Medical Questions & Answers

Question: My teenage son recently had one of his testes removed because of torsion. Please warn parents about this dreadful disease!
A man’s testes and a woman’s ovaries both start life together inside the abdomen of a fetus. Just before birth, the testes start migrating through the wall of the lower abdomen to settle in the scrotum, while the ovaries remain behind in the abdomen to lie beside the womb.
As they migrate through the muscles, fat and fibrous tissue of the abdominal wall, the testes trail behind them the arteries, veins, nerves and sperm tube that connect them to the body and keep it nourished and healthy. These pass through a tube called the inguinal canal back into the abdomen. Torsion of the testes is a medical emergency, and treatment delayed for more than 12 hours can have serious consequences. If the testis, hanging from its network of veins, arteries and nerves, twists horizontally, these vital connections to the body may have undue pressure placed upon them, and the blood supply to the testicle can be cut off. The testis then dies unless the tubes are surgically untwisted.
The victim experiences pain and the testes become red, swollen and tender. This problem usually occurs in teenage boys, and is almost unknown over 30 years of age. Any such symptoms should result in immediately seeing a doctor.

Question: I am an 80 year old male, and have a distressing complaint. I urinate far too much night and day, and cannot hold my urine, but must go to the toilet at once. I am otherwise in good health and don’t smoke or drink. Hoping you may have a remedy for me.
Unfortunately, as you become older, it is not only the muscles of the arms, legs and back that weaken. The muscle ring (sphincter) around the base of the bladder, that controls whether you pass urine or not, also weakens.
As the bladder fills up with urine, at the rate of about one milliliter per minute (depending on how much you drink), the pressure on the muscle sphincter also increases. In a young man this causes no problems, but in an older person with a weaker sphincter, the pressure from the increasing volume of urine rapidly becomes too much, and a sudden desire to pass urine develops. You should not avoid drinking fluids throughout the day to prevent this problem, as this may cause dehydration and damage to other parts of the body, but if you have to go out for a few hours, restricting your fluid intake during and immediately before this time may give considerable relief.
There are no simple medications or surgical operations to help men with this problem, although your doctor may try using a drug called probanthine, which helps a small number of men. In women, an operation is available to give relief. There are two devices available that can give control and confidence, although they sound rather horrendous. The first is a soft rubber clamp which can be placed across the base of the penis to prevent the escape of urine, and which is released as required. The second is a sheath of rubber (rather like a condom) which fits over the penis, but has a tube leading from the end to a bag that is strapped to the inside of the thigh to collect the urine.
Neither of these devices should be dismissed out of hand as they can easily be concealed under clothing, the user is barely aware of their presence, and they can give freedom to move more than a few meters from a toilet.

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