DR JOSH CULLIMORE GP CLINICAL LEAD UROLOGY

Slides:



Advertisements
Similar presentations
Advances in the Management of BPH
Advertisements

A Case Study GP Masterclass Catherine Dale, RN, BSc Cancer Care
Acute Urinary Retention
BPH Diagnosis and Medical Treatment
Phase 2 Patrick King The Peer Teaching Society is not liable for false or misleading information…
Urinary tract infections … I can’t wait…. Symptoms of UTI: Dysuria, frequency, urgency, suprapubic tenderness, haematuria, polyuria.
Case 1: George Case 1: George
Non Acute Scrotal Swelling
SAIMA USMAN. HAEMATURIA Common finding Incidental DEFINING HAEMATURIA Visible haematuria Non visible haematuria (dipstick and microscopic)
Ken Chow. What is haematuria?  Macroscopic Visible haematuria Pink or red  Microscopic Gold standard – Microscopy ○ Presence of >3 RBCs per high-powered.
Urinary Incontinence Nachii Narasinghan. Types History and Examination Initial Assessment When to refer?
MODULE 5 1/26 Case 6: Anthony. MODULE 5 Case 6: Anthony 2/26 Patient History  Anthony is a 55-year old lawyer.  He has been suffering from voiding complaints.
MODULE 5 1/23 Case 9: Pierre. MODULE 5 Case 9: Pierre 2/23 Patient History  Pierre is 65 years of age who has suffered with benign prostatic hyperplasia.
Lower urinary tract symptoms (LUTS) in elderly males
Urology outpatients. Case 1 52 year old man Presents with increasing hesitancy of micturition Frequency Nocturia.
Hematuria By: Kayla Jahr.
All About the Prostate For Intelligent Internists
Prostatitis Behavioral Objective:
Red Urine – a mystery Shaila Sukthankar.
Lower Urinary Tract Symptoms (LUTS) in men Kamal Patel GPST2.
2008. Causes of symptoms  Hyperplasia of epithelial and stromal components of prostate  Progressive obstruction of urinary outflow  Increased activity.
This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration.
Lower Urinary Tract Symptoms (includes ketamine cystitis) Dr Peggy CHU Tuen Mun Hospital.
Dr Charles Chabert Urinary Symptoms &GreenLight Laser Prostatectomy.
LUTS Shawket Alkhayal Consultant Urological Surgeon Benenden Hospital Tunbridge Wells Nuffield Hospital.
Check your knowledge in… BHP/LUTS. 5-alpha-reductase inhibitors in the treatment of BPH Induce a significant decrease of libido 2 - Increase maximum.
Mark Lynch Clinical Lead Urology, Croydon University Hospital Consultant, St George’s Hospital
HEMATURIA Danger Signal that can’t be ignored. 1. Duration of symptoms and are they painful? 2.Presence of symptoms of an irritated bladder 3.What portion.
Heamaturia Dr.Badi AlEnazi Consultant pediatric endocrinologest and diabetologest.
Imaging in Haematuria Dr. Jaswinder Singh Consultant Radiologist
Primary care team meeting Hypertension Dr Som Desilva.
Figure 1. Gross specimen of prostate gland.. Figure 2. Microscopic effects of BPH.
1 Ambassador Program Presentation Prevention & Early Detection PROSTATE CANCER.
The GOLIATH Study ..
Benign prostatic hyperplasia
Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)
NICE GUIDELINES FOR SUSPECTED CANCER: RECOGNITION AND REFERRAL JUNE 2015 UROLOGY SSG MEETING 15 October 2015 Jamal Ghaddar, Matthew Goh Department of Urology.
Microscopic Haematuria. Transient Causes Transient –UTI –Exercise Spurious –Menstrual contamination –Sexual intercourse.
This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration.
Diagnostic approach of hematuria
Case 1 Urology Clinical Interactive Teaching Session.
Carcinoma of Bladder & Prostate BPH
Benign Prostate Hypertrophy (BPH). Introduction Benign prostatic hyperplasia refers to nonmalignant growth of prostate. – age-related phenomenon in nearly.
Men's Health By Dr. Ranil Perera Bincote Road surgery Patient Education Event.
Life after Prostate Cancer and its treatment Mr Sanjeev Pathak Consultant Urological Surgeon and Cancer Lead Doncaster and Bassetlaw NHS Trust 12 th March.
Men’s health. Mr Williams Mr Williams is 56, African-Caribbean and comes to see you with a 6month history of increasing difficulty passing urine and nocturia.
Prostate cancer update Suresh GANTA Consultant urological surgeon Manor Hospital.
PROSTATIC ENLARGMENT& LUTS
OAB / LUTS Urology Pathway for Primary Care within Frimley Health locality Developed with key local stakeholders including Urologists, Gynaecologists,
Signs and Symptoms of Urinary Tract Disorders
Genitourinary Phase 2 Patrick King
Benign Prostatic Hyperplasia (BPH)
Group Issues Guidelines on Prostate Cancer Screening . . .
Retention of Urine Acute or Chronic.
Haematuria Haematuria is a common condition and one which must be taken seriously. Haernaturia is usually divided into :- - Macroscopic (where the urine.
Bladder & Bowel Service – A Nurse Led Service; Trafford NHS Provider Services Diane McNicoll Continence Advisor/Service Manager Delamere Centre
Urinary Symptoms in the Female
Primary Care Stratified Follow-up of Stable Prostate Cancer Patients
Urology Referrals QP Day 5/11/13.
Haematuria Dr. Abdelmoniem E. Eltraifi College of Medicine & KKUH
Diagnosis and Management of UTI in Women
Body Systems and Disorders
Common cancers and NICE
Common urological problems
Case 3 – Alan Hays Consultation 1 Doctor :
Cystitis Lawrence Pike.
Standardised follow-up
Urinary Retention.
HAEMATURIA (Whistle-stop tour)
Presentation transcript:

DR JOSH CULLIMORE GP CLINICAL LEAD UROLOGY Visible haematuria DR JOSH CULLIMORE GP CLINICAL LEAD UROLOGY

clarify that the blood is coming from the urethra rather than from the rectum or vagina. Urine discoloration may result from other causes, including beetroot (more rarely myoglobinuria, haemoglobinuria or drugs such as rifampicin, nitrofurantoin and doxorubicin) Other relevant aspects of the history include smoking status, any past urological problems, occupational history and whether the patient is on antiplatelet or anticoagulant therapy. all cases of VH are significant and require further investigation, including patients taking warfarin or antiplatelet therapy. It is important to enquire whether there are any associated symptoms such as dysuria, frequency, lower urinary tract symptoms, loin pain or whether the haematuria is painless (a red flag symptom).

Significant haematuria is considered to be 1+ or more on dipstick and trace haematuria should be regarded as negative. If haematuria is identified on dipstick, routine laboratory confirmation is not necessary. after treatment (ideally seven days after completing antibiotics), dip urine again to confirm that the haematuria has completely resolved. REFER Urgently if haematuria still present.

Non-visible haematuria Dr josh cullimore Gp urology clinical lead

Causes of non-visible haematuria include: transient urinary tract infections exercise related spurious menstrual contamination sexual intercourse foods such as beetroot, blackberries and rhubarb rhabdomyolysis drugs - doxorubicin, cholorquine, rifampicin chronic lead or mercury poisoning (2)

Urological Benign prostatic hypertrophy Stones (8% of those with persistent microscopic haematuria) Cancer (5%) (bladder, kidney, prostate, ureter) Cystitis/pyelonephritis Prostatitis or urethritis Schistosomiasis rarer: Radiation cystitis, Urethral strictures, TB, Medullary sponge kidney, Cyclophosphamide-induced, AV, Renal artery thrombosis, Polycystic kidney, Papillary necrosis of any cause, Loin pain haematuria syndrome.

Nephrological Ig A nephropathy (Berger's disease) Thin basement membrane disease. Rarer: Acute glomerular diseases (some forms of glomerulonephritis, lupus, vasculitis, Goodpasture's disease, HSP, haemolytic uraemic syndrome), Chronic primary glomerular disease (some forms of glomerulonephritis, membranous nephropathy), Familial causes (polycystic kidney disease, Alport's syndrome, Fabry's disease, nail– patella syndrome).

PSA & Suspected Prostate Cancer Jhumur Pati Consultant Urological Surgeon

BAUS Age Specific Normal PSA Values 40-49 2.7 50-59 3.9 60-69 5 70-79 7.2 80-84 10 85+ 20

Causes of Raised PSA Urinary infection Prostatitis Benign prostatic hypertrophy Urinary retention Vigorous cycling Ejaculation Prostate stimulation (cystoscopy, biopsy, DRE, anal intercourse).

Prostate Cancer Risk Factors  Age : Prostate cancer mainly affects men over 50, and risk increases with age. The average age of diagnosis is between 70 and 74 years  Family history : Father or brother had prostate cancer, risk increases 2.5 fold; risk increases further if father or brother were less than 60 years old when diagnosed. Increased risk if mother or sister has had breast cancer, particularly less than 60 years old or BRCA1/2 carriers  Ethnicity: Afro-Caribbean men have an increased risk; 1 in 4 Afro- Caribbean men will have prostate cancer in their lifetime.

When To do a PSA Tests ? All patients should have a history, examination and counselling :  LUTS : nocturia, frequency, hesitancy, urgency  Erectile dysfunction  Visible haematuria  Family History

What the Patient Should Expect The patient is on a suspected cancer pathway : 1st Appt : History, Examination, Discussion Day 1-7 2nd Appt: MRI (CT/Bone) Scan Day 8-10 3rd Appt : TRUS Biopsy Day 15 MDT Meeting Discussion Day 30 4th Appt : Results After MDT Day 30-32 5th Appt : External Referral Day 33-35

Patients with Prostate Cancer Patient attends an MDT Clinic: Diagnosis & Staging Treatment Options Treatment may be commenced Referral where appropriate Key Worker is allocated e-HNA planned Follow-up planned

JHUMUR PATI CONSULTANT UROLOGICAL SURGEON LUTS in MEN JHUMUR PATI CONSULTANT UROLOGICAL SURGEON

Initial Consultation History of Complaint (IPSS) PMH DH FH Examination (General, Abdo, DRE, genitals, ankles) Urine Dip Test U/Es (PSA after counselling if appropriate) KUB US

BPH Nocturia Polydipsia High caffeine intake Diabetes Mellitus Diabetes Insipidus CCF CVA/Head Injury BPH

Management of LUTS Mild (IPSS <7) : Life Style changes to improve QoL Mod (IPSS 8-19): Tamsulosin (+ Finasteride, + anticholinergic) Severe (IPSS 20-35): Refer to secondary care

When to Refer ? Refractory to medical therapy Unable to tolerate medical therapy Recurrent UTIs/orchitis Abnormal USS –calculus, thickened wall Increasing residual urine volumes on USS Hydronephrosis Acute Urinary retention (A&E)

What happens next ? Changes to therapy Tests – FR & BS, UDS, cystoscopy Counsel regarding surgery Surgery : BNI, TURP Offer CISC or long-term catheter

Thank You !

Prostate cancer stratified follow up of stable prostate cancer patients in primary care Background National Cancer Survivorhip Initiative 2012 recommended stratified follow up for low risk patients in breast/colorectal/prostate NICE Prostate Cancer CG 175 2014 recommends that patients undergoing “watchful waiting” and those stable 2 years after radical treatment should be offered follow up outside of secondary care TCST and PCUK developed a primary care led follow up model, piloted in Croydon CCG Now being rolled out across London, with exception of NEL/Bartshealth patch, which is using secondary care led follow up at present

Aims: Release some secondary care capacity Improve patient experience through care closer to home and extended cancer care reviews for prostate cancer

Secondary care (Homerton) will identify patients suitable for transfer to primary care-led follow up GP practices required to: Have a register of prostate cancer patients Conduct a quarterly search for patients with prostate cancer who are not under secondary care Offer a 30 min welcome appointment to all newly transferred patients within four weeks of notification of transfer from secondary care under the Time to Talk Cancer scheme Organise PSA testing as per the instructions on the patient’s Treatment Summary, review the results and organise follow-up testing or re-referral to secondary care as appropriate