Benign Prostatic Hypertrophy– Common in older men; varies from mild to severe– Change is actually hyperplasia of prostate • Nodules form around urethra • Result of imbalance between estrogen and testosterone– No connection w/ prostate cancer– Rectal exams reveals enlarged gland– Incomplete emptying of bladder leads to infections– Continued obstruction leads to distended bladder, dilated ureters, renal damage • If significant, surgery required
Signs and Symptoms• It causes canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes with the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, dysuria (painful urination), increased risk of urinary tract infections, and urinary retention. Although prostate specific antigen levels may be elevated in these patients because of increased organ volume and inflammation due to urinary tract infections, BPH does not lead to cancer or increase the risk of cancer.[
BPH—Signs and Symptoms– Initial signs • Obstruction of urine flow – Hesitancy, dribbling, decreased force of urine stream – Incomplete bladder emptying » Frequency, nocturia, recurrent UTIs
Treatment – Only small amount require intervention • Surgery when obstruction severe – Drugs (Flomax) used to promote blood flow helpful when surgery not required• Surgery• Transurethral resection of the prostate - is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualizing the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.
Prostate Cancer– Most are adenocarcinomas from tissue near surface of gland • BPH arises from center of gland • Many are androgen dependent– Tumors vary in degree of cellular differentiation • The more undifferentiated, the more aggressive and the faster they grow and spread– Metastasis to bone occurs early • Spine, pelvis, ribs, femur– Cancer has typically spread before diagnosis– Staging based on 4 categories: • Asmall, nonpalpable, encapsulated • Bpalpable confined to prostate • Cextended beyond prostate • Dpresence of distant metastases
Causes – Cause not determined • Genetic, environmental, hormonal factors – Common in North American and northern Europe – Incidence higher in black population than white • Genetic factor? – Testosterone receptors found on cancer cells• The cause of prostate cancer is unknown, but hormonal, genetic, environmental, and dietary factors are thought to play roles. The following risk factors have been linked with development of this condition:
Causes• Genetic factors: Men who have a history of prostate cancer in their family, especially if it was a first-degree relative such as a father or brother, are at an increased risk• .
Causes• Infection: Recent evidence has suggested the role of sexually transmitted infections as one of the causative factors for prostate cancer. People who have had sexually transmitted infections are reported as having 1.4 times greater chance of developing the disease as compared to the general population
Causes• Diet: A diet high in fat has been associated with an increased risk of prostate cancer.• Chemical agents: Exposure to chemicals such as cadmium has been implicated in the development of prostate cancer.
Signs and Symptoms– Hard nodule in periphery of gland • Detected by rectal exam– No early urethral obstruction • b/c of location • As tumor develops, some obstruction occurs – Hesitancy, decreased stream, urinary frequency, bladder infection– Hard nodule in periphery of gland • Detected by rectal exam– No early urethral obstruction • b/c of location • As tumor develops, some obstruction occurs – Hesitancy, decreased stream, urinary frequency, bladder infection
How to diagnose?– 2 helpful serum markers • Prostate-specfic Antigen (PSA) – Useful screening tool for early detection • Prostatic acid phosphatase – elevated when metastatic cancer present – prostate biopsy is performed after a raised serum prostate specific antigen– Ultrasound and biopsy confirms • prostate cancers are discovered incidentally when a digital rectal exam is performed.
TreatmentRadical prostatectomy is surgical removal of the entire prostate. This operation is indicated for cancer that is limited to the prostate and has not invaded the capsule of the prostate, any other nearby structures or lymph nodes, or distant organs.– Risk of impotence or incontinence– When tumor androgen sensitive: • orchiectomy (removal of testes) or • Antitestosterone drug therapy– 5 yr survival rate is 85-90%
Treatment• Prostate Cancer Treatment• Treatments for prostate cancer are effective in most men.• They cause both short- and long-term side effects that may be difficult to accept. You and your life partner or family members should discuss your treatment options in detail with your urologist and other physicians. Make sure you understand which treatments are available, how effective each is likely to be, and what side effects can be expected.• You must weigh all these choices carefully before making a decision about which course to pursue.• Continue visiting your Urologist
Prevention• Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer.• Eating certain foods that contain substances called antioxidants (vitamins C and E and beta carotene) may be protective.• Some research suggests that taking vitamin E, an antioxidant, may reduce the risk of not only prostate cancer but also other cancers. This theory remains unproven.• Certain medications like finasteride (Propecia, Proscar) and dutasteride (Avodart) have been shown in some recent studies to be effective in decreasing the risk of developing prostate cancer. A discussion with your urologist with regard to these medications should be considered especially, if you have a higher risk of acquiring the disease based on your family history.
Erectile Dysfunction• Erectile dysfunction (ED) is when a man has trouble getting or keeping an erection. ED becomes more common as you get older. But male sexual dysfunction is not a natural part of aging.• Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you dont see your doctor, these problems will go untreated
• Erectile dysfunction (impotence) occurs when a man can no longer get or keep an erection firm enough for sexual intercourse. Having erection trouble from time to time isnt necessarily a cause for concern. But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect your self-confidence.
Symptomssymptoms may include persistent:• Trouble getting an erection• Trouble keeping an erection• Reduced sexual desire
Cause• Physical causes of erectile dysfunction In most cases, erectile dysfunction is caused by something physical. Common causes include:• Heart disease• Clogged blood vessels (atherosclerosis)• High cholesterol• High blood pressure• Diabetes• Obesity• Metabolic syndrome, a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol• Parkinsons disease• Multiple sclerosis
• Low testosterone• Peyronies disease, development of scar tissue inside the penis• Certain prescription medications• Tobacco use• Alcoholism and other forms of substance abuse• Treatments for prostate cancer or enlarged prostate• Surgeries or injuries that affect the pelvic area or spinal cord
• Psychological causes of erectile dysfunction The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:• Depression, anxiety or other mental health conditions• Stress• Relationship problems due to stress, poor communication or other concerns
Complications• complications resulting from erectile dysfunction can include:• An unsatisfactory sex life• Stress or anxiety• Embarrassment or low self-esteem• Marital or relationship problems• The inability to get your partner pregnant
Test and diagnosis• Tests for underlying problems may include:• Physical exam. This may include careful examination of your penis and testicles and checking your nerves for feeling.• Blood tests. A sample of your blood may be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health problems.• Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
• Ultrasound. This test can check blood flow to your penis. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to determine if blood flow increases normally.• Overnight erection test. Most men have erections during sleep without remembering them. This simple test involves wrapping special tape around your penis before you go to bed. If the tape is separated in the morning, your penis was erect at some time during the night. This indicates the cause of your erectile dysfunction is most likely psychological and not physical.• Psychological exam. Your doctor may ask you questions to screen for depression and other possible psychological causes of erectile dysfunction.
• Oral medications Oral medications are a successful erectile dysfunction treatment for many men. They include:• Sildenafil (Viagra)• Tadalafil (Cialis)• Vardenafil (Levitra, Staxyn)
Other medications• Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis.• Alprostadil penis suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra.
• Testosterone replacement. Some men have erectile dysfunction caused by low levels of the hormone testosterone, and may need testosterone replacement therapy• Penis pumps.• Penile implants. This treatment involves surgically placing devices into the two sides of the penis• Blood vessel surgery. In rare cases, leaking or obstructed blood vessels can cause erectile dysfunction and surgery is necessary to repair them
Inguinal Hernia• An inguinal hernia occurs when soft tissue — usually part of the intestine — protrudes through a weak point or tear in your lower abdominal wall. The resulting bulge can be painful — especially when you cough, bend over or lift a heavy object.
Inguinal Hernia• Not necessarily dangerous by itself, an inguinal hernia doesnt get better or go away on its own. An inguinal hernia can lead to life- threatening complications. For this reason, your doctor is likely to recommend surgical repair of an inguinal hernia thats painful or becoming larger. Inguinal hernia repair is a common surgical procedure.
Symptoms• Some inguinal hernias dont cause any symptoms, and you may not know you have one until your doctor discovers it during a routine medical exam. Often, however, you can see and feel the bulge created by the protruding intestine. The bulge is usually more obvious when you stand upright, especially if you cough or strain.• A bulge in the area on either side of your pubic bone• A burning, gurgling or aching sensation at the bulge• Pain or discomfort in your groin, especially when bending over, coughing or lifting• A heavy or dragging sensation in your groin• Weakness or pressure in your groin• Occasionally, in men, pain and swelling in the scrotum around the testicles when the protruding intestine descends into the scrotum
Signs and symptoms• Signs and symptoms in children Inguinal hernias in newborns and children result from a weakness in the abdominal wall thats present at birth. Sometimes the hernia may be visible only when an infant is crying, coughing or straining during a bowel movement. In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period of time.
Causes• Some inguinal hernias have no apparent cause. But many occur as a result of:• Increased pressure within the abdomen• A pre-existing weak spot in the abdominal wall• A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall• Straining during bowel movements or urination• Heavy lifting• Fluid in the abdomen (ascites)• Pregnancy• Excess weight• Chronic coughing or sneezing
Risk factors• Risk factors include:• Being male. Youre far more likely to develop an inguinal hernia if youre male. Also, the vast majority of newborns and children with inguinal hernias are boys.• Family history. Your risk of inguinal hernia increases if you have a close relative, such as a parent or sibling, with the condition.• Certain medical conditions. Having cystic fibrosis, a life- threatening disorder that causes severe lung damage and often a chronic cough, makes it more likely youll develop an inguinal hernia.• Chronic cough. A chronic cough, such as occurs from smoking, increases your risk of inguinal hernia.
• Chronic constipation. This leads to straining during bowel movements — a common cause of inguinal hernias.• Excess weight. Being moderately to severely overweight can put extra pressure on your abdomen.• Pregnancy. This can both weaken the abdominal muscles and cause increased pressure inside your abdomen.• Certain occupations. Having a job that requires standing for long periods or doing heavy physical labor increases your risk of developing an inguinal hernia.• Premature birth. Infants who are born sooner than normal are more likely to have inguinal hernias.• History of hernias. If youve had one inguinal hernia, its much more likely that youll eventually develop another — usually on the opposite side.
Complications• Complications include:• Pressure on surrounding tissues. Most inguinal hernias enlarge over time if theyre not repaired surgically. Large hernias can put pressure on surrounding tissues — in men they may extend into the scrotum, causing pain and swelling.• Incarcerated hernia. This complication of an inguinal hernia occurs when a loop of intestine becomes trapped in the weak point in the abdominal wall. This may obstruct the bowel, leading to severe pain, nausea, vomiting and the inability to have a bowel movement or pass gas.• Strangulation. When part of the intestine is trapped in the abdominal wall (incarcerated hernia), blood flow to this portion of the intestine may be diminished. This condition is called strangulation, and it may lead to the death of the affected bowel tissues. A strangulated hernia is life- threatening and requires immediate surgery.
Test and Diagnosis• A physical exam is usually all thats needed to diagnose an inguinal hernia. Your doctor is likely to ask about your signs and symptoms and to check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you may be asked to stand up and cough or strain as part of the exam.
Treatment andMedications• Herniorrhaphy. In this procedure, also called "open" hernia repair, your surgeon makes an incision in your groin and pushes the protruding intestine back into your abdomen.• Laparoscopy. In laparoscopic surgery, your surgeon uses several small incisions rather than one large one. A fiber-optic tube with a tiny camera is inserted into your abdomen through one incision, and miniature instruments are inserted through the other incisions.
Prevention• Maintain a healthy weight. If you think you may be overweight, talk to your doctor about the best exercise and diet plan for you.• Emphasize high-fiber foods. Fresh fruits and vegetables and whole grains are good for your overall health. Theyre also packed with fiber that can help prevent constipation and straining.
• Lift heavy objects carefully or avoid heavy lifting altogether. If you have to lift something heavy, always bend from your knees, not from your waist.• Stop smoking. In addition to increasing your risk of serious diseases such as cancer, emphysema and heart disease, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia.• Dont rely on a truss, a supportive garment designed to keep hernias in place
Sexually Transmitted DiseasesSTD Overview• A term applied to a variety of infections that are passed from one person to another primarily though vaginal oral or anal sex.• STD’s : group of Communicable Diseases Mode of transmission: Predominantly by Sexual Contact Agents: Bacterial, Viral, Protozoal, Fungal, Ectoparasites Causes for increased prevalence :• Causes for increased prevalence Increased promiscuity and multiple sex partners Better understanding of modes of transmission Better screening tests Antibiotic resistance Increasing DNA virus infection
AIDS• AIDS stands for: Acquired Immune Deficiency Syndrome• AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections.• Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 34 million people living with HIV and AIDS worldwide.
• What causes AIDS?• How HIV affects the body• AIDS is caused by HIV.• HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. If left untreated, it can take around ten years before HIV has damaged the immune system enough for AIDS to develop.
CAUSES• AIDS is caused by HIV.• HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. If left untreated, it can take around ten years before HIV has damaged the immune system enough for AIDS to develop.
What are the symptoms of AIDS?• A person is diagnosed with AIDS when they have developed an AIDS related condition or symptom, called an opportunistic infection, or an AIDS related cancer. The infections are called ‘opportunistic’ because they take advantage of the opportunity offered by a weakened immune system.• It is possible for someone to be diagnosed with AIDS even if they have not developed an opportunistic infection. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level.
Is there a cure for AIDS?• Worryingly, many people think there is a cure for AIDS - which makes them feel safer, and perhaps take risks that they otherwise wouldnt. However, there is still no cure for AIDS. The only way to stay safe is to be aware of how HIV is transmitted and how to prevent HIV infection.
How is AIDS treated?• Antiretroviral treatment can significantly prolong the lives of people living with HIV. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS.
Why do people still develop AIDS today?• Even though antiretroviral treatment can prevent the onset of AIDS in a person living with HIV, many people are still diagnosed with AIDS today. There are four main reasons for this:• In many resource-poor countries antiretroviral treatment is not widely available• . Even in wealthier countries, such as America, many individuals are not covered by health insurance and cannot afford treatment.
• Some people who became infected with HIV in the early years of the epidemic before combination therapy was available, have subsequently developed drug resistance and therefore have limited treatment options.• Many people are never tested for HIV and only become aware they are infected with the virus once they have developed an AIDS related illness. These people are at a higher risk of mortality, as they tend to respond less well to treatment at this stage.• Sometimes people taking treatment are unable to adhere to, or tolerate the side effects of drugs.
Caring for a person with AIDS• In the later stages of AIDS, a person will need palliative care and emotional support. In many parts of the world, friends, family and AIDS organizations provide home based care. This is particularly the case in countries with high HIV prevalence and overstretched healthcare systems.• End of life care becomes necessary when a person has reached the very final stages of AIDS. At this stage, preparing for death and open discussion about whether a person is going to die often helps in addressing concerns and ensuring final wishes are followed.
Candidiasis• Candidiasis is an infection caused by Candida fungi, especially Candida albicans. These fungi are found almost everywhere in the environment. Some may live harmlessly along with the abundant "native" species of bacteria that normally colonize the mouth, gastrointestinal tract and vagina. Usually, Candida is kept under control by the native bacteria and by the bodys immune defenses.
Types of candidiasis include:• Thrush. Thrush is the common name for a mouth infection caused by the Candida albicans fungus. It affects moist surfaces around the lips, inside the cheeks, and on the tongue and palate.• Esophagitis. Candida infections of the mouth can spread to the esophagus, causing esophagitis. This infection is most common in people with AIDS and people receiving chemotherapy for cancer.
• Cutaneous (skin) candidiasis. Candida can cause skin infections, including diaper rash, in areas of skin that receive little ventilation and are unusually moist. Some common sites include the diaper area; the hands of people who routinely wear rubber gloves;
• Vaginal yeast infections. Vaginal yeast infections are not usually transmitted sexually. During a lifetime, 75% of all women are likely to have at least one vaginal Candida infection, and up to 45% have 2 or more. Women may be more susceptible to vaginal yeast infections if they are pregnant or have diabetes. The use of antibiotics or birth control pills can promote yeast infections. So can frequent douching.
• Deep candidiasis (for example, candida sepsis). In deep candidiasis, Candida fungi contaminate the bloodstream and spread throughout the body, causing severe infection. This is especially common in newborns with very low birth weights and in people with severely weakened immune systems or severe medical problems
Signs and symptoms• Diagnosis• Budding cells or hyphae detected on a KOH preparation or Gram stain. Culture on chromagen agar is more sensitive than smear. and• Symptoms and/or signs of vaginitis, eg discharge, vaginal itch or discomfort, dysuria, vulvovaginal erythema.
Treatment and managementTreatment is provided only for symptomatic women.• Seven day regimens are preferred.• miconazole 100 mg pessaries or cream 2% intravaginally at night for 7 nights• clotrimazole 100 mg pessaries or cream 1% intravaginally at night for 7 nights
Health Advice• Explain the nature of the infection and provide literature on candidiasis.• Ensure that the patient is aware of the need for adequate hygiene and avoidance of potential irritants.• Sexual transmission has negligible significance in the aetiology of vulvovaginal candidiasis. Sex partners do not need to be examined and treated.
Genital warts• Genital warts are a sexually transmitted disease (STD) caused by the human papillomavirus (HPV).• The warts are soft, moist, pink or flesh-colored bumps. You can have one or many of these bumps. In women, the warts usually occur in or around the vagina, on the cervix or around the anus. In men, genital warts are less common but might occur on the tip of the penis.
How it is acquired?• You can get genital warts during oral, vaginal or anal sex with an infected partner. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading HPV.
Treatment:• The warts might disappear on their own. If not, your health care provider can treat or remove them. The virus stays in your body even after treatment, so warts can come back.• Anti biotics
What is genital herpes?• Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2).• It causes herpes sores in the genital area and is transmitted through vaginal, oral, or anal sex, especially from unprotected sex when infected skin touches the vaginal, oral, or anal area. Occasionally, it can cause sores in the mouth, and can be spread by secretions in saliva. Because the virus does not live outside the body for long, you cannot catch genital herpes from an object, such as a toilet seat.
Symptoms• You usually get sores near the area where the virus has entered the body. They turn into blisters, become itchy and painful, and then heal. Sometimes people do not know they have herpes because they have no symptoms or very mild symptoms. The virus can be more serious in newborn babies or in people with weak immune systems.
How to treat or Cure:• Medicines do not cure genital herpes, but they can to help your body fight the virus. This can help lessen symptoms, decrease outbreaks, and lower the risk of passing the virus to others. Correct usage of latex condoms can reduce, but not eliminate, the risk of catching or spreading herpes.
Scabies• Scabies is an itchy skin condition caused by the microscopic mite Sarcoptes scabei. It is common all over the world, and it affects people of all races and social classes. Scabies spreads quickly in crowded conditions where there is frequent skin-to-skin contact between people.
How it is transmitted?• Scabies can easily infect sex partners and other household members. Sharing clothes, towels, and bedding can also spread scabies. You cannot get scabies from a pet. Pets get a different mite infection called mange.
Symptoms are• Pimple-like irritations or a rash• Intense itching, especially at night• Sores caused by scratching
Prevention and Treatment:• Several lotions are available to treat scabies. The infected persons clothes, bedding and towels should be washed in hot water and dried in a hot dryer.
Syphilis• Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
Causes• How do people get syphilis?• Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex.
• Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
Signs and symptoms• in adults:• Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection
How does syphilis affect a pregnant woman and her baby?• The syphilis bacterium can infect the baby of a woman during her pregnancy.• Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth.• An infected baby may be born without signs or symptoms of disease.• However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die
• Syphilis is easy to cure with antibiotics if you catch it early. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading syphilis.