Benign prostate enlargement: Symptoms and Treatment

In this video, Dr. VijayPal Singh Consultant Urologist Chandigarh talks about the condition of benign prostate enlargement. It is called prostatomegaly, or an increase in prostate size. 

What is benign prostate enlargement?

The prostate is mainly present in the male sex. Typically it’s a 20 gm walnut-size gland. Basically, it encircles around the urethra behind the urinary tract. Besides, this gland can cause many diseases like benign prostate enlargement and prostate cancer. Above all, it can cause prostate inflammation and prostate infection. 

What are the common symptoms of benign prostate enlargement?

Besides, it affects after the 50 years of age group. Basically, the prostate gland’s size increases after 50-70 years of age, narrowing the urinary passage. The patient develops symptoms. We can divide symptoms into two subgroups: voiding  and storage symptoms.

Indication of storage symptoms

Storage symptoms occur due to changes in the urinary bladder. Voiding symptoms include hesitancy in initiating urination and poor flow of urine. Evidently, patients may need to push themselves to pass urine. Altogether, the urinary bladder doesn’t get empty. There is always some residual urine left in the urinary bladder. Altogether, the storage symptoms bother the patients more. They are pretty irritating, like frequent urination and urgency.

Complications of prostatomegaly

Some complications of benign prostate include recurrent urinary tract infections and hematuria. As a matter of fact, there are bladder stones due to urine blockage.

Diagnosis

The clinical examination of the patient is critical to diagnose the condition. The most important in this is distal rectal examination. First, doctors assess the prostate’s approximate size. Altogether, doctors check for the presence of any nodules or suspicious malignancy and rectal tone. Then comes the urine examination and culture.

Imaging techniques for diagnosis

Ultrasound of the urinary bladder determines the residual urine. It explains how much residual urine is present in the urinary bladder. In addition, doctors examine the prostate size and changes in the urinary bladder. Depending on the patient’s condition, one can also opt for uroflowmetry and cystoscopy.

Who needs a PSA test?

Sometimes doctors recommend PSA tests for prostate cancer screening. 

Treatment

General category

The planning of the therapy is majorly on the patient’s symptoms and the complicating factors. In most cases, doctors suggest behavioural therapies and management. Additionally, doctors recommend pelvic floor exercises.

Moderate category

For bothersome symptoms, doctors give medical management. It includes alpha-blockers, bladder relaxants, and anticholinergics. 

Surgical treatment 

Doctors suggest surgery when medical management fails, or the patient cannot tolerate the medicines. In addition, complications like recurrent UTI, recurrent haematuria (blood in urine), or formation of stones require surgery. Altogether, an increase in prostate size and changes in the bladder require surgical treatment. There are lasers,HoLEP and HoLAP. 

What is TURP?

The gold standard of treatment is TURP. There are minimally invasive surgical therapies (MIST),UroLift, and bladder neck incision or bladder neck resection. However, it is opted only after analysing the patient’s condition, complicating factors. Sometimes it also depends upon the comorbidity and gland size.

Hematospermia(Blood in Semen): Causes , Diagnosis & treatment

Dr. Vijay Pal Singh, Consultant Urologist at Apollo Clinic Chandigarh, discusses the causes, diagnostic methods, and treatment of hematospermia: 

What is blood in semen or hematospermia?

It is a condition in which blood is present in semen or during ejaculation. 

Why does it affect men badly?

It is a problematic and anxiety-provoking condition for the patient as they believe it would affect their fertility or impair their erection. Hence, it causes significant anxiety in the patients.

Incidence of blood in semen

It is not that common. However, out of 1% of urological patients, 1-4% have blood in the semen.

What are the common causes of hematospermia?

Blood in the semen is benign and self-limiting. However, their course or blood may come up in weeks. Usually, it’s STI or inflammation if it starts commencing after the age of 40. But there may be other causes, like inflammation in minor vesicles or male reproductive organs. The stone formation can also lead to blood in the semen.

Other causes of blood in semen

There can be an obstruction in the ejaculatory duct or any vascular malformation like AV fistula, mucosal vessel, or hemangioma. After age 40, there is a suspicion of benign or malignant tumors in the prostate or urethra, but these are rare phenomena.

How to diagnose hematospermia?

Knowing patient history is the initial mode of diagnosis. It includes the amount of blood in semen and its frequency or quantity. In addition, urine condition, presence of any underlying conditions, and blood in the urine. Also, if the patient is on blood thinners or suffering from any hemolytic diseases, there are more chances of bleeding.

Physical Examination

In physical examination, the doctor checks vitals, temperature, sepsis or infection, and abdominal palpation. The doctor even performs an external genital analysis by evaluating testis, vas deferens, and epididymis. In addition, doing a penile urethra, palpitation is essential to detect abnormalities like stones or any tumour if present. 

Distal rectal examination

It is essential to opt for a distal rectal examination. One can detect giant tumours, stones, or distention in seminal vesicles. Also, prostate gland palpitates to inquire suspicious nodules that may indicate prostate cancer. 

Lab Test

Doctors ask for urine analysis, mandatory urine culture semen analysis, semen culture, and blood tests to diagnose this condition. To detect blood thinning and bleeding tendencies, doctors do PTI test

Do imaging techniques help in diagnosis?

Transrectal ultrasonography, pelvis MRI, and Vasography help better understand the condition. So doctors can use these individual tests or, in combination, make the proper diagnosis. 

Treatment

Treatment includes anxiety relief, essential reassurance, and wait and watch. Apart from that, there are certain culture-specific antibiotics if there is an STD infection, like chlamydia or gonorrhoea. So they require different types of treatment and are beneficial.

Other Treatment Include

Doctors do ultrasound-guided aspiration if there is an underlying cause, like a seminal vesicle cyst or ejaculatory duct obstruction. It is one modality through which we can treat them. Patients suspected of Seminal vesicle stones or tumours need specific treatment according to the cause. If there is a tumor, doctors opt for surgical procedures and therapies. But this depends upon the patient’s condition and diagnosis.

Bottom line 

In most cases, it is self-limiting and heals on its own. However, if it starts at the age of 40, it is probably STIs for which one can easily take an antibiotic course. But if it persists for longer, accompanied by pain, then one must seek a doctor’s advice. 

Thank you.

Prostate Cancer: Signs, Symptoms & Treatment

In this video, Dr. Vijay Pal Singh, Consultant Urologist at Apollo Clinic, Chandigarh, has given a complete overview of prostate cancer, its signs, and its Symptoms. Also, he has shared information about its treatment.

It usually originates from the periphery or outer part of the gland. Initially, it doesn’t show any symptoms. Its signs are visible only when it has locally advanced or increased. 

Metastasis of Prostate cancer

It can extend its growth to the urinary passage or may reach the rectum. In a few cases, it may get the pelvis side wall. In adverse situations, it may metastasize into bone. One may have back pain or retroperitoneal lymph node metastasis. It may block the ureter and cause swelling in the kidney. 

How can we detect prostate cancer? 

We do screening if the asymptomatic patients fulfill the following parameters. The patient’s age is above 50 or may also have other problems. PSA or Prostate-specific antigen test. PSA is the most widely used test to suspect prostate cancer in patients. 

What are the other screening methods ?

In addition, doctors perform distal rectal examinations. In this, doctors examine the prostate via rectal for any suspicious growth. Various factors can increase PSA levels, including urinary infection, prostate inflammation, chronic inflammation, tuberculosis, or prostate cancer. So a high PSA level doesn’t always indicate prostate cancer. Hence we doctors consider all things. 

How does the PSA value sign cancer?

After ruling out other possibilities like UTI or prostate inflammation, the doctor analyzes PSA values. If the value of the PSA level is between 4-10, then we do make a suspicion. To further confirm, Doctors may opt for MRI, multi-parametric prostate test, and prostate health index.

How does Biopsy help in diagnosis?

To further confirm the suspicion, the doctor performs a Biopsy. It is usually a translationally guided ultrasound of the abnormal area. Further histopathological studies confirm the presence of prostate cancer and its grading and further tell us its adversity. 

Prostate Cancer Treatment

Various treatment options are available depending upon the patient’s age and cancer grade. Further, whether the cancer is localised to the gland or has advanced further or metastasized distantly affects the treatment choice. There are surgical modalities available for localised cancer, like prostate tactics. 

Other options of treatment:

Doctors prefer hormonal therapy and chemotherapy if cancer has spread further or is locally advanced. If the patient has developed bony metastasis, we must consider bone health. So there are multi modalities options available for this.

 Bottom line 

It is majorly a condition of aged people. It doesn’t show any early signs and symptoms until it has metastasized to the rectum or causing urinary problems. Doctors confirm the diagnosis by PSA, Biopsy, and prostate health index. however, treatment options are available with a high success rate

Foods to avoid with Enlarged prostate

In this video, Dr. Vijay Pal Singh, Consultant Urologist at Apollo Clinic, Chandigarh, talks about foods to avoid with an enlarged prostate.

What are the foods to avoid with an enlarged prostate ?

A healthy prostate is devoid of any prostatic diseases. A few examples of prostate diseases are prostate enlargement or BPH, inflammation, chronic prostatitis, and prostate cancer. Too much protein, especially red meat like beef, pork, and lamb, is consumed less for a healthy prostate. The second thing one should do is to consume fats, especially trans fat, that are abundant in street food. The third thing is one should limit their salt intake in the diet.

Do too many sweet drinks affect the prostate?

One should avoid consuming sweet drinks supplemented with artificial sweeteners like cold drinks, energy drinks, or packed juices. They all are a bit high in sugar content.

Which foods are healthy for an enlarged prostate?

Green leafy vegetables and fruits enriched with antioxidants improve prostate health. Therefore, one must have them in abundance. Second, instead of white bread, we must use whole grain or brown bread; they are high in fiber and further improve enlarged prostate health.

Instead of a commercial kitchen oil, one should opt for healthy fats like olive oils, avocado, and almonds. 

What common lifestyle modifications improve enlarged prostate health?

Smoking, obesity, stressful life, and sedentary lifestyles harm prostate health. One should adopt a habit of physical and active life. Irrespective of work and stress, men should take 15-20 minutes from their schedule and dedicate it to any form of physical activity. Light yoga, brisk walking, and aerobics promote a healthy prostate. A sedentary lifestyle makes space for other diseases too. In addition, smoking may affect other body organs too.

Risk factors of prostate cancer 

Prostate cancer develops after the age of 50. In addition, Africans and Americans ethnicity are more prone to developing prostate. Specific mutations like BRCA1 and BRCA2 may cause an unhealthy prostate. Obesity and metabolic syndrome are other common risk factors affecting prostate health. Patients with underlying conditions of diabetes or hypertension may acquire prostate problems in the later stages. In addition, there are certain chronic inflammatories and STDs linked to prostate cancer. 

Bottom line 

One can improve their body’s health, including the prostate, by doing a few lifestyle modifications. Keeping tabs on BMI to avoid obesity and quit smoking. Improving eating habits, eating more fruits, green leafy vegetables, and avoiding unhealthy oil and too much of a protein diet may increase the lifespan and improve the quality of life. One must avoid smoking and keep tabs on BMI. Young people may adopt pelvic floor exercises and kegel exercises to improve lower urinary tract symptoms. 

Thank you.

Urinary Tract Infection Treatment and Prevention  

In this video, SimpliHealth expert Dr. Vijaypal Singh is talking about Urinary Tract Infection Treatment and prevention.

TREATMENT OF UTI

We plan the treatment of patients based on the type of UTI, complicated or uncomplicated. We can easily manage uncomplicated UTIs with 3-5 days of antibiotics. 

Most of the time, we give oral antibiotics to them. In addition, we ask them to follow good hydration and maintain local hygiene practices. If it’s a complicated UTI, we find the underlying cause and address it after antibiotics. 

PREVENTION OF UTI

• How can we prevent Urinary Tract Infection? 
• Does the patient become more susceptible to Urinary Tract Infection during summers? 

Yes, since during summers, our urine output is less because there is an increase in our insensible losses like sweating and perspiration. As a result, the kidney comparatively filters less urine. 

Hydration 

So we must hydrate our body frequently, especially in the summer, with a glass of water, a cooler, or a drink every 2-3 hours. You can take lemon water, but the purpose is to hydrate the body every 3-4 hours so that the body’s urine output is adequate. 

Do Not Hold In Your Pee 

Also, it does not allow the urine to store in the bladder; voiding is also very important. We must avoid it after every 3-4 hours so that urine doesn’t stay in the bladder for a more extended period if we hold the urine for a longer duration. It further increases the risk of UTIs.

This was all about urinary tract infection. Thank you for watching this video. Please visit Apollo Clinic Chandigarh in case of further inquiries or any other information. I am available at Apollo Clinic from 9-11 every Tuesday and Friday. Stay Healthy, Stay Happy.

 

What is UTI? Its Types and Diagnosis

In this video, SimpliHealth expert Dr. VijayPal Singh, Consultant Urologist at Apollo Clinic, Chandigarh, is talking about Urinary Tract Infection (UTI). 

What Is UTI?

UTI is a very common disease, primarily seen in young females and diabetes. Diabetic patients frequently visit us with a complaint of UTIs. 

• What are UTIs? 
• What symptoms does the body show? 
• Which test holds importance in diagnosis? 
• What are the treatment options available? 

We will cover all these topics in today’s discussion.

Cause Of UTI

What are the most common causes of Urinary Tract Infection?

Many factors contribute to UTIs. 

Frequent in Females 

Young females are the most predominant group which mostly gets affected by UTIs. 

Diabetes patients 

Apart from them, diabetic patients are more prone to Urinary tract infections.

Anatomical abnormalities 

Then there are certain groups of people with specific anatomical abnormalities like a blockage in the passage of urine so they are more at risk of having Urinary Tract infections.

Why does UTI occur? 

Usually, Urinary Tract Infection occurs when urine stays in the bladder for a longer duration. Urinary stasis occurs and the urine is unable to move forward due to stress. Pooling of urine in the bladder causes infection. 

Risk factors 

The risk factor or condition in which UTI is more prone to occur in females, diabetes, presence of kidney stone, bladder stone, ureteric stone, or any stone disease may serve as a nidus for bacterial infection. 

In addition, specific congenital abnormalities might lead to urinary tract infections like VUR (Vesicoureteral reflux) or Posterior urethral valve in males. So they are at higher risk of having UTIs.

Types of UTI 

We can divide Urinary Tract Infections into uncomplicated Urinary Tract infections and complicated Urinary Tract Infections. 

Uncomplicated UTI 

Young females generally have uncomplicated Urinary Tract Infections. They are not associated with complex risk factors like comorbid conditions, diabetes, or anatomical defects. They don’t have any stone diseases. 

Symptoms 

Their symptoms are also mild. Patients usually suffer from burning micturition, storage symptoms, frequent urination at small intervals, and urgency symptoms, like patients who feel that they need to use the loo or washroom at a particular moment. So we club all these factors into uncomplicated UTIs. 

Usually, these patients don’t show any signs of fever, and there is less chance of kidney infection. Within 3-5 days, they get settled by taking the antibiotic course. There is another sub-group which we call complicated UTI.

Complicated UTI 

In this condition, certain underlying defects or any comorbid condition like diabetes or UTI progress early in such patients; fever may commence early; bladder infection (cystitis) may spread to the kidney resulting in pyelonephritis. 

It might result in kidney infections. Patients with a stone problem or elderly, immunocompromised patients like cancer patients, HIV, or other related diseases whose immune system is low then these patients usually suffer from complicated UTIs. 

Men also sometimes come in the sub-category of complex patients. Uncomplicated UTIs are rare in men. Typically there are some underlying causes of Urinary tract infection in men like enlargement of the prostate or any stricture diseases or stone disease. So these causes lead to Urinary Tract Infections. 

Symptoms 

So the symptoms of these patients, as I told you before, are burning micturition, frequent urination, frequent will to go to the bathroom, and urgency. Apart from that, some may suffer from Spurapubic pain and blood in the urine. And if there are complications, this may result in pyelonephritis that may accompany flank pain. 

Diagnosis of UTI 

Urine examination 

So next is the evaluation of Urinary Tract Infection and documentation of UTI in patients. So the most basic and preliminary test is a complete urinary examination, a microscopic examination in which we see the presence of pus cells or blood in the urine, pH of the urine, and presence of any crystals that further signify the presence of stone diseases. 

Urine culture 

Next is a urinary culture which is mandatory. We do urine culture for mainly two reasons: one is for documentation that this organism is growing and causing UTI, and with the culture, we do antibiotic sensitivity test, which guides us on which antibiotic we must give to patients. 

X-Ray KUB, and CT KUB

If we suspect any underlying anatomical defects or the presence of stone, we do imaging techniques like ultrasound, X-Ray KUB, and CT KUB. These are some of the additional tests that help in the evaluation of Urinary Tract Infection.