FREQUENTLY ASKED QUESTIONS
Stones, Prostate Gland, Prostate Cancer, mpotence, Urinary Incontinence, Infertility, Kidney Transplantation, Frequently Asked quotions
Stones (calculus disease):
1.WHAT ARE THE SYMPTOMS OF THE PRESENCE
OF KIDNEY STONES
1.WHAT ARE MY
CHANCES OF GETTING PROSTATE CANCER?
1.HOW IS ERECTILE DYSFUNCTION TREATED?
1. WHAT IS URINARY
1.MY HUSBAND REFUSES TO GET HIS SEMEN
TESTED.HE SAYS THAT IT IS THICK AND VOLUMINOUS MEANS IT MUST BE NORMAL
WHAT ARE THE SYMPTOMS OF THE PRESENCE OF KIDNEY STONES?
The presentation of symptoms depends upon the location, size, and shape of the stone. Many times they are symptom free. They are called silent stones. Common symptoms are as follows:
Medical science have advanced considerably particularly in the last decade. These advances have greatly improved our understanding of course of the stone disease and the management of this ailment has undergone revolutionary changes. This knowledge has further been helpful in the prevention and treatment of stone disease.
Various factors play a role in the formation of kidney stone in a susceptible individual. These factors are diet, water intake, urinary output, climate, occupation, and heredity, radical and family background.
1. Diet- Ingestion of excessive amount of calcium, oxalates, purines (uric acid), phosphates and other elements often results in excessive excretion of these components in the urine. The stone formation can be precipitated by high intake of calcium in the form of milk, ice creams, cheese, chocolates, cocoa, calcium containing drugs or vitamin D.
2.Water Intake and Urinary Output- It has been well established that increased water intake and increased urinary output decrease the incidence of urinary stone in patients predisposed to the disease.
3.Climate- High environmental temperature increases sweating, which may result in increased concentration of urine. This hyper concentration may contribute to stone formation.
4.Occupation- Stone disease is more likely to be found in individuals with sedentary occupation like professionals and managerial class rather than unskilled and partly skilled labourers.
5.Genetic Disorders- Like Gout, Cystinuria, primary Oxaluria, metabolic disorders like bowl, endocrine and kidney problems that increase blood and urine calcium and oxalates can promote the tendency for stone formation. Other rarer conditions like rickets, hyperparathyroidism and demineralization of bone may lead to stone formation.
6.Obstruction and Infection- Due to stricture or enlarged prostate may cause stagnation of urine leading to stone formation. Chronic infection in the kidney may also allow stone formation around the debris in the urine.
In stone belts, where the disease is endemic, it is the hot dry climate and the high content of calcium in the hard water and in the food grown in the soil that leads to stone formation. In areas where this disease is not endemic, in most cases no cause can be detected and it may be the tendency of the kidneys in the individual to form urine of high calcium or urate content. In some it may be due to a period of negligence in intake of adequate fluids worsened by excessive sweating.
Stones form due to many reasons
DOES WATER HELP IN FLUSHING OUT THE STONES?
Yes. Water helps in the flushing out the stones. But fortunately
not all stones, stones which are in the size range of 3-6 mm can be passed
out with the increased in take of water
If you find a stone, bring it in to your doctor for analysis. The type
of stone you have, will determine the diet and prevention programme your
doctor recommends. You may need additional tests and X-ray in future to
ensure that new stones do not form.
Knowing the fact that you are harbouring the stone you should not ignore
that. You should go for check up for the stone size every 6 months and
should notice for increase in the size of the stone. Increase in size
is the indication that stones need some intervention.
ESWL is an absolute safe procedure in almost all cases.
There may be dull aching pain in site of treatment after the procedure for few hrs. Further there will be colic pain due to passage of stone particles. This normally responds to the medication.
There is no damage to the other organs as the shock waves are effective
on the targeted point at the junction of solid and liquid, which is stone
and urine respectively.
Lithotripsy is safest with above diseases as it is totally non-invasive
procedure. However, one should keep these diseases under control when
treating with Lithotripsy.
A good first step for prevention is to drink more liquids – water
is the best. If you tend to form stones, you should try to drink enough
liquids throughout the day to produce at least two litres of urine in
every 24 hours period. People who form calcium stones used to be told
to avoid dairy products and other foods with high calcium content. However,
recent studies have shown that foods high in calcium, including dairy
foods, help prevent calcium stones. Taking calcium in pill form, however,
may increase the risk of developing stones. Women taking vitamin D and
calcium pills in the postmenopausal period to prevent osteoporosis, especially
with family history of stones, need to be careful.
In general, you require surgical intervention if your stones are large
enough to obstruct urine flow, if they are potentially harmful to your
kidneys or if they are causing symptoms for which medication does not
Any person with a family history of stones may be at higher risk. Stone disease in a first degree relative, such as a parent or sibling, can dramatically increase the probability for you. In addition, more than 70 percent of people with certain rare hereditary disorders are prone to the problem. Those conditions include cystinuria, an excess of the amino acid, cystine, that does not dissolve in urine and instead forms stones of cystine; and primary hyperoxaluria, an excess production of the compound oxalate, which also does not dissolve in urine, forming stones of oxalate and calcium.
No there is no known link. They are formed in different areas of the body. Also, if you have a gallstone, you are not necessarily more likely to develop kidney stones.
The treatment of renal calculi has undergone significant changes over
the last decade. The endo-urologist has a large armamentarium of treatment
options. The advent of ESWL, along with improvements in fiberoptic technology
and video equipment has virtually eliminated the need for open stone surgery.
In an era of minimally invasive surgery, the use of ureteroscopy, Lithotripsy,
and Percutaneous procedures has expanded the use of endoscopic management
of renal stones. Continued progress in Lithotripsy technology, advances
in endoscopic techniques and refinements in medical management will improve
our ability to choose the appropriate treatments for renal calculi in
an era of cost confinement.
Prostate Gland :
Benign prostatic hyperplasia (BPH) is a condition that affects the prostate
gland in men. The prostate is a gland found between the bladder (where
urine is stored) and the urethra (the tube urine passes through). As men
age, the prostate gland slowly grows bigger (or enlarges). As the prostate
gets bigger, it may press on the urethra and cause the flow of urine to
be slower and less forceful. "Benign" means the enlargement
isn't caused by cancer or infection. "Hyperplasia" means enlargement.
Most symptoms of BPH start gradually. One symptom is the need to get up more often at night to urinate. Another symptom is the need to empty the bladder often during the day. Other symptoms include difficulty in starting the urine flow and dribbling after urination ends. The size and strength of the urine stream may decrease.
These symptoms can be caused by other things besides BPH. They may be signs of more serious diseases, such as a bladder infection or bladder cancer. Tell your doctor if you have any of these symptoms, so he or she can decide which tests to use to find the possible cause.
After your doctor takes a complete history of your symptoms, a rectal exam is the next step. This exam allows your doctor to actually feel the size of the prostate gland.
It might not be possible for your doctor to be sure that your prostate problem is benign just by taking a history and performing a physical exam. Your doctor might need to look at a sample of your urine for signs of infection. Your doctor may also do a blood test. An ultrasound exam or a biopsy of the prostate may help your doctor make the diagnosis.
Once your doctor is sure that your symptoms are caused by benign growth of the prostate gland, treatment can be recommended. However, your doctor may suggest that you wait to see if your symptoms get better because sometimes mild symptoms get better on their own. If your symptoms get worse, your doctor may suggest another treatment option.
Surgery is considered the most effective treatment and is used in men with strong symptoms. This is also the best way to diagnose and cure early cancer of the prostate. Surgery is usually done through the urethra, leaving no scars. Surgery does have risks, such as bleeding, infection or impotence. These risks are generally small.
Drug treatments are available. Finasteride (brand name: Proscar) makes the prostate shrink, but it does not help all patients. The side effects of finasteride are rare and mild, but they usually have to do with sexual function. They go away when the medicine is stopped. The prostate will enlarge again when the medicine is stopped, so another treatment may have to be tried.
Another kind of medicine, called alpha blockers, also can help the symptoms of BPH. Some of these drugs are terazosin (brand name: Hytrin), doxazosin (brand name: Cardura) and tamsulosin (brand name: Flomax). Alpha blockers have been used for a long time to treat high blood pressure, but they can also help the symptoms of BPH, even in men with normal blood pressure. These medicines may not work in all men. The side effects of alpha blockers are mild and go away if you stop taking the medicine. The side effects include dizziness, fatigue and lightheadedness.
Prostate cancer is the most common cancer among men and the second leading
cause of annual cancer deaths, following lung cancer. One in 10
men will be diagnosed with prostate cancer. More than 70 percent of all
prostate cancer cases are diagnosed in men over the age of 65. Black
men are in the highest risk group and represent approximately 270 cases
per 100,000 men. In addition, prostate cancer has the strongest
familial link of all the major cancers.
Often, early stages of prostate cancer do not cause symptoms. But, in some cases, men with prostate cancer may experience any of these problems:
You should speak with your doctor immediately if you have these symptoms
or if you are over 50 and not had a recent prostate cancer screening.
If you have a family history of prostate cancer, or are an African-American
male, you should consider screening beginning at age 45.
Prostate cancer may be highly curable when detected in its early stages.
One in every seven men diagnosed with prostate cancer will die from
the disease. In advanced stages of the disease, new data
from two large clinical trials suggest chemotherapy extends survival among
men who have failed hormone therapy. Your physician can provide you with
specific guidance based on the facts and circumstances of your case.
Screening for prostate cancer is a relatively simple procedure.
While others may begin with a visit to the urologist. Urologist will be
able to help you learn more about the screening process.
The first analysis many physicians will perform is a
The DRE and PSA tests cannot diagnose prostate cancer; they merely indicate that further testing is needed. Abnormal findings in either the DRE or PSA may indicate the need for a biopsy. During a biopsy, ultrasound is used to view and guide a needle (or multiple needles) into the prostate to take small samples of tissue. Typically, a prostate cancer biopsy employs a multi-needle device that is able to take six or more tissue samples simultaneously from different parts of the prostate to be sure that cancerous tissue is not missed. This procedure is typically performed using local anesthesia.
A biopsy is the only way to confirm or diagnose the presence of prostate cancer. The biopsy procedure may cause some discomfort or pain, but the procedure is short, and it can usually be performed without an overnight hospital stay on an outpatient basis.
There are a variety of ways to treat prostate cancer including
Urologists, radiation oncologists and medical oncologists all play a vital role in the treatment of prostate cancer.
By measuring levels of a substance called prostate-specific antigen in the blood, your physician can measure disease progression. If you are receiving treatment for prostate cancer and your PSA numbers keep rising, it may be a sign that your therapy isn't working and you may need to consider a more aggressive treatment.
Most men whose cancer returns after local treatment or are diagnosed with advanced disease are treated with hormone therapy. However, at some point, hormone therapy may stop working and the PSA levels will begin to rise again. At this point it is particularly important to seek the advice of a medical oncologist who can work with the rest of your healthcare team to determine the best treatment for you at this stage of the disease.
If prostate cancer is diagnosed at an advanced stage or if the cancer
returns after localized therapy such as surgery or radiation, additional
treatment with hormonal therapy is typically initiated.
How erectile dysfunction is treated depends on what things are causing
it. After your doctor checks you for medical problems and medicines that
might cause erectile dysfunction, he or she may have you try a medicine
to help with erectile dysfunction. Some of these medicines are injected
into your penis. Other medicines are taken by mouth. Not everyone can
use these medicines. Your doctor will help you decide if you can try them.
If the medicines aren't right for you, you could also try using vacuum
pump devices, or you could have surgery. Your doctor may send you to an
urologist to talk about these options.
HOPE THROUGH RESEARCH
Advances in suppositories, inject able medications, implants, and vacuum
devices have expanded the options for men seeking treatment for ED. These
advances have also helped increase the number of men seeking treatment.
Gene therapy for ED is now being tested in several centers and may offer
a long-lasting therapeutic approach for ED.
POINTS TO REMEMBER
Urinary incontinence is the inability to hold urine leading to involuntary loss of urine. The urine loss can range from slight leakage of urine to severe frequent wetting. This condition severely affects quality of life by interfering with work, travel, social recreation and sexual activities.
At least 10% of people over the age of 65 years have urinary incontinence. According to World Health Organisation estimates, there are 200 million patients worldwide with symptoms of male or female urinary incontinence. However, as this condition is associated with shame, embarrassment and silence, the exact figure is not known.
With aging, the urge to urinate may occur more frequently and be harder
to control: however, incontinence can affect men and women of all ages
and is not a normal response to aging.
No, women experience incontinence two times more often than men. Pregnancy
and child-birth, menopause and the structure of the female urinary tract
account for this difference. However, both women and men can become incontinent
from stroke, multiple sclerosis and other physical problems associated
with old age.
Risk factors for urinary incontinence vary, but include:
Urinary incontinence has far reaching consequences not only on a person's
physical health but also on the mental condition. Embarrassment, stigmatization,
isolation, demoralization and depression are common in these patients.
Urinary incontinence is also associated with an increased number of falls,
urinary tract infections and skin breakdown. The economic burden of the
disease is also considerable as it often leads to premature admission
of the patient to nursing home.
There are three basic types of urinary incontinence:
Urge incontinence or detrusor over activity is a common problem that increases in frequency and severity with advancing age. In this condition, the patient often loses urine for no apparent reasons while suddenly feeling the need or urge to urinate. In urge incontinence, the bladder involuntarily empties during sleep, after drinking a small amount of water, or while touching water or even when hearing it run (as when someone else is taking a shower or washing dishes).
The most common cause of urge incontinence is inappropriate and involuntary
bladder contractions. These involuntary contractions may occur because
of inflammation or irritation within the bladder or when certain neurological
diseases impair control of bladder contractions.
* Urinary tract infections
Urge incontinence can also occur when mobility is impaired (for example,
in patients with arthritis), making it difficult for patients to get to
the bathroom in time. This condition is sometimes referred to mass "functional"
Stress incontinence is the most prevalent form of incontinence in elderly patients. It is caused by malfunction of the urethral sphincter that causes urine to leak from the bladder when intra-abdominal pressure increases, such as during laughing, coughing or sneezing.
Physical changes resulting from pregnancy, childbirth and menopause are common causes of stress incontinence. It is the most common form of incontinence in women and is treatable. Certain muscles, known as the "pelvic floor muscles" support the bladder. If these muscles weaken, the bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken. Stress incontinence can worsen during the week before menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause. Stress incontinence can also occur as a result of drugs, Surgical trauma or radiation damage.
Overflow bladder is more relatively uncommon. Urinary incontinence due to overflow bladder is more common in men because of the prevalence of obstructive prostate gland enlargement. In this condition urine accumulates in the bladder until maximum bladder capacity is reached. It then leaks through the urethra by "overflow", usually manifesting as dribbling. However, increased intra-abdominal pressure, which occurs during coughing and sneezing, may also cause loss of urine, so that overflow incontinence may be confused with stress incontinence.
When stress and urge incontinence occur together, it is sometimes referred
to as "mixed incontinence". This is common in women. "Transient"
or temporary incontinence can be caused by medications, urinary tract
infections, mental impairment, restricted mobility and severe constipation,
which can push against the urinary tract and obstruct outflow.
Most types of urinary incontinence can be effectively treated and the symptoms improved the type of incontinence present is determined. In some patients, incontinence is often improved by weight loss. Smokers who have a chronic cough have fewer problems when they stop smoking (and stop coughing). Some common drugs can also aggravate the situation.
These patients often respond to behavioural therapy consisting of bladder re-training provided they are motivated to do so and their mental faculties are all right. For example, such patients are instructed about a fluid intake schedule, voiding techniques and scheduled voiding. Institutionalised patients can also benefit from behavioural training using scheduled toileting or prompted voiding. Urge incontinence also responds to various drugs. Special care must be taken when using these medications, especially in patients who may have urinary outflow obstruction, as these drugs can precipitate urinary retention.
The urinary sphincter, with the help of surrounding pelvic floor muscles, controls release of urine from the bladder. Pelvic floor exercises strengthen these muscles, which help to prevent or reduce incontinence.
Exercises used to strengthen these muscles called "Kegels".
To do them, imagine that you are trying to stop passing gas. Squeeze the
muscles you would use to stop the gas and hold the squeeze as you count
to 3. Relax, count to 3 again, and then repeat the squeezing exercise.
Don't use stomach, leg, or buttock muscles. Do this for about 5 minutes
three times a day. It may take 6-8 weeks before any beneficial effect
is noted. Reported improvement/cure rates have been as high as 77%. These
exercises can be done practically anywhere-while driving, watching television,
or fixing a meal. But the important thing is to get into the habit of
doing Kegels regularly. But remember to avoid pelvic floor exercises while
you are urinating, because that may actually weaken the muscles
Patients with overflow incontinence have difficulty emptying their bladder. The goal of treatment is therefore to improve bladder drainage. This can be achieved by drugs, catheterisation and surgery. Intermittent self-catheterisation may also be used for chronic management in patients with overflow incontinence. Most of these patients can be taught to self-catheterise safely with clean catheters. Patients with overflow incontinence can also be instructed in assisted voiding techniques (e.g., abdominal strain, Crede maneuver).
Treatment of functional incontinence depends on the successful management
of causative or contributing conditions. Mobility can be improved by relieving
pain and providing equipment for patients suffering from arthritis, contractures,
deconditioning and neurologic impairments. Environmental modifications
(e.g., improved lighting, use of a bedside commode or reducing the distance
to the toilet) can be useful in selected patients
Although absorbent undergarments can help elderly patients regain freedom lost as a result of urinary incontinence, they may cause many patients to avoid medical evaluation and simply accept the incontinence. Absorbent undergarments are expensive and may cause skin irritation and breakdown with long-term use.
Behavioural therapy has been recommended as the initial approach to urinary incontinence. Even when surgery is the treatment of choice , it is often complemented with some form of behavioural treatment . Behavioural interventions include pelvic muscle exercises, biofeedback, bladder training and fluid /dietary modifications.
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Brief doses of electrical can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.
Ans- Semen consists mainly of seminal fluid, secreted by
the seminal vesicles and the prostate. The volume and consistency of the
semen is not related to its fertility potential, which depends upon the
sperm count. This can only be assessed by microscopic examination.
Ans-Even a normal (fertile) man's sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, illness, and medications. There are other factors which affect the sperm count as well, all of which we do not understand.
Ans-There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.
Ans-Masturbation is a normal activity
There is no connection between sexual pleasure and fertility. Don't forget that even a woman who gets raped can get pregnant! And don't forget that the commonest reason women do not enjoy sex is because their husbands are unskilled lovers! Maybe you should improve your sexual technique, and spend more time in foreplay and in pleasuring your wife!
TESE (Testicular Sperm Extraction): Sperm collected out of the testicles
Spermatozoa are ejaculated in the seminal fluid during intercourse or masturbation. During assisted reproduction the spermatozoa are extracted from the semen by a series of processes - centrifugation and washing, layering (to select the active sperm and leave the immotile or dead sperm behind) or selecting the best sperm by making them swim through a denser medium and using those that succeed.
Kidney Transplantation :
A kidney transplant is a surgical procedure in which a kidney is removed from one person (donor) and placed into the body of a person suffering from renal failure (recipient), in whom the transplanted kidney can perform all the functions which the patient's own kidneys are not able to perform.
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