Jul
19
RETROPUBIC PROSTATECTOMY w5tbpqac7u
In this surgery the same type incision is made as in the suprapubic operation. The muscle is separated and the sac containing the intestines is moved away from the bladder.
Now the surgeon makes an incision into the prostate capsule and removes the enlarged gland. The tissue removed is tested by a pathologist to determine if there is any cancerous growths present.
Now the surgeon sutures or cauterizes the bleeding vessels and the catheter with the three way tube is placed into the bladder. This catheter is usually the same type as used in a TURP operation. Next the balloon is inflated to keep the catheter in place.
All that is left is for the surgeon to “close”. The prostate capsule is sutured shut and the muscles, fascia and skin are put back in place and stitched closed.
This operation differs from the previous one since the bladder itself was not opened. It’s slightly simpler with less violation of the body. This means there is no need for the second catheter through the belly to drain the bladder.
The draining and irrigation of the prostate needed can be done with the usual three-way catheter. Most urologists say that this operation is less stressful to the patient since the bladder is not cut open, so it doesn’t have to recover.
General recovery procedures and time is about the same for either type of operation. Which type your urologist might suggest would be determined by the individual patient’s condition and sometimes the doctor’s preference.
In surgery for the prostate, the general rule is that a medium sized enlarged prostate and smaller ones can be successfully removed by the TURP method. However when the gland swells in size to over fifty to sixty grams, the urologist will usually do one of the other operations because of the difficulty in scraping out that much tissue and drawing it out of the urethra.
In these cases the larger prostate removal by the retropubic or suprapubic is simply the most efficient method to be used for the well being of the patient.
OTHER TYPES OF PROSTATE SURGERY
Perinea) prostatectomy is another kind of open surgery for the prostate but it is seldom used today. This procedure is quick and simple to do, but almost always severs the nerve bundles that control erection and leaves the patient Impotent.
Doctors back in the 1930’s often used a two stage operation for the prostate. The first stage was opening and draining the bladder. Then two weeks later they would go in and remove the prostate. It is seldom used today.
With the new treatments now coming into focus for the prostate, particularly BPH, there may be a general slowing in the number of surgeries needed. Any surgery has risks but with the prostate the risks seem to be reasonable in regards to impotence and incontinence, the two problems most men fear the most.
With the development of the new drugs, we may see products that will cause the enlarged prostate to shrink without objectionable side effects. With the increased use of the balloon as at least a temporary treatment for BPH, and other inventive methods, some experts are predicting that the use of surgery will not be required as often in future years as it is today. Only time will tell. As the public learns more about the male prostate and BPH, more men will demand non-intrusive treatments whenever possible. Right now a lot of men are hanging their hopes on the new drugs Hytrin and Proscar.
Jul
17
DANGERS AND SIDE EFFECTS
Let’s take a closer look at TURP and the statistical dangers and side effects.
1. Retrograde Ejaculation. This is in effect defacto sterilization. There is no other way to describe it. A vital part of the reproductive system in the male is contained in the prostate and other elements are injected into and flow through the urethra situated inside the prostate.
When most or all of the prostate is removed, the fluid that the prostate produces to lubricate and carry the sperm down the urethra is also gone. Now when orgasm takes place, muscular contractions propel the spermatozoa and fluid from the prostate and seminal vesicles into the prostatic urethra.
At the same time this happens, the neck of the bladder closes so the fluids must go down the urethra and out the penis. But after TURP surgery, this bladder neck closure is usually cut away to provide more space for the urine flow.
With the bladder neck open, the sperm and the fluid take the path of least resistance and are propelled into the bladder instead of out the penis.
This is called retrograde ejaculation. The sensation of the orgasm is the same for the man, there just isn’t any outside ejaculation.
With many TURP patients this is not a problem. Most men in the good TURP surgery candidate pool are no longer interested in fathering children. In most of the cases when a patient is told about this drawback and result of the TURP, he will not have any major problems with it. The trouble comes when a patient is not told about retrograde ejaculation and finds out on his own and is furious that he wasn’t informed before the operation.
In the extreme case where fatherhood is still desired, the ejaculate can be retrieved after the next urination after the orgasm, and the semen gathered and preserved and used in an insertion procedure into the woman’s vagina, the same as any artificial insemination. It works.
2. Bleeding. TURP involves a lot of cutting of tissue and the enclosed blood vessels. Bleeding is a natural course of events. Most of the bleeding is stopped during the operation by cauterization.
As with any cut or wound, a scab develops. This should stay for two or three weeks and then fall off. By then the blood vessel should be healed. If the scab falls off sooner bleeding usually begins and shows up in the urine.
This happens in only about one percent of all TURP patients and is often caused by straining to pass a stool. Usually this bleeding can be helped by a patient drinking lots of fluids to cleanse the area. Only rarely is there a need for the patient to be readmitted to the hospital to correct the condition.
3.1ncontinence. (The inability to control voiding of urine.) This is one of the big fears of a TURP surgical patient. It is embarrassing and distressing, and can lead a patient to total social isolation.
Incontinence happens to from one to four percent of all TURP patients. Many urologists claim it is less frequent, and say it can be the result of the normal surgical risk factor.
The problem comes when the electric knife cuts too near the sphincter voluntary muscles which control the flow of urine. If these muscles are damaged then the patient may become incontinent.
The other means of continence is the external urethral sphincter. Damage here can lead to a stress type of incontinence.
Incontinence after a TURP operation does not have to be permanent or irreversible. There are drugs that can be used to relieve the situation. Another possibility here is the use of an artificial sphincter.
At any rate this is one of the areas that you should discuss with your doctor prior to any prostate operation.
4. Impotency. Experts in this field say about five percent of all TURP patients come out of the operation and are impotent even though they were not that way going in.
Impotency is simply a man’s inability to achieve an erection, or to maintain it long enough for vaginal penetration.
The “manliness” of a male is a highly subjective area, and statistics on this element may be dramatically wrong in either direction. Many men may say they are able to achieve an erection and have intercourse when they are 70, 75, even 80. But age and other problems may have reduced that libido drastically so that even they were not totally cognizant of their ability to achieve a working erection. Time and age does this to all men.
Sometimes such an operation is a handy whipping boy for the sudden realization of impotency.
In any case, impotency is a fact of life for some of the men who have TURP operations, and you should know about it now. There is one sure way to develop impotency in a TURP patient. That is to damage one or both of the nerve bundles that are on each side of the prostate. These bundles are outside of the true capsule of the prostate. That means they are well outside of the area a surgeon’s electric knife should be operating to remove the prostatic tissue clogging the urethra. This is to say that a TURP properly carried out, should not harm these nerve bundles and that should not be the reasons for any impotency.
Some psychologists say that sex is at least 75% mental. This is why the cause of impotency, especially in men from 60 to 90 is extremely difficult to tie down. It may have been there before the operation and not recognized. The operation might create a psychological block preventing the erection. A now and then lack of a man’s ability to “get it up” is not uncommon even in younger men. The trauma of the operation, even the thought of some danger to a patient’s “manhood” and a negative spousal situation all can combine to create a psychosomatic impotency. This may be of a short or long duration.
There are drugs that can be used to help this impotency, and several devices that will be covered in a later chapter. Impotency, while not a large factor, is one that the surgery candidate for TURP should be well aware of.
Jul
7
PROSTATE PROBLEMS AND ALCOHOL, BEER AND COFFEINE.
July 7, 2009 | Leave a Comment
ALCOHOL AND BEER
You knew this was coming. Alcohol is not good for the human body. Alcohol is especially not good for men with BPH.
“Hell, give up beer and a few shots of bourbon and maybe a highball or two? Damn, I’d rather die!” Such typical comments by moderate and heavy drinkers is often answered with the assurance of: “You will die and probably sooner than you expected to.”
For years some urologists have said that alcohol irritates the prostate. It also can cause serious problems with the liver. Some of the flavorings in alcohol can affect the prostate to such a degree that it can cause a kind of chronic prostatitis
For a man with even early BPH, the sudden or overuse of alcohol can bring on a surprise attack of acute retention of urine. This condition results in a desperate need to urinate but it is impossible. A quick trip to a doctor’s office or the emergency room of a hospital for catheterization and draining the bladder follows.
Good old common sense dictates that a man with even early BPH should seriously consider his consumption of alcohol and its relation to his prostatic condition. At this point many men simply don’t want to take the risk or stand the pain and problems associated with alcohol and BPH and stop drinking.
Beer drinkers will be furious, but the pint-in, pint-out and the much used bathrooms at bars and taverns, indicate that it is well known that beer drinking is immediately followed by voluminous urination.
Here common sense leaps up again. Beer drinking in the afternoon may be easily tolerated by some men, but not by others. Late night beer drinking will almost surely trigger two or three additional night time trips to the bathroom that otherwise could have been avoided.
If you insist on drinking beer, use a little common sense so it doesn’t trigger more unpleasant BPH reactions.
COFFEE, COLAS AND CAFFEINE
Yes, caffeine is the big tiger on your back here. Caffeine is a stimulant to the urinary tract: it makes you urinate more and more frequently. For most well people this is no problem, not even a minor inconvenience. Over the years your body will adapt to the added caffeine.
But when you have BPH, it’s different. You don’t need any more stimulation in your urinary tract. Neither do you need any more volume.
The BPH coffee drinker who normally goes through twelve, eight ounce cups of coffee a day is going to have a much harder time living with his urinary tract, than the non-coffee drinker, or even the man who drinks twelve, eight ounces of non-caffeine fluids a day.
Ounce for ounce, coffee and tea contain twice the amount of caffeine that regular cola drinks do. Of course now most of the colas come in caffeine free types as well. This is one place where you can have your cola and not your caffeine.
In the same manner, there are many caffeine free coffee brands now on the market.
If you want to manage your body with a little more “smarts” give the caffeine free drinks a test in your own bathroom. You’ll probably be pleasantly surprised when you make the test.
Oh, the “Principle of the single differential”. When you make any of these intake tests, try to do everything else the same, except for the item you’re testing. If you have two differentials (variables) in your life style, you won’t be able to tell which one made the difference, if there is a difference. It’s an old principle from the physical sciences but it works.
If you drink caffeine fluids, take the test. Try the caffeine free types for a week, doing nothing else different. One BPH patient said it cut his nocturia risings down from two a night to one. After a few weeks you’ll even forget what the caffeine laced drink tasted like.
Don’t forget that many of the current pain pills for headaches, colds and hay fever also contain caffeine. While these aren’t taken often, you might look for some that don’t have caffeine in them, such as the ibuprofen medications.
Jul
7
EXAMINATIONS TO CONFIRM BPH
The first exam will be the digital one. Since the prostate is right next to the rectum, it can be palpitated. In this slightly uncomfortable digital exam, the doctor is checking to see if your prostate feels enlarged. He is also finding out if there are any hard spots or lumps or nodes on the two lobes he can touch.
The healthy prostate is smooth, elastic and about the size of a walnut. If there is BPH, the prostate will still feel about the same way but it will be obviously enlarged.
Most urologists say that a digital examination can’t confirm 100 per cent the presence of BPH. They point out, however that with such an exam showing the prostate is soft and rubbery, that there is an enlargement outward of two of the prostate lobes, and that the patient reports three symptoms of BPH, there is sufficient evidence to diagnose BPH.
In the fast paced routines in many HMO’s these days, a patient with these workups may very well be told he has BPH, be shown a video tape concerning the problem, and be told what to do to make living with the condition easier.
He’ll be told that in the early stages of BPH, a patient is not a good candidate for surgery or other regular treatment. Rather he will be put on a “maintenance” program where he is checked by a urologist yearly for any progress of the condition.
Many doctors and urologists say this is the proper course of care. They show histories of men in their fifties who have been on maintenance care for ten, even fifteen years before the prostate enlarged to such a point that surgery or one of the new treatments was necessary.
Another test your urolgist may make is a peak flow test. This can be done with an instrument that will record the flow much as the charts below show.
The first chart shows a more or less normal rate of flow with a peak about half way through and stopping quickly. The lower chart shows a much weaker flow and over twice to three times the length of time. This usually means some serious blockage in the urethra and the urologist will want to follow up with other tests.
Some urologists use a stop watch and a timed urination into a glass to approximate the same results.
25 ml/s Flow Rate
Results of UROFLOWMETRY
T100 17 s
TO 17 s
TOmax 7 s
Qmax 24.0 ml/s
Qave 14.1 ml/s Vcomp 247 ml
0 10 20 s
25 ml/s Flow Rate Results of UROFLOWMETRY
I
T100 60 s
TO 51 s
TQmax 8 s
Qmax 10.2 ml/s
Qave 4.1 ml/s Vcomp 211 ml
I T I
10 20 30 40 50 60 70 s
ARE ANY OTHER TESTS AVAILABLE?
Yes, there are several other tests that urologists can use with the prostate. Some of these are used when prostatic cancer is suspected.
However, since some ten percent of all surgery done to relieve BPH results in finding early stages of prostatic cancer development, some men ask for additional tests. They want to make sure that their prostate is not cancerous as well as having BPH.
These tests in effect become Negative Testing, to assure the patient that there is no cancer in the prostate lobes that can’t be felt by the digital exam.
One of these routines is a simple blood test called the prostate specific antigen (PSA) test. If this test shows an elevation of the antigen, it is a positive factor that cancer possiblyy is present in the prostate. A companion test, the PAP test for prostatic acid phosphatase, may show if the cancer has spread outside the prostate to other parts of the body.
A biopsy could be performed on the prostate, but it would be done only if the doctor found hard lumps and suspected spots on the outer lobes when he examines them digitally.
ULTRASOUND TESTING
One of the newer tools of the urologist is the use of ultrasound. This is sometimes called sonography. It simply uses high-frequency sound waves to examine a specific part of the body and make a record of it.
The record can be a sonogram on special film or on paper, or the whole process can be recorded on video tape for critical examination later, and as a record for comparison later of any growth or changes or condition of the examined areas.
The test is quick, simple and painless. A wand instrument called a transducer is passed back and forth over the area being examined. The wand transmits sound waves that are echoed back to it much like a radar does.
The echoes are electronically transmitted to the recording or viewing device.
When examining the bladder and prostate with ultrasound, the bladder needs to be full of urine. Then the test is repeated after the man has urinated to see what urine remains in the bladder.
Ultrasound is becoming more and more popular with urologists and most hospitals have it available. Many urologists now have ultrasound capability as a part of their office equipment for use when needed.
Another use of the ultrasound system is called a transrectal probe. It can be used in conjunction with a surface sonogram.
Many urologists recommend the transrectal. In this test a probe, covered with a rubber balloon which is then filled with water, is inserted into the rectum. This creates an ultrasonic image of the prostate and bladder area that can be recorded and at the same time viewed on a screen.
Some urologists say the transrectal sonogram will show many false leads that are not really cancer. Others say it is a fine method to determine if there is an area that seems to be a cancer and calls for more investigation.
MAGNETIC RESONANCE IMAGING
MRI is an expensive testing method that is painless and quick and can produce a three-dimensional cross section of any part of the body. Users say it is even more detailed than the images produced by a CAT scan.
This test is non-invasive and has no radiation. It uses radio waves in a magnetic field to produce the picture. This test is almost always done in a large hospital.
These days, all testing is expensive. If you have the three-symptom case of BPH, and the digital examination has led to a diagnosis by the physician that as far as he can feel there is no sign of cancer, then it is up to you to decide if you wish to have any more tests to prove to yourself that you are cancer free. Some of these tests, such as ultrasound, are not covered by some of the insurance companies.
One patient was adamant about receiving more tests. He had the three symptom BPH, felt fine, but had a friend who was dying of prostatic cancer. It was well worth it to him to have a $200 sonogram taken that showed no noticeable sign of cancer in his prostate. He was still concerned about the 10 percent of BPH surgery that reveals prostatic cancer. His doctor pointed out to him that such surgeries were performed at a much later point in life than he was. The doctor also said that such BPH problems were much farther developed and had been growing for a greater length of time than his had.
He understood the logic of the urologist. He had been living with his BPH for only about five years. He left the office but a week later called for another appointment. When he came in he said he wanted to take the two blood tests that could reveal the presence of cancer in the prostate, the PAP and PSA tests. Both were made and both showed up negative. Another sign that he did not have prostatic cancer.
The patient was now convinced. He told the urologist that he was not showing disrespect for his qualifications or his skills, but he wanted a little more assurance that he didn’t have cancer than the simple digital examination by the doctor.
Jul
7
BENIGN PROSTATIC HYPERPLASIA (BPH). SYMPTOMS OF AN ENLARGED PROSTATE.
July 7, 2009 | Leave a Comment
SYMPTOMS OF AN ENLARGED PROSTATE
Do you have any of the symptoms of an enlarged prostate? Here is a list of those problems that relate directly to BPH. Study the list critically. Have you experienced any of them?
• A slowing of your urinary stream and its force.
• A slowness to begin urination. You say “start now,” but it may be a few seconds before your stream begins.
• A problem with stopping urination. You tighten the muscles to stop the flow or to prevent any more, but you get a series of continuing dribbles.
• A sensation that your bladder is not completely empty when it should be.
• Frequent urination. You may not notice this during the day, especially if you’re near a bathroom. But at night this is much more evident. Doctors call this nocturia, and it may get you up two, three, four times a night.
• In extreme cases, urinary retention — when you simply can’t urinate. The discomfort and pain can be tremendous.
• Nausea, dizziness, unusual sleepiness brought on if retention has caused kidney damage.
A SIMPLE TEST YOU CAN GIVE YOURSELF
Below is a chart with the symptoms listed above. Some of them are worded differently. At the top are the points to be given for each symptom and its severity. Along the left side are the symptoms.
TOTAL SCORE
POINTS 0 1 2 3 4
STREAM Normal Variable Weals Dribbling
Abdominal
VOIDING No Strain strain or re”
HESITANCY None Yes
INTERMITTENCY None Yes
BLADDER Don’t know Variable Incomplete Single Repeated
EMPTYING or Complete retention
Yee ii ,Wd .9 INCONTINENCET— =
URGE None Mild Moderate Savers
tlmo-d~)
NOCTURIA 0-1 2 3-4
DIURIA ci>llh q2-3h qt-2h ci<lh
Intermittency means that your stream starts, stops and starts again once or more before you feel empty. Incontinence means that you can’t stop urinating when you want to, or you dribble, or pass some water when you don’t want to.
Diuria, means how often your need to urinate during the day. Zero points for three hours or more and 3 points for the need to void each hour during the day.
Mark down what you think your symptoms are. If your score reaches 10 or more, you should probably see your doctor soon about the chances you have BPH.
Jul
7
BENIGN PROSTATIC HYPERPLASIA (BPH)
Benign Prostatic Hyperplasia, sometimes called Hypertrophy, is the medical way of saying that the prostate gland has enlarged. In early stages this enlargement may not cause any problems. As it enlarges more and more with a man’s increasing age, it may squeeze the urethra smaller and smaller.
This reduces the force and size of your urine stream, and if left untreated, BPH could lead to the closure of the urethra resulting in severe sickness and even death.
Doctors say that in BPH the glandular tissue within the prostate capsule enlarges, grows, and no one seems to know why it happens or how to prevent or stop this growth.
This is a benign growth. That means it is not cancerous, it does not spread to other parts of the body or attack other tissues or cells. If it were malignant, as in cancer of the prostate, it would destroy and attack other tissue or cells and spread.
In the drawings here, notice how the urethra is fully open in the first one. It passes through the prostate allowing normal flow of urine from the bladder through the urethra and out the penis.
In the second drawing, the darker growth of benign tissue has begun and already has taken the bulge out of the urethra. In the third drawing, the BPH tissue has almost closed the tube the urine must pass through, making urination extremely difficult and bringing on all sorts of BPH symptoms and problems.
We come back to the apple example. Your prostate is like an apple with the core taken out. Through the core goes the urethra. The size of the urethra may begin to shrink when the prostate starts to enlarge when most men are about forty to forty-five. Often by the time a man is in his fifties he’s noticing some changes in his urination pattern.
It is just outside the urethra where the benign growth of the prostatic tissue begins, and it usually grows in both directions, which at once impacts the size of the urethra.
The growth of the tissue usually is not uniform or consistent all along the urethra. It may develop in one section and not in another, so the urethra is not compressed all along its length, at least not at first.
However, as with any tube or a garden hose, pressure at any one spot can shut off the tube entirely and cause all sorts of problems.
The new growth in the prostate consists of the same types of tissue as the normal prostate gland has, but in different proportions. The new, benign growth is going to have more of the glandular type of tissue.
The new growth in the prostate usually develops in both an inward and outward direction, toward the urethra and toward the exterior of the gland. When it grows outward it compresses the normal prostatic tissue against the sturdy outer capsule of the prostate.
When this outer growth takes place in the two lobes of the prostate nearest the rectum, a specialist can feel this with a digital examination. The outward growth does not narrow the urethra so there would be none of the usual BPH symptoms.
In most cases, however, when there is an outward growth of the tissue, it also grows toward the inside as well. Now we get the narrowing of the urethra over the years, and the normal symptoms of BPH.
The prostate has several sections, and digital examination can touch only the back part of the prostate. The sections that can’t be felt can harbor benign or malignant growth. This is one of the reasons for other tests for prostatic cancer that we’ll explain in detail later.
Jul
7
LIES, MYTHS AND OLD WIVES TALES ABOUT PROSTATITIS
This is a good time to start debunking some of the wild stories and myths and gossip that usually makes the rounds about the lowly prostate. Here are a list of the top ten. You may have heard of some more:
1. Prostate surgery always causes a man to become impotent.
This is simply not true. In the past it was more true than it is today, but now there are newer techniques used in surgery that do not disturb the nerve bundles that run on either side of the prostate. These nerves control a man’s ability to have an erection and intercourse. In cancer surgery, doctors have learned to remove the prostate usually without damaging these nerve bundles. However, some patients still suffer impotency. In the BPH surgery, only five percent of patients suffer any impotency.
2. An enlarged prostate, BPH, is a leading cause of prostate cancer.
Absolutely not. The enlargement of the prostate is in no way connected to the development of prostatic cancer. The cause of the enlargement is not known, but the cause of cancer is and the two are not linked. This myth may have come about because during some surgeries for the relief of BPH, the prostate is found to be cancerous when it had not been so diagnosed before. This actually can be one of the hidden benefits of such surgery.
3. Prostate surgery automatically sterilizes you.
In one half to two-thirds of the patients who have prostatic surgery where some or all of the prostate is removed, the normal course of the semen and other fluids usually ejaculated is disrupted. The fluid takes the course of least resistance and flows upward into the bladder instead of down the urethra and out the penis. To a man 60 or 65 this is usually not so important. However if children are wanted, the semen can be captured from urination soon after the orgasm and used for artificial insemination.
4. Prostate problems turn a man into a wimp.
If this happens it isn’t the result of the prostate problems. There is no loss of manhood, physical or psychological from any of the prostatic problems. There may be psychological side effects by various individuals, but these are mental in nature and could be casued by any number of reasons.
5. Prostate disorders are embarrassing to talk about because they mean a man is oversexed and having sex far too often.
A pure fantasy. Prostate problems and their treatments should not be embarrasing to talk about. Indeed a woman should realize an intelligent and understanding attitude toward prostate testing and evaluation, could save her husband’s life.
6. Orgasm for the man after prostate surgery isn’t the same, isn’t satisfying.
Simply not true. In case after case, the men report that the feeling at the time of orgasm and ejaculation is unchanged from what it was before surgery. Whether the ejaculation fluids go back into the bladder or out the penis, the feeling is exactly the same for the man. If there is a change, it is psychological and unfounded.
7. “Damn, man. Your sex life is over after BPH surgery.
Again, not factual. Any man’s sex life changes as he gets older. In his sixties and seventies a man has sex less frequently than when he was twenty. For at least ninety-five percent, a man’s sex life will be the same after BPH surgery as it was before. For the other five percent, there will be some problems with impotency—but that can be dealt with.
8. Incontinence is an automatic result of BPH surgery.
Researchers show us that only four percent of all BPH surgeries will result in the patients having trouble retaining their urine. That’s twenty-five to one odds, not bad.
9. There are lots of over the counter remedies that will cure my prostate without surgery.
By the end of 1990, the FDA took all such advertised remedies off the market. Previously the Postal Inspectors had closed down dozens of mail order houses who sold them. We will talk about the compounds in these products. Many people believe they are effective in reducing symptoms of BPH. Most do not say they can cure prostatic problems.
10. Prostate is a dirty word and a gentleman never mentions it in mixed company.
Ridiculous. In this more enlightened age, when women are encourged to examine their breasts for lumps, men must be encouraged and badgered into having at least yearly prostate examinations. The best way to do this is through education, and talking about the problem. Talking to the wives of the target men is often the most effective method.
Now, let’s move on to an in depth look at the ailment that affects nearly all older men, BPH.