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.

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Jul

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.

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