Health Issues is a general health based blog concentrating on multiple health topics.

WHEN BPH NEEDS TO BE TREATED: BEFORE OPEN PROSTATECTOMY OR TUR

Monday, March 30th, 2009

Are you in shape for surgery? Your doctor will want to check you out thoroughly beforehand. Surgery may be delayed if certain conditions, such as a urinary tract infection, need attention, or if a catheter is needed to empty the bladder. Men with urinary retention and an elevated level of creatinine in the blood (indicating impaired kidney function) must also be treated for these conditions before having a prostatectomy. When you give the doctor your medical history, be sure to say so if you’ve had any unusual problems with bleeding in the past (from dental work, for example). Also, aspirin can cause excessive bleeding; if you are taking aspirin regularly, make sure you stop at least ten days before the operation.

Another important point to discuss with your doctor: About 15 percent of men who undergo open prostatectomy need a blood transfusion during the procedure. The best blood for you to receive is your own; if your hospital allows this, it’s a good idea to donate several units of your blood ahead of time.

Shortly before surgery, your doctor may want to get a baseline evaluation of your upper urinary tract to spot anything out of the ordinary. One way of doing this is with ultrasound, which can help detect hydronephrosis (distention of the ureters and renal pelvis, caused by an obstruction downstream) and pick up any unusual masses in the kidneys. This painless, noninvasive technique will also give doctors a pretty good indication of the size of your prostate and the state of your bladder—whether there’s any residual urine there. And at the time of surgery, your doctor will probably use a cystoscope—a lighted tube, inserted into the tip of the anesthetized penis—to check for any other surprises in the bladder, such as a stone or tumor that needs to be removed.

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Tags: Erectile Dysfunction, Men’s Health
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HELP FOR IMPOTENCE AFTER PROSTATE TREATMENT: WHAT HAPPENS IN NORMAL SEXUAL FUNCTION?

Monday, March 30th, 2009

Normal erection in men can be reduced in medical terms to a “vascular event,” but this seems too simple a description for the delicate, complex interplay between blood vessels (veins and arteries) and nerves. The penis itself is a remarkable structure, made up of nerves, smooth muscle tissue, and blood vessels. It has three cylindrical, spongy chambers that are essential to erection; one of these is called the corpus spongiosum, and the other two are called the corpora cavernosa.

When sexual function is normal, this is what happens: A man becomes sexually aroused. A substance called nitric oxide is released by the nerve endings, and the smooth muscle tissue in the penis begins to relax. The spongy chambers (also called sinusoids) within this smooth muscle tissue begin to dilate. Meanwhile, arteries continue to pump blood, as usual, into these spongy chambers of the penis. As the penis elongates, the veins are stretched; they clamp down against the thick tissue that surrounds the corpora cavernosa —shutting themselves off so the blood can’t leave the penis. The chambers become engorged, and this keeps the penis “inflated” during sexual activity. An erection is born.

After ejaculation, nitric oxide stops being released; the smooth muscle tissue contracts and the blood flow to the penis is reduced—the veins ease their viselike grip. Once again, blood is allowed to leave the penis, and the erection goes away.

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Tags: Erectile Dysfunction, Men’s Health
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CASTRATION: SIDE EFFECTS

Monday, March 30th, 2009

Its disadvantages are certainly psychological (this can vary depending on a man’s age and stage of illness)—and cosmetic. (To help alleviate the stigma of castration, some surgeons perform what’s called a “subcapsular technique”— see above—in which only the testosterone-producing parts of the testicles are removed, and the outer shell remains. Also, testicular implants—which make the testicles appear normal—are available for some men.)

Castration is irreversible, and for many men, this is too final a treatment. In one 1989 survey, only 22 percent of prostate cancer patients opted for surgical castration; 78 percent of these men chose alternative hormonal therapy (they picked LHRH analogs, discussed in this chapter).

Testosterone is the hormone that makes men feel “manly.” When it is missing, some of the characteristics associated with being male vanish along with it. Side effects of castration—surgical or medical—can include tenderness, pain or swelling of the breasts (this is called gynecomastia), and loss of sex drive. Impotence is not an absolute certainty; 10 percent of men do remain potent. However, they are rare exceptions to the rule. (Impotence here, unlike impotence in other situations, means loss of libido as well as the ability to achieve an erection.)

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Tags: Erectile Dysfunction, Men’s Health
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EXTERNAL-BEAM RADIATION TREATMENT FOR PROSTATE CANCER: RESULTS

Monday, March 30th, 2009

It’s difficult to show any real differences between the results of radiation and radical prostatectomy, if you look at overall fifteen-year survival rates of men with prostate cancer after both treatments. A large study from Stanford reported an overall survival of 50 percent, fifteen years after treatment, for men with stages T1a and T1b (A1 and A2) disease. From these statistics, radiation therapy looks highly promising. However, most of the patients who are initially diagnosed with localized prostate cancer who die during the first fifteen years after any form of treatment die from other causes—so studies of overall survival don’t always reveal the whole story.

Other studies of radiation therapy use different measuring slicks—prostate biopsies and PSA tests. Depending on how many biopsies are taken, anywhere from 30 percent to 90 percent of men who have received external-beam radiation therapy can have a positive biopsy two years or more after treatment. Although this does not mean that allot these men will have treatment failure— that their cancer will come back—long-term follow-up studies have found that many patients do. At five years after treatment, only 25 percent of patients will have low or undetectable levels of PSA. At ten years, only 10 percent will. However, despite the fact that PSA may be measurable, many of these men have not yet demonstrated any clinical signs of treatment failure (urinary tract obstruction, for example); these findings suggest that radiation therapy can effectively control local symptoms from prostate cancer in many patients. And frankly, for many older men—a 75-year-old man who gets radiation today, for example—it isn’t going to matter too much if PSA rises slightly ten years from now, if the therapy has controlled the cancer.

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Tags: Erectile Dysfunction, Men’s Health
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