Jul
15
Recovery from Prostate Surgery.
July 15, 2009 | Leave a Comment
Recovery from Prostate Surgery
Whatever anyone tells you, a prostatectomy is a major operation and you need to allow yourself sufficient time to recover from it bupropion. Men are notoriously impatient, especially if they have to go back to work, but you must accept that you will probably have to slow down for a while. Don’t expect miracles, and don’t be too hard on yourself. You may not have had a leg amputated, but you have nevertheless had a major operation and you must make allowances for this. You must not expect too much of yourself during your recovery period in order to give yourself the best chance to get better as quickly as possible. Any impatience may, in
the long run, only make matters worse and set you back on your road to recovery. Exactly how long it takes you to get yourself back to a state of good health depends to a large extent on how fit you were before you had the operation. It also depends on how large your prostate gland was, and on whether or not there were any complications as a result of surgery.
Remember that old cliche about time being the great healer? It may not be very original but, like a lot of cliches, it’s true. So grit your teeth and take things easy for a while. It may take as long as three months before you feel completely well again, but once you do, you’ll be utterly convinced that it was worth every minute!
Your bladder
In the first few weeks after your operation, don’t be surprised if your symptoms do not seem any better than before. They may even seem worse. This doesn’t mean that the operation hasn’t been a success - only that you haven’t healed yet. It can take anything up to about six weeks for the cut surface inside the prostate to heal over completely. Expecting everything to work perfectly before this happens is unrealistic. Until then, you will have to be prepared to make allowances. Even when your urinary system returns to a state of good health, do not be surprised if you have problems getting used to this. You’ve probably spent a long time - years maybe - getting used to having to empty your bladder all too frequently, and it may take a long time -several weeks, probably, or even months - before you succeed in unlearning those habits. Be patient and you will gradually build up confidence in your bladder again until you are able to forget about it completely.
Medication
You will probably still be taking a course of antibiotics when you leave hospital. You must be disciplined about taking these. Remember to finish the course, and don’t just stop taking the pills as soon as you feel better. This could set you back a long way and allow any leftover bacteria to multiply and mount another attack just when you’re least expecting it and you’re congratulating yourself on getting better .
AFTER AN OPEN PROSTATECTOMY
If you’ve had an open prostatectomy, you will have stitches in your abdomen and you will have been given strict instructions on what you can and can’t do. You will be tired after your general anaesthetic and you will need to look after your wound. A district nurse will probably come to your house every other day to change the dressing, and she will take the stitches out when necessary. You will have been told what movements you can make to avoid putting too great a strain on both the scar and the surrounding muscles. You should also:
• Avoid carrying anything at all heavy - even a full kettle may be too heavy, so fill it only half full.
• Get out of your chair cautiously and gently by wriggling your way to the edge of the chair before getting up.
• Build up slowly to normal activities.
• Use your common sense at all times and don’t attempt to do too much.
• STOP immediately if you suspect you are doing too much.
Even when you’ve had the stitches removed, you will still need to be careful. It takes a good six weeks for the wound to heal itself, and several months before the abdominal muscles get back to their full strength.
AFTER A TRANSURETHRAL PROSTATECTOMY (TURP)
If, on the other hand, you’ve had the more common transurethral prostatectomy (TURP), you won’t have any visible signs of your operation, like a scar, and it’s all too easy to forget that you’ve actually had an operation at all. But you have, and you mustn’t forget it. Any operation puts a great physical strain on the body and, as a result, takes a surprisingly long time for you to get over. In hospital, you will have spent most of your time sitting or lying in bed. You probably won’t have done anything more strenuous than reading or watching television. As soon as you get home, the temptation will be to resume all your favourite occupations - going for a walk in the park, perhaps, or doing a bit of gardening. But it is not a good idea to get back into the swing of things too soon. This should be a slow and gradual process, and you must be careful not to push yourself too far, or to do more than you can genuinely cope with. In the meantime, make sure that you get plenty of rest. Get up late, have a rest whenever you feel you need one, and go to bed early. Whenever you are sitting, remember that a firm seat is more comfortable than a soft one that can press upwards between the buttocks.
The problem is obviously greater for people who live alone and who are looking after themselves. But even where this is the case -perhaps even more so, in fact, because you can’t risk driving yourself so hard that you make yourself ill - you must restrict yourself at First to doing the essentials. You’ll obviously need to do the cooking and washing, but most other things can wait. There is absolutely no shame in spoiling yourself at a time like this. Your priority is to get well, and everything else comes second to that average.
BLADDER CONTROL
The great majority of prostatectomies are successful, and recovery is usually straightforward. Having said that, though, recovery can sometimes be slow, and efficient urination is something you may have to work at will.
Just after the operation, the urethra may be swollen, which may in turn be painful. This pain can make the urethral muscles contract from time to time, which can mean that the flow of urine is either slow or intermittent. Bruising of the tissues around the urethra can also prevent the muscles surrounding the urethra working properly, which can mean that the urethra neither opens nor closes completely. This can result in a low stream of urine, of continual leakage of urine. Such problems are, of course, unpleasant and debilitating, but they should disappear as soon as the swelling and bruising get better, which should take only a fortnight or so.
Another problem following the operation may be that you suffer from just as bad - if not worse - a degree of frequency and urgency of urination as you did before the operation. This is likely to be brought about by inflammation of the prostate and urethra, and may continue until the cut surface of the prostate is completely healed, which can take as long as six to eight weeks. It can last even longer 11′ you develop a urinary tract infection, which is a good reason to have your urine tested at your six-week check-up. It may surprise you to know that the opposite problem of an absence of urgency can, contrary to what you might expect, be
even more worrying than its presence. This is because if you suffered from chronic retention of urine before your operation, your bladder may have become so accustomed to holding a large amount of urine that it does not send the right signal when it is full. The danger, in this case, is that the bladder may become so full that it will be unable to contract properly and empty itself efficiently. You will have to empty it by the clock - say every hour or so - until you begin to feel the natural urge to urinate. This should happen spontaneously, if gradually. In short, you can expect your bladder to behaving abnormally for up to six weeks or so after the operation.
Bladder training
You will probably benefit from training - or retraining - your bladder to hold more urine and to last comfortably for longer periods of time. This should help reduce increased frequency and urgency of urination, as well as night-time urination.
Start by making a urination chart, or frequency/volume chart, detailing the time and amount of urine each time you go to the toilet. Equip yourself with a measuring jug, of the type you can buy in hardware or kitchen equipment shops, so as to measure the volume of urine. Continue keeping this chart while you are bladder training. You will probably be used to emptying your bladder each time you feel the slightest urge to do so, or even each time you pass a toilet ‘just in case’. Stop doing this and gradually increase the time between visits to the toilet. Start by holding on for another two minutes after you feel the need to go to the toilet, then increase this to five minutes, then another five minutes, and so on. All this is easier said than done, but there are a few ‘tricks’ that should make it easier for you to hold on between visits.
• Sit rather than stand when you feel the desire to urinate.
• Keep still rather than moving around.
• Pull up your pelvic floor muscles.
• Cross your legs.
• Hold your penis, if you can do this discreetly .
• Take regular, slow, deep breaths.
• Think about something else to keep your mind off your bladder.
• Try to do something else to take your mind off your bladder, such as making a telephone call, or reading the newspaper.
You will find that you can gradually manage to hold on for longer and longer intervals. Aim, ultimately, for an interval of three to four hours.
Bladder training can achieve a lot for most people in just four weeks. Try to keep it up for three months or, even better, six months. Don’t expect to have dealt with all your problems even after six months. Symptoms can continue to improve for as long as a year -or even longer.
RESUMING SEXUAL ACTIVITY
You can resume sexual activity as soon as you feel up to it. Some doctors are wary of advising patients to do this, in case of disturbing clots and scabs, others say that the passage of semen cannot do any more harm than the passage of urine. Be alert to how you feel, and follow your natural inclinations. You may, however, not feel like sex for some time after the operation. If this happens to you, you shouldn’t worry It does not mean that you have lost your sex drive or your potency as a result of the operation - it simply means that you have a natural degree of fatigue after what is, after all, a major operation side affects. This is even more likely if you have had a general anaesthetic.
Retrograde ejaculation
You are unlikely to ejaculate in quite the same way as you did before the operation and may experience retrograde ejaculation. This means that semen goes backwards up the urethra into the bladder, rather than forwards and down into the urethra. This often has the effect of making you sterile, and a lot of men find this a very difficult hurdle to deal with, even if they do not actually want to father any more children. In their eyes, the fact that they are now sterile seems to emasculate them in some way, to make them less of a man. It is important that a man is told that this is a likely side-effect of a prostatectomy before the operation, as this seems to help them deal with it better. Even if you do have retrograde ejaculation, this cannot guarantee that your partner won’t become pregnant and you should still use some form of contraception if this is an issue. You cannot rely on a prostatectomy to give you a reliable form of contraception medicare. It is estimated that between 5 and 10 per cent of men are still fertile afterwards. If you want a reliable and permanent method of contraception, you may want to discuss the possibility of having a vasectomy with your surgeon, as this can easily be done at the same time as a prostatectomy. Your urine will probably look a little cloudy after intercourse, as the semen that went into the bladder is washed out. You may also find that you bleed slightly after intercourse during the first six weeks or so after the operation - just as you notice a little blood in your urine - but as long as this is not a large amount of blood, you should not have anything to worry about.
YOUR SIX-WEEK CHECK-UP
By six weeks after the operation, most of your symptoms should have cleared up, though you may still be suffering from frequency and urgency of urination. You will probably have a check-up after six weeks, which is your opportunity to discuss anything that is worrying you. It is particularly important to have a test done on a urine sample, just to check that you are free of any urine infection. Some hospital clinics also like to repeat the urine flow test, which will indicate that the operation has been successful.
Tags: aggrenox, altace, avandia, bacteria, bladder, bromocriptine, caffeine, celexa, chocolate, cholesterol, cliches, clinda, clomid, clomiphene, erythromycin, everything, ffects, hammer drill, HAVING, Headache, hypertension, Ibuprofen, indigestion, inflammation, information, irritation, lancet, lithium, lithium ion, male, methocarbamol, metronidazole, nexium, plavix, PLENTY, prednisone, premarin, prilosec, problem, prostate gland, prostate surgery, prostatectomy, recovery period, retention, shame, surface, synthroid, Tetracycline, theophylline, tract, training, TRANSURETHRAL, triplets, urinary system, urination, Urine, volume, warfarin, zantacJul
15
Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.
July 15, 2009 | Leave a Comment
Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.
Prostatitis is a catch-all expression covering various types of inflammation of the prostate. It is not as serious as enlargement of the prostate, and especially not as serious as cancer of the prostate. It can, however, be a very difficult condition to treat and can sometimes drag on for several years. In prostatitis, the tiny glands in the prostate become infected, inflamed or clogged - either with thickened secretions or with small gravel-like stones. As we have seen in Chapter 1, the prostate is a complex system of glands, cells, tubules and ducts. Once infection gets a hold in this complicated network, it is hardly surprising that it can be very difficult to eradicate.
Even when it has been treated - and even when it seems as though it has been successfully treated - it can still come back. And in the absence of successful treatment, it can flare up for years, with depressing regularity.
THREE TYPES OF PROSTATITIS
There are three main types of prostatitis. These are:
• Acute bacterial infection.
• Chronic infection, which may be bacterial or non-bacterial.
• Prostatodynia, which may cause the symptoms of prostate pain without any obvious signs of inflammation or infection.
DIAGNOSIS OF PROSTATITIS
Prostatitis is sometimes difficult to diagnose. In general, the person best qualified to diagnose prostatitis is a doctor specialising in urology or genito-urinary medicine clinical trials. Your doctor may refer you to a special genito-urinary (GU) clinic. This does not mean that your doctor suspects that you are suffering from a sexually-transmitted disease. It simply means that genitourinary clinics have the best experience and equipment to investigate and treat your symptoms. The staff are used to dealing with this kind of problem, and will do so sympathetically and in confidence, so you have no need to feel embarrassed. You are likely to have a number of tests as part of the investigation of your symptoms. These may include some, or all, of the following:
• A digital rectal examination, which means that the doctor inserts a lubricated gloved finger into the rectum and gently palpates, or feels, the prostate through the front wall of the rectum, which lies against the back of the gland. If you have prostatitis, the prostate will feel boggy, soft and tender. A digital rectal examination should not hurt,
though it may be uncomfortable if the prostate is inflamed and therefore tender to the touch. A lot of men are embarrassed to have one, but they shouldn’t be: doctors are used to doing this and have a very matter-of-fact attitude to it.
• Swabs from the end of the penis, which are taken by gently inserting a sterile cotton bud into the end of the penis and taking any fresh discharge.
* Urine tests to check for cloudiness, signs of protein or blood, and threads of cellular niaterial, which are then examined under the microscope for pus cells or bacteria.
® Urine cultures to see if any bacteria grow, which should also distinguish between infection in different parts of the urinary tract.
• A blood test to check for a raised white cell count.
• Routine screening for sexually-transmitted diseases such as chlamyclia.
• The doctor will look for a discharge from the penis, and for signs of inflammation and soreness both on the penis and in the testicles. If prostatitis is untreated, or it’ drug treatment is unsuccessful, there is a risk that the prostate gland may become full of pus 5 online sildenafil citrate . Not surprisingly, this can have dreadful consequences. It may eventually burst, releasing pus into the urethra, which will discharge from the tip of the penis. And it may also result in severe infection elsewhere in the urinary tract.
ACUTE BACTERIAL INFECTION
This is an uncommon complaint. It is usually caused by bacteria from the intestines. These find their way into the urinary system, either through the urethra or through the bloodstream or lymphatic fluids.
Sometimes there is a link with organisms that cause a sexually-transmitted disease, such as gonorrhoea or chlarnydia. Sometimes, too, the fungus that causes thrush (Candida) is responsible.
Symptoms
These can happen suddenly and can include one or several of the following:
• Feeling generally under the weather.
• Chills or fever.
• An aching feeling around the thighs and genitals.
• A deep pain in the perineurn, which is the area between the pouch containing the testicles, known as the scrotum, and the anus.
• Low back pain.
• Pain in the lower abdomen.
• Pain on passing water.
• Blood in the urine.
• Difficulty in passing water.
• Increased frequency of passing water.
• Urine may be cloudy or smelly.
• Pain on ejaculation.
Diagnosis
The doctor will probably perform a digital rectal examination by inserting a lubricated gloved finger into the rectum. He will then feel the prostate through the wall of the rectum. If a man has prostatitis, the prostate will probably feel hot, swollen and tender. The doctor will then do a series of tests on a sample of urine and On urethral secretions obtained after massaging the prostate gland, in order to investigate the cause of the infection.
Treatment
Acute bacterial prostatitis, when symptoms come on suddenly, is the most dramatic form of the disease, but it is also the form that responds best to treatment. A prolonged course of antibiotic tablets is prescribed. This is usually for at least four weeks. Acute infection responds well to antibiotics, probably because the intense inflammation allows the drugs to penetrate into the interior of the gland. Symptoms should begin to show some improvement within the first few days. Sometimes, though, infection may persist in the prostate, in spite of treatment, and it is necessary to have careful follow-up treatment to make sure that the condition has cleared up. If this does not happen, the condition may tend to recur and chronic prostatitis will usually result. Occasionally, though rarely, infection may cause the gland to swell sufficiently for the urethra to be squeezed shut. This causes urinary outflow obstruction . It necessitates urgent admission to hospital, where urinary flow is eased by inserting a catheter directly into the bladder. With rest and the administration of antibiotics, the infection will usually clear up well in only a few days.
CHRONIC PROSTATITIS
Chronic prostatitis is more common than acute prostatitis, but is much more difficult to eradicate. There are two types of chronic prostatitis, which can be bacterial or non-bacterial. Chronic bacterial prostatitis Swelling occurs rapidly and this traps the bacteria in the gland, as the usual drainage channels become blocked. Prostatic secretions may coat the offending bacteria, which then harden to form tiny stones, or crystals. This protects them from being attacked by the body’s immune system or by antibiotics. This explains the repeated flare-ups that tend to occur in chronic bacterial prostatitis. This means, too, that the condition can be difficult to treat successfully. Some sufferers may even be unlucky enough to suffer from recurrent symptoms throughout their lives.
Symptoms
These vary from one person to another. They may include any, or several, of the following:
• Frequency in passing water.
• Pain on passing water.
• Pain in the prostate, genitals or rectum.
• Swelling of the testes.
• Lower back pain.
• Watery discharge from the penis.
• Pain on ejaculation.
• Blood in the semen.
• Premature ejaculation.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.
Fertility
There is some evidence that chronic bacterial prostatitis may impair. This may probably be true in all cases of prostatitis, but seems to be especially true of chronic bacterial prostatitis. Analysis of the prostatic fluid of men with chronic bacterial prostatitis has shown significant changes in both the physical properties and the chemical constituents of the fluid. It is thought that these changes may well affect the quality of the semen, and thus the level of fertility. It is not unusual for doctors to hear the wives of men with chronic bacterial prostatitis complain that they are finding it difficult to become pregnant. A sperm count and sperm quality assessment can be done to find out how much a man’s fertility has been affected.
Chronic non-bacterial prostatitis
This is a complaint in which inflammation is present without any signs of infection. In other words, prostate secretions contain white pus cells, but no bacteria. It is not known exactly what causes chronic non-bacterial prostatitis, but several theories have been suggested. One is that it is caused by abnormal emptying of the bladder, which forces urine into the prostate channels and ducts, where it causes irritation and inflammation. This may be triggered, or aggravated, if a man jogs or plays any strenuous sport on a
full bladder. Another theory is that some men produce thicker prostate secretions, which are perhaps more acid then normal. These secretions are unable to drain away through the narrow ducts and therefore build up to cause irritation and swelling.
Symptoms
The most common symptoms of chronic non-bacterial prostatitis are:
• Frequency in passing water.
• Pain on passing water.
• Pain or ache in the prostate, genitals or rectum.
• Lower back pain, especially after sexual intercourse.
• Discharge from the urethra, especially after intercourse.
Treatment
Any chronic infection is difficult to treat, particularly when inflammation and swellings trap the infection inside the gland. In the case of chronic bacterial prostatitis, a course of the appropriate antibiotic, depending on which bacterium is responsible for the condition, will be prescribed for at least six weeks. Sometimes antibiotics may be required for as long as three months, or even longer. Chronic non-bacterial prostatitis can be treated with a natural food supplement derived from rye pollen extracts, which
has been shown to reduce inflammation, irritation and swelling, though improvement may not be apparent for at least three months and full recovery may take as long as six months or even more. Swelling, inflammation and pain may be helped by anti-inflammatory painkillers such as ibuprofen.
Self-help
Chronic non-bacterial prostatitis is sometimes relieved by an increased frequency of ejaculation. This can be brought about through intercourse, of course, but if this does not happen it may equally be brought about by masturbation. Ejaculation drains the prostate of any excess secretions and causes a temporary increase in blood. Both these things help to flush away any toxins. In some cases, however, an increased frequency of ejaculation only makes the problem worse.
PROSTATODYNIA
This is characterised by the usual symptoms of prostate problems, including pain, but with no evidence of inflammation or infection in the gland. Prostate secretions look perfectly normal and contain no pus cells. Prostatodynia is surprisingly common and accounts for around one third of all cases where men experience the symptoms of chronic prostatitis.
Symptoms
The symptoms of prostatodynia are therefore similar to those of chronic prostatitis. They may often also include psychosexual problems.
Symptoms include the following:
• Frequency in passing water, sometimes with associated pain.
• Pain in the prostate, genitals or rectum.
• Lower back pain.
• Watery discharge from the penis.
• Blood in the semen (haemospermia).
• Premature ejaculation.
• Pain on erection.
• Pain on ejaculation.
• Low sex drive.
• A diminished volume of semen.
• Impotence.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.
Treatment
Prostatodynia can be difficult to treat. Painkillers are not usually helpful. It is, however, likely to have a physical cause, such as spasm of the pelvic muscles, which may be brought on by stress and anxiety. In this case, tranquillisers may be prescribed in order to reduce muscular spasm in the gland, though it is not a good idea to take these in the long-term as they can become addictive. Recent studies have suggested that prostate pain can be relieved by microwave hyperthermia. The technique was originally developed at the Beilinson Medical Centre, Petah Tiqva, in Israel in the early 1980s and is now attracting a lot of interest in other countries. An hour’s treatment is usually given weekly for six weeks.
Other treatments that have been tried for prostatodynia include:
• Acupuncture.
• Laser irradiation.
• Muscle-relaxant drugs, such as diazepam.
• Antispasmodic drugs.
Self-help
As in chronic non-bacterial prostatitis, symptoms may be worsened when ejaculation is infrequent, in which case the pain may be caused by prostatic gland engorgement. Symptoms may therefore be relieved by an increased frequency of ejaculation, as a result of either intercourse or masturbation. Ejaculation drains the prostate of any excess secretions
and causes a temporary increase in blood supply. In some cases, however, an increased frequency of ejaculation only makes the problem worse. Sitting in a hot bath for half an hour can help to warm up the prostate gland. Relaxation techniques may also be used to relax the muscles and as an alternative to muscle-relaxant drugs. The combination of regular exercise and a high-fibre diet will help keep the bowels regular, which is particularly important for men suffering from prostatodynia. This is of special benefit to those men who sit at a desk for most of the day, as both constant sitting and constipation tend to increase prostate congestion. Symptoms of prostatodynia may be triggered by the nicotine in cigarettes and by alcohol or caffeine, so it is best to reduce consumption of all three. It may also be advisable to consult an allergy specialist who may be able to identify foods that you should avoid.
Natural treatments
Rye pollen extracts have been shown in clinical trials in Europe to help ease the symptoms of prostatitis, particularly chronic non-bacterial prostatitis and prostatodynia. They reduce inflammation and ease irritation. They may take as long as three months before they show any improvement, which may then continue over the next three months. Rye pollen
extracts, such as Cernilton and ProstaBrit, are available from health food stores.
Jul
15
The Prostate in Sexual Activity.
July 15, 2009 | Leave a Comment
The Prostate in Sexual Activity
The prostate is part of the male reproductive system and supplies part of the seminal fluid. It is not essential for the man’s sexuality, though, nor even for his ability to reproduce. When a man’s prostate is removed, male sexuality is not normally affected ripped fuel. His sex drive is intact, and his ability to
achieve and maintain an erection is unchanged.
SEMINAL FLUID
In fact most of the fluid you ejaculate isn’t sperm at all. Most of the fluid consists mainly of secretions from a number of glands. The largest of these glands is the prostate.
The various secretions from these glands probably serve the purpose of providing the sperm with a greater motility after they have been ejaculated, which stimulates their activity and enables them to move towards the egg. It is thought by some people that the prostate also has a lot to do with the feeling that an orgasm gives you. When a man
has an orgasm, sperm fluid from the seminal vesicles and the secretions from the prostate all mix together as semen at the top of the urethra, just below the bladder. A man gets an intensely pleasurable sensation when the semen floods down the urethra into the penis . He also gets a pleasurable feeling when the semen squirts out of the penis and into the tight region of a woman’s vagina. The prostate gland can be felt, as a man’s orgasm proceeds, to contract i-liythmically, which some people believe to be very much an integral part of the pleasure he experiences on orgasm.
What prostate fluid contains:
• Water.
• Salts.
• Minerals.
• Proteins.
• Antibodies.
• Enzymes.
• Citric acid.
• Fats buy domain fioricet tramadol .
• Prostaglandins, which are hormone-like chemicals.
PROSTATIC DISEASE
Prostatic disease can have an effect not only on the urinary system, but also on the reproductive system. The male reproductive and urinary systems are, of course, closely linked, if only because they share the same exit route - the penis - or, to be more exact, the urethra which runs through the centre of the penis. The prostate gland is the site at which the male sex hormone testosterone, which is made by the testicles, is broken down. It is here that it then forms another hormone called dihydrotestosterone (DHT). The conversion is controlled by an enzyme called 5-alphareductase. In a study conducted by Imperato-McGinley (Science, 1974), the males in an obscure tribe in the Dominican Republic are deficient in 5-alpha-reductase and are often mistaken for girls until they reach puberty. Until then, they have a very small penis and scrotum, which suddenly enlarge at puberty, along with the development of a deep voice. These males only ever develop a very small prostate gland, they never go bald, and they do not suffer from acne check.
It is this genetic deficiency in 5-alpha-reductase that has enabled researchers to comprehend the role played by dihydrotestosterone in the enlargement of the prostate gland.
Testosterone
As well as prostate enlargement, the male hormone testosterone also has several other effects on the male body.
These include the following:
• The growth of the penis.
• The growth of testes.
• The production of sperm.
• A deeper voice.
• The growth of facial and body hair.
• The male sex drive.
• Bone growth hair loss.
• Strength.
• Acne.
• Baldness.
A MAN’S GREATEST FEARS
One of man’s greatest fears on seeing a urologist and considering the prospect of a prostatectomy is what effect this will have on his sexuality. The idea of having any sexual organ tampered with by a surgeon is very frightening for most men, who worry that it may have a deleterious effect on their sex lives. Many men are so frightened that their prostate problems will affect their sex lives, particularly if they have to have an operation, that they put off going to the doctor gastroparesis caused by prozac . And even when they do eventually go to the doctor, they may be too embarrassed to discuss sexual matters. Sex is something that all too many men find difficult -if not impossible - to talk about with their doctor. But this is foolish. It is only by talking the matter over with their doctor that they will find their fears were groundless and that they can therefore be reassured.
The doctor’s role.
To make matters worse, some doctors and urologists are sometimes insensitive on this subject. It is quite wrong of them to assume that their patients are too old to be interested in sex. Sex can play an important role in the lives of many men until well into old age, and they should treat their fears as real and serious. A man who is due to have a prostatectomy should not just fret about this in secret, he should talk to his doctors about it - his GP, his consultant, his surgeon. Most importantly, the doctor should respect his fears, and him for coming to air them with him. It’s not easy for any man to do this, and if he succeeds in overcoming his reluctance to do so, the doctor should recognise what that has cost him. If the doctor reacts badly, it might have catastrophic effects: it might just send him scuttling back to his burrow, his pride injured, and he might never be able to take the risk again. Only when both doctor and patient can talk about this calmly, sensibly, realistically, will the patient be reassured that it will have no effect on his sexuality - neither on his libido, nor his ability to obtain or maintain an erection, nor on his performance.
Retrograde ejaculation
What it may well do, however, is cause him to be infertile after the operation. Even a man who has no intention of becoming a father again may find the idea of losing his potential to be a father very distressing. A man may find this emasculating, as if it were questioning his manhood. He’s only lost his ability to procreate, not his sexuality, but this can have a devastating effect on him. This is reminiscent of a woman who regrets the loss of her womb after a hysterectomy, even though she is beyond childbearing, and feels she has lost her femininity. A doctor should have the sensitivity to talk to his patient about this. Only with patience and understanding can he help
him come to terms with his feelings of fear and loss. Retrograde ejaculation will not make a man impotent, nor - in most cases - will it prevent him from having orgasms. It will, however, make the sensation of orgasm a different one - and, in all honesty, probably not as good. Some women, too, are disappointed by the new feeling of a ‘dry’ climax in their male partner. These changes in a man’s sexuality should be addressed beforehand. He should be told what to expect. A sensitive doctor will also help a couple come to terms with their new-found sexuality.
Impotence
It is possible, though by no means certain - nor even common -that prostatectomy may cause impotence Some men are frightened that it might have this effect, probably because they have heard tales of the old perineal prostate operation (which is hardly ever done nowadays) or the radical prostatectomy in which the entire prostate, including the capsule in which it is enclosed, is removed (sometimes performed for prostate cancer). In both these operations, the nerves supplying the penis were sometimes cut, which led to a man’s impotentence. The problem of impotence is therefore unlikely but it may arise. If a man is very frightened that the operation may lead to impotence, he may actually experience a kind of psychological impotence afterwards. This underlines how important it is for a man to be reassured before the operation. If a psychological problem does occur, a counsellor or sex therapist should be able to deal with it.
An excuse to avoid sex
In spite of all the evidence that prostate surgery has no effect at all on a man’s sexuality (other than retrograde ejaculation), it does occasionally seem to happen. An obvious explanation for this is that some men may use surgery as an excuse to avoid sex, which they had stopped enjoying ages ago anyway. Occasionally, if a man is not in very good health, a prostate operation - which is, after all, a major operation requiring a long convalescence period - may be enough to push his sexuality over the edge.
Generally, though, most men do not have any problems with their sex lives after the operation. In fact, a man may actually find that his sex life has greatly improved since he had his prostatectomy, if only because he now has full control of his bladder.
Jul
14
CAN I STILL HAVE SEX AFTER PROSTATE TROUBLE?
This probably will be the most read chapter in the book, and rightly. The prostate is tightly bound up with a male’s manhood, and how he thinks of himself as a man. That’s why even the mention, let alone the discussion, of the prostate and its troubles, make most men uneasy, nervous and embarrassed. We’ll look at all problems with the prostate and how they may or may not affect a man’s libido, his attitude, his sexual performance and his sexual desires.
PROSTATITIS AND SEX
The first problem many men have with their prostate is prostatitis. Symptoms of this involve lower back pain, pelvic discomfort, a burning in the penis when urinating, urinary frequency and sometimes a slight pain after ejaculation. This form of noninfectious prostatitis may be caused by some infectious agent we know nothing about, or by some noninfectious form of inflammation. On the other hand, it also can be caused by a man’s sexual habits — too much sex or too little. During arousal, a man produces four times the prostatic fluid he usually does. If this fluid is not discharged by ejaculation, it remains in the prostate. If this happens often, the prostate can become seriously congested.
To prevent this problem, a normal, healthy sex life is the best course of action. If this is not possible, a massage of the prostate by a urologist will relieve the congested prostate and eliminate the pain. If that’s not desired, masturbation is a quick solution suggested by many urologists. Too much sex, too quickly, say eight or ten ejaculations in a two day period, can overwork the prostate and again cause problems. On the other hand, abstinence may cause a build up of prostatic fluids and lead to congestion so a massage is needed. Coitus interruptus, simply the removal of the penis before ejaculation, is a method of birth control once practiced by millions. If done often enough, and if it stops the man’s climax, this too, can lead to an oversupply of fluid in the prostate and bring about congestion and its symptoms. If coitus interruptus is used frequently by a couple, the man or woman should continue to excite the penis to a normal ejaculation to prevent buildup problems in the prostate. So for prostatitis, which can strike men of any age, sexual intercourse may be both the cause and the solution.
INFECTIOUS PROSTATITIS
This inflammation of the prostate is caused by some type of infection and can cause fever, chills, nausea and vomiting as well as an urgency to urinate, burning, pain and blood and pus in the urine. It’s more serious than the non-infectious type. There may be serious congestion of the prostate and urologists sometimes use a prostate massage to relieve it. Most urologists feel that sexual activity of any type that leads to ejaculation is the ideal way to empty the prostate and relieve the congestion.
BENIGN PROSTATIC HYPERPLASIA
With the enlargement of the prostate there will be some sexual changes, particularly if there is surgery involved. As you may remember, a man will have a normally enlarging prostate for ten to fifteen years, maybe more, before he notices it. The enlargement itself does little to sexual performance with the exception of a seriously pinched urethra that could reduce the amount and force of an ejaculation. When it comes to needed surgery for BPH, the question of sex becomes more important.
First, there should be no sexual intercourse for six weeks after a normal TURP surgery. This is to allow time for the “canal” dug through the enlarged prostate tissue to heal.
On a standard TU RP operation to remove enlarged prostate tissue, about six percent of all men operated on will become impotent. That means they will not be able to have a normal erection. There are bundles of nerves on each side of the prostate, and some of these control the impulses and nerve responses that combine to produce an erection. If these nerve bundles are damaged in any way, impotence can follow. Remember, this six percent figure may not be totally accurate. The figure is based on subjective information supplied by the patient. It wouldn’t be unusual for a man 68 or 70 or older to claim that he could have an erection before the operation, when in reality he had lost that ability due to natural aging or some other problem. It is a factor to consider. The other change in a man who has had a TURP operation is that the bladder neck may have been damaged or removed during the TURP. The bladder neck is like a “valve” that automatically closes when a man is ejaculating. It prevents the fluids from going upward into the bladder. The urethra muscles then force the fluid out the end of the penis. After a TURP operation, the bladder neck may no longer be there or it may be enlarged to such an extent that the fluids of the ejaculation take the path of least resistance, and flow upward a half inch or so and empty into the bladder. When this happens the man has exactly the same physical sensations that he had when the ejaculate emptied out the end of his penis. The feeling, the motion, the thrill is the same, only the path the fluid takes is different. This retrograde ejaculation is almost a one hundred percent probability in a TURP or open surgery for BPH. It’s simply a fact of life. However, with men who usually are in the operative stage, their age is often in the early to late sixties or later, and the lack of a penile ejaculation does not present much of a problem. This is especially true if the situation is carefully explained to the patient and his wife before the operation.
CANCER OF THE PROSTATE
Stage A and B cancer of the prostate will usually involve a radical prostatectomy, the complete removal of the prostate. This almost always harms the nerve bundles on both sides of the prostate and results in a man being impotent. However new techniques have now been developed to preserve these nerves. Some urologists say that in so doing, they may leave some cancer cells behind after the operation. At this point the cancer is the main concern, the life of the patient, and not his sexual function. The surgeon will try his best to get all of the cancerous growth. The nerve bundles are not a high priority. For the man who might be in his fifties, and is cured of a stage A cancer of the prostate, there are drugs and devices that can help him achieve an erection for satisfying intercourse. The cancer patient who is treated with radiation, internal or external, can usually continue his sex life without any problems. His sexual ability would be the same before or after the radiation with the exception of the normal radiation caused fatigue problems. When used in certain areas, radiation can also cause impotence. For the cancer patient with stage D cancer of the prostate, which is usually not operable, the man’s sex life would be in direct relation to where the cancer was situated and how it affected his ability to perform. At this point the patient is much more interested in extending his life, and not worried about his sexual function.
Tags: ampicillin, Anxiety, arimidex, avelox, Benadryl, benign prostatic hyperplasia, birth control, bladder, blood, CANCER, cancer cells, clomiphene, congestion, Depression, Drug, drugs, endometrial, flagyl, function, gemfibrozil, imitrex, impotence, impotent, infectious agent, injection, Insomnia, intercourse, lower back pain, Medicine, nausea and vomiting, needle, nexium, overwork the prostate, pain after ejaculation, paroxetine, pelvic discomfort, penicillin, pill, prednisone, prescription, problem, prostate, prostate trouble, prostatectomy, Prostatic, prostatic fluid, prostatitis, prostatitis symptoms, prozac dosages, quick solution, radiation, sexual desires, sexual habits, sexual performance, somacid, tamoxifen, urinary frequency, urologist, urologists, zyrtecJul
14
PROSTATE CANCER WHAT’S THE DIAGNOSTIC SEQUENCE?
July 14, 2009 | Leave a Comment
PROSTATE CANCER: WHAT’S THE DIAGNOSTIC SEQUENCE?
A patient goes to a urologist for many reasons. More and more family physicians are doing rectal digital examinations and when they find a lump or nodule on the prostate refer the patient to a specialist. The urologist will confirm the digital diagnosis and then begin other tests to confirm or deny the first decision. He might do a biopsy of the prostate to test the tissue in the hard nodule. He almost certainly will do an ultrasound test and look at the findings on a sonogram or on a screen. There are also two blood tests he’ll do for further confirmation of a cancerous growth. As we pointed out before, there is no connection between an enlarged prostate and cancer. Usually the cancer does not press in on the urethra so there are none of the usual BPH symptoms which might get a man to go see his doctor. There could be some symptoms a man might feel such as pain in the upper thighs, the pelvis or lower back, serious weight loss and shortness of breath. Symptoms such as these might mean nothing unusual, or be a sign of some other physical problem or disease — or they could be from cancer.
If the pain is related to prostate cancer, it may be a sign that the disease has spread outside of the prostate, and often it is too late to save the patient. That’s why prostate cancer is often called a silent killer and the reason that preventive medicine must be practiced, the digital rectal exam, once a year.
Now, back to those tests to determine if the lump or nodule is cancer of the prostate. The drawing on the following page shows one way that cancer might grow in the prostate. This is viewed from the two lobes of the prostate that can be digitally examined. A biopsy is the use of a needle inserted through the perineum or the rectum to remove a sample of tissue from the suspected nodule. This can be done by feel by the urologist or with the help of ultrasound to locate the specific area.
A biopsy can be done in the doctor’s office or as an outpatient at a hospital and requires a local anesthesia. A relatively new way to take a biopsy is with what is called a “biopsy gun”. It isn’t a real. It’s a biopsy needle that is used through the rectum and guided by ultrasound, but is “fired” in and out so quickly that the patient feels pressure and hears the sound the device makes, but he feels almost no pain. No anethesia is given.
One urologist says he shows the patient the device and the noise it will. During the actual biopsy the patient jumps when he hears the sound, not because of pain. For most the use of the biopsy gun is quick, simple and painless. A lot easier than going to the hospital for a biopsy the old way. And that means it’s less costly as well for the patient. One patient said it was less painful for him than a shot in the arm.
The tissue core taken in the biopsy is evaluated to see if it is cancerous. Another technique known as fine-needle aspiration cytology is often used these days. Here a urologist inserts an extremely fine needle through the rectum and removes cells from the prostate in three, four or five different locations. The technique results in minimum pain for the patient and no anesthesia is required. If the tissue shows evidence of cancerous growth, the urologist usually will do more testing. This is to find out the placement of the cancer and the extent of it. One of these tests is the PSA test, the prostate specific antigen test. If the prostate is producing a higher level of antigen than usual, it is a good indication that cancer is present.
The other test, the PAP, or the prostate acid phosphatase, may reveal if the cancer has spread to other parts of the body. If the PAP is elevated, the urologist will follow up with chest X-rays and X-rays of the pelvic area as well as bone scans and perhaps a CAT scan if equipment is available.
There is another way that many men learn that they have cancer of the prostate. This happens during a routine TURP operation where BPH has resulted in an operation. The scrapings of tissue from the prostate are examined to see if they are benign or cancerous. If the pathologist reports there are some flakes that show cancer, the doctor then does more tests to determine the placement of the tumor, and the chance that he has already removed all of the cancerous tissue.
When cancer is found in this instance, it is usually an early beginning of the disease, and one that was not found, or was not in the right place to be discovered, with the digital exam. Again here more tests would be done and the prostate examined again to determine what procedure might be needed. This would be after the regular BPH surgery, since most evaluations of prostate tissue by a pathologist take two to three days in most areas on a routine basis.
Jul
14
PROSTATE CANCER
July 14, 2009 | Leave a Comment
PROSTATE CANCER
Cancer is the word that has brought agonizing pain and terror to the last half of the twentieth century. To most people cancer means death. Many still think that a man with cancer has a death sentence. Not true. Increasingly in this last decade of the century it is proving not necessarily so. There are hundreds of different kinds and types of cancers, the medical experts tell us, and some can and are being cured. One of those types of cancer strikes men in their prostate. Cancer is described as being an uncontrolled growth of abnormal cells. Cancer cells can spread quickly throughout the body through the blood stream and the lymph system. Wherever they lite they create new tumors that begin replacing the normal tissue.
Some types don’t move at all, some are aggressive and attack different parts of the body quickly first. Cancer can develop in the lymphatic system, in bones, a man’s lungs, chest, throat, colon, stomach, even his brain. One of the areas cancer hits in a man is his prostate. When cancer strikes a man’s prostate it is usually what doctors call a primary cancer. This simply means the cancer begins, originates, in the prostate and has not been transported there from some other cancer in another part of the body.
WHAT CAUSES PROSTATE CANCER?
Scientists say there are hundreds of different kinds of cancer and they undoubtedly are caused by hundreds of different inciters. A few of the cancers have been researched enough so the medical people have the beginnings of the causes of them and can then go ahead and utilize some kind of anti-body to stop or kill the cancer. Massive research is going on for many forms of cancer, but less than one percent of that work is being done on prostate cancer. What this says is that there probably won’t be a miracle cure for prostate cancer within the lifetimes of most of us. That, like some of the preventive inoculation vaccines we have, will have to be applied to our children or our grandchildren. So who can develop prostate cancer? Unlike smoking and lung cancer, there isn’t even a hint of what might cause prostate cancer. Most researchers have ruled out any of the usual work and behavior activities such as alcohol, diet, work place, smoking, venereal diseases, too much sex or too little, or any other currently defined lifestyle.
There is one exception: men who work in nearly constant exhaust fumes from cars and those exposed to cadmium in the work place, are found to be at slightly higher risks of prostate cancer than the rest of us.
The one constant in prostate cancer and man seems to be age. As with the enlargement of the prostate, cancer seems to strike older men. Yes, some men die of prostate cancer in their forties, but most of the confrontations with the disease comes when men are over sixty. One researcher reports that the average age of men who are diagnosed as having cancer is seventy-two. Slightly over eighty percent of all prostate cancers reported come in men who are over the age of sixty-five.
Most doctors understand that by the age of eighty, nearly eighty percent of men have cancer of the prostate to some degree too. It may have been dormant for years, or it may just be starting and of a type that will grow slowly. Most of these men will never develop any symptoms of prostate cancer and will die of some cause not related to their prostate.
Most of our readers probably know someone who either has prostate cancer or has died of it. The American Cancer Society says that one out of eleven Americans will develop cancer of the prostate during his lifetime. Nearly 100,000 prostate cancer cases are reported by doctors each year. With men living longer now each year, there is expected to be an increasing number of prostate cancers. Men are simply living longer now and that’s when the disease develops. The American Cancer Society reports that nearly 28,000 men died of prostate cancer last year.
WHAT CAN THE AVERAGE MAN DO?
The problem is far from hopeless. They key to any cancer, and especially prostate cancer, is to catch the problem as early as possible. Some urologists suggest that all men over forty should have a digital rectal examination once a year.
Most of these examinations will be negative, which is good news to the man examined. We do dozens of examinations each year on people and expect negative results. Cholesterol testing is done routinely on people in their twenties and thirties, but the problem usually isn’t critical until much later in life. Chest X-rays are done routinely with usually a 99% negative result.
Testing for prostate cancer should be as routine for all men over forty. Yes, it’s a bit uncomfortable, but not painful. It takes about three minutes in a doctor’s office. Some urologists say the digital exam of the upper two lobes of the prostate will reveal ninety percent of prostate cancer. Other urologists think this is a bit high, but the exam should be made.
If such exams could catch 50% of starting prostate cancers in an early stage, most of those could be cured completely.
The big problem with prostate cancer is that it is a silent killer. It can show no symptoms at first. By the tune it starts hurting, the cancer usually has spread into other parts of the body and it’s often a matter of time until it kills the patient.
SCARE TACTICS?
If your reading this book does nothing more than makes you decide to have a yearly physical examination including a digital rectal exam of the prostate, that will be reward enough. You could be saving your life with a digital examination by discovering a cancer early enough to cure it.
Right now, about sixty-four percent of prostate cancers are discovered while they are small. Of these men, almost eighty-four percent are still alive five years after their surgery. Doctors compile statistics on cancer patients and most consider a man cured after a 15 year free period. The secret is catching it early so all of the cancerous tissue can be removed so it can’t spread or grow again. Ann Landers in her syndicated column has repeatedly pushed for greater awareness of testing to catch early cancer development. In one recent column she urged women to do the job this way. Whenever they go in for a mammogram, usually once a year, they should make an appointment for their husband to have his prostate checked by a digital exam or by the more expensive ultrasound probe. She urges women to do this so they won’t become premature widows. The lady has a good idea.
The American Cancer Society reports that currently seventy-one percent of all patients with cancer of the prostate live for five years or more after treatment. That’s for all cases whether diagnosed early or late. The later the diagnosis, the worse the chance for a cure.
HOW DOES YOUR DOCTOR KNOW IT’S CANCER?
More and more these days there is a push to try to catch prostate cancer in its earliest stages. This is a difficult job because very small cancers in the prostate traditionally have been from hard to impossible to detect by the traditional digital exam.
Now there are new tools to use to find these cancers. One of the best may be a simple blood test called the PSA. That stands for Prostate Specific Antigen. Prostate antigen is a protein found only in the prostate tissue. It has long been known that when the prostate is cancerous, the antigen level is elevated. The problem has been in finding how much this elevation may be made when the cancers are small and can’t be felt digitally.Now with the PSA there has been enough research to make some general pointings.
The tests showed that in the BPH men when the level of antigen had risen to 4 units, BPH was likely by a ratio of 4 to 1. But when the antigen level lifted to 10 or more units, the likelihood of cancer was more likely by a ratio of 33 to 1. Cooner also suggests the use of prostate ultrasonography as another diagnostic tool for screening patients who fall in the over 50 year category. This is done with a probe in the rectum and the use of ultrasound to reveal the tissue and mass in the prostate area.
Cooner concludes in his paper that we need to employ these two tools in a try to improve the ability to find curable cancers before they cause pain. He suggests that all men over 50 years should have a digital rectal elimination, then a PSA blood test, and a prostate ultrasound sonogram done as a baseline for future comparisons.
At this time PSA looks like a tool that the urologists need to make more use of. What if it only catches two or three percent of early cancer cases. Those men, cured of their cancer, are going to be wildly enthusiastic about the benefits of the test. As a parallel, how many positive readings do physical exams get these days from a routine chest X-ray? A dramatically low percentage.