Male UTI and Female cystitis plus 60 seconds on ED • • • • KJ Ng 26 Feb 2014 LUTS-BPH: Definition of terms Prevalence of LUTS Comorbidities with LUTS The epidemiological and pathophysiological link between ED and LUTS-BPH. • Impact of LUTS on Patient & Partner • Assessment & Treatment of LUTS-BPH • Tadalafil 5mg Once Daily in the Treatment of ED and LUTS-BPH Male UTI and Female cystitis plus 60 seconds on ED • • • • KJ Ng 26 Feb 2014 LUTS-BPH: Definition of terms Prevalence of LUTS Comorbidities with LUTS The epidemiological and pathophysiological link between ED and LUTS-BPH. • Impact of LUTS on Patient & Partner • Assessment & Treatment of LUTS-BPH • Tadalafil 5mg Once Daily in the Treatment of ED and LUTS-BPH Male UTI and Female cystitis plus 60 seconds on ED KJ Ng 26 Feb 2014 Axon • • • • Axonal terminal LUTS-BPH: Definition of terms Prevalence of LUTS 5-HT Comorbidities with LUTS The epidemiological and pathophysiological link between ED and LUTS-BPH. • Impact of LUTS on Patient & Partner 5-HTT 5-HTT 5-HTT 5-HTT • Assessment & Treatment of LUTS-BPH • Tadalafil 5mg Once Daily in the Treatment of ED and 5-HT 5-HT 5-HT LUTS-BPH 1A Synaptic cleft Post-synaptic neuron Bladder neck dyssynergia 29 year-old city trader Poor flow, hesitancy Dysuria, penile tip pain Perineal pain Scrotal pain (epididymitis) MSU’s – WBCs, ± bacteria Bladder neck dyssynergia Bladder neck dyssynergia 29 year-old city trader Poor flow, hesitancy Dysuria, penile tip pain Perineal pain Scrotal pain (epididymitis) MSU’s – WBCs, ± bacteria Treatment : α-blockers (eg. Tamsulosin, Alfuzosin) Prostatic obstruction Retired Army Colonel Poor flow, hesitancy Frequency and nocturia Occasional dysuria and urgency Rarely, painful frank haematuria MSU – WBCs , RBCs, bacteria (E.Coli) PSA (after Rx UTI) – 1.8 ng/ml DRE – 40g BPH Prostatic obstruction PSA > 1.4 ng/ml ‘Large’ prostate Prostatic obstruction Retired Army Colonel Poor flow, hesitancy Frequency and nocturia Occasional dysuria and urgency Rarely, painful frank haematuria MSU – WBCs , RBCs, bacteria (E.Coli) PSA (after Rx UTI) – 1.8 ng/ml DRE – 40g BPH Treatment: Dutasteride + tamsulosin (Combodart) for PSA > 1.4 ng/ml Prostatic obstruction Retired Army Colonel Poor flow, hesitancy Frequency and nocturia Occasional dysuria and urgency Rarely, painful frank haematuria MSU – WBCs , RBCs, bacteria (E.Coli) PSA (after Rx UTI) – 1.8 ng/ml DRE – 40g BPH Treatment: Dutasteride + tamsulosin (Combodart) Cialis 5mg OD (new) for PSA > 1.4 ng/ml Female Cystitis Bacterial Cystitis Interstitial Cystitis Female Cystitis (Bacterial) Retired school teacher Recurrent episodes of dysuria, frequency and smelly urine MSU’s - several proven episodes of UTI over the past few months Symptoms recur soon after short courses of antibiotics Female Cystitis (Bacterial) Retired school teacher Recurrent episodes of dysuria, frequency and smelly urine MSU’s - several proven episodes of UTI over the past few months Symptoms recur soon after short courses of antibiotics Treatment : Vagifem PV 10g alternate days , cranberry capsules if no better after 6 months, consider 6 months of Nitrofurantoin 100mg nocte Female Cystitis (Bacterial) Female Cystitis (Bacterial) Female Cystitis (Interstitial) 30 year-old Actress Recurrent urethral and suprapubic pain – worse pre- and post-micturition MSU’s - usually white cells only Symptoms not improved with antibiotics Lower backache, groin and thigh pain Irritable bowels, dyspareunia Female Cystitis (Interstitial) Female Cystitis (Interstitial) Female Cystitis (Interstitial) Female Cystitis (Interstitial) Female Cystitis (Interstitial) Female Cystitis (Interstitial) 30 year-old Actress Recurrent urethral and suprapubic pain – worse pre- and post-micturition MSU’s - usually white cells only Treatment : Bladder instillations of GAGs Oral medication : to reduce neurogenic inflammation Increase bladder capacity to block central sensitisation Botox bladder injection Premature ejaculation Traditional treatment: Axon Axonal terminal “Squeeze” technique 5-HT1A EMLA cream 5-HTT New: 5-HTT 5-HT Short-acting SSRI - Dapoxetine (Priligy) 5-HT 5-HTT 5-HTT 5-HT Synaptic cleft Post-synaptic neuron Thank you KJ Ng mobile – 0780 141 7635 [email protected]
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