Farooqi Surgery

Remembering Prof. Dr. Afzal Farooqi on his 7th Death Anniversary today. He continues to live on in the hearts of his family, friends, patients & students around the globe. His life & legacy still continues to be a beacon of light for many.
May Allah keep him with the best of His people in Jannat ul Firdous.

Farooqi Surgery updated their phone number.

Farooqi Surgery updated their phone number.

Prof. Farooqi – Rawalpindi Medical University

Prof. Farooqi – Rawalpindi Medical University PROFESSOR DR. MUHAMMAD AFZAL FAROOQI ( 23/03/1953 TO 06/10/2014) Prof. Dr. M. Afzal Farooqi was born in Distt. Hafizabad on 23rd March 1953. He did his MBBS from King Edward Medical College, Lahore in November 1976 and FRCS from Royal College of Edinburgh, UK in January 1982. He started his career a...

Mosquitoes are one of the deadliest animals in the world. Their ability to carry and spread disease causes hundreds of thousands of deaths every year. If mosquitoes are around you, there are ways to protect yourself and your family.

Our time with antibiotics is running out. Always seek advice of a healthcare professional before taking antibiotics.

Remembering Prof. Afzal Farooqi on his 3rd death anniversary today. He will forever live on in the hearts & prayers of his family, friends, students, patients & colleagues.

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Litholapexy - Huge stone (>6cm) extracted from urinary bladder. Patient stable and discharged.

Cholecystectomy. Difficult gall bladder removed. Size about 6.5 cm. Previous history of Acute Pancreatitis due to Gall stones.

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Dr. Ashfaq Ahmed, Consultant Urologist, on World Kidney day

‘Alarming increase in end-stage kidney disease’

‘Alarming increase in end-stage kidney disease’ Nephrologist spells out possible causes

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The assessment and medical treatment of LUTS secondary to BPH
By Roger Kirby

The term benign prostatic hyperplasia (BPH) describes prostate enlargement due to non-cancerous processes. Several aetiological mechanisms are involved, including hormonal and vascular alterations; abnormal regulation of apoptosis; and prostatic inflammation, which may stimulate cellular proliferation. With ageing, prostate enlargement can affect the storage and flow of urine, leading to voiding symptoms (weak flow, intermittency) and storage symptoms (daytime frequency, nocturia, urgency) in many men. Lower urinary tract symptoms (LUTS) and benign prostate obstruction (BPO) occur secondary to BPH due either to increased smooth muscle tone within the prostate, or to the bulky enlargement of the prostate. Approximately 90% of men will develop histologic evidence of BPH by the age of 80 years.
LUTS can be divided into storage, voiding and post-micturition symptoms. LUTS are prevalent, cause bother and impair quality of life (QoL). Increasing awareness of LUTS and storage symptoms in particular, should lead to a discussion about management options that could improve QoL. LUTS are strongly associated with ageing; associated costs and burden are therefore likely to increase with future predicted demographic changes

Assessment of LUTS
Few clinicians would disagree that a full history, International Prostate Symptom Score (IPSS) and physical examination, including a digital re**al examination (DRE), are indicated in the assessment of LUTS, as well as a uroflowmetry and measurement of post void residual (PVR). More controversial is the need for a prostate specific antigen (PSA) determination and urodynamic testing.

PSA
Quite apart from its ability to predict the presence of prostate cancer, pooled analysis of placebo-controlled BPH trials showed that PSA has a good predictive value for assessing prostate volume, with areas under the curve (AUC) of 0.76-0.78 for various prostate volume thresholds (30ml, 40ml, and 50ml). A strong association between PSA and prostate volume was found in a large community-based study. A PSA threshold value of 1.5ng/ml could best predict a prostate volume of >30ml, with a positive predictive value (PPV) of 78%. Serum PSA is a stronger predictor of prostate growth than prostate volume. In addition, the PLESS study showed that PSA also predicted the changes in symptoms, QoL / bother, and maximum flow rate (Qmax). In a longitudinal study of men managed conservatively, PSA was a highly significant predictor of clinical progression. In the placebo arms of large double-blind studies, baseline serum PSA predicted the risk of acute urinary retention (AUR) and BPE-related surgery. An equivalent link was also confirmed by the Olmsted County Study. The risk for treatment was higher in men with a baseline PSA of >1.4ng/m. Patients with BPO in general seem to have a higher PSA level and larger prostate volumes.

Urodynamics
In male LUTS, the most commonly used invasive urodynamic techniques employed are filling cystometry and pressure flow studies (PFS). The major goal of urodynamics is to explore the functional mechanisms of LUTS and to identify risk factors for adverse surgical outcomes. PFS are the basis for the definition of bladder outflow obstruction (BOO), which is defined as increased detrusor pressure and decreased urinary flow rate during voiding. BOO has to be differentiated from detrusor underactivity (DUA), which signifies decreased detrusor pressure during voiding in combination with decreased urinary flow rate.

Urodynamic testing may also identify detrusor overactivity (DO). Studies have described an association between BOO and DO. In men with LUTS attributed to BPE, DO was present in 61% and independently associated with BOO grade and ageing. The prevalence of DUA in men with LUTS varies from 11-40%. Detrusor contractility does not appear to decline in long-term BOO and surgical relief of BOO does not always improve contractility. Due to the invasive nature of the test, a urodynamic investigation is generally only recommended if conservative treatment has failed.

Non-invasive treatment options

Watchful waiting
Many men with LUTS are not sufficiently troubled by their symptoms to require drug treatment or surgical intervention. Men with LUTS should be formally assessed prior to any allocation of treatment in order to establish symptom severity and to differentiate between men with uncomplicated (the majority) and complicated LUTS. Watchful waiting (WW) is a viable option for many men with non-bothersome LUTS as few will progress to AUR or other complications (e.g. renal insufficiency or stones), while others can remain stable for many years. One study comparing WW and transurethral resection of the prostate (TURP) in men with moderate LUTS showed the surgical group had improved bladder function (flow rates and PVR volumes), especially in those with high levels of bother; 36% of WW patients crossed over to surgery within five years, leaving 64% doing well in the WW group. Increasing symptom bother and PVR volumes are the strongest predictors of clinical failure. Men with mild-to-moderate uncomplicated LUTS who are not too troubled by their symptoms may be considered suitable for WW.

Pharmacological management
α1-adrenoceptor antagonists (α1-blockers)
aim to inhibit the effect of noradrenaline on smooth muscle cells in the prostate and thereby reduce prostate tone and BOO. However, α1-blockers have little effect on urodynamically determined bladder outlet resistance, and treatment-associated improvement of LUTS is correlated only poorly with obstruction. Currently available α1-blockers include: alfuzosin hydrochloride (alfuzosin); doxazosin mesylate (doxazosin); silodosin; tamsulosin hydrochloride (tamsulosin); terazosin hydrochloride (terazosin). Indirect comparisons and limited direct comparisons between α1-blockers demonstrate that all α1-blockers have a similar efficacy in appropriate doses. Beneficial effects take a few weeks to develop fully, but significant efficacy over placebo can occur within a few days. Placebo controlled studies show that α1-blockers typically reduce IPSS by approximately 30-40% and increase Qmax by approximately 20-25%. α1-blockers can reduce both storage and voiding LUTS. Prostate size does not affect α1-blocker efficacy in studies with follow-up periods of less than one year, but α1-blockers do seem to be more efficacious in patients with smaller prostates (45 years with comorbid LUTS / BPH and erectile dysfunction (ED), tadalafil improved both conditions.

Analyses from four placebo controlled clinical studies showed that total IPSS improvement was largely attributed to direct (92.5%, p

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