SURGICAL TREATMENT FOR KIDNEY STONES

Surgery .

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If a kidney stone does not move through the ureter within 30 days, surgery is considered. Urologists use several procedures to break up, remove, or bypass kidney stones.

Ureteroscopy .

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This procedure can be used to remove or break up (fragment) stones located in the lower third of the ureter. A fiberoptic instrument resembling a long, thin telescope (ureteroscope) is inserted through the urethra and passed through the bladder to the stone. Once the stone is located, the urologist either removes it with a small basket inserted through the ureteroscope (called basket extraction) or breaks the stone with a laser or similar device. The fragments are then passed by the patient. Ureteroscopy is performed under general or local anesthesia on an outpatient basis.

Lithotripsy.

This procedure is effective for stones in the kidney or upper ureter. It uses an instrument, machine, or probe to break the stone into tiny particles that can pass naturally. Lithotripsy is not appropriate for patients with very large stones or other medical conditions.

Ultrasonic lithotripsy.

uses high frequency sound waves delivered through an electronic probe inserted into the ureter to break up the kidney stone. The fragments are passed by the patient or removed surgically.

Electrohydraulic lithotripsy (EHL).

uses a flexible probe to break up small stones with shock waves generated by electricity. The probe is positioned close to the stone through a flexible ureteroscope. Fragments can be passed by the patient or extracted. EHL requires general anesthesia and can be used to break stones anywhere in the urinary system.

Extracorporeal shock wave lithotripsy (ESWL).

uses highly focused impulses projected from outside the body to pulverize kidney stones anywhere in the urinary system. The stone usually is reduced to sand-like granules that can be passed in the patient's urine. Large stones may require several ESWL treatments. The procedure should not be used for struvite stones, stones over 1 inch in diameter, or in pregnant women.
Patients undergoing lithotripsy are given a sedative and general or local anesthesia, and the procedure takes over an hour. More than one treatment may be required.

Percutaneous Nephrostolithotomy (PCN).

This surgical procedure is performed under local anesthesia and intravenous sedation. Percutaneous (i.e., through the skin) removal of kidney stones (lithotomy) is accomplished through the most direct route to stones through the kidney. A needle and guidewire are used to access the stones. The surgeon then threads various catheters over the guidewire and into the kidney and manipulates surgical instruments through the catheters to fragment and remove kidney stones. This procedure achieves a better stone-free outcome in the treatment of medium and large stones than shock wave lithrotripsy. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.

Ureteroscopic Stone Removal.

This procedure is performed under general anesthesia to treat stones located in the middle and lower ureter. A small, fiberoptic instrument (ureteroscope) is passed through the urethra and bladder and into the ureter. Small stones are removed and large stones are fragmented using a laser or similar device. A small tube (or stent) may be left in the ureter for a few days after treatment to promote healing and prevent blockage from swelling or spasm

Open Surgery.

This procedure requires general anesthesia. An incision is made in the patient's back and the stone is extracted through an incision in the ureter or kidney. Most patients require prolonged hospitalization and recovery takes several weeks. This procedure is now rarely used for kidney stones.

Prevention .
Prevention of renal stone disease depends on the type of stone produced, underlying urinary chemical risk factors, and the patient's willingness to undergo a long-term prevention plan. The patient may be asked to make lifestyle modifications such as increased fluid intake and changes in diet.
Orange juice and lemonade with real lemon juice are good sources of citrate and may be recommended as an alternative to water. Limiting meat, salt, and foods high in oxalate (e.g., green leafy vegetables, chocolate, nuts) in the diet may also be recommended. Medication may be prescribed and treatment for an underlying condition that causes renal stone disease may be necessary.

24-Hour Urine Test .
Effective preventative measures are based on the patient's chemical risk factors, which can often be uncovered with a 24-hour urine test and a blood test.
1.The patient strains their urine to collect stones for chemical analysis.
2.The physician performs a blood test to evaluate the serum calcium, uric acid, phosphate, electrolytes, and bicarbonate content.
3.Urine is collected during a 24-hour period and analyzed for calcium, citrate, uric acid, magnesium, phosphate, sodium, oxalate, pH (acid level), and total volume.
The physician evaluates the data and recommends dietary modifications, supplements, and medications to minimize the risk for developing kidney stones. The 24-hour urine test may be repeated several months after treatment has begun to determine the success of the therapy and any adjustments that should be made. Long-term strict compliance and periodic retesting may substantially reduce the risk for future stone formation

from urologychanel.com

KIDNEY STONES / RENAL STONES

What is a kidney stone?

A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi. One in every 20 people develops a kidney stone at some point in their life.
The condition of having kidney stones is termed nephrolithiasis or urolithiasis.

What causes kidney stones?

Kidney stones form when there is a decrease in urine volume or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.
Dehydration through reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones.
Men are especially likely to develop kidney stones, and whites are more often affected than blacks. The prevalence of kidney stones begins to rise when men reach their 40s, and it continues to climb into their 70s. People who have already had more than one kidney stone are prone to develop more stones. A family history of kidney stones is also a risk factor for the development of kidney stones.

A number of different conditions can lead to kidney stones:

1.Gout results in an increased amount of uric acid in the urine and can lead to the formation of uric acid stones.

2.Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.

3.Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.

4.People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.

5.Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor Crixivan (indinavir), a drug used to treat HIV infection.

What are symptoms of kidney stones?

While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills.

How are kidney stones diagnosed?

The diagnosis of kidney stones is suspected by the typical pattern of symptoms when other possible causes of the abdominal or flank pain are excluded. Imaging tests are usually done to confirm the diagnosis. A helical CT scan without contrast material is the most common test to detect stones or obstruction within the urinary tract. Formerly, an intravenous pyelogram (IVP; an x-ray of the abdomen along with the administration of contrast dye into the bloodstream) was the test most commonly used to detect urinary tract stones, but this test has a greater risk of complications, takes longer, and involves higher radiation exposure than the non-contrasted helical CT scan. Helical CT scans have been shown to be a significantly more effective diagnostic tool than the IVP in the diagnosis of kidney or urinary tract stones.
In pregnant women or those who should avoid radiation exposure, an ultrasound examination may be done to help establish the diagnosis.

What is the treatment for kidney stones?

Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Pain medications can be prescribed for symptom relief. There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9-10 mm rarely pass on their own and usually require treatment.
Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine and alpha blockers such as tamsulosin. These drugs may be prescribed some people who have stones that do not rapidly pass through the urinary tract.

For kidney stones which do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.
Surgical techniques have also been developed to remove kidney stones. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as an ureteroscope passed through the urethra and bladder up into the ureter.

How can kidney stones be prevented?

Rather than having to undergo treatment, it is best to avoid kidney stones in the first place. It can be especially helpful to drink more water. (The National Institutes of Health recommend drinking up to 12 full glasses of water a day, if you've already had a kidney stone.) Water helps to flush away the substances that form stones in the kidneys.
Depending on the cause of the kidney stones and an individual's medical history, dietary changes or medications are sometimes recommended to decrease the likelihood of developing further kidney stones. It is particularly helpful, if one has passed a stone, to have it analyzed in a laboratory to determine the precise type of stone so specific prevention measures can be considered.

from medicinenet.com

MANAGEMENT POSTOPERATIVE TONSILLECTOMY

A.What is Tonsillitis?
Tonsillitis is an infection involving inflammation of the tonsils. There are two tonsils, situated on either side of the back of the throat and they form part of the body's immune system. Like the rest of the immune system they contain special cells to trap and kill bacteria and viruses travelling through the body. When the main site of infection is within the tonsils they swell, become red and inflamed and may show a surface coating of white spots.
Tonsillitis is extremely common in children and young people but it can occur at any age. The characteristics of the disease are pain in the throat, trouble swallowing and in severe conditions, trismus (difficulty opening the mouth).
(Image here) Basic Position of the Tonsils

B.How do we contract Tonsillitis?
Whether due to viruses or bacteria, the infection is spread from person to person by airborne droplets, hand contact or kissing hence the term "kissing disease". It is typically seen in young people but can on occasion effect the older adult, in these cases other possible causes need to be investigated.

There are many different individual viruses and bacteria that can potentially cause tonsillitis e.g. the Epstein-Barr virus, which causes glandular fever. The streptococcus group A is the most common cause of tonsillitis and sore throats - often known as 'strep throat'. The incubation period between picking up the infection and the disease breaking out is two to four days - sometimes it can be less. Tonsillitis is usually a self-limiting condition, i.e. it gets better without treatment, and generally there are no complications.
Brian Nicholl, ENT Clinical Nurse Specialist, University Hospital Lewisham. October 2002

C.Signs and symptoms of tonsillitis
1.Sore throat.
2.Pain or discomfort when swallowing.
3.Inability to swallow oral secretions.
4.Tonsils may be coated or have a covering of white spots on them.
Fever.
5.Trismus (difficulty opening the mouth).
6.Glands in the neck and at the angle of the jaw may be swollen and painful.
7.Loss or change in voice.
8.In children, tonsillitis may include symptoms that appear less focused on the throat, such as poor feeding, runny nose, ear pain, and a slight fever.

D.Treatment

1.Visit to the general practitioner (GP) who may commence a course of appropriate antibiotics and analgesia, with advice on oral intake, hygiene and to return if condition does not improve.
2.If the condition does not improve the GP should refer the patient either to a local ear, nose and throat (ENT) referral clinic or to accident and emergency (A&E) for review and treatment by an ENT specialist.
3.If there is an inability to swallow the oral secretions the patient will need to be admitted for a minimum of 24 hours for re-hydration, pain relief and intravenous (IV) antibiotics and reviewed on a daily basis.

E.Inpatient monitoring
.Visual examination of the tonsils.
.Blood tests, including the mono-spot test to rule out glandular fever.
.Tonsullar swab, as above.
.Insertion of a venflon for administration of fluids and IV antibiotics.
.Regular temperature check
.Routine observations including oxygen saturation monitoring.
.Analgesia for pain relief both regular and as required. This is also to assist in reducing any above normal temperature. Paracetamol is the most common one given. Aspirin is sometimes of benefit but this must not be given to children under the age of 12.
.If oral medication is not suitable then intra-muscular (IM) or per rectum (PR) should be prescribed.
.Fan therapy if necessary but taking care not to reduce the pyrexial patients temperature too suddenly.
.Documentation of fluid and oral intake
.Ongoing reviews of care delivered and appropriate alterations, depending on patient response and results of investigations undertaken.

Within 24 hours of analgesia, IV fluids and antibiotics the patient often makes a dramatic recovery and is suitable for discharge home.

F.The patient is ready for discharge when;
.They are apyrexial
.Are managing adequate oral fluids and diet.
.Their pain is controlled on oral analgesia.
.Any investigations are complete and show no other underlying condition that requires immediate investigation / treatment.

G.What happens when discharged?
.The patient will continue on a course of oral antibiotics, which must be completed otherwise the infection may return.
.A seven-day supply of appropriate analgesia will be prescribed.
.Verbal and written advice on areas such as dietary advice, when to return to work & refraining or cessation of smoking and oral hygiene should be given to the patient or carer once discharged.
.If the patient suffers from tonsillitis i.e. 2-3 episodes annually and it affects work/ school attendance, they should be offered a tonsillectomy and if agreed, added to the ENT waiting list.
.A copy of their discharge letter will be given to the patient and one posted to their GP.
.They should be advised if their symptoms return they should see their GP and if appropriate .the GP will refer them back to the hospital.

Taken from entnursing.com

TONSILLITIS AND TONSILLECTOMY

What Is Tonsillitis?
Tonsillitis is an infection of the tonsils. It is caused by either a virus or a bacterium (usually the bacterium known as streptococcus - the same bacterium that causes "strep throat"). Tonsillitis mostly occurs in young children.

What Are Tonsils and Adenoids?
The tonsils are a pair of small almond-shaped organs located of the mouth on both sides of the throat. The adenoids are similar to the tonsils but are located in the upper portion of the throat behind the nose, where they can't be seen.

At one time many doctors believed that tonsils had no real purpose and often routinely removed them to avoid tonsillitis. Today, tonsils and adenoids are seen as perhaps the "first line of defense" against disease-causing germs that enter the body through the nose, mouth, or throat.
Tonsils and adenoids protect against germs during early childhood by producing antibodies . By attacking bacteria and viruses, antibodies play an important role in the body's immune system. The problem is that in the process of protecting the body, the tonsils and adenoids can become infected themselves.

As children grow and develop, the tonsils and adenoids eventually begin to shrink and are probably no longer important in protecting against disease-causing germs. Even in young children, removal of infected tonsils or adenoids does not seem to weaken the body's defenses. There are many other tissues in the body that are part of the immune system. These tissues, known as lymphoid tissues , also make antibodies to fight against infection.

Facts About Tonsillitis:
Doctors once believed that tonsils and adenoids served no purpose and routinely removed them to prevent tonsillitis. Today these organs may be considered to be the "first line of defense" against upper respiratory infections, which enter the body through the nose, mouth, and throat.
An abscess, or pocket of pus, that forms around a tonsil is also known as a quinsy.
When tonsils become so enlarged that a child's voice changes, it is called "hot potato" voice. This is one sign that the tonsils should be removed.

What Are The Symptoms Of Tonsillitis?
The main symptom of tonsillitis is a sore throat. It may develop either suddenly or gradually. It may be either mild or severe.

Your child may:
.Find that it hurts to swallow. If the pain is intense, the child may stop swallowing saliva and start to drool.
.Complain of an earache
.Have a fever of 101 degrees Fahrenheit or higher.
.Complain of a headache.
.Complain of a stomachache (this is quite common).
.Complain of general aches and pains, loss of appetite and may vomit.
.Have bad smelling breath.
.Because the tonsils are swollen and enlarged, the child may have trouble speaking and may even experience difficulty breathing.

What Does Tonsillitis Look Like?
When tonsils are infected, they will look redder than usual and swollen.
A grayish-white or yellowish coating may cover part or all of the tonsils.
The surrounding area of the throat near the tonsils also may appear red and inflamed. There may be swelling at the sides of the neck as the lymph nodes grow larger while producing cells to fight the infection.

Is Tonsillitis Ever Serious?
Tonsillitis can occasionally become serious. For example, infection may spread beyond the tonsil to form an abscess , which is a localized collection of pus.

An abscess that forms around an inflamed tonsil is known as a peritonsillar abscess or quinsy. This almost always develops on one side only, and usually in adults rather than children.
Another type of abscess, one that develops mainly in young children, is a retropharyngeal (behind the throat) abscess . This usually causes high fever and great difficulty in swallowing. If detected very early, peritonsillar or retropharyngeal abscesses can sometimes be treated successfully with antibiotics. In most cases, however, surgery is required to drain the abscess.

Other Possible Complications
The most serious complication of tonsillitis is rheumatic fever, which often is accompanied by rheumatic heart disease. Rheumatic fever develops only if the tonsillitis is due to a type of bacterium known as group A beta hemolytic streptococcus. It also usually occurs only in children who have had repeated infections that have not been adequately treated with antibiotics.
Another complication of streptococcal tonsillitis is a type of kidney disease known as acute glomerulonephritis. However, whether glomerulonephritis can be prevented by early antibiotic treatment of streptococcal tonsillitis is not clear.

A common complication of tonsillitis is infection of the lymph nodes in the neck, known as cervical adenitis. This type of infection can usually be successfully treated with antibiotics. Occasionally the infection progresses, an abscess forms, and surgery is required to drain it.
Other possible complications of tonsillitis include middle-ear infections (otitis media) and sinus infections. More often, however, these infections develop at the same time as, or independently of, tonsillitis.

How Is Tonsillitis Treated?
Treatment of tonsillitis aims to relieve its symptoms. Surgery is very rarely required.
It is not always necessary to identify the exact cause of tonsillitis before beginning treatment, but it generally is advisable to at least determine whether the infection is due to streptococcal bacteria, so that appropriate treatment can be started. A "rapid strep" test is now available. If the test is positive, it is almost certain that your child's tonsillitis is caused by streptococcus bacteria. If the test is negative, a traditional laboratory culture will be needed.

Tonsillitis caused by streptococcus bacteria must be treated with penicillin or other suitable antibiotics in order to prevent the development of rheumatic fever. Penicillin is the best drug to use, unless your child has an allergy to it. It should be given by mouth for at least 10 days. Taking penicillin for shorter time periods may not completely clear up the infection.
Alternatively, a single intramuscular injection of long-acting penicillin can be given, but this is relatively painful. For children who are allergic to penicillin, other suitable antibiotics are available.

Tonsillitis due to viruses, like other infections due to viruses, does not respond to any currently known antibiotics.
Acetaminophen or ibuprofen may relieve sore throat and other symptoms of tonsillitis. Aspirin is best avoided in children of any age because of the risk of Reye's syndrome.
Tonsillitis may sometimes be due to other types of bacteria that also may respond to antibiotic treatment. Judgments about such treatment should be left to your doctor.

taken from ehealthMD.com

HEALTH TEACHING FOR PATIENT POSTOPERATIVE TURP

POSTOPERATIVE INFORMATION

This information to give you advice on what to expect after the operation and when you leave the hospital.you may already have been given information from the urology doctor during your preadmission clinic appointment.

WHAT WILL HAPPEN IMEDIATELY AFTER SURGERY?

1.After operation you will have an intravenous drip in your arm to give you fluid to make sure you don't get dehydrated.

2.you will have a catheter in your penis to drain urine out of your bladder into a bag.an irrigation drip (saline) will be attached to the catheter to wash any blood or tissue out of the bladder.your urine will look red at first but will gradually become lighter in colour.

3.It is important for you to drink plenty to help keep the urine clear and prevent the catheter becoming blocked.the nurses looking after you will keep the irrigation flowing and will unblock the catheter if the need arises.they will also ensure that the catheter is kept clean.

WHAT WILL HAPPEN DURINE THE FIRST FEW DAYS?

1.Once you are up and about which is usually the day after the operation the nurse will teach you how to care for the catheter.

2.when the urine is clear or very light pink and you have opened your bowels to the catheter will be removed and you should be able to pass urine normally.the catheter is usually removed 2-4 days after the operation

3.It is usual to want to pass urine frequently when the catheter is first removed and you may find it difficult to control at first.it is important therefore to practice pelvic floor exercises which will help you to hold onto your urine for longer

4.The ward nurses will scan your bladder with a portable scanner to make sure that your bladder is emptying properly before the docto allows you to leave the hospital.

5.An out-patient appoinment will be made for you to see the urology doctor in about 6 weeks to ensure that you are well and your urinary problems have resolved.

WHAT WILL HAPPEN AFTER I GO HOME?

1.It is advisable during the 2 weeks after you are sent home to rest as much as possible and not carry out any heavy lifting.if you are employed,you can resume work about 4 weeks after the operation.

2.Sometimes betwen 10-14 days after your operation you may experience bleeding in your urine.this is due to the scab coming away form the healing tissue.if this happens,drinking more fluids will wash away the blood and avoid clothing.

3.If you experience any burning pain when passing urine or have a fever this could mean you have a urinary infection which will need to be treated with antibiotics by your doctor.

4.You will be able to resume sexual intercourse 2 weeks after the operation, however when you ejaculate there is a strong possibility that the semen will up into the bladder instead of out through the peni.this is called retrograde ejaculation and should have been discussed with you before operation.if this happen it means you will be infertile,but otherwise you will not be harmed by it.

taken from urology nurse specialist

NURSING CARE PLAN FOR BPH

BENIGN PROSTATIC HYPERPLASIA (BPH)
Benign prostatic hyperplasia is characterized by progressive enlargement of the prostate gland (commonly seen in men older than age 50), causing varying degrees of urethral obstruction and restriction of urinary flow.

CARE SETTING
Community level, with more acute care provided during outpatient procedure.

RELATED CONCERNS
Psychosocial aspect of care
Renal failure:acute
Patient assesment database

CIRCULATION
May exhibit:elevated BP (renal effects of advanced enlargement)

ELIMINATION
Hesitancy in initiating voiding
inability to empty bladder completely; urgency and frequency of urination.
Nocturia,dysuria,hematuria.
Sitting to void.
Recurrent UTI,history of calculi (urinary statis).
Chronic constipation (protrusion of prostate into rectum)
May exhibit: Firm mass in lower abdomen (distended bladder), bladder tenderness.
Inguinal hernia,hemorrhoids (result of increased abdominal pressure required to empty bladder against resistance).

FOOD/FLUID
May report :anorexia,nausea,vomiting.
Recent weight loss.

PAIN/DISCOMFORT
May report:suprapubic,flank or back pain; sharp,intens (in acute prostatitis).
Low back pain
SAFETY
May reprot: fever
SEXUALITY
May report:concerns about effect of condition therapy on sexual abilities
Fear or incontinence/dribling during intimacy
Decrease in force of ejaculatory contractions
May exhibit :enlarged,tender of prostate
TEACHING/LEARNING
May report:Family history of cancer,hypertension,kidney disease.
NURSING PRIORITIES
1.Relieve acute urinary retention
2.Promote comfort.
3.Prevent complication.
4.Help patient deal with psychosocial concerns.
5.Provide information about disease process/prognosis and treatment needs.

DISCHARGE GOALS
1.Voiding pattern normalized.
2.Pain/discomfort relieved.
3.Complications prevented/minimized.
4.Dealing with situation realistically.
5.Disease process/prognosis and therapeutic regimen understood.
6.Plan in place to meet needs after discharge.



taken from nursingcareplan.blogspot.com

BENIGN PROSTATIC HYPERPLASIA

ENLARGED PROSTATE (BPH)

An enlarged prostate -known as benign prostatic hyperplasia or BPH-is caused by an overgrowth of prostate cells.this enlargement constricts the urethtra so the flow of urine is reduced,making it increasingly difficult to empty the bladder.

BPH is very common ,affecting about one third of men over 50 years although it is not prostate cancer,the symptoms of BPH are similar to those of prostate cancer so you should see your doctor if you start to experience problems passing urine.

SYMPTOMS OF BPH

- hesitancy (difficulty starting to pass urine)

- a weak stream.

- the need to strain to pass urine.

- the feeling that your bladder is not empty after urination.

- the need to pass urine urgently.

- frequent trips to the toilet,including having to get up several times in the night.

- feeling a burning sensation or pain when passing urine.

DIAGNOSTIC STUDY

1.Digital rectal examination (DRE) to examine the size and consistency of prostate

2.Abdomen examination to find out if the bladder is distended.

3.Urine test to check for infection or blood

4.Blood test including a prostate specific antigen (PSA)

5.Other test-less common test may include:urine flow test,ultrasound abdomen and pelvis,urodynamic measurements using a catheter inserted into the bladder to measure the pressure of urine there, and TRUS and prostatic biopsy.

TREATMENT OF BPH

= Drug treatment.

1.Alpha-blockers-work by relaxing the muscles of the neck of the bladder and in the prostate.around 60% of men find symptoms improve significantly within the first 2-3 weeks of treatment with an alpha-blockers.the currently of alpha-blockers are alfuzosin (xatral), doxazosin (cardura), indoramin (doralese), prazosin (hypovase), terazosin and tamsulosin.

2.5-alpha-reductase inhibitors-these drug work by inhibiting the production of hormone called DHT,which contribute to prostate enlargement.Finasteride (proscar) is the most commonly used drug of this type for BPH.

= Surgery treatment.

1.TURP

Trunsurethtral resection of the prostate (TURP) is the most common operation of BPH.TURP is an effective procedure with over 90% of men reporting an improvement after the operation.however, as with any surgical procedure there is a risk of side effects and complications.a common side-effect of this procedure is retrograde ejaculation-where semen pass into the bladder during orgasm instead of out of the penis.

2.TUIP

Transurethral incision of the prostate (TUIP) may be appropriate for men who have a less enlarged proetate.it is a quicker operation than TURP and involves remiving less tissue.

3.Open prostatectomy

Open prostatectomy is only recommended for men whose prostate is very large.it is major operation and carried out under general anaesthesia.

4.Other treatment is laser therapy (using a laser probe to cut away prostate tissue) and transurethral microwave thermotherapy (using heat to remove some of the prostate tissue via a probe) are becoming more common in the treatment of BPH.

PREVENTION

Although it is not known why only some men develope BPH,it is clear that advancing age is the prime risk factor.Eating a diet that is low in fat and rich in fruit and vegetables (five portions perday) may well help to reduce the risk of prostate cancer and has been proven to bring other health benefits.

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