Showing posts with label Men Health. Show all posts
Showing posts with label Men Health. Show all posts
Epididymitis is the infection of an epididymis. Epididymis is found at the posterior lateral side of the testis with its main purpose been to collect and store sperm, produced by testicles before an ejaculation. In older adults, epididymits occurs as a result of prostatitis, BPH or an urinary tract infection that descend downwards to the testis.
In young male who are still on their pre-puberty stage, it is most commonly caused by E-coli. In male below 35 years old, the main cause of epididymitis is Chlamydia Trachomatis; a gram negative bacteria that is responsible for Chlamydia - a sexually transmitted disease. It can also develop from gonorrhea infection as a complication.
Epididymitis Symptoms
- Initially, the patient complains of pain and soreness, occuring only on one side along the vas deferens, followed by a swollen and a tender epididymis. Other symptoms include;
- Pain and swelling in the scrotum that slowly get worse.
- Fever and chills
- Increase in urinary frequency and urgency.
- Pain during urination.
- Pus or discharge coming from the penis.
Epididymitis Diagnostic Tests
Epididymitis is diagnosed by use of the following tests;
- Physical examination
- Urinalysis
- Complete blood tests
- Culture and gram staining of the urethra drainage.
- Testing of sexually transmitted diseases like HIV, gonorrhea, syphilis for sexually active individuals.
- Ultrasound may be performed to rule out tumor and other conditions.
Epididymitis Treatment
The kind of treatment given depends on what is causing the infection, if the infection is caused by bacteria like Chlamydia Trachomatis, the infected patient plus his sexual partner are treated with antibiotics. The patient is then observed for atleast 2 weeks and if no improvement occurs, he is further evaluated for other medical conditions, such as testicular tumor. Pain relievers are also prescribed.
For patient with recurrent infection or painful chronic infections that does not respond to treatment, epididymectomy (removal of epididymis from the testis) may be performed.
Other non-pharmaceutical ways and health education given to the patient include;
- Patients are advised to take a bed rest.
- Patients are advised to keep the scrotum elevated to relieve pain and prevent traction.
- Use of intermittent cold compress to relieve pain and discomfort.
- Patients are advised to avoid straining, lifting or sexual stimulation until fully recovered.
Epididymitis Complication
Possible complications associated with epididymitis include;
- Scrotal abscess formation
- Infertility if the infection occurs in both testis.
- Decreased blood flow to the testis due to cord swelling leading to necrotic of testis.
- Chronic or recurrent epididymitis infection.
Disorders of the male genitals or reproductive system are usually diagnosed using different methods. Diagnostic tests involve use of a physical examination, obtaining a thorough personal history, psychological evaluations (as part of tests of male sexual function) and use of other diagnostic procedures. The two commonly screening tests used as part of physical assessment are; the Digital Rectal Examination (DRE) and Testicular Examination.
Digital Rectal Examination
Digital Rectal Examination is recommended as a routine checkup screening test for men aged 50 and above and high risk groups from the age of 40 years and above. It is an important screening examination that is used to detect prostate cancer. Digital Rectal Examination is usually performed by an examiner to access the size, shape and consistency of the prostate gland or tenderness.
Testicular Examination
The Testicular Examination is used to detect any abnormality in the scrotum, penis and testes. The scrotum is palpated for masses, nodules or tendness. Penis is inspected and palpated for tenderness, checked for discharge and ulcerations. Testicular Examination is an important screening examination that can help in detecting cancer of the testicular early in the course. All male should be taught how to perform the testicular-self examination once they reach the adolescent age.
Other Diagnostic Tests
Prostate Fluid or Tissue Analysis
Prostate Specimen or Tissue Analysis is usually performed if an inflammation of the prostate gland is suspected. Prostate gland specimen or tissue is obtained for culture and further analysis. A biopsy of prostate gland may also be performed to obtain tissue for histologic examination.
Prostate Specific Antigen Test
Prostate gland produces a kind of protein known as Prostate Specific Antigen. An elevated level of PSA may be due to prostate cancer or other conditions such as; BPH or acute prostatitis. DRE together with PSA are recommended as normal routine tests for men at a high risk. Prostate Specific Antigen Test is also used as a monitoring test for prostate cancer recurrence.
Ultrasonography
Transrectal Ultrasound is usually performed for those men with elevated PSA and after an abnormal DRE screening test. The test is used to detect small nodular masses that are not palpable and to help in staging of prostate cancer. A needle biospy is usually performed, guided by the Transrectal Ultrasound.
Cancer of the Prostate is a malignant tumor that develops in the prostate gland. A walnut shaped gland found under the bladder, that is part of the male reproductive system. It is the second most common type of cancer in men, after non melanoma skin cancer and the second most common cause of death in USA (after lung cancer). Prostate cancer usually progresses slowly over a long period of time. The risk of getting prostate cancer is increased in men who are above 50 years old.
What Causes Prostate Cancer?
As with any other type of cancer, prostate cancer occurs as result of change in DNA of the prostate gland over a period of time. There is no known reason why some men develop prostate cancer while others do not but several risk factors have been associated with the development.
Risks for Prostate Cancer
- Advancing age - 70% of cases occurs in men over 65 years.
- Race
- Family history of the prostate cancer.
- Unhealthy eating habits (men who consume alot of red meat or daily products).
- Studies also shows that men with a gene mutation class of BRCA2 (class of genes known as tumor suppressor genes) are at higher risk of acquiring prostate cancer.
Prostate Cancer Symptoms and Signs
Signs and symptoms of prostate cancer are similar to those experienced from other conditions affecting the prostate gland, such as BPH (Bening Prostate Hyperplasia). That is the reason why it is recommended to seek medical help as soon as possible to get the right diagnosis early in the course.
Some of those signs and symptoms are;
Some of those signs and symptoms are;
- Nocturia (frequent urination at night)
- Difficult in initiating urination.
- Urgency (a feeling of a need to urinate).
- Decreased urine flow (urine is less in quantity).
- Incomplete bladder (feeling as if you haven't emptied your bladder after urinating).
- Painful or burning sensation during urination.
- Presence of blood in urine.
- The speed of urine flow is decreased.
- Pain during ejaculation
Prostate Cancer Diagnosis
If prostate cancer is diagnosed early in the course of the illness, the likelihood of cure is very high. That is why routine DRE (direct rectal examination and PSA is recommended) for men 50 years and above and young men between 40 and 45 years, who are at a high risk for prostate cancer.
Prostate cancer is diagnosed through;
- DRE (Digital Rectal Examination)
- Serum PSA (Prostate Specific Antigen) - A protein that is produced by prostate gland (both normal and neoplastic prostate gland). Also referred as a tumor marker.
- TRUS (Transrectal ultrasound) with needle biopsy - used to detect non palpable prostate cancer and helps in tumor staging.
Other tests that are performed to detect metastases are:
- Bone x-ray for detecting bone metastases.
- Urography - for detecting changes caused by the ureteral obstruction.
- CT Scan (Computed Tomography) - for identifying metastases in the lymph nodes.
- Renal Functions Tests - to measure creatinine levels.
Prostate Cancer Treatment
The choice of treatment depends on the stage at which the disease is diagnosed, age, patient's preferences, symptoms and other medical conditions. Several surgical procedures are available, that I discussed in my previous article; Prostate Cancer and BPH surgical procedures.
What is the usual surgery for BPH? This a common question asked by most patients once they are diagnosed with BPH that require surgical management. There are different types of invasive and surgical procedures that are used to Manage BPH with TURP (transurethral Resection of Prostate) been the most commonly used.
You and your physician will discuss the available surgical options and select one that seems to be the best for you. In consideration of other things such as; other symptoms that you may be experiencing, the size of your prostate gland, your preference, what surgical procedures are available in your area, past and current medical history.
The following is a list of 6 invasive and surgical procedure that are performed to manage BPH;
Transurethral Resection of Prostate (TURP)
This is the most commonly used surgical procedure - It is the removal of the prostate gland via urethra.
Transurethral Microwave Thermotherapy and Transurethral Needle Ablation (TUMT and TUNA).
Both procedures use heat to destroy or to cause death to the cells of the prostate gland.
Laser Prostatectomy
Laser Prostatectom is the of laser to ablate or remove the enlarged prostate.
Suprapubic Prostatectomy
An incision is made on the low midline section to remove the enlarged prostate tissue. Patients undergoing this type of procedure requires insertion of a Suprapubic Catheter.
Retropubic Prostatectomy
An incision is done at the lower side of the abdomen to remove the enlarged prostate tissues.
Perineal Prostatectomy
An incision is made between the scrotum and the rectum to get rid of the hypertrophied prostate tissues (prostate gland enlarged tissues).
Patients undergoing prostatectomy usually require insertion of a Suprapubic Catheter. This a simple procedure that is done during the surgery. What is Suprapubic Catheter?
Suprapubic Catheter Definition
A suprapubic catheter is a type of catheter that is used to drain urine out when the normal passage of urine is obstructed or blocked. The catheter is usually inserted through the wall of the abdomen, above the pubic bone into the bladder.
What is UTI? Urinary tract infection is an infection of the upper or lower urinary tract caused by various pathogenic micro-organisms. Urinary infections are simply classified by location as; Upper Urinary Tract Infections (the ureters and the kidneys), Lower Urinary Tract Infections (bladder and other structures found below it), Complicated Lower or Upper Urinary Tract Infections; acquired during hospitalization and may be related to catheterization and other medical procedures. It is also common among patients with urologic abnormalities and compromised immune system, possible recurrent. Uncomplicated Lower or Upper Urinary Tract Infections; acquired in community (non recurrent).
Risk Factors for UTI
- Individuals who do not empty their bladders completely.
- Conditions that obstruct urine flow such as; urethral stricture, tumors, kidney or ureter stones, congenital and neurological abnormalites, BPH (Benign prostatic hyperplasia).
- Individuals with compromised immunity such as; patients suffering from AIDS.
- People needing frequent catheterization or undergoing medical procedure such as; cystoscopic.
- Bladder and urethral mucosa inflammation.
- Other medical conditions associated with increased risk of acquiring UTI include; diabetes, pregnancy, comatose patients and people with neurologic disorders.
Lower UTI (Urinary Tract Infection)
The infections of lower tract include; inflammation of the urinary bladder, prostate gland (prostatitis) and urethra (urethritis).
Lower UTI Symptoms
- Pain during urination (dysuria).
- Burning sensation while urinating.
- Increase in urination frequency.
- Need to urinate at night (nocturia).
- Presence of blood in the urine (hematuria).
- Urine incontinence (involuntary elimination of urine).
- Presence of a discomfort in the pelvic region or pelvic pain.
- Back pain may also be presence.
Lower UTI Diagnostic
- Bacterial colony count
- Urinalysis (urine culture)
- Cellular studies
- CT or Ultrasound may also be ordered to detect other possible causes.
The treatment of lower UTI depends on the causative agent and the level of the infection. For recurrent UTI infections, long term therapy may be necessary. If other medical conditions such as kidney stone are responsibe for the infection, they are also treated.
Upper UTI (Urinary Tract Infections)
Infections of upper tract include; inflammation of the renal pelvis, kidney and formation of renal mass (abscesses). The infection initially start from the bladder and spread upwards towards the kidney. It may also start from other parts of the body (systematic infection) and gradually spread to the kidney through the bloodstream.
Upper UTI Symptoms
Since the infection of upper urinary tract involves kidneys (Pyelonephritis). There are two types of Pyelonephritis; Acute and Chronic.
An individuals with Acute Pyelonephritis usually manifests with fever and chills. Urinalysis test shows an abnormal increase in bacteria colonies, increased white blood cells and presence of pus. Presence of flank pain (pain felt just below the rib and above the ilium due to overstimulation of nerve endings). Other symptoms may include; vomiting, nausea, headache, body fatigue and pain during urination.
Upper UTI Diagnostic
Upon physical examination, it reveals tenderness and pain in the costovertebral region.
Upon physical examination, it reveals tenderness and pain in the costovertebral region.
- CT Scan or an ultrasound is performed.
- Urine culture and sensitivity test to determine the cause of the infection.
Upper Urinary Tract Infection Treatment
Patients who have acute un-complicated Pyelonephritis without other associated symptoms like nausea or vomitting are given antibiotics and treated as out patients (2 weeks antibiotics therapy is usually recommended). A follow up check-up is indicated to monitor the effectiveness of the prescribed regimen and to prevent progression (Acute Pyelonephritis turning to Chronic Pyelonephritis).
Chronic Pyelonephritis
In chronic Pyelonephritis, patients may have no symptoms and they may only re-appear during the exacerbation period (worsening of the condition). Some of the other symptoms that may be present during an acute exacerbation episode are; fatigue, frequent urination, thirst, weight loss and headache. The physician may also request for a pyelography (test to access the kidneys, bladder, ureter using a dye).
Other tests that are performed include; measurement of the level of creatinine and BUN. Antibiotics if bacterial infections is present. In other cases, a long term use of a low dose of antiobiotics may be considered to prevent frequent reccurent of the infection and renal scarring, which can eventually lead to renal failure.
Preventing UTI (in Both Men and Women)
Here is a list of a few things that you can do to prevent having recurrent urinary tract infections;
- You should always shower rather than using a bath tub since if there are bacteria on the water, they may enter the urethra.
- After waste elimination, remember to wipe from front to back. To prevent transmission of micro-organism (fecal contamination is responsibe for most of UTI).
- Drink adequate amount of fluid, daily to flush out bacteria.
- As much as possible, avoid foods that may irritate urinary tract such as; excessive coffee, alcohol and soft drinks.
- Make sure you are completely emptying your bladder.
- Void atleast every 2 to 3 hours during the day.
- Take your medication as prescribed.
- Never miss a followup schedule with your physician.
What is Acute Prostatitis? Acute Prostatitis is a sudden inflammation of the prostate gland. Prostate gland is found directly below the bladder (walnut-sized) with its primary function been to produce fluid that forms a part of the seminal fluid. Prostatitis can be caused by various infectious agents such as; bacteria, fungi and mycoplasma. E-coli is responsible for 60% of acute bacterial prostatitis (ABP) cases. Other medical conditions like urethral stricture and BPH may also cause prostatitis.
There are two types of bacterial prostatitis; Acute Bacterial Prostatitis and Chronic Bacterial Prostatitis.
Acute Prostatitis Symptoms
The following are signs and symptoms of an acute bacterial prostatitis;
- Sudden onset of fever and chills
- Perineal, rectal or back pain
- Pain during urination
- Feeling of an urgency
- Increase in urinary frequency
- Excessive urination at night (nocturia).
Other infectious agents like fungi (not bacteria) usually causes the following signs and symptoms;
- Urgency and increase in frequency
- Perineal discomfort
- Pain during or after an ejaculation.
- Pain during urination (due to prostatodynia - pain in the prostate gland).
In chronic prostatitis, the symptoms are usually milder in comparison to an acute prostatitis but patients do suffer from frequent urinary tract infection.
Prostatitis Complications
The most common complications associated with prostatitis include; urinary retention, swelling of the prostate gland, bacteremia, epididymitis and pyelonephritis (the inflammation of the upper urinary tract and kidney).
Prostatitis Diagnosis
If an individual is suspected of suffering from an acute prostatitis, culture of the prostate gland fluid is performed together with urinalysis. In some instances, a histologic examination of the prostate tissue may also be ordered.
To locate the source of the infection, a segmental urine collection is usually done. The patient is advised to void and the first 10 - 15 ml of urine is collected in a separate container (urethra urine). Immediately after and making sure the flow is not interrupted, a second urine specimen (50-75ml) is collected (bladder urine).
Incase the individual is not suffering from an acute prostatitis, a prostate massage is performed by a physician and a third culture is collected (prostatic fluid) for further analysis.
Prostatitis Treatment
The major goal of acute prostatitis treament it to halt the progression of the infection and to avoid the complications. Depending on the causative agent, a broad spectrum of antibiotics is usually given. Intravenous administration of the antibiotics may be necessary for optimal serum levels. Pain relievers are also given and patient is put under bed rest to decrease the discomfort.
Other forms of treatment used may include; Antispasmodic drugs (to treat pain and spasms), stool softener (to relieve constipation and decrease pain caused by straining during a bowel movements) and non pharmacology interventions like use of sitz bath (to decrease pain and spasm in the lower part of the body).
Despite the fact that, chronic prostatitis is much harder to treat. However, the same kind of treatement is applied, a muscle relaxant together wilth a low dose of antibiotics may be prescribed as a continuous therapy. The patient is also taught about UTI (urinary tract infection) and how to recognize the symptoms since individuals with chronic prostatitis are prone to frequent UTI infections. Patients with chronic prostatitis are treated as outpatients.
Benign Prostatic Hyperplasia or BPH refers to a non malignant enlargement of the prostate gland. The cells inside the prostate gland increases in number leading to an enlarged prostate. As the prostate gland enlarges, it extends upwards towards the bladder hence obstructing the outflow of the urine. Eventually, it may lead to other medical conditions. BHP is more common in men aged 50 years and above, about 50% of them develop BPH. It is more evidenced in older men aged 80 years and above, affecting 80% of the population.
Though the cause of BPH is unknown but there are studies that suggest the level of estradiol hormone may be directly related to the size of the prostate gland among men with high testosterone levels.
BPH Risk Factors
- Race - Benign Prostatic Hyperplasia is more common in African American men and it develop at a younger age than in other races.
- Less likely in men of Asian origin.
- Men with smoking history.
- Heavy alcohol consumption
- Hypertension and heart diseases.
- Diabetes
- Diet
Benign Prostatic Hyperplasia Symptoms
- Increase in urinary frequency and urgency.
- Nocturia (excessive urination at night).
- The urine flow force is decreased.
- A feeling of abdominal straining while urinating.
- A decrease in the amount of urine.
- A delay in initiating urination (hesitancy).
- Decrease in urine volume.
- Urine dribbling (urine still drib out after urinating).
- A feeling that the bladder has not been completely emptied.
Other medical conditions that product similar symptoms like the one listed above are; prostate cancer, neurogenic bladder, urethral stricture and urinary bladder stones.
Benign Prostatic Hyperplasia Possible Complications
- May lead to Acute Urinary Retention if more than 60 ml of urine remains in the bladder.
- Urinary statis result to frequent urinary infections.
- The accumulation of the nitrogenous (waste products that are usually removed by urine) may lead to azotemia.
- Possible renal failure with chronic urine retention.
- Other generalized symptoms like fatigue, nausea and vomiting.
- Hemorrhage (major complication).
Benign Prostatic Hyperplasia Diagnostic
Diagnosis of BPH includes;
- Looking at patient's past medical history and current medical conditions.
- Current symptoms experienced by the patient.
- Family history of the any other medical conditons.
- A thorough physical examination to check whether the prostate is enlarged.
Other test that are performed to diagnose BPH includes;
- Digital Rectal Exam (DRE) - reveals large, rubbery and non tender prostate gland.
- Prostate specific antigen test (PSA test) - Used for measuring the amount of prostate-specific antigen in the blood. The amount of PSA is increased as the prostate enlarges. Men with normal sized prostate gland usually have low amounts of PSA in the blood.
- Urinalysis and urodynamic studies to assess the flow of urine.
- Renal functions test (creatinine test).
- Cytoscopy (visualization of the urinary bladder via the urethra).
- Complete Blood Count to access hemorrhage.
Benign Prostatic Hyperplasia Treatment
The kind of the treatment given depends on;
- The severity of the obstruction by the time the patient seek medical help.
- The cause of Benign Prostatic Hyperplasia (BPH).
- Patient overall health conditions (current and previous medical history).
For example, a patient who is admitted because he cannot void is immediately catheterized. A thin wire called stylet may be inserted by the an urologist to prevent the catheter from collapsing when it gets into contact with resistance.
Pharmocological interventions include use of medications to relax the smooth muscle to improve the urine flow.
Antiandrogen agents may be given to prevent the conversion of testosterone to dihydrotestosterone when hormone is suspected as supporting the growth.
Other treatment options include the TULP (a laser beam is used to make an incision in the prostate to decrease the resistance of urine flow into the bladder and improve the symptoms.
Microwave therapy which involves the application of heat to the prostatic tissue.
Transurethral Neeedle Ablation - Use of low radiation to produce localized heat that destroy the prostate tissue, leaving other parts like urethra intact.
Resection of the prostate gland can also be performed, guided by an ultrasound.
Though BPH is non cancerous, in some cases patients suffering from BPH may also have Prostate cancer or BPH may change to Prostate Cancer later on. High risk men above 40 years should under go regular Prostate examinations tests and recommended for all men above 50 years.
Patients who may have enlarged prostate gland without obstruction problems are periodically monitored to make sure the disease is not progressing and to prevent development of other complications.
Related Posts
BPH Invasive Procedures and Surgeries
What is Acute Prostatitis
Related Posts
BPH Invasive Procedures and Surgeries
What is Acute Prostatitis
