Medical Questions & Answers » Glands

After Prostate Operation

medicalquestions — Wed, 25 Mar 2009 06:00:06 +0000

My old friends are too embarrassed to see a doctor about their prostate problems, and several of them have poor flow when they urinate. Others are very worried about the side effects of prostate surgery such as impotence. I have recently had prostate surgery with no problems.
You have put the problems of men’s health in a nutshell. The golden rule is ‘If in doubt, check it out.’ Prostate cancer is certainly a significant problem in older men, but may occur in men as young as 40. The main symptoms are difficulty in starting the flow of urine, and then instead of a jet of urine, a dribble that splashes on your shoes instead of the porcelain.
There are other causes for these symptoms other than cancer, particularly an enlarged prostate gland which is not cancerous, but the only way to find out for sure is to be examined by a doctor.
The examination will consist of an examination by the doctor placing a gloved and lubricated finger through the anus (back passage) to feel the gland, and a blood test. If there is any suspicion of a problem, further tests such as an ultrasound scan, will be performed. If a prostate cancer is found early, it can be removed. There may be side effects of surgery such as impotence and difficulty in controlling the urine flow, but these are more common if a bigger operation is necessary for an advanced cancer. If impotence occurs, there are tablets and injections available that will enable the man to have a normal erection and sex life.
Remember, if delay in making the diagnosis because you do not go to a doctor leads to complications, or even premature death, the only person to blame is yourself.

Prostate Gland Operation

medicalquestions — Sun, 15 Mar 2009 06:00:14 +0000

I had my prostate gland removed by an open operation that left a scar across my belly. Now, six months later, I have an egg-sized lump at one end of the scar for which I am wearing a corset. What should I do with this lump?
It is possible that you have a cyst in the scar caused by a stitch that has been left behind, but the far more likely explanation is that you have an incisional hernia.
In older people, the frail tissue may break down after an operation, allowing part of the bowel to escape through the deeper layers of the wound to the area just under the skin. If the lump goes away when you lie down, but recurs when you stand or exercise, the problem is almost certainly a hernia.
The development of such a hernia can be caused by a wound infection, but is often just bad luck, as the deeper tissue gives way under the strain of supporting your belly after an operation.
The lump certainly needs to be checked by a doctor, but if it is causing only minimal discomfort, a corset may be all that is required to control it. In other circumstances, further surgery, often with insertion of some surgical mesh to strengthen the area, will be required.

I’m an old codger, stuck in a nursing home—but I’ve still got my wits! Ever since I had my prostate out, I have to have a horrible tube up my private bit to get rid of my piss. My doctor says it has to stay in, and keeps pushing them in and out every month. How can I get rid of this tube for good?
There are a number possibilities here, but the most likely is that you cannot pass urine normally because of a bladder that will not contract properly after the operation. The prostate is certainly responsible for a lot of problems in older men, and if it is enlarged, you sometimes cannot pass urine at all because of its size, and after the operation the bladder may be so slack that it cannot force the urine out.
It is often unfortunate that the body gives out before the brain, leaving you having to deal with the embarrassment and inconvenience of urinary catheters. They have to be changed every month because if they are left for too long infections can develop, and the rubber of the catheter deteriorates.
I fear that you will not be able to get rid of the tube for good, because if there was any way in which this could be done, your doctor would have tried it. Ask your doctor why the catheter is required, and ask if you can try for a couple of days without it—you may soon wish to have it back in again.

Prostate Cancer & Its Treatment

medicalquestions — Sun, 15 Mar 2009 06:00:05 +0000

My doctor has told me that I have cancer of the prostate, but doesn’t seem too worried about it, but I am! How serious is this? Can it be cured?
The prostate gland sits inside the body at the base of the penis, and secretes a fluid that lubricates the urine tube from the bladder through the penis, and supplies part of the man’s ejaculate during sex. Cancer can develop in this organ, but it occurs normally in old men and early signs include difficulty in passing urine, pain and bloody urine.
The seriousness of this (and most other cancers) depends on how far advanced it is when the diagnosis is made and treatment started. Doctors consider a five year survival after diagnosis to be equivalent to cure, and with cancer of the prostate, 70% of all patients survive for five years. If the diagnosis is made early, the survival rate exceeds 90%.
Treatments will involve one or more of several different medications, surgery to remove all or part of the prostate, radiotherapy (high intensity x-rays), removal of the testes (to stop the male hormone being produced that encourages the cancer to grow) and female hormone tablets.
It is possible that your cancer was diagnosed during an operation to clear a blocked urethra (urine tube). This operation, carried out by passing an instrument up from the end of the urethra, is the most common way in which this type of cancer is found, and if only a small number of cancer cells were detected, the operation you have already had may have cured the cancer.

I had a prostate operation ten years ago, and no problems since until recently. Now I pass a few drops of blood before the urine with my first trip to the toilet in the morning. As I don’t have a regular doctor, would appreciate your opinion.
The best thing you could do would be find a GP whom you like and trust. Ask friends and neighbours who they go to, then visit that GP for a routine matter. If satisfied, return to discuss your intimate problem, and let the doctor know that you intend to be a regular patient.
If you are not satisfied, keep trying until you find a doctor with whom you are compatible.
As far as your current problem is concerned, you do need to be thoroughly assessed, and in particular, your prostate requires further checking, both by blood and urine tests, and probably by a specialist urologist. It is likely that your prostate is causing the bloody discharge, but the bladder, sperm storage sac or even the testicles could be responsible.
Investigation and treatment as soon as possible would be appropriate.

Prostate Gland Problem

medicalquestions — Sat, 14 Mar 2009 06:00:59 +0000

I am 72 and I can’t pee very well any more. I have to stand for ages, and then go back again after half an hour. What can I do to speed things up?
The tube from the bladder to the outside in men runs through a golf ball sized gland called the prostate before passing along the penis. The prostate gland is responsible for secreting part of the semen a man ejaculates during sex. There is no female equivalent.
As a man ages, the prostate slowly enlarges, putting pressure on the urethra (the urine carrying tube) so that it is narrowed, and the urine has difficulty in passing. When you go to the toilet, the bladder is usually not emptied completely because of inadequate pressure to keep the narrowed tube open. Therefore the urge to pass urine comes on again after only a short period of time.
The enlargement of the prostate gland is normally benign in older men, but it can be due to a cancer. For this reason it is essential for any man with a poor urinary stream to be checked by a doctor. If a benign enlargement is the cause, a simple operation will set the problem right, and you will rejoin the jet set!

My prostate has been giving trouble, and my surgeon says he is going to remove it—through my penis! How on earth can he do that?
Impossible as it may seem, most (but not all) of the prostate can be removed through the penis.
The prostate secretes a fluid that lubricates the urethra (the tube that carries urine from the bladder to the outside) and nurtures sperm. It sits at the base of the penis behind the pubic bone. The gland is the size and shape of a small egg, but in older men it can enlarge to be two or three times this size. There is no cancer or other disease necessarily present when this enlargement occurs, but because of its position around the opening of the urethra from the bladder, it can constrict the outflow of urine from the bladder when it is enlarged (see diagram).
If the flaccid penis is held straight, it is quite easy (under an anaesthetic) for an instrument to be passed down the urethra to the prostate. This instrument has a sharp edged cup at the end, which is used to scrape away layer after layer of the prostate to remove any blockage that is present. The scrapings are then washed out of the bladder and urethra. In this way, a quite large internal gland can be removed through a very small rube.

Urinary Bladder Query

medicalquestions — Thu, 25 Dec 2008 12:51:48 +0000

I feel an irritation in the urinary tract whenever I get the urge to pee. But as soon as I enter the John I cannot pee. This is especially so in public toilets. I feel great discomfort in public toilets, hearing noises inside, of people talking, etc, whereas if I am alone at home I can easily relieve myself. Do I have a problem? I fear what will happen when I start living in a hostel where I’d be forced to use a public toilet.
You appear to be suffering from a condition called Shy Bladder Syndrome, a.k.a. avoidant paruresis. Try this classic bladder-retraining technique: Have someone stand as close to you as you can tolerate while you try to go — even if he has to loiter outside the facility. Set aside an hour for each session; Drink lots of water first, so you’ll have enough ammunition for several attempts. Practice this 2 to 3 times a week as your friend/parent moves gradually closer, until your comfort zone shrinks to acceptable proportions. As for the irritation while passing urine, you probably have a mild Bladder neck spasm. Consult an urologist who’ll probably prescribe the drug Dynapress. You may need to get an Ultrasound KUB done.

Bladder Treatment

medicalquestions — Sun, 21 Dec 2008 12:12:43 +0000

I am 82 years old and suffering from an irritable bladder that has me running to the john every hour, especially at night.
You need to do an ultrasound K.U.B. with post void residue. Your urologist, after analyzing the report, will probably prescribe medications such as Tamsulosin (0.4 mg) and Detrusitol (2 mg), usually taken in the night.

Gall Bladder Stones Treatment

medicalquestions — Sun, 03 Aug 2008 06:00:54 +0000

Question: My parents both had gall stones. I am worried that I might too. Who gets gall stones and how are they treated?
Fair, fat, female, forty and flatulent. These are the people who, according to traditional medical textbooks, are more likely to suffer from gall stones. Of course the problem can occur in many people outside this group, but I find it quite surprising just how many do belong to this ‘5F’ group. Problems occur when the bile in the gall bladder becomes too concentrated and precipitates out as a crystal or stone. Small stones can pass out along the ducts, but larger stones block up the bile ducts, and when the gall bladder contracts, the movement of the stone in the duct causes severe pain.
The only effective treatment is surgery to remove the gall bladder and the stones it contains. If there are no acute problems, it can be carried out routinely at the patient’s convenience. Some patients can have stones very low in the common bile duct removed by an instrument that is passed through the mouth and stomach into the intestine. Patients who are too old or ill for an operation may use an expensive drug that slowly dissolves some gall stones over many months.
A newer technique to disintegrate gall stones by ultrasound waves is being trialed in some hospitals, but this is not routinely available yet.

Question: Following an extensive liver resection for metastatic cancer my husband developed intense itching all over but there is no sign of a rash. What could cause this?
The liver is an extraordinarily complex organ that is responsible for the production of many of the body’s essential chemicals and enzymes, and for removing waste products from the blood stream. Any surgery to the liver may interfere with these processes, and metastatic deposits of cancer may also have an effect. If any one of the hundreds of substances produced in the liver is being manufactured in excess, or in insufficient quantities, there may be a minor imbalance in the body’s metabolism. The same applies if one particular waste product is not being removed efficiently. Either problem can lead to a wide variety of symptoms, one of which could easily be an itch.
Identifying the chemical imbalance can be very difficult or impossible, as it may be an interaction between two or more different substances. If nothing obvious is found on routine investigation, it is often just a matter of time while your husband waits for the liver to repair itself (which it usually does).
In the meantime, there are medications that can be prescribed by your general practitioner to ease the itch and discomfort. You should discuss the various options further with him/her.

Gall Bladder Surgery

medicalquestions — Sat, 02 Aug 2008 06:00:54 +0000

Question: What is the gall bladder? What does it do? I’m told that it is essential for digestion, but I have to have mined taken out because of stones, even though they only give occasional pains.
The liver, which sits behind the lower ribs on the right side of the body, produces bile at a more or less constant rate. This bile moves through a series of collecting ducts, which join up to form the common bile duct. This duct leads to the small intestine. There is a side duct to the common bile duct that leads to the gall bladder.
Bile is required to help in the digestion of food, but as we do not eat constantly, it is not needed in the gut all the time. There is a valve at the lower end of the common bile duct where it opens into the intestine. This valve opens when food passes to allow bile to be added to the food in the gut. When the valve is closed, the bile must be stored, and this is where the gall bladder fits in to the picture. The gall bladder is a storage area for bile not immediately required, and the bile from the liver is directed into it when the valve is closed. When extra bile is required in the gut to digest food, the gall bladder contracts to squeeze the bile out through the open valve onto the food.
If your gall bladder is removed, the bile trickles into the gut constantly, and although not an ideal situation, the bile and food will eventually mix together, and digestion will occur, with minimal consequences to you or your gut.

Question: I had my gall bladder removed recently, a cholestomy (sic) it is called, and I would like to know what parts are missing. I am frightened about what foods I can eat. Can you advise me?
In a cholecystectomy, the only part of you removed is the gall bladder. Bile is produced constantly in the liver, but is only required in the gut when food is present. As a result, the bile is stored in the gall bladder, and when food is eaten, the gall bladder contracts to squirt bile onto the food, and help its digestion (see diagram on page 242).
If the bile becomes too concentrated, stones may form, and cause pain and discomfort. The only way to remove these is to remove the entire gall bladder. After the operation, you will still produce bile, but it will trickle into the gut constantly. Some patients find they get a bit bloated after a cholecystectomy, and have intermittent indigestion, but generally there are minimal symptoms.
There are no general rules on foods to avoid, but some people find that fried and fatty foods upset them. By trial and error, you will find those foods that cause problems, and learn to avoid them.
The vast majorities of people who have their gall bladder removed have no problems afterwards and lead a totally normal life.

Gall Bladder Removal

medicalquestions — Sat, 02 Aug 2008 06:00:24 +0000

Question: I had a laparoscopic gall bladder removal four years ago, but still have discomfort in the area, particularly after a large meal. Is this normal?
Laparoscopic removal of the gall bladder involves cutting three or four one-centimeter long holes in the abdomen, and inserting tubes through these holes, which are used for the surgeon to see what he or she is doing and the passage of instruments to perform the operation. Recovery is usually far faster than the open operation in which a 12 to 15 cm cut is necessary.
With any operation there is some scarring, and it may be that scar tissue has formed around the site of the gall bladder which is pinching nerves or adhering to surrounding structures. This is the most common cause of post-operative pain. It may be that the cause of your pain is due to some other disease process in the liver, stomach, intestine, pancreas or overlying muscles, and totally unrelated to your surgery.
Rarely, a gallstone may be left behind in the bile duct, and may be responsible for continuing post-operative discomfort. In all cases you should return to your doctor so that a further examination and investigations can be performed to determine the exact cause of your problem.

Question: Ten weeks ago I had my gall bladder removed by laparoscopy. f was discharged after three days, but since then I have had discomfort under the right rib cage and in the shoulder blade. Is this pain normal?
Laparoscopic surgery is marvelous innovation that enables medium level surgery, such as removing the gall bladder, to be performed through tiny holes using long thin tubes to look into the belly and operate through.
The main advantages are far less pain from the incision, and being able to leave hospital in a very short time.
During the operation, the belly is blown up with gas in order to separate the organs from each other and enable the surgeon to see what he or she is doing. At the end of the operation, every attempt is made to remove this gas, but it is impossible to remove all of it.
As you recover, the remaining gas is slowly absorbed into the bloodstream, but this may take some weeks.
One of the places the gas tends to accumulate is above the liver, and under the diaphragm, behind the ribs on your right side. Here it can cause some irritation and discomfort. The nerves that supply the diaphragm run down from the shoulder, so it is not unusual to experience referred pain in the shoulder from the gas under the diaphragm.
All your symptoms should settle gradually in the three months after the operation, and there is no cause for concern unless the pain worsens.

Liver Function

medicalquestions — Fri, 01 Aug 2008 06:00:15 +0000

Question: What does the liver actually do? I can’t work this out, but unlike the gall bladder, it seems to be essential to the body.
The liver is the largest gland and internal organ in the body. Wedge-shaped, it lies behind the lower few ribs on the right side. It weighs about 1.5 kg and has the same reddish brown color as the animal livers we are familiar with in the butcher shop. When food has been digested it still has to be absorbed into the body. The liver plays an integral part in this process.
The liver is a mass of complex tissue containing millions of cells and blood vessels. Among its functions, it regulates the amount of blood sugar, assists in producing the blood-clotting mechanisms, helps to nourish new blood cells, destroys old blood cells, breaks down excess acids to be eliminated as urine, stores and modifies fats so they can be more efficiently utilized by cells all over the body, stores certain vitamins and minerals, and removes poisons from harmful substances such as alcohol and drugs. The liver is also an important source of the heat which is essential to maintain the body’s temperature.
The liver manufactures bile, which mixes with the digestive juices in the duodenum. Bile is a thick, yellowy-green liquid containing salts that breaks down fat into small droplets so that it can mote easily be digested. Another of the functions of the liver is to remove a yellow pigment called bilirubin, produced by the destruction of old red blood cells, from the blood. If the liver becomes diseased and can not function properly, this yellow pigment stays in the bloodstream and gives a yellowish tinge to the skin and whites of the eyes—the jaundice that is such a striking symptom of the liver disease, hepatitis.
The chemical processing capabilities of the liver are very complex. Substances which enter as one thing frequently leave as something else, depending on the body’s needs. For example, most amino acids are converted into proteins, but if the body is short of glucose, the liver will combine some of the amino acids with fat to make extra sugar. Similarly, if the level of blood sugar is too high, glucose is converted into a substance that can be stored.
The liver also stores vitamins. If more vitamins are consumed than the body needs, some will be stored to be released if needed later. A person may survive as long as 12 months without taking in any vitamin A, and for up to four months without new supplies of vitamins B12 and D.