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Article
Transurethral Microwave Thermotherapy (TUMT) For Benign Prostatic Hyperplasia

Author: Firas Shakir Attar
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 24-26
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Benign prostatic hyperplasia (BPH) is one of the most common diseases of the aging male. Minimally invasive therapies for treatment of BPH compete with the gold standard transurethral resection of the prostate (TURP). The aim of this study is to assess the efficacy of transurethral microwave therapy (TUMT) in patients with otherwise poor general health.METHODS:Thirty (30) patients with associated chronic medical diseases and lower urinary tract symptoms due to BPH were subjected for TUMT as an outpatient single session procedure, from June 2001 to August 2005. Follow up was performed 2 weeks, and then one month following treatment clinically and by assessing residual urine volume, maximal flow rate and prostate size.RESULTS:Out of (28) treated patients, (21) were labeled as non – responders as they were unable to pass urine freely 2-weeks after a trial of decatheterisation. In contrast (7) patients passed urine freely after decatheterisation. In the latter group, it was found that there was no statistical significance of the values of maximum flow rate, residual urine volume or prostate size between pre- and one month post TUMT.CONCLUSION:TUMT is a possible option for the treatment of BPH in poor general health patients or those refusing other surgical modalities. However, it did not prove to be effective for those patients with chronic urinary retention and BPH


Article
EVALUATION OF CHANGES IN THE LEVELS OF PROSTATE SPECIFIC ANTIGEN (PSA) AND PROSTATIC ACID PHOSPHATASE IN PATIENTS PRESENTING WITH URINARY RETENTION AND PROSTATE DISEASE

Author: Firas Shakir Attar*
Journal: The Medical Journal of Basrah University المجلة الطبية لجامعة البصرة ISSN: 02530759 Year: 2009 Volume: 27 Issue: 2 Pages: 108-112
Publisher: Basrah University جامعة البصرة

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Abstract

ABSTRACTProstate specific antigen (PSA) has established itself as the most useful marker for adenocarcinoma of the prostate(ADCA) adenocarcinoma of the prostate and in the recent years has almost replaced the total acid phosphatase andprostatic acid phosphatase prostatic acid phosphatase (PAP) for screening, diagnosis and monitoring the prostatecarcinoma patients. The prostate specific antigen levels also rise in benign prostatic hypertrophy benign prostatichypertrophy but to a lesser extent and high values are usually diagnostic of malignant disease. A cross-sectionalcomparative study was planned to see the effect of urinary retention and catheterization on plasma concentration ofadenocarcinoma of the prostate and prostatic acid phosphatase and the value of this effect in the diagnosis of patientsas having benign prostatic hypertrophy or adenocarcinoma of prostate. Sixty patients with prostatic disease wereincluded in the study. Adenocarcinoma of the prostate and prostatic acid phosphatase levels were assessed in allpatients. The patients were divided into two groups; group I are those presented with urinary retention andcatheterization and group II those presented without urinary retention (without catheter). Following histologicalexamination of prostatic tissues, the patients were diagnosed as cases of benign prostatic hyperplasia oradenocarcinoma of prostate. The data were analyzed using t-test. Benign prostatic hypertrophy was detected in 48patients whereas 12 patients were diagnosed with adenocarcinoma of the prostate. In the study, 66.2% of benignprostatic hypertrophy and 50% of adenocarcinoma of the prostate patients presented with urinary retention andcatheterization. It was observed that prostate specific antigen levels were significantly raised in benign prostaticpatients with urinary retention and catheterization as compared to those with no retention. There was, however, nosignificant rise in prostatic acid phosphatase levels in those patients. In conclusion, prostatic acid phosphatase is stilla very good tumor marker of prostatic disease in differentiating the malignant from the benign disease. It appears tobe particularly important in patients with benign prostatic hyperplasia and urinary retention as catheterizationappears to raise significantly the levels of prostate specific antigen but not those of prostatic acid phosphates. Thisfinding means that patients presenting with urinary retention and catheterization and high prostatic acid phosphateslevels are more likely having carcinoma of the prostate because retention and catheterization don’t significantly raisethe prostatic acid phosphates levels in benign prostatic hypertrophy as they raise prostate specific antigen levels insuch patients.

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Article
COMPARATIVE STUDY BETWEEN THE EFFICACY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY AND URETEROSCOPY WITH PNEUMATIC LITHOTRIPSY FOR TREATMENT OF DISTAL URETERIC CALCULI…48

Author: Firas Shakir Attar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 1 Pages: 48-54
Publisher: Basrah University جامعة البصرة

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Article
COMPARATIVE STUDY BETWEEN ORCHIDECTOMY ALONE AND ORCHIDECTOMY WITH HORMONAL THERAPY (COMBINED ANDROGEN BLOCKADE) FOR PATIENTS WITH ADVANCED CARCINOMA OF THE PROSTATE

Author: Firas Shakir Attar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 95-101
Publisher: Basrah University جامعة البصرة

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Abstract

Worldwide, prostate cancer incidence and mortality vary significantly between countries andregions and are highest in African American men. In the USA, prostate cancer is the mostcommon visceral malignant neoplasm in men and the second leading cause of cancer-relateddeaths. Bilateral orchidectomy with or without hormonal therapy are the main treatment optionsfor patients with advanced prostate carcinoma.The objective of this study is to compare the efficacy of orchidectomy alone and orchidectomyplus flutamide in treating patients with advanced carcinoma of prostate.The study was conducted from June 2006 to March 2010. Thirty six patients were included inthe study. The inclusion criteria were histologically documented carcinoma prostate along withdistant metastasis (stage D2). Following orchidectomy, the patients were stratified into twogroups. Group I had patients treated with orchidectomy alone (17 patients) and Group II thosetreated with orchidectomy plus flutamide therapy (19 patients). Follow up of patients was donefor the next two years following initiation of therapy.The maximum percentage change in PSA was found in the first three months afterorchidectomy. The mean percentage change at two years, in the two groups was 65% and 62%respectively. Based on the evaluation of response, there was no significant difference inresponse rate between the two treatment groups.In conclusion, addition of antiandrogen like flutamide to orchidectomy has not given anysignificant benefit to effect the PSA changes as well the survival in advanced carcinoma ofprostate. Hence, routine use of additional antiandrogen to orchidectomy is not advisable.

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ORCHIDECTOMY


Article
EVALUATION OF THE EFFICACY OF TADALAFIL IN IMPROVING LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT

Author: Firas Shakir Attar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2015 Volume: 21 Issue: 2 Pages: 70-75
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Lower urinary tract symptoms (LUTS) are common bothersome association with benign prostatic enlargement (BPE). The relationship between erectile dysfunction(ED) and LUTS/ BPE has been studied in the Multinational Survey of the Aging Male and in several epidemiologic studies, suggesting that the two diseases may share a common pathophysiology. The aim of the present study is to evaluate the efficacy and safety of use of tadalafil monotherapy in improving LUTS in patients with symptomatic BPE. Sixty patients aged more than 50 years with symptomatic BPE with LUTS more than 6 months were included from January 2013 to May 2015. These patients were assessed for their International Prostate Symptoms Score (IPSS) which was ≥7 and maximum urinary flow rate (Q max) which was >10 and < 20 ml/s. Patients were given tadalafil tablet 5 mg once daily without other therapy. The treatment was continued for three months and the patients were asked to come back for follow up each four weeks. Among the 60 patients, 50 (83.3%) showed significant improvement in their IPSS by achieving ≥3- points total IPSS improvement in symptoms. There was also significant improvement in the maximum urinary flow rate. The end point was at 12 weeks. It is concluded that, Tadalafil 5 mg once daily can be considered as an option for relieving LUTS in patients with symptomatic BPE


Article
EVALUATION OF THE USE OF DORSAL DARTOS FLAP FOR THE PREVENTION OF FISTULA AFTER SNODGRASS REPAIR OF HYPOSPADIAS

Author: Firas Shakir Attar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 52-56
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract The Snodgrass technique or the tubularized incised plate (TIP) repair is considered as excellent option for treatment of distal and mid-shaft hypospadias. Urethro-cutaneous fistula remains the most frustrating complication of hypospadias repair. After performing a tubularized incised plate (TIP) repair, the incidence of fistulae is reported to be up to 17% of cases. This study aimed to evaluate the use of dorsal dartos flap for the prevention of fistula formation after Snodgrass repair for distal hypospadias. The current study included 35 patients aged 2-6 years during the period between February 2013 to January 2016. All the patients had distal hypospadias and underwent Snodgrass or TIP repair. The neo-urethra was covered by dorsal preputial interpositional flap transposed ventrally via a button hole maneuver as a method to prevent fistula formation. Patients were followed up and their complications were assessed based on the patients’ medical records. The procedure was completed successfully in all patients, with no intraoperative complications. All patients had good functional results with straight penis and vertical slit shaped meatus at the tip of the glans. Thirty four (97.14%) patients had no evidence of fistula development. One patient only (2.8%) developed fistula. Meatal stenosis occurred in 3 patients (8.5%). In conclusion, the neo-urethral covering with well-vascularized dartos flap, harvested dorsally and button holed at its base for ventral transposition, represents a good choice for fistula prevention after Snodgrass repair.

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