Introduction

The prostate is a part of the male reproductive system. The prostate is about the size of a walnut and weighs about one ounce. The prostate is below the bladder and in front of the rectum. The prostate surrounds the urethra. The urethra is a tube that carries urine from the bladder out through the penis. Therefore, men with an enlarged prostate have difficulty in urinating. It can disrupt the flow of urine from the bladder.

 Prostate cancer is marked by an uncontrolled growth of cells in the prostate gland Growths in the prostate can be benign (not cancer) or malignant (cancer). Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph nodes to reach other parts of the body

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

• Stage I: Cancer in this early stage is usually slow growing. The tumor cannot be felt and involves one-half of 1 side of the prostate or even less than that. PSA levels are low. The cancer cells look like healthy cells.
• Stage II: The tumor is found only in the prostate. PSA levels are medium or low. 

• Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. 
• Stage IIB: The tumor is found only inside the prostate, and it may be large enough to be felt. The PSA level is medium. The cancer cells are moderately differentiated.
• Stage IIC: The tumor is found only inside the prostate, and it may be large enough to be felt. The PSA level is medium. The cancer cells may be moderately or poorly differentiated.

• Stage III: PSA levels are high, the tumor is growing, or the cancer is high grade. 

• Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high.
• Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum.
• Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells.

• Stage IV: The cancer has spread beyond the prostate.

• Stage IVA: The cancer has spread to the regional lymph nodes.
• Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.

Risk factors

• Age: The risk of prostate cancer increases with age, especially after age 50
• Race: For reasons not yet determined, Black people have a greater risk of prostate cancer than do people of other races
• Family history: If a blood relative, such as a parent, sibling or child, has been diagnosed with prostate cancer, your risk may be increased
• Obesity: People who are obese may have a higher risk of prostate cancer
• Smoking: Studies show prostate cancer risk may double for heavy smokers.
• Diet and lifestyle: may affect the risk of prostate cancer. It isn’t clear exactly how. Your risk may be higher if you eat more calories, animal fats, refined sugar and not enough fruits and vegetables
• Chemical exposures: There is some evidence that firefighters can be exposed to chemicals that may increase their risk of prostate cancer.
• Inflammation of the prostate: Some studies have suggested that      prostatitis (inflammation of the prostate gland) may be linked to an increased risk of prostate cancer

Signs and Symptoms of Prostate Cancer

• Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night
• Blood in the urine or semen
• Trouble getting an erection (erectile dysfunction or ED)
• Losing weight without trying
• Pain in the hips, back (spine), chest (ribs), or other areas from cancer that has spread to bones
• Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord

Diagnosis

Prostate screening test 

• Digital rectal exam (DRE): During a DRE, doctor inserts a gloved, lubricated finger into the rectum to examine the prostate, which is adjacent to the rectum to find abnormal parts of the prostate by feeling the area using the finger.
• Prostate-specific antigen (PSA) test: A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that’s naturally produced by prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, if a higher than usual level is found, it may indicate prostate infection, inflammation, enlargement, or cancer.

Diagnosing prostate cancer

• Transrectal ultrasound (TRUS): During a transrectal ultrasound, a small probe, about the size and shape of a cigar, is inserted into the rectum. The probe uses sound waves to create a picture of prostate gland.
• Magnetic resonance imaging (MRI): In some situations, doctor may recommend an MRI scan of the prostate to create a more detailed picture. MRI images may help your doctor plan a procedure to remove prostate tissue samples.
• Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope to get a tissue sample, a surgeon most often uses transrectal ultrasound and a biopsy tool to take very small slivers of prostate tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.

Determining whether the cancer has spread

• Bone scan: It is important to know that structural changes to the bone to identify the metastasis of cancer to bone.
• Computerized tomography (CT) scan: A CT scan can be used to measure the tumor’s size.
• Magnetic resonance imaging (MRI): MRI can be used to measure the tumor’s size, and a scan can focus specifically on the area of the prostate or on the whole body.
• Positron emission tomography (PET) scan: A PET scan is a way to create pictures of organs and tissues inside the body.

Treatment

• Surveillance

Active surveillance – It means monitoring the cancer closely who have a low risk of their cancer spreading. Can be done by  prostate-specific antigen (PSA) blood test about every 6 months and a digital rectal exam (DRE) at least once a year. Prostate biopsies and imaging tests may be done every 1 to 3 years as well. With active surveillance, will know very quickly if the cancer grows.  If that happens, then doctor will suggest next step.

Watchful Waiting – It does not involve regular biopsies or other active surveillance tools. It is best for men with prostate cancer who do not want or cannot have therapy. It is also good for men who have other medical conditions that would interfere with more aggressive forms of treatment.

• Localized Therapy

Surgery to remove the prostate

• Open prostatectomy: The surgeon operates through a single long skin incision (cut) to remove the prostate and nearby tissues
• Laparoscopic prostatectomy: The surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate

• Transurethral resection of the prostate (TURP): This operation is more often used to treat men with non-cancerous enlargement of the prostate. But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating. (It is not used to try to cure the cancer.)

Side effects of prostate surgery

• Urinary incontinence 
• Erectile dysfunction 
• Loss of fertility 
• Lymphedema 
• Change in penis length 
• Inguinal hernia 

Radiation Therapy

Radiation therapy uses high-energy rays to kill or slow the growth of cancer cells. Radiation can be used as the primary treatment for prostate cancer 

Side Effects of Radiation Therapy

incontinence and bowel problems. Urinary problems usually improve over time.

Cryotherapy

It is the controlled freezing of the prostate gland. The freezing destroys cancer cells. Cryotherapy is done under anesthesia.

Side Effects of Cryotherapy

Incontinence and other urinary or bowel problems. Erectile dysfunction is likely. Worth noting is the risk of a fistula between the urethra and the rectum

Focal therapies

Focal therapies are less-invasive treatments that destroy small prostate tumors without treating the rest of the prostate gland. These treatments use heat, cold, and other methods to treat cancer.

• Systemic Therapy 

Hormonal Therapy or Androgen Deprivation Therapy

This therapy uses drugs to block or lower testosterone and other male sex hormones that fuel cancer or removes the testicles and glands that produce testosterone with a procedure called an orchiectomy

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells anywhere in the body. It is used for advanced stages of prostate cancer. It is also used when cancer has metastasized (spread) into other organs or tissue.

 Immunotherapy

Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively.

Follow-up care

• Follow up  visits will usually include PSA blood tests, possibly with digital rectal exams (DREs) if your prostate hasn’t been removed. These will probably begin within a few months Even after treatment
• Get regular physical activity men who exercise regularly after treatment might be less likely to die from their prostate cancer than those who don’t
• Quit smoking men who smoke are more likely to have their prostate cancer 
• Nutrition and dietary supplements include eating a diet rich in fruits and vegetables and lower in animal fats might be helpful.
• Feelings of depression, anxiety, or worry are normal when prostate cancer is a part of life. Get emotional support from friends and family, religious groups, support groups, professional counselors, or others. 
• Sexuality and feeling good about your body Prostate cancer treatment can often affect sexual function. Information and support can help you cope with these changes over time

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.

References

https://www.cancer.org  (American Cancer Society)

https://www.cancer.net/ (cancer net (ASCO))

https://www.mayoclinic.org/  (Myoclinic)

https://www.urologyhealth.org/ (urology care foundation)  

Introduction

Kidneys are two bean-shaped organs.  each about the size of a fist. They are located behind the abdominal organs, with one kidney on each side of spine. The kidneys’ main job is to remove excess water, salt, and waste products from blood coming from the renal arteries. These substances become urine.

A tumor, or mass, is an abnormal growth in the body. A kidney mass, or tumor, is an abnormal growth in the kidney. Some kidney masses are benign (not cancerous), and some are malignant (cancerous). In adults, renal cell carcinoma is the most common type of kidney cancer. 

Types of kidney cancer

• Renal cell carcinomas (RCC): These are the most common malignant kidney tumors. They are found in main substance of the kidney, where the filtering occurs. RCC may form as a single tumor within a kidney or as two or more tumors in one kidney.
• Benign kidney tumors: About 20% of tumors removed from kidneys are benign. There are about nine named tumors in this class. Some can grow quite large, but they are almost always non-cancerous and do not spread to other organs.
• Wilms tumors: Wilms tumors almost always occur in children and are rarely found in adults.

Stages of kidney Cancer

The staging system most often used for kidney cancer is TNM system

The size and extent of the main tumor (T): How large is the tumor? Has it has grown into nearby areas?

The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?

The spread (metastasis) to distant sites (M): Has the cancer spread to other organs such as the bones, brain, or lungs?

Stage I 

The tumor is 7 cm across or smaller and is only in the kidney (T1). There is no spread to lymph nodes (N0) or distant organs (M0).

Stage II 

The tumor is larger than 7 cm across but is still only in the kidney (T2). There is no spread to lymph nodes (N0) or distant organs (M0).

OR

The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota’s fascia (T3). There is no spread to lymph nodes (N0) or distant organs (M0).

Stage III 

The main tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota’s fascia. The cancer has spread to nearby lymph nodes (N1) but has not spread to distant lymph nodes or other organs (M0).

Stage IV

The main tumor is growing beyond Gerota’s fascia and may be growing into the adrenal gland on top of the kidney (T4). It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant lymph nodes or other organs (M0). 

OR

The main tumor can be any size and may have grown outside the kidney (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes and/or other organs (M1).

Risk factors

• Older age: Your risk of kidney cancer increases as you age.
• Obesity: a body mass index (BMI) of 30 or more 
• Smoking: the more you smoke, the greater the risk
• High blood pressure (hypertension): High blood pressure increases your risk of kidney cancer.
• Family history of kidney cancer: The risk of kidney cancer is higher if close family members have had the disease.
• Some inherited genetic conditions: such as those who have von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex, hereditary papillary renal cell carcinoma or familial renal cancer.
• Treatment for kidney failure: People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer.
• Certain medicines: Acetaminophen Some studies have suggested that acetaminophen, a common pain medicine, may be linked to an increase in the risk of RCC.
• Race: African Americans have a slightly higher rate of RCC than do whites.

Symptoms

• Blood in the urine (hematuria)
• Low back pain on one side (not caused by injury)
• A mass (lump) on the side or lower back
• Fatigue (tiredness)
• Loss of appetite
• Weight loss not caused by dieting
• Fever that is not caused by an infection and that doesn’t go away
• Anemia (low red blood cell counts)

Diagnosis

• Medical history and physical exam – If symptoms or the results of the physical exam suggest you might have kidney cancer, more tests will probably be done. 
• Blood tests – Complete blood count (CBC) to check the blood for signs of disease. Serum creatinine levels or other kidney function tests to check if the kidneys are getting rid of waste
• Urinalysis (urine testing) – Urinalysis to check for infection, blood and protein in urine
• Ultrasound scan – To get images of your kidneys. Different ultrasound patterns can also help doctors tell the difference between some types of benign and malignant kidney tumors.
• CT scan – It can provide precise information about the size, shape, and location of a tumor and spread to nearby lymph nodes or to organs and tissues outside the kidney.
• MRI scan – MRI scans may be done if there’s a chance that the cancer has grown into major blood vessels in the abdomen because they provide a better picture of blood vessels than CT scans and to look at abnormal areas in the brain and spinal cord due to cancer spread.
• Cystoscopy – where a thin tube is passed up your urethra (the tube that carries urine out of your body) so your doctor can see any problems in your bladder
• Biopsy – where a needle is inserted into your kidney to remove a small tissue sample for analysis in a laboratory; local anesthetic is used to numb the area so the procedure should not hurt
• PET scan – a detailed body scan that can be helpful for investigating confirmed cases of kidney cancer to see if the cancer has spread and how well it’s responding to treatment
• Bone scan and chest x-ray – to find out if the cancer has spread to bones and lungs 

Treatment

surgical treatments

• Partial nephrectomy– the surgeon removes the cancer and a small margin of healthy tissue that surrounds it rather than the entire kidney. 
• Radical nephrectomy– A complete (radical) nephrectomy involves removing the entire kidney, a border of healthy tissue and occasionally additional nearby tissues such as the lymph nodes, adrenal gland or other structures.

Nonsurgical treatments

• Treatment to freeze cancer cells (cryoablation)– Very cold gases are passed through a probe to destroy the tumor cells.
• Treatment to heat cancer cells (radiofrequency ablation)- An electric current is passed through the tip of the probe placed on the skin to heat the tumor and destroy the cells. 
• Active Surveillance – Some small kidney tumors are benign. And most (3 out of 4) small kidney cancers are slow growing.  One option for some people with these small kidney tumors (less than 4 cm may be to give no treatment at first and watch the tumor carefully to see if it grows. This is usually done by imaging tests (ultrasound, CT or MRI scan) every 3 to 6 months. If it grows quickly or gets larger than 4 cm, the tumor is removed or treated another way.
• Targeted therapy- Most of the targeted drugs used to treat kidney cancer work by blocking growth of the new blood vessels that feed cancers or important proteins in cancer cells (called tyrosine kinases) that help them grow and survive.  Some targeted drugs affect both.
• Immunotherapy– Immunotherapy is the use of medicines to boost a person’s own immune system to recognize and destroy cancer cells more effectively.
• Radiation therapy- Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation is sometimes used to treat kidney cancer if a person is not healthy enough to have surgery or has only one kidney
• Chemotherapy– Chemotherapy (chemo) uses anti-cancer drugs that are given into a vein (IV) or taken by mouth (as pills). These drugs enter your blood and reach nearly all areas of the body, which makes this treatment potentially useful for cancer that has spread (metastasized) to organs beyond the kidney.

Coping and support

• Learn enough about kidney cancer to feel comfortable making treatment decisions. Ask your doctor for details of your diagnosis, such as what type of cancer you have and the stage. This information can help you learn about the treatment options.
• Take care of yourself. Take care of yourself during cancer treatment. Eat a healthy diet full of fruits and vegetables, be physically active when you feel up to it, and get enough sleep so that you wake feeling rested each day.
• Take time for yourself. Set aside time for yourself each day. Time spent reading, relaxing or listening to music can help you relieve stress. 
• Gather a support network. Your friends and family are concerned about your health, so let them help you when they offer. Talking about your feelings with close friends and family also can help you relieve stress and tension.
• Get mental health counseling if needed. If you feel overwhelmed, depressed or so anxious that it’s difficult to function, consider getting mental health counseling. From a certified social worker, psychologist or psychiatrist.

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.

References

https://www.mayoclinic.org/     – (mayoclinic)

https://www.nhs.uk/      – (nhs.uk)

https://www.urologyhealth.org/     – (urology care foundation)

https://www.cancer.org/     –    (American cancer society)

Kidney stones also called renal lithiasis and ureteral stones (kidney stones that have moved to the ureters) are both a type of stone disease, otherwise known as urolithiasis. Stone disease is the most common type of urological disorder and is believed to be the most painful. 

Kidney and ureteral stones are formed from dissolved substances in the urine. They concentrate in the urine to form solid crystals that can lead to stones when materials in the urine build up around them. This is buildup is known as cystolithiasis. Most kidney stones are made up of calcium oxalate or calcium phosphate, but they can also contain cysteine, uric acid, or struvite.

Possible Causes of Kidney and Ureteral Stones

Kidney and ureteral stones can form when the healthy balance of substances in the urine, like water, minerals, and salts, is disturbed. There are different types of stones, but the most common type, the calcium type, forms when there is a change in the calcium levels in urine.

Although the cause of stones may be difficult to determine, there are some factors that can increase the risk of stones. 

• Lack of fluid Intake: If you don’t drink enough water, substances in the urine are more likely to stick together and form stones. If you’re at risk for stone disease or have a history of kidney stones, you should drink 2 to 3 liters of water every day. Ask your doctor if it’s okay for you to drink fluids other than water to reach your fluid intake.
• A diet high in protein, sodium, and oxalate-rich foods: If you are susceptible to stones, you may want to reduce sodium and animal protein. Eat plenty of calcium and avoid high-oxalate foods, like spinach, kale, and nuts.
• Medical conditions: Medical conditions, like inflammatory bowel disease and gout, can affect the normal balance of urine.
• Weight: If you are overweight, you’re at risk for both insulin resistance and increased calcium in your urine, and both things can lead to kidney stones.
• Hormonal imbalance: Rarely, an increase in the hormones produced by the parathyroid glands can lead to hypercalcemia (excess calcium), which can cause stones to form.
• Excess vitamin D could be a risk factor for kidney and urinary stones.

Heredity is an important predictor of the development of kidney stones. If someone in your immediate family has had kidney stones, you are more likely to develop them as well.

Signs and Symptoms of Kidney and Ureteral Stones

Just having kidney stones may not cause any symptoms, but when they begin to move or pass into your ureter (ureteral stones), you will likely experience symptoms.

Signs and symptoms of kidney and ureteral stones may include:

• Pain in the back and side, often just below the ribs
• Pain that changes, for example:

• Pain spreads to the lower abdomen and possibly the groin
• Pain comes in waves
• Pain changes in intensity
• Pain shifts locations
• Pain with urination
• Nausea and/or vomiting

• More frequent urination
• Urine that is cloudy or has a strong, foul smell
• Blood in the urine

You may also have a fever and/or chills if you have an infection along with your stones. Consult the Doctor If you have any of the above signs or symptoms of kidney or ureteral stones.

Seek immediate medical advice if you have the following symptoms:

• Pain that is accompanied by nausea and vomiting, fever, or chills
• Severe pain that makes finding a comfortable position difficult
• Blood in your urine
• Difficulty urinating

Diagnosing Kidney and Ureteral Stones 

Our Consultant Urologist at t Westminster Ortho Med Clinic may suspect kidney or ureteral stones based on your symptoms alone; however, tests are usually required to make an official diagnosis. 

Diagnostic tests for kidney and ureteral stones include:

• Imaging tests – X-rays can help diagnose some stones, but they may miss smaller stones. CT scans of the urinary tract are often used to help diagnose kidney and ureteral stones. An ultrasound can sometimes help diagnose stones as well.
• Blood tests – Blood tests cannot tell whether you have stones, but they can reveal high levels of calcium and uric acid in the blood, which can aid in diagnosis. Blood tests can also help our Urologist to monitor how healthy your kidneys are.
• Urine tests – Urine tests can help find stone-forming particles in your urine and may also reveal if you have too few substances that help prevent stones.

Treating Kidney and Ureteral Stones 

The treatment of kidney or ureteral stones will depend on how large the stones are, how severe the symptoms are, type and the cause of the stones . 

Most kidney stones can be managed with fluid intake and pain relievers. Some will require medication to help pass the stones quickly and with less pain. Most people who have stones will not require surgery or medical procedures to remove or destroy the stones.

Treating small stones with mild symptoms:

Our Consultant Urologist may recommend the following to treat small stones without many symptoms:

• Drinking water – It is important to drink plenty of fluids when you have kidney or ureteral stones. Most doctors recommend about 2 to 3 liters of water per day. This is meant to flush your urinary tract system. Talk to our Urologist about how much fluid you should be drinking and whether any of that fluid can be in a form other than plain water.
• Taking pain relievers – Because passing even small stones can cause pain, our doctor may recommend over-the-counter pain relievers to help you manage the pain and discomfort.
• Taking medications to help you pass the stones – Our Urologist may recommend a medication called an alpha-blocker to help you pass your kidney stones. It helps relax the muscles in your ureter, which should reduce pain and help you pass the stone more quickly.

Treating larger stones or stones with more severe symptoms or risks of complications:

If the stones are large with severe symptoms, or the type of stone puts you at higher risk for complications, you may need to have a medical or surgical procedure. 

Those procedures include:

• SHOCK WAVE LITHOTRIPSY (SWL)

This procedure, also known as extracorporeal shock wave lithotripsy or ESWL, uses a machine called a lithotripter to break up stones. The machine delivers ultrasonic waves through the skin to the stones to break them up. 

• PERCUTANEOUS NEPHROLITHOTOMY (PNL)

This is a surgery to remove large kidney stones. It is done under general anesthesia in the hospital. Nephrolithotomy, also known as endoscopic removal of kidney stones, is done using a tiny, lighted telescope and instruments that are inserted through an incision on your back.

• URETEROSCOPY (URS)

This procedure uses a ureteroscope (a thin tube with a light on it) to locate a stone in the kidney or ureter. During the procedure, the surgeon will insert the ureteroscope into your urethra and through the urinary tract until the stone is located. Once the surgeon can see your stone, he can use a tool to either grab the stone and remove it or to break it into tiny pieces you will be able to pass when you urinate. 

• SURGERY TO REMOVE PARATHYROID TUMORS

Some kidney stones are caused by a condition called hyperparathyroidism, which is overactive parathyroid glands. The parathyroid glands produce parathyroid hormone, but when they produce too much, calcium levels in the body can increase. When you have too much calcium in your body, kidney stones may form. Sometimes, hyperparathyroidism is caused by small, non-cancerous tumors that form on the parathyroid glands. These tumors often lead to an overproduction of parathyroid hormone. In this case, removing the tumor from the gland should stop the overproduction of the hormones and in turn reduce calcium levels in the body.

Preventing Kidney and Ureteral Stones 

The most important thing you can do to prevent kidney and ureteral stones is to drink lots of fluids. Drinking fluids helps you pass more urine, which is important in preventing stones. Most doctors will recommend that you pass about 2.5 liters of urine every day to keep your urinary tract flushed. The amount of fluid you’ll need to drink to pass that much urine depends on factors such as how hot and dry the climate is and how much you exercise. 

For most people, drinking 2 to 3 liters of fluid every day should be enough. If you’re at high risk of forming stones, Our Doctor may recommend you measure your urine output for a while to make sure you’re making enough. The color of your urine should help you know whether you’re drinking enough fluids. Urine should be light and clear. If your urine is dark or cloudy, you probably need to increase your fluids.

The lifestyle changes you can make to reduce your risk of developing stones are:

• Reduce oxalate-rich foods: If you have had calcium oxalate stones (which are the most common form), limiting or eliminating certain foods can help reduce your risk for stone formation. Some of those foods are spinach, Swiss chard, rhubarb, nuts, wheat germ, soy products, sweet potatoes, beets, chocolate, and tea.
• Eat less animal protein: Cut down on animal protein, such as meat, eggs, and fish, and increase your intake of non-animal protein, such as beans and legumes.
• Reduce sodium intake: A diet low in sodium can help you reduce your risk of forming stones. Most processed foods have a lot of sodium, so limiting those can help.
• Eat calcium-rich foods, but limit calcium supplements: It’s important to eat calcium-rich foods unless your doctor tells you not to. But ask your doctor before taking calcium supplements. If you need supplemental calcium, be sure to take it with food.
• Control your weight: Since being overweight is a risk factor for stone disease, take steps to keep your weight at an optimal level. If you are overweight, talk to our doctors about healthy ways to lose weight.

If you have any signs or symptoms of kidney or ureteral stones, contact our Clinic to Consult our Urologist to set up an appointment to discuss your treatment choices.

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.

Benign prostatic hyperplasia is a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.

Benign prostatic hyperplasia (BPH) is when the prostate and surrounding tissue expands. The prostate goes through two main growth periods as a man ages. The first is early in puberty when the prostate doubles in size. The second begins around age 25 and continues during most of a man’s life. As you age, your prostate may get larger. BPH is when it gets large enough to cause problems.

How Does the Prostate Work?

The prostate is part of the male reproductive system, and its main job is to make fluid for semen. It is about the size of a walnut and weighs an ounce or so. It sits below the bladder and in front of the rectum. It goes around a tube called the urethra. The urethra carries urine from the bladder and out through the penis.

Causes of Benign Prostate Enlargement

The cause of prostate enlargement is unknown, but it’s believed to be linked to hormonal changes as a man gets older.

The balance of hormones in your body changes as you get older, and this may cause your prostate gland to grow.

Who is at Risk for BPH?

There are many risk factors for BPH. Men who are at a higher risk include:

• Men over the age of 50 as the risk for BPH rises with age
• Men whose fathers had BPH
• Men who are overweight or obese
• Men who don’t stay active
• Some men with erectile dysfunction

Symptoms

When the prostate is enlarged, it can bother or block the bladder. Needing to pass urine often is a common symptom of BPH. This might be every 1 to 2 hours, mainly at night.

Other symptoms include:

• Incomplete emptying: the feeling your bladder is full, even after passing urine.
• Frequency: the need to pass urine often, about every one to two hours.
• Intermittency: the need to stop and start several times when passing urine.
• Urgency: feeling the urgent need to pass urine as if you can’t wait.
• Weak stream: a weak urine flow.
• Straining: trouble starting to pass urine or the need to push or strain to pass urine.
• Nocturia: the need to wake up at night more than two times to pass urine.

If BPH becomes severe, you might not be able to pass urine at all. This is an emergency that must be treated right away.

Diagnosis

See your doctor if you have symptoms that might be BPH. See your doctor right away if you have blood in your urine, pain or burning when you urinate, or if you cannot urinate.

 The following tests might be used to diagnose BPH.

• Physical Examination

• Urine Tests

These tests are done to measure how well you release urine. This shows the doctor if the urethra is blocked or obstructed. There are several types:

• Urinalysis tests your urine sample to check for important things such as blood, signs of infection, glucose (sugar), protein, and other factors that can tell your urologist the cause of your symptoms. Urine tests are also used to screen for bladder cancer. If you have blood in your urine, pain or burning when you pass urine, or you cannot pass urine, it is important to see your doctor right away.
• Post-void residual volume (PVR) measures urine left in the bladder after passing urine. This is done to diagnose the problem. It may also be done before surgery.
• Uroflowmetry measures how fast urine flows. This is done to diagnose the problem. 
• Urodynamic pressure-flow study tests pressure in the bladder during urination.

• Scans

These tests are done to see the size and shape of the prostate. Some BPH scans include:

• Ultrasounds to look inside the body and see the size and shape of the prostate.
• Cystoscopy is an exam used to look at the urethra or bladder with a scope.
• Magnetic resonance imaging (MRI) and computed tomography (CT) are more detailed scans. These are done if surgery is necessary to reopen the flow of urine. These scans provide a very clear image of the prostate and surrounding area. It shows exactly how and where the prostate is enlarged.

• Blood Tests

If cancer is suspected, blood tests may be done.

• Prostate-specific antigen (PSA) blood tests are used to screen for prostate cancer. The PSA blood test checks the level of PSA, a protein made only by the prostate gland. Avoid sexual activity several days prior to the test, as this may artificially increase the PSA reading.

Treating Benign Prostate Enlargement

Our Consultant Urologist at Westminster Ortho Med Clinic will conduct the necessary examinations for a benign prostatic hyperplasia diagnosis. Treatment for an enlarged prostate will depend on how severe your symptoms are.

If you have mild symptoms, you do not usually need immediate treatment. Our Urologist will agree with you when you need more check-ups.

You’ll probably be advised to make lifestyle changes, such as:

• Drinking less alcohol, caffeine, and fizzy drinks
• Limiting your intake of artificial sweeteners
• Exercising regularly
• Drinking less in the evening

Medicine to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of an enlarged prostate.

Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine.

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.

Urinary and genital infections affect your urinary tract or the genital organs and surrounding area. The urinary tract includes the kidneys, ureters, and the bladder while the genital system includes the reproductive organs. Urinary and genital infections may affect the kidney, prostate, bladder, urethra, testes, penis, and vagina. 

What is the urinary tract?

The urinary tract makes and stores urine, one of the body’s liquid waste products. The urinary tract includes the following parts:

• Kidneys: These small organs are located on the back of your body, just above the hips. They are the filters of your body — removing waste and water from your blood. This waste becomes urine.
• Ureters: The ureters are thin tubes that carry urine from the kidneys to your bladder.
• Bladder: A sac-like container, the bladder stores your urine before it leaves the body.
• Urethra: This tube carries the urine from your bladder to the outside of the body

Urinary tract infections (UTIs) are the second most common infectious diseases worldwide. UTI’s involve a wide range of clinical manifestations, including acute, chronic, uncomplicated, complicated, asymptomatic, symptomatic, and recurrent. The infections may affect the lower and/or the upper parts of the urinary tract. They can be either bacterial or viral in nature.

Risk Factors:

UTI’s are usually caused by bacteria entering the urethra and moving up into the bladder. 

Factors that can increase the possibility of having a UTI:

• Not drinking enough fluids. You should aim to drink 8 glasses of fluid every day to prevent dehydration. 
• If you drink regular alcohol, this causes dehydration which increases the risk of a UTI.
• Medicines or conditions which weaken your immunity, for example, diabetes.
• Having unprotected sex with multiple partners.
• Bad personal and genital hygiene.
• Pregnancy.
• Having a urinary catheter. 
• Incomplete emptying of the bladder, such as in men with an enlarged prostate and in women with a uterine (womb) or bladder prolapse. 
• Other conditions which block the urinary tract, for example, kidney stones.

Signs and Symptoms 

Symptoms of a urinary tract infection (UTI) may include:

• Pain or a burning sensation when peeing (dysuria)
• Needing to pee more often than usual during the night (nocturia)
• Urine that looks cloudy, dark, or has a strong smell
• Needing to urinate suddenly or more urgently than usual
• Needing to urinate more often than usual
• Blood in the urine
• Lower tummy pain or pain in your back, just under the ribs
• A high temperature, or feeling hot and shivery
• A very low temperature below 36C

Children

Children with UTIs may also:

• Have a high temperature – your child is feeling hotter than usual if you touch their neck, back or tummy
• Appear generally unwell – babies and young children may be irritable and not feed or eat properly
• Wet the bed or wet themselves
• Be sick

Older, frail people or people with a urinary catheter

In older, frail people who have problems with memory, learning, and concentration (such as dementia), and people with a urinary catheter, symptoms of a UTI may also include:

• Changes in behavior, such as acting agitated or confused (delirium)
• Wetting themselves (incontinence) that is worse than usual
• New shivering or shaking (rigors)

Diagnosis

The following tests may be conducted to diagnose a urinary tract infection:

• Urinalysis: This test will examine the urine for red blood cells, white blood cells, and bacteria. The number of white and red blood cells found in your urine can indicate an infection.
• Urine culture: A urine culture is used to determine the type of bacteria in your urine. This is an important test because it helps determine the appropriate treatment.

If your infection does not respond to treatment or if you keep getting infections repeatedly, your doctor may use the following tests to examine your urinary tract for disease or injury:

• Ultrasound: In this test, sound waves create an image of the internal organs. This test is done on top of your skin, is painless, and doesn’t typically need any preparation.
• Cystoscopy: This test uses a special instrument fitted with a lens and a light source (cystoscope) to see inside the bladder from the urethra.
• CT scan: Another imaging test, a CT scan is a type of X-ray that takes cross-sections of the body. This test is much more precise than typical X-rays.

Treatment Plans:

The treatment for urinary and genital infections differs with symptoms and an individual treatment plan will be developed by our Consultant Urologist to help you recover. 

The Doctor may prescribe antibiotics to treat the urinary infection if there is clear evidence of a UTI. The antibiotics need to be taken as directed. Symptoms should improve within 5 to 7 days. It is important to finish the prescribed course of antibiotics, even if you start to feel better and your symptoms are improving.

 Other common treatment plans include oral medicine therapy, local medicated ointments, and vaccination which will be administered by your doctor to suit your condition.

How to try to prevent a UTI (self-help)

Drink plenty of fluids. Aim to drink at least 8 glasses of fluid every day to prevent dehydration. In warmer weather, the risk of developing a UTI increases so you should increase your fluid intake. 

Alcoholic drinks can also cause dehydration. Always check the color of your urine; if your urine is a dark orange/brown (strong) you need to drink more. Be aware of how much urine you are passing at each time. If you are passing small amounts, increase the number of fluids you are drinking. Your urine should be a pale-yellow color. If you struggle to drink fluids try adding water-based foods to your diet such as soups, melons, cucumbers, tomatoes, strawberries, peaches, oranges, grapefruit, lettuce, cauliflower, cabbage, skimmed milk, plain yogurt, cottage cheese.

Other simple lifestyle changes:

• Genital Hygiene – Washing from front to back after you go to the toilet to prevent bacteria from entering your urethra.
• If you experience constipation this can increase the risk of UTI therefore avoid constipation.
• Allow yourself time on the toilet to empty your bladder fully.
• Wear loose cotton underwear, avoid wearing tight fitted synthetic underwear, tights and tight trousers made from man-made fabrics i.e. nylon material.
• Take a shower rather than a bath.
• Avoid waiting too long to go to the toilet, as this can hold the bacteria in the bladder.
• Sexual hygiene – passing urine and washing gently with warm water after sex can help reduce the number of bacteria present.
• Avoid soaps, shower gels, and intimate hygiene products (wet wipes or talcum powder); these can irritate the urethra.
• Incontinence – treating the incontinence, whether urinary or fecal, can help to reduce the risk of UTI. Leakage of urine as women get older is not just as part of aging. Wearing pads to cope with incontinence can increase your risk of UTI so if you are suffering from this you may want to talk to your Urologist about addressing the incontinence.

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.