A Simple Guide to Benign Prostatic Hyperplasia

A Simple Guide to Benign Prostatic Hyperplasia
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What is Benign Prostatic Hyperplasia?
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Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.

What are the Causes of Benign Prostatic Hyperplasia?
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The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.

It is a walnut size gland encircling the lower urinary outlet of the bladder.

With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.

The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.

What are the symptoms and signs of Benign Prostatic Hyperplasia?
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The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.

Symptoms:
1. difficulty in starting urination

2. straining at urination to produce a weak flow of urine

3. dribbling of the urine after urination

4. feeling of incomplete emptying of bladder even after urination.

5. nocturia -getting up at night more frequently to pass urine

6. frequency of urination

7. interrupted urine flow

8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)

Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate

2.urine examination to exclude infections

3.blood tests to check on kidney function

4.an ultrasound to have a better look at the prostate and also any damage to kidneys

5.a urine flow test(Uroflow) to see how fast you can pass urine

6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer

7. Cystoscopy - a ligted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine

8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)

What are the complications of Benign Prostatic Hyperplasia?
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Prolonged blockage of the urine by BPH can cause serious complications:

1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain

2. Urine leakage or incontinence

3. recurring urine infections

4. bladder stone formation

5. blood in the urine

What is the treatment of Benign Prostatic Hyperplasia?
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BPH sufferers may be referred to an Urologist for review. As lonas Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.

In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by :
1.adjustment of fluid intake

2.regular exercise,

3.proper diet with less red meat , more vegetables and fruits.

In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as :

4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.

In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,

5.catherisation and drainage of the urine may be necessary in acute retention of the urine

6.Surgery may be necessary.
This operation called TURP or transUrethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract.
Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfuction problems.

7. Antibiotics may be given for urinary infections

What are the preventive measures taken in Benign Prostatic Hyperplasia?
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1.Changing Fluid Intake

You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.

2.Bladder training & periuretharal muscle exercises
This involves training your bladder to control the urge to void.

3.Maintain a healthy weight.

4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.

What is the prognosis of Benign Prostatic Hyperplasia?
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Very good after treatment.

A Simple Guide to Erectile Dysfunction

A Simple Guide to Erectile Dysfunction
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What is erectile dysfunction (ED)?
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Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"

The WHO sponsered Consultation recommend" a minimum of three months of erectile difficulty qualified foe a diagnosis of Erectile Dysfunction."

What is the incidence of ED?
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The incidence of ED is unknown:
ED is currently underdiagnosed and undertreated.
More than 50% of all men 40-70 years old are likely to experience it.

What are the Causes of ED?
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Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.

Medical causes:
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1.vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)

high blood pressure

high cholesterol

heart disease

stroke

All these conditions affects the blood flowing and out of the penis.

2.diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED

3.nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis

4.hormonal problems-
low levels of testosterone(male hormone) can cause ED

5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.

6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.

7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillisers) may reduce the blood flow to the penis

8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.

Lifestyle causes:
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1.alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.

2.Smoking-
The incidence of ED in smokers are hiher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.

3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.

4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation

Psychosocial Causes:
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1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause

3. Depresssion

4. Relationship Problems- marital problems and tensions may affect sexual relationship

5. fatigue.

How is the diagnosis of ED made?
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1.medical hisory especially about diabetes, hypertension, medications, alcohol adrug abuse,smoking.

2.medical examination including genitals and prostate

3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)

What is the treatment of ED?
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Successful treatment of erectile dysfunction includes:

1. Lifestyle modifications:
exercising

dieting

quitting smoking

reducing alcohol/drug abuse

counselling to manage anxiety/stress/marital problems

2.treatment of underlying medical conditions such as diabetes

3.change of medications

4.medication for treatment of ED.

There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors
e.g. Viagra, Cialis, Levitra.

There is no instant erections when the medicine is taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.

Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.

6.Other treatments for erectile dysfunction

a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity

b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.

c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis

d:surgery for blocked blood vessels

e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse.
This surgery is offered when all other options failed.

How to cope with ED?
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Erectile dysfunction can cause a lot of stress on one’s marital relationship.

Communication and honesty with the spouse is important in ED.so that she understands the problem and that she is not the cause of the problem.

In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.

A Simple Guide to Urinary Stones

A Simple Guide to Urinary Stones
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What are Urinary Stones?
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Urinary Stones are small, solid stones which occur when salts or minerals in the urine become solid crystals inside the kidney.

How are Urinary Stones formed?
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Urinary Stones are formed usually because of the accumulation of salts and minerals especially calcium in the urine.

Usually the stones may be so small that they pass out through the urine without the knowledge of the patient.

Some however become bigger due to accumulation of the salts and minerals and the concentration of the urine.

The bigger stones may remain in the tubes of the kidney and are called renal stones.

Some smaller stones may move out of the kidney and passes through the ureters which are the the tubes bringing urine from the kidney to your bladder.
These are called ureteric stones.

If a ureteric stone gets stuck in the ureter, this can cause blockage of the urine and severe pain.(ureteric colic)

What are the types of Urinary Stones?
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Different kinds of Urinary stones form from different salts in the urine.

1.Calcium stones forms about 80% of the urinary stones.
50% are made up of calcium oxalate and the rest are calcium phosphate.
They are spiky or large and smooth


2.Uric acid stones are caused by accumulation of excess amounts of uric acid which can be due to eating a lot of meat.
They are smooth, brown and soft

3.Struvite stones (infection stones) are produced when there is too much ammonia in the urine occuring especially in urinary tract infection.
The bacteria that cause these urinary infections can generate ammonia.
They are usually large and have a horn-like shape
This kind of kidney stone is most often found in women.

4.Cystine stones occurs when there is high levels of cystine in the urine. A hereditary disorder called cystinuria is the source of high cystine in the urine.
They are yellow and crystalline

Who is at risk of Urinary stones formation?
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Risk factors include:

1.Men get urinary stone more commonly than women

2.a previous history of kidney stone - 50% will develop another one within five years.

3.a family history of kidney stones

4.Age between 20 and 40

5.Not drinking enough water

6.eating a diet high in protein

7.taking certain medicines such as diuretics (water tablets), antacids and thyroid medications

8.having only one kidney, or an abnormally shaped kidney

What causes Urinary Stones?
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Urinary Stones are caused by 4 main factors:

1.Insuffient water in the urine leading to concentration and stagnation of urine flow:
a.insufficient intake of water
b.intake of alcohol causing concentration of the blood volume

2.Excess Urinary Constituents:
a. Calcium:
High calcium intake (includes calcium tablets and high calcium milk)

Primary Hyperparathyroidism leading to high blood calcium

high Vitamin D intake cause high adsorption of calcium

medical conditions such as cancer, some kidney diseases, or sarcoidosis are more likely to develop calcium stones.


b. Oxalates:
high oxalate intake (cabbage,spinach,tomatoes, chocolates) in diet leads to high concentration of oxalates in urine

c. Uric Acid:
Gout or High Uric Acid can form crystals which may lead to stones

Treatments such as chemotherapy can also increase the risk of getting uric acid stones.

d: Cystine:
Hereditary cystinuria leads to high cystine in the urine and formation of cystine stones

About one in a hundred urinary stones is due to this illness.

Cystine stones tend to appear earlier in life between the ages of 10 and 30 years.

3. Infection of urine:
clumps of bacteria can form the nucleus of the stone.

Bacteria also produce ammonia which can promote formation of stones

4. Congenital deformity of the kidney and urinary tract:

these block the passage of concentrated urine and causes formation of stones.

What are the symptoms of Urinary Stones?
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Many Urinary stones do not cause any symptoms.
Once an urinary stone enters the ureter and blocks the passage of urine flow, it may cause the following symptoms:

1.severe pain or aching in the back on one or both sides

2.sudden spasms of excruciating pain which usually starts in the upper back below the ribs, radiates around the flanks of the abdomen, down to the pubes, groin and genitalia.

3.Urine is bloody, cloudy or smelly

4.frequent urge to urinate, or a burning sensation during urination

5.fever and chills

6.nausea and vomiting

Urinary stones can be passed out of the body within 48 hours.

Sometimes attacks of pain from urinary stones may last for over 30 days.

How are Urinary Stones diagnosed?
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1.History of ureteric colic symptoms and physical examination showing tenderness of abdomen and flanks

Other tests may be done to confirm the diagnosis and to reveal the size, location and type of stone:

2.blood tests - to identify excess amounts of certain chemicals (calcium, uric acid, oxalates, cystines) related to the formation of stones

3.urine analysis - to look for signs of infection and presence of crystals

4.X-ray of abdomen - stones that contain calcium (80%) usually appears white on X-rays

5.Intravenous urogram (IVU) - an injection of a special dye that shows up the whole urinary system on X-ray images, revealing stones that can't usually be seen

6.ultrasound scan - can detect stones in kidneys and solid internal organs

7.non-contrast helical computerised tomography - X-ray images taken at different angles - can diagnose kidney stones, and is probable the most accurate diagnostic test

How are Urinary Stones treated?
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Treatment depends on the
1.type and
2.cause of the stone.

Most stones can be treated without surgery:
1.Drinking lots of water (two and a half to three litres per day)

2.staying physically active are often enough to move stones smaller than about 5mm out of the urinary tract.

3.paracetamol or codeine may be given to reduce the pain.

4.Infections can be treated with antibiotics.

Stones that are stuck can be removed in several ways:

1.Extracorporeal shock wave lithotripsy (ESWL)
Location of the urinary stone is dtermined using X-ray imaging or ultrasound scanning.
The patient lies in a side position while a machine called a lithotriptor sends targeted shock waves to break up the kidney stone.
There may be some pain as the stone breaks up, so the procedure is usually performed under local anaesthesia.

2.Ureteroscopic stone removal
A narrow, flexible instrument called a cystoscope can be passed up through the urethra and bladder and up the ureter where the stone is stuck. The stone is captured and removed.It can also be broken up with a laser beam or shock waves generated by a device attached at the end of the cytoscope. This procedure is usually done under general anaesthesia.

3.Percutaneous nephrolithotomy (PCNL)
Large stones can be surgically removed from the kidney.
The surgeon makes a small opening at the back and uses a telescopic instrument called a nephroscope to pull the stone out or break it up with shock waves or a laser.
This procedure is performed under general anesthesia.

How to prevent Urinary Stones?
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1.drink more fluid at least three litres every 24 hours.

2.reducing the amount of calcium in the diet to a normal level(not excessively high)

3.For calcium oxalate stones, reduce intake of high levels of oxalate - chocolate, tea, cooked spinach and asparagus.

4.For uric acid stones, less meat, fish, poultry, organs, peanuts and soya beans should be taken. Daily intake of allopurinol medicine can help reduce the level of uric acid in the urine.

5.For cystine stones, medicines can be given to reduce formation of the stones.

6.For struvite or "infection" stones,long term antibiotics may prevent chronic urinary infection.


Added 4th October 2008
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Urinary stone:
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Melamine a chemical used for hardening plastic has found illegally in milk products in China in September 2008.

This causes urinary stones in babies.

A Simple Guide to Gallstones

A Simple Guide to Gallstones
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What are gallstones?
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Gallstones are stones which are found in the gallbladder which is a sac storing bile from the liver.
They are made from cholesterol and other substances in the bile.


What causes gallstones?
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Gallstones are formed when cholesterol and other substances like calcium found in bile combine to form stones.

They are more common in
1.overweight people

2.Females more than males

What are the symptoms?
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Most people with gallstones do not have symptoms.

Symptomsoccur when a gallstone causes blockage in the bile duct causing obstruction to flow of bile from the liver to the intestine.

The symptoms may be:

1.mild pain in the upper right part of the abdomen and also just below the sternum just like gastritis.

2.Pain in the right upper back or shoulder blade area.

3.Pain is worse when you eat.

4.fever and chills

5.Yellowness of the eyes or skin

6.Dark coloured urine

7.Chest pain occurs when the pain radiates to the chest

How are gallstones diagnosed?
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1.Pain in the right side of the abdomen

2. Murphy's sign positive.
A thumb pressing against the right of the epigastrium causes more pain when the patients breathes in deeply

3.An ultrasound of the right side of the abdomen is the best way to find gallstones.
Most gallstones can be detected from the ultrasound.

4.gallbladder scan. A dye is injected into a vein in your arm.
X-rays are taken as the dye moves through your liver, bile duct, gallbladder.

What are the complications of gallstones?
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A gallsone which is stuck in the bile duct(a tube which leads the bile from the liver to the gallbladder and small intestine) can give rise to:
1.Gallbladder inflmmation or infection(Cholecystitis)

2.Swelling and inflammation of the Pancreas(pancreatitis)

3.Hepatitis due to reflux of the bile back to the liver

4.Peritonitis(inflammation of the inner lining of the abdomen) if the bile duct or gallbladder perfoates or burst.
This is an emergency.

What is the treatment of gallstones?
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1.If there is no symptoms, treatment is not needed.

2.If there is mild pain, some pain and antispasmodic medicines are given.
Patient is kept for observation.
If the pain goes away, the gallsone may have become unstuck in the bile duct and pass out into the intestine.

3.If there is severe pain or recurrence of another attack of pain, it is advisable to have the gallbladder removed.

a.Normal surgery to remove the gallbladder and the gallstones involve 4 holes in the abdomen and the use of a laparoscopic to cut away the gallbladder followed by stitching.
The surgery is usually very safe and the patient may not need to be hospitalised.

b.In an emergency, such as perforated gallbladder, immediate surgery may be required to remove the gallbladder and cleared the inner abdomen of leaked bile.

What is the prognosis of gallstones?
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Most people with gallstones do not have symptoms.

Sometimes gallstones may be detected while having tests for other health problems.

Sometimes an ultrasound done on an woman during pregnancy may show gallstones.

The prognosis for patients after surgery is usually good.

The bile will go straight to the intestine from the liver.
Digestion of oily food may not as good as before and is usually not noticeable.

A Simple Guide to Vulvitis

A Simple Guide to Vulvitis
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What is Vulvitis?
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Vulvitis is an acute inflammation of the vulva in females.

What are the causes of Vulvitis?
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Vulvitis is usually caused by the following:

Infections:

1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.

2.Fungal infection such as candidiasis

3.Herpes simplex in recurrent cases

4.Pediculosis pubis or lice

5.pinworm infection in children

6.Urinary infection such as cystitis

Allergies:

1.Clothings

2.perfumes

3.powders

4.drugs

Chemical irritants:

1.vaginal douche

2.detergents used to wash underwear

Mechanical irritants:

1.ill fitting underwear

2.inadequate sexual lubrication

Postmenopausal:

Atrophic vulvovaginitis after menopausal with dryness and inflammation of the vulval and vaginal lining

Generalised disorders:

Dermatological disorders such as lichen simplex


What are the symptoms and signs of Vulvitis?
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Persons who has Acute Vulvitis has the following
Symptoms:

1.vulval irritation and itch

2.discharge from vagina

3.painful or frequency of urination

4.excoriation of the inner lining of vulva

Signs:

1.discharge can be seen in female vagina

2.redness and inflammation of the vulva

How do you diagnose Vulvitis?
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Diagnosis can usually be made by :

1.History of vulval itch associated frequency of urination, painful urination or discharge from vagina

2.Vulva shows inflammation, excoriation of lining,

3.Vulval and vaginal swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

4. biopsy of the suspicious vulval lesions to exclude other causes of vulval problem such as tumor

What is the treatment of Vulvitis?
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1.Approprate Antibiotics, antifungal for infections especially after urine bacterial culture

2.Antihistamine medicine for itch

3.Topical oestrogen cream for postmenopausal atrophic vulvovaginitis

4.Proper hygience after urination, sexual intercourse and bathing

5.Avoid strong soaps

6.Use of lubricants during sexual intercourse

7.Weight reduction if obese

8.Treat underlying condition such as diabetes,allergic dermatitis,other skin
conditions.

What is the prognosis of Vulvitis?
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Prognosis is usually good with medication.

Sexual partner may need to be treated.

Recurrence is quite common.