mark lynch clinical lead urology, croydon university hospital consultant, st george’s hospital...

Mark Lynch

Clinical Lead Urology, Croydon University Hospital

Consultant, St George’s Hospital

Mlynch100@doctors.org.ukMark.lynch@croydonhealth.nhs.ukMark.lynch@stgeorges.nhs.uk

Croydon Urology – the future

• July 2013• July 2014– M Lynch– Consultant Interview– Job plan for further Consultant

• July 2015– SGH integration

• July 2015+– Urology centre?

Lower Urinary Tract Symptoms

• BPH (50%)

• Prostate cancer (16%)

• Other pathology

BPH

BPH

• Epidemiology: Autopsy– 23% men aged 41-50– 42% men aged 51-60– 71% men aged 61-70– 82% men aged 71-80

• Epidemiology: Clinical– 14% men aged 40-49– 24% men aged 50-59– 43% men aged 60-69– 40% men aged 70-79

BPH

• Epidemiology:– Higher income groups– Western / industrialized countries

• Less common– Alcohol and cirrhosis– Far East (Japan, China, Korea)

AUA / IPSS Symptom Score

BPH

• Assessment– Variability– Symptom score– Quality of life– Drug therapy– Surgery– Examination – neurology– PSA ??

BPH

• Complications– Renal failure– Bladder calculi– Infection– Incontinence– Retention– Haematuria

BPH

• Management– Watch and wait– Pharmacology– Surgery

TURP - TURiS

Medical Therapy

• Conservative measures• Bladder diary• Alpha blockers• 5 alpha reductase inhibitors• Combination therapy

Bladder Diary

Bladder Diary

BPH

• DRE• Routine bloods • MSU

AUA / IPSS Symptom Score

Bladder Diary

LUTS

• Advice• Medication• Review

CUH – Here to help!

• LUTS clinic– IPSS– Flow-rate– Information documents– Decision making clinic for surgery– Medical management strategy for primary care