HEALTH INFORMATION

Prostate Examination Procedure

2009-07-01T10:51:00.000-07:00

The Prostate Examination

At some point most men will either be offered a prostate examination as part of general health screening, or, it will be advised because of their age (usually 50+) or some problem relating to difficulty in passing urine.

Procedure

· The man is advised that a finger needs to be inserted into their rectum in order to examine the prostate gland.
· Usually the man is asked to stand, feet apart, face the examination couch and bend forward so that arms or elbows are on the couch.
· The doctor will put on a surgical glove and will cover a finger in lubricant
· The doctor will most likely say that you will feel a little pressure but no discomfort
· The finger will be inserted in a downwards angle as if pointing to the umbilicus (belly button)
· A few seconds may elapse as the doctor waits for the external sphincter muscle to relax
· You may be aware of some movement of the finger before it is removed. The doctor will probably tell you they are going to remove their finger and then offer you some tissue to wipe the lubricant from the anus and buttocks.

What The Doctor is Examining

The doctor moves their finger in a circular motion in order to identify the lobes and groove of the prostate gland. In a normal sized prostate gland they would expect to find the prostate around 2-4 cm long and triangular in shape. They would also expect the prostate to feel firm and rubbery.

Prostate Prevention

2009-06-29T09:40:00.000-07:00

Prevent Prostate-related Diseases by Knowing the Cause of Prostate Problems

It is wise for all the men to know the cause of prostate problems as these problems can be prevented.
The major reason for prostate problem is Aging. As men get older, their prostate keeps growing. In old age, the body looses its flexibility and moreover it becomes heavier. It gradually clamps down on the urethra, disrupting the flow of urine.

Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control. Hence, aging is the major contributor to this problem and as human, it is impossible for us to prevent aging! In fact, some people believe that all men would have an enlarged prostate if they lived long enough!

However, a regular medical check up is always necessary for men from time to time to prevent themselves from prostate problems. Men shouldn’t feel ashamed to consult doctors. Men who notice any signs of prostate problems, even those who are under 50 years of age, should make it a point to visit a health care provider. Those who are after the age of 50, regular prostate check-ups are highly recommended for them. An annual medical examination can assist to avoid major complications with prostate cancer in life.

Besides aging, there are other risk factors that contribute to these prostate problems. Those men whose occupations involve sitting for long time at the workplace, for instance, in the office, workshops, sites or in the car are at the higher risk of getting prostate problem because sitting for a long time increases the pressure on pelvis which in turn develops congestion for the prostate gland.

Moreover, some men who like to work with their notebooks / laptops on their lap for a long period are having higher risk to suffer from prostate-related diseases. Another factor that may cause prostate problem is constipation. In some case, the extra excitement for sex is also found to contribute this problem.

A man’s risk of facing prostate related problems can be reduced by doing physical exercise frequently and maintaining a low-fat diet that includes plenty of fruits, vegetables and whole grains.

Those suggested nutritious food and drinks are tomatoes, garlic, watermelons, red grapefruit, papaya, red berries, onions, broccoli, green tea and red wine. Eating healthy food can help to prevent prostate problems as such food promotes a strong immune system and helps in supporting prostate health in men.

Here are some eating tips to ensure prostate health:

1.You should always eat fresh food. The nutrients in fresh food provide more health benefits.
2.Stay away from food that is high in fat which is not good for prostate health

How to do Prostate Examination

2009-06-26T02:50:00.000-07:00

Rectal examination

A rectal examination or rectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.
Digital rectal exam; drawing shows a side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder; also shows a gloved and lubricated finger inserted into the rectum to feel the prostate.

The digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple procedure. The patient is placed in a position where the anus is accessible and relaxed (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups). The physician inserts a gloved and lubricated finger into the rectum through the anus and palpates the insides for approximately 60 seconds.

The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; colonoscopy is preferred. However, it's an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum.

This examination may be used:
for the diagnosis of rectal tumors and other forms of cancers
in males, for the diagnosis of prostatic disorders, notably tumors and benign prostatic hyperplasia
for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease);
for the estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries;
in females, for gynecological palpations of internal organs
for examination of the hardness and color of the feces (ie. in cases of constipation, and fecal impaction);
prior to a colonoscopy or proctoscopy
to evaluate haemorrhoids

The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.Sometimes proctoscopy may also be part of a rectal examination.

What I need to know about Prostate Problems

2009-06-25T11:54:00.000-07:00

What is the prostate?

The prostate is part of a man’s sex organs. It’s about the size of a walnut and surrounds the tube called the urethra, located just below the bladder.

The urethra has two jobs: to carry urine from the bladder when you urinate and to carry semen during a sexual climax, or ejaculation. Semen is a combination of sperm plus fluid that the prostate adds.
The male urinary tract. The prostate surrounds the urethra, where urine leaves the bladder.

What are prostate problems?

For men under 50, the most common prostate problem is prostatitis.

For men over 50, the most common prostate problem is prostate enlargement. This condition is also called benign prostatic hyperplasia (BPH). Older men are at risk for prostate cancer as well, but this disease is much less common than BPH.

For younger men, the most common prostate problem is prostatitis. For older men, it’s an enlarged prostate.

What is prostatitis?

Prostatitis means the prostate might be inflamed or irritated. If you have prostatitis, you may have a burning feeling when you urinate, or you may have to urinate more often. Or you may have a fever or just feel tired.

If you have bacterial prostatitis, your doctor can look through a microscope and find bacteria in a sample of your urine.

You may have to work with your doctor to find a treatment that’s right for you. Changing your diet or taking warm baths may help. Your doctor may give you a medicine called an alpha-blocker to relax the muscle tissue in the prostate.

What is prostate enlargement, or BPH?

If you’re a man over 50 and have started having problems urinating, the reason could be an enlarged prostate, or BPH. As men get older, their prostate keeps growing. As it grows, it squeezes the urethra. Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.

If you have BPH, you may have one or more of these problems:

A frequent and urgent need to urinate. You may get up several times a night to go to the bathroom.

Trouble starting a urine stream. Even though you feel you have to rush to get to the bathroom, you find it hard to start urinating.

A weak stream of urine

A small amount of urine each time you go

The feeling that you still have to go, even when you have just finished urinating

Leaking or dribbling urine

Small amounts of blood in your urine

Is BPH a sign of cancer?

No. It’s true that some men with prostate cancer also have BPH, but that doesn’t mean that the two conditions are always linked. Most men with BPH don’t develop prostate cancer. However, because the early symptoms are the same for both conditions.

Is BPH a serious disease?

By itself, BPH is not a serious condition, unless the symptoms are so bothersome that you can’t enjoy life. But BPH can lead to serious problems. One problem is urinary tract infections.

If you can’t urinate at all, you should get medical help right away. Sometimes this happens suddenly to men after they take an over-the-counter cold or allergy medicine

What tests will ordered by doctor

Digital rectal exam. This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the prostate, which sits directly in front of the rectum. This exam gives the doctor a general idea of the size and condition of the prostate.

Blood test. The doctor may want to test a sample of your blood to look for prostate-specific antigen (PSA). If your PSA is high, it may be a sign that you have prostate cancer. But this test isn’t perfect.

Imaging. The doctor may want to get a picture of your prostate using either x rays or a sonogram. An intravenous pyelogram (IVP) is an x ray of the urinary tract. For an IVP, dye will be injected into a vein.

Urine flow study. You may be asked to urinate into a special device that measures how quickly the urine is flowing.

Cystoscopy. Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.

How is BPH treated?

Watchful waiting. If your symptoms don’t bother you too much, you may choose to live with them rather than take pills every day or have surgery. But you should have regular checkups to make sure your condition isn’t getting worse.

Medicines. In recent years, scientists have developed several medicines to shrink or relax the prostate to keep it from blocking the bladder opening.

Nonsurgical procedures. A number of devices have been developed that allow doctors to remove parts of the prostate during nonsurgical procedures. These procedures can usually be done in a clinic or hospital without an overnight stay.

Several transurethral procedures are treatments for BPH:

PVP (photoselective vaporization of the prostate): destroys excess prostate tissue interfering with the exit of urine from the body by using a controlled laser beam inside the prostate.

TUIP (transurethral incision of the prostate): widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.

TUMT (transurethral microwave thermotherapy): destroys prostate tissue by using a probe in the urethra to deliver microwaves.

TUNA (transurethral needle ablation): destroys excess prostate tissue with electromagnetically generated heat by using a needle-like device in the urethra.

Surgical treatment. Surgery to remove a piece of the prostate can be done through the urethra or in open surgery, which requires cutting through the skin above the base of the penis. The most common surgery is called transurethral resection of the prostate (TURP). In TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop while looking through a cystoscope. TURP and open surgery both require general anesthesia and a stay in the hospital.

Is TURP the same as removing the prostate?

No. TURP and other procedures for BPH remove only enough tissue to relieve urine blockage. In a few cases, the prostate may continue to grow, and urinary problems return.
A prostate removal, or radical prostatectomy, is usually done only to stop prostate cancer from spreading.

Enlarged Prostate Signs and Symptoms

2009-06-24T11:36:00.000-07:00

What is enlarged prostate or BPH?

BPH stands for benign prostatic hyperplasia.Benign means "not cancer," and hyperplasia means too much growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not raise your chances of getting prostate cancer--yet the symptoms for BPH and prostate cancer can be similar.

BPH Symptoms

BPH symptoms usually start after the age of 50. They can include:

Trouble starting a urine stream or making more than a dribble
Passing urine often, especially at night
Feeling that the bladder has not fully emptied
A strong or sudden urge to pass urine
Weak or slow urine stream
Stopping and starting again several times while passing urine
Pushing or straining to begin passing urine

At its worst, BPH can lead to:

A weak bladder
Backflow of urine causing bladder or kidney infections
Complete block in the flow of urine
Kidney failure

BPH affects most men as they get older. It can lead to urinary problems like those with prostatitis. By age 60, many men have signs of BPH. By age 70, almost all men have some prostate enlargement.

The prostate starts out about the size of a walnut. By the time a man is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon.

References

Kirby R, Lepor H. Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 87.

Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Morrill B, et al. The effects of dutasteride, tamsulosin, and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement. 2-year results from the CombAT study. J Urol. 2008;179:616-621.

Prostate Enlargement : Benign Prostatic Hyperplasia

2009-06-23T12:43:00.001-07:00

General Information

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.
It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.
Enlarged-Prostate.jpg

As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.
Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.

Throughout their lives, men produce both testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done on animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth.

Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood's testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH.

Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as

a hesitant, interrupted, weak stream
urgency and leaking or dribbling
more frequent urination, especially at night

Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.

Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence—the inability to control urination.

References

Bent S, Kane C, Shinohara K, et. al. Saw palmetto for benign prostatic hyperplasia. NEJM. 2006; 354:557-566

Roehrborn CG, McConnell JD. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 86.

Rich KT, Safranek S. PPIN's clinical inquiries. Medical treatment of benign prostatic hyperplasia. Am Fam Physician. 2008;77:665-666.

2009-05-19T12:53:00.000-07:00

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2008-11-30T12:06:00.000-08:00

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SURGICAL TREATMENT FOR KIDNEY STONES

2008-07-19T06:50:00.000-07:00

Surgery .

Click to enlarge
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 .

Click to enlarge
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

2008-07-19T05:43:00.000-07:00

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

2008-07-15T12:21:00.000-07:00

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

2008-07-13T12:32:00.000-07:00

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

2008-07-11T13:28:00.000-07:00

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

2008-07-10T05:01:00.000-07:00

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

2008-07-09T13:40:00.000-07:00

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.

Ear , Nose and Throat Association

2008-06-30T05:15:00.000-07:00

Introduction

Otolaryngology is the oldest medical specialty in the united states.Otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with deseases and disorders of the ear,nose and throat (ENT), and related structures of the head and neck.they are commonly referred to as ENT physicians.

Their special skills include diagnosing and managing deseases of the sinuses,larynx,oral cavity and upper pharynx (mouth and throat), as well as structures of the neck and face.Otolaryngologists diagnose,treat, and manage specialty-specific disorders as well as many primary care problems in both children and adults.

Otolaryngologists treat.

The Ears-Hearing loss effects one in ten north American.The unique domain of otolaryngologists is the treatment of ear disorders.They are trained in both the medical surgical treatment of hearing ,ear infection,balance disorders,ear noise (tinnitus),nerve pain and facial and cranial nerve disorders.Otolaryngologists also manage congenital (birth) disorders of the outer and inner ear.

The Nose-About 35 million people develop chronic sinusitis each year,making it one of the most common health complaints in america.care of the nasal cavity and sinuses of the primary skills of otolaryngologists.management of the nasal area includes sense of smell,breathing through and and the appearance of the nose are also part of otolaryngologists expertise.

The Throat-communicating (speech and singing) and eating a meal all involve this vital area.also specific to otolaryngologists expertise in managing deseases of the larynx (voice box) and the upper aero-digestive tract or esophagus ,including voice and swallowing disorders.

The Head and Neck-This center in the body includes the important nerves that control sight,smell,hearing,and the face.in the head and neck area ,otolaryngologists are trained to treat infectious diseases,both benign and malignant (cancerous) tumors,facial trauma and deformities of the face.they perform both cosmetic palstic and reconstructive surgery.

INTRODUCTION

2008-06-29T05:24:00.000-07:00

Urology is surgical specialty which deals with deseases of the male and female urinary tract and the male reproductive organs.although urology is classified as surgical specialty,a knowledge of internal medicine,pediatrics,gynecology and other specialties is required by the urologyst because of the wide variety of clinical problems encountered.in recognition of the wide scope of urology,the American Urologycal association has identified seven subspecialty areas:

1.Pediatric urology

2.Urologic oncology (cancer)

3.Renal transplantation

4.Male infertility

5.Calculi (urinary tract stones)

6.Female urology (urinary incontinence and pelvic outlet relaxation disorders)

7.Neurology (voiding disorders,urodinamic evaluation of patients, and erectile disfunction or impotence).

Historically,the subject which clearly established the specialty of urology as being distinct from general surgery was the treatment of obstructive urupathy.This treatment ranges from the correction of obstructing posterior urethral valves or ureteropelvic junction obstruction in the infant to the correction of bladder outlet obstruction from benign prostatic hyperplasia in the older male.throuhg the decades,we have witnessed a tremendous increase in our general understanding of the diverse functional disorders of urine transport associated with various overt and covert forms of neouromuscular dysfunction.The rapidly evolving discipline of urodinamics has established itself as a major resource in the diagnosis and therapy of such disturbances.

Stones desease of the urinary tract has always provided a substantial portion of general urologic practice.The recent introduction of rigid and flexible ureteroscopy has greatly improved the capacity of the urologist to deal with the problem while the management of stones in the kidney has been revolutionized twice in the immediate past:first with the introduction of percutaneous methods for stone disintegration and extraction ,and secondly by the application of extracorporeal shockwave lithotripsy.Colectively these techniques have largely rendered open surgical procedure for dealing with kidney and urethral stones absolute.These new technologies remain under urological stewardship.In addition,advances in the diagnosis and metabolic management of recurrent nephrolithiasis allow urologist to reduce the risk of recurrent stone formation.

Another area of major urologic concern is that of congenital anomalies.The urinary tract is affected by congenital anomalies more than any other organ system.these congenital abnormalities run the gamut from the relatively common problem of cryptorchidism to the complex area of intersexuality.Most urologists do surgically repair many congenital anomalies in children,but the more complex problems are often referred to urologists with specialized training in pediatric urology.

Involvement of the urologist in the problem of renal insufficiency and end-stage renal desease has been necessitated by an enormous increase in the number of patients dialysis and requiring transplantation.In a number of centers,urologist are the prime surgical arm for renal transplantation and in others ,serve as member of the surgical team

Treatment of malignant disease is very large portion of urologic practice.some of the most encouraging results in the medical and surgical management of solids tumors have involved genitourinary tumors,namely testis tumors and wilms' tumors.the development of multimodal therapy,in which chemotherapy,radiation therapy, and surgical treatment are used in conjucntion,will hopefully improve the results of treatment of othre genitourinary malignancies.newer diagnostic methods for the detection of prostate cancer occupies much of many urologits time.