dose PDE5-IIntracavernosal injections Alprostadil (caverject)Trimix Theoretically makes senseLack of evidence

ExpensiveSlide17

Erectile dysfunction – penile implants

Ideal for men who have tried other treatments without success

On the market for over 30 years

25,000 penile implants per year Over 300,000 implants to date High patient and partner satisfactionSlide18

Types of Penile Implants

One-piece non-inflatable

Two-piece inflatable

Three-piece inflatable

Slide19

One - Piece Non-Inflatable Penile Implant

Advantages

Easy for you or your partner to activate

Good option for men with limited dexterity

Totally concealed in body

The simplest surgical

procedure

Least expensive prosthesis

Disadvantages

Stays firm when not in erect position

May

show

through clothingSlide20

Three – Piece Inflatable Penile Implant

Simple to use

Fast and simple one-step deflation

Totally concealed in bodyActs and feels more like a natural erection

Expands the girth of the penis

More firm and full than other implants

Feels softer and more flaccid when deflated

Advantages

Disadvantages

Requires some manual dexterity

Possibility of leakage or malfunction

Possibility of unintentional erectionsSlide21

Questions?