Jul
16
TRADITIONAL PROSTATE SURGERY.
July 16, 2009 | Leave a Comment
The electrical wire loop emerges from the end of the tube and is used to cut away the prostatic tissue. Power is applied to the electric loop by the use of a foot switch when the surgeon wants to cut.
As he does this, the surgeon is watching the procedure through a lens that is located just outside the end of the penis.
When bleeding occurs inside the urethra, another foot pedal is pressed and the bleeding part is sealed off by cauterization so it won’t bleed. During the surgery the entire area is washed by glycine.
After the surgeon decides that he has removed enough of the enlarged prostate, the chips and shavings of the prostate tissue are removed with the glycine wash and sent to a pathologist who studies them to see if there are any beginnings of cancer of the prostate.
The surgeon may elect to remove most or all of the prostate but he will not harm the prostate’s surgical capsule. This new hole that has been created through the overgrown prostate now becomes a urinary canal. This means that the prostate enlargement tissue was growing around the urethra gradually closing it down and narrowing it. The inner walls of the urethra have been cut away carving a new canal through the prostatic tissue growth.
After the cutting is done, a thin, flexible rubber or plastic tube is then passed through the penis and urethra and into the bladder so urine can be drawn from the bladder.
This tube remains in place for a few days because of some bleeding that may take place in the prostate. When the tube is removed, the patient will be able to urinate normally again.
This catheter, used after the TURP surgery, consists of three lumens or tubes. One is used to send in and remove a wash of saline solution, salt water, into the bladder to irrigate and clean it. This saline solution usually is used for twenty-four hours after surgery.
The second tube is used to draw off urine. The third usually has a small balloon attached and is inflated so the catheter will not fall out.
The catheter to draw urine from the bladder stays in place for two days after surgery.
Most patients feel good enough to get out of bed a day after surgery and are feeling much better after four days. Yes, you can walk and talk and sit down with the catheter in place. It usually comes out on the second day and no pain is involved.
The surgeon will deflate the balloon and the catheter can then simply slide out. The following day, most patients are discharged and sent home. Hospital stay: two days.
Most TURP patients get a prescription for antibiotics to be taken by mouth for one to two weeks after the surgery. This is a precaution to ward off any infection.
Post surgical suggestions from his urologists will probably advise the patient to take hot baths rather than showers for a while, drink lots of fluids, avoid spicy foods and watch out not to become constipated.
There won’t be any touch football games for a while, but most of the patient’s activities can be resumed, including driving, sitting at a desk and taking walks.
If there is any trouble it probably will be a slight burning during the first two weeks when he urinates, and even small amounts of blood in his urine. If this happens, the patient should call his urologist and report the problem just to be on the safe side.
When can you get back to work’? These are general guidelines. You’ll follow your doctor’s orders here. They will depend on the doctor, the patient and how well he recovers. Generally: If you do heavy manual labor, best to wait four to six weeks. Moderate labor will call for three to four weeks of vacation. The mental giant behind a desk or in a white collar position can get back in his harness after two weeks.
One caution. The TURP patient should hold off any sexual activity for six weeks after surgery. This will allow the canal through the prostate to heal completely.
The TURP surgery is performed about 400,000 times a year in the U.S. and the numbers probably are rising with the increase in percentage of our male population reaching the BPH age.
PROSTATE SURGERY
When you and your urologist decide that the best way to handle your BPH or other prostrate trouble is surgery, you have another decision to make. Which type of surgery will do the job that needs to be done?
Today, about 95 % of all BPH surgery uses the standard transurethral resection of the prostate, or TURP, as it is called.
Your urologist will explain to you in detail what this surgery involves.
The TURP is what surgeons call a closed operation. That simply means that there is no incision made in the body to get at the problem.
The TURP uses a surgical instrument that is inserted into the penis through the urethra. He’ll point out to you that this is done after the use of anesthesia. The instrument is a nonflexible hollow tube that extends into the narrowed portion of the urethra inside the prostate.
Inside this tube the urologist will insert a fiber optic micro-lens system that doctors call a resectoscope. This device includes a fiber optics light source, a lens and a electric wire element for surgery. The light inside the urethra lets the doctor see the problem and determine the severity of the problem.
Jul
16
OVER THE COUNTER DRUGS FOR PROSTATITIS
July 16, 2009 | Leave a Comment
OVER THE COUNTER
Just what does the March, 1990 publicity release by the FDA mean? Will there still be over the counter preparations designed to help with BPH problems by the end of the year, or into 1991? Only the FDA knows.
A check of health food and nutrition specialty stores in mid 1990 showed at least five products on the market. Many of these tend to be regional and there well could be twenty or fifty more out there. These are shown as examples of what’s on the market now. We do not judge any of them but present them here as another element of the BPH real-life picture for the layman.
Prostate Plus
This product came to our attention through a multi-page tabloid type newspaper mailed to a name and address (or current occupant). It was a national mass mailing and held a 3/4 page story and advertisement for Prostate Plus.
Prostate Plus was described as a “Total nutritional support for a healthy prostate.” It went on to say that it: “provides every nutrient known to benefit a healthy, well-functioning prostate gland.” Since it is advertised as a nutritional supplement and not a medical treatment, perhaps it will get around the FDA broadsword.
What’s in it? I-Glycine, I-Alanine, I-glutamic acid, zinc, raw prostate, saw palmetto, pumpkin seed concentrate, vitamin E, golden rod, and flaxseed oil.
Ninety capsules cost you $14.95 in the store.
Prostone
Prostone comes from the Enzymatic Therapy people in Green Bay, Wisconsin. The Prostone No. 190 is described this way: “The nutrients in this formula including zinc, Vitamin A, essential fatty acids and amino acids, are vital for proper prostate function.”
What’s in it? Oil concentrate from wheat germ and safflower seeds, linoleic acid from safflower seed oil, intrinsic glandular lipids, lecithin, L-Glutamic acid, L-A Ian i fie, Amenoacetic acid, Prostate tissue, Vitamin B6, Vitamin A from fish liver oil, Zinc chelate, bee pollen and saw palmetto berries extract.
Sixty capsules will cost you $11.95.
Raw Prostate With Gaba
This product is made up exclusively of raw bovine prostate and gamma amino butyric acid. That’s about all we know about it except that it comes from Country Life, a large maker of health food additives and products. It’s on the market. Glad they told us it was bovine prostate. Ninety tablets will cost you $13.00
Prostatrophic Concentrate
This one is made up entirely from raw bovine prostate. One such ingredient indicated it had been freeze dried. Here 100 tablets are priced at $8.00.
Search
This small bottle of sixty tablets was priced at $10 and the ingredients were listed as raw bovine prostate.
So, we’ve talked about the non-surgical, minor surgery and drug type of treatments for BPH. Where do we go from here? If none of the other methods are right for you, your urologist may suggest traditional surgery for your BPH. What’s that? Move right on to the next chapter and find out.
Jul
11
PROSTATITIS: LASER MINOR SURGERY AND OTHER NON MAJOR SURGICAL APPROACHES.
July 11, 2009 | Leave a Comment
LASER MINOR SURGERY
Yes, the laser is now finding its way into prostatic surgery. For some patients the balloon treatment doesn’t open the urethra enough. To help these patients, Dr. Roger S. Warner, a urologist at New York University in Manhattan, wields his laser to remove some of the offending tissue around the urethra, and then follows that up with the use of the balloon dilation. Dr. Warner said this treatment helped twenty-five out of twenty-nine patients treated.
Other doctors say that laser surgery, first used in medicine in the 1970’s, is only scratching the surface of its potential. In the future they say there will be a much greater use of the laser. Lasers can also be used to vaporize benign and malignant growths, and it’s all done quickly and simply without the patient trauma of an open surgery.
The role of laser surgery in urology is limited but it has a great potential. Dr. Israel Barken, a urologist in private practice in San Diego, and a researcher at University of California at San Diego Medical School, has a patent on a device to use in laser surgery of the prostate.
Intrasonix Company from Boston in conjunction with the Lahey clinic has developed a new device by the name of TULIP. They have used it in operations on 25 dogs so far with promising results.
In the future, from mid 1990, you may wish to ask your urologist about the possibility of having laser surgery by your urologist. Right now it’s still experimental, but work is going on in three places aroud the world.
OTHER NON MAJOR SURGICAL APPROACHES
Dr. Terrence R. Malloy, chief of urology at Pennsylvania Hospital in Philadelphia, attacks the enlarged prostate tissue with ultrasound waves. The tissue is turned into a pulp and dislodged and then sucked out of the body by an aspirator.
Some research is now being done with microwaves. They are aimed directly at the enlarged prostate. Testing is now underway to see what results are of attempts to shrink the enlarged prostate tissue, thereby relieving the pressure on the urethra.
Another experimental type of minor surgery is the use of cryogenics. This utilizes a probe through the penis and urethra and into the heart of the enlarged prostate. The probe then releases liquid nitrogen into the enlarged tissue.
This intensely cold fluid freezes and shrinks the tissue and destroys it which relieves the pressure on the urethra. More experiments and results of this type of cryosurgery will be reported in the first half of the 1990’s we are sure.
Another new development in the opening of the urethra through the prostate is the insertion of a spring like spiral device that mechanically keeps the urethra open. This is a new technique and while some urologists have the springs available and can insert them, we expect much development in this area of the open urethra in the coming years.
Jul
10
NON MAJOR-SURGICAL BPH TREATMENTS
July 10, 2009 | Leave a Comment
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BPH TREATMENTS
Remember our typical early BPH patient example? Well your clock has swept around and you’re now 63, your minor BPH symptoms are more severe. You can’t get through a night without getting up three or four times to urinate. Everytime you wake up you leap out of bed and rush to the bathroom.
During the day you’ve had to hold up a board meeting while you went to the toilet. You can’t take a car drive of more than an hour without stopping. On your business flights you always get an aisle seat so you can hurry to the cramped convenience two or three times during a flight.
Besides that, sometimes it hurts like outrageous sin.
So, you go back to see your urologist. For the past eight years he’s been “monitoring” your BPH. At every examination he assures you that there are no hard lumps or irregular growth of the two side prostate lobes. He says that means you probably don’t have prostatic cancer.
What happens next? You want some relief, you want to feel better and be able to lead a more normal life. It’s a quality of life situation you’re talking about and you want some help, now!
Your urologist agrees and the two of you sit down to talk about the possible ways that your situation can be eased.
You realize that once the prostate starts to grow, nothing we know of now will stop it, except total sterilization. That’s out. What other remedies are there?
THE BALLOON METHOD
One of the new treatments now getting wider acceptance is the use of a balloon. Urologists have borrowed this technique from the heart surgeons. The physician inserts a small tube about the size of spaghetti into the urethra. On the far end of the tube is an un-inflated balloon.
When the balloon is in the proper position in the urethra within the enlarged prostate, the physician inflates the balloon. This inflation is held for different lengths of time. Some urologists use a ten minute period of pressure by the balloon within the urethra to force the urethra to expand back to its original position.
This forces the prostate tissues outward. In some cases the outer casing of the prostate is “cracked” or broken to allow the enlarged prostatic tissue to move in that direction and eliminate the pressure on the urethra.
Just who first developed this technique is not known, but Dr. Flavin Castaneda, a radiologist at St. Francis Medical Center at the University of Illinois in Peoria, is one of the pioneers in the use of this new technique. He says that seventy-five percent of the BPI I patients he has used the balloon treatment on have been symptom free for up to three years after the treatment.
In another part of the country, more than 60 patients have been treated with the balloon dilation method at the University of Minnesota.
For eighty percent of these patients the urination problem was eliminated or significantly eased. This was for patients with enlargement of the side lobes of the prostate. When the narrowing of the urethra was because of enlargement of the middle lobe, the success rate dropped to thirty to forty percent.
Dr. Israel Barken, a urologist in San Diego, California, has been using the balloon treatment.
He says for this procedure the patient is tranquilized and the urethra is numbed with a local anesthetic. Then a thin, flexible tube with a balloon on the tip is inserted into the urethra and guided to the narrowed portion. The balloon is then inflated. He says he uses a time of about 20 minutes. This is an outpatient treatment and no hospitalization is needed. If the patient wants the procedure done in the office or the hospital, he can be accomodated.
Dr. Barken says before this procedure is undertaken, tests are made to assess the extent of the obstruction and to determine its precise location. At this point other tests are done to be sure there is no cancer present or any prostatic infection.
A catheter is left in the bladder until the following morning and then removed.
Dr. Lester A. Klein, an urologist at the Scripps Clinic in La Jolla, California says that at first the balloon treatment was effective on only about thirty percent of the cases. But now with doctors screening out the patients with poor chances for success with the balloon dilation, Dr. Klein says there is a success rate of eighty-six percent.
Dr. Klein is the designer of one of the balloon devices used in the operation and does the procedure himself at Scripps.
Dr. Barken has developed a similar technique using the same principles as Dr. Klein, but without the use of the sophisticated multiple balloons. This helps bring the cost down tremendously.
At this point in mid 1990, urologists who use the balloon technique have praise for it. They say it is effective, and is easy to do with the least amount of stress and worry on the patient. It is non-surgical, and as of yet, there have been no side effects reported. These three factors make it a favorite with patients as well especially when contrasted with surgery.
Another factor is the cost. While few hard figures are obtainable, one Boston urologist said the average total cost for a balloon dilation in the hospital is about $3,600. For the same TURP operation the cost is about $12,000. TURP surgery is one of the operations that remove part or all of the growth in the prostate.
A medical writer in the Wall Street Journal estimated that more than 2,000 of these balloon treatments have been done. A CBS news report about the same procedure said that over 5,000 of them have been undertaken in the past two years.
Not everyone agrees with the use of the balloon dilation treatment. Dr. John W. Schumacher, M.D. from Minneapolis says that this ignores the 10 percent of those who do get a TURP operation and the pathologist find that they have prostate cancer as well. Dr. Schumacher says that if a hundred thousand balloon treatments are used for BPH, then ten thousand of those men who have Stage A or B Cancer won’t find out about it — perhaps until it’s too late to cure them.
Dr. William J. Somers, M.D., a urologist, agrees. He puts hidden cancer of BPH patients at twenty to twenty-five percent.
He says that the use of the balloon dilation or drugs to reduce BPH symptoms is actually doing those twenty-five percent of the patients with hidden cancer a disservice. Other experts say these hidden cancers are rarely fatal in nature.
He maintains that there is no accurate way of determining who has prostate cancer and who doesn’t. Biopsy and ultrasound can help, but he says unless shavings of the gland are examined in a pathology laboratory, the cancer can metastasize and no one will know about it until it’s too late.
Dr. Walter Desmond, Jr. Ph.D. and research manager at Hybritech in San Diego has a slightly different view of the evaluation of the scrapings from a TURP operation. His firm makes a test called the PSA to evaluate the prostate specific antigen level in the blood. A high level can indicate the strong possibility of a silent cancer in the prostate.
He says that some pathologists fail to examine all of the tissue taken out during a TURP operation. Those who don’t evaluate all of the scrapings are shortchanging the patient.
He says the odds are even greater that a hidden cancer may be missed because a proper TURP cuts out the central part of the prostate tissue. The great majority of small cancers start not at the center of the prostate but near or on the surface of the lobes of the prostate, and these areas are often never touched by the surgeon’s electric knife when he cuts out the new canal for the urine to pass through.
Dr. Desmond seems to be saying that if pathologists are finding small cancers in the ten percent, or as high as 30 percent by some scientific evaluations of the TURP scrapings, then the true figure must be much higher than that taking into consideration the two factors presented here.
His slant seems to be that a chemical test such as PSA offers a much better method to detect early prostate cancer than any other method.
Jul
7
WHAT IS MY PROSTATE? THE GENITOURINARY SYSTEM, PROSTATE, COMMON PROBLEMS
July 7, 2009 | Leave a Comment
WHAT IS
MY PROSTATE?
In the male of the species, the prostate is situated directly below the bladder and in front of the inner wall of the rectum. The bladder stores urine produced in the kidneys. A tube going from the bladder to the penis is called the urethra. The urethra passes through the middle of the prostate something like an apple core is in the center of an apple.
Urinary bladder
Pubic bone Prostate gland
Penis Urethra
Rectum
Bulbourethral
gland
Anus
Coccyx
THE GENITOURINARY SYSTEM
The prostate is both muscle and gland, so it’s called musculoglandular. It is made up of true prostate tissue and of a harder, fibrous material on the outside called the prostate capsule.
This roughly triangular shaped gland is one to one and a half inches in width, and can weigh between fifteen and twenty grams, depending on the size of the man. That means the prostate gland in most men normally weighs less than an ounce.
When you were born, your prostate was about the size of a medium garden pea and grew gradually. At puberty, the prostate takes a spurt of quick growth. This growth continues at a slower pace until a man is about thirty. At this point the prostate reaches its full adult size.
Striated voluntary muscle
Arteries, veins and venous sinuses
Striated muscle On the surface of the prostate
Urethra
Sinus
pocularis Ejaculatory ducts
Longitudinal cross section of ducts leading from the
lobules of the prostate gland
LONGITUDINAL CROSS SECTION OF PROSTATE
SHOWING THREE DISTINCT LOBULES AND
CENTRAL URETHRAL AREA
Urinary bladder
Striated voluntary muscle
in the bladder
Ejaculatory ducts
into urethra
Prostate gland external
muscular wall
Levator ani
(pelvic diaphragm)
Internal portion of the prostate gland
Pubic bone
Bulbourethral gland Urethr
Crus of penis Skin
Bulb of the penis
Glans penis
Foreskin
From thirty to fifty years of age, most men’s prostates remain about the same size, but after fifty, for some unknown reason, the prostate in most men begins to enlarge. Medical experts say this growth may be the result of a change in the male hormone balance in the system, or it could be some other result of age sneaking up on us that we don’t know about yet.
The prostate gland itself is a complex one. It is made up of muscles, glands and fibrous tissues. The many small glands in the prostate are where the fluid is produced that is emptied into the prostatic urethra.
This fluid is injected into the urethra. At the same time the tube that brings the spermatozoa from the testes also emits its product into the urethra. These two fluids, plus one from the seminal vesicles all are combined in the urethra and then ejaculated by the spasmodic contractions of muscles surrounding the urethra.
Which is all to say that the prostate has a big role to play in the male animal, and his ability to function normally in sexual intercourse. So most men are afraid that anything that disrupts the normal operation of the postrate can have an adverse affect on their sex life. This is true only in some cases, and we’ll get to those points as we move along.
Many men go through a serious change in life, in lifestyle, perhaps in their work and relationships with others at this fifty-year-old time period.
The enlargement of the prostate and its resulting problems can have a bad psychological effect on a man already burdened with other life problems.
Some men have a sharp decline in their sexual performance about this time. Others might be having work or career problems. A man’s wife might be having her own changeof-life difficulties and the children often are drifting away from a close family unit about this time.
When things start to happen to his “water works”, and he isn’t sure how this will affect his performance in bed, many men become over sensitive about prostate and prostatic problems.
The extent of this enlargement during the fifties and later often is accompanied by three gradually developing habit patterns: there is a decrease in the force and stream of urine. This sometimes is accompanied by a hesitancy to begin urination. Another early symptom that something is wrong is what doctors call nocturia, or simply the need to get up once, twice, or three times a night to urinate.
These minor difficulties are not horrendous, and you can learn to live with them with little disruption of your normal daily activity. Many men live through their fifties and sixties with few of the symptoms of BPH. These letters will be used a lot in this book. They stand for Benign Prostatic Hyperplasia. That simply means a non-cancerous enlarge-ment of the prostate gland.
In the seventies and eighties in most men, more problems can occur and other prostate ailments and dysfunctions can arise. We’ll be dealing with them in detail later on.
One expert said that sixty percent of all men over sixty years of age have some BPH, and more than ninety-five percent of men in their eighties have some BPH problems.
What we’re saying here is that BPH is simply a factor of older age, like balding heads and weakening muscles. BPH is a fact of life that almost all of us are going to have to learn to live with. The more we can know about it, and the other prostatic problems now, the better we’ll be able to cope with it when it becomes serious about hitting us where it hurts.