Dr. Shrinivas R.P

Urinary incontinence is a health condition in men, which causes loss of bladder control. Urinary incontinence usually occurs in cases of medical conditions such as an enlarged prostate, Parkinson's disease and diabetes, and may also occur after a prostate surgery. Urinary incontinence is an irritating and embarrassing condition, but with proper treatment, it can be cured.

Here are several methods used to treat urinary incontinence:

1. Caffeine, soda and carbonated drinks cause irritation in the bladder and worsen the symptoms of urinary incontinence. Alcohol is a diuretic and increases the amount of urine too. So abstain from coffee, alcohol and soft drinks to make a difference.
2. Dietary adjustments are required for the treatment of urinary incontinence. Several spicy and acidic food items can make urinary incontinence worse. Hence, you should avoid having such foods for some time.
3. Urinary incontinence can lead to stress and you must get rid of it for better health. You can try relaxation techniques, such as meditation and breathing exercises. Biofeedback is another option by which you can observe your bladder muscle contractions on a monitor.
4. You should try a behavioral technique known as bladder training. This would require you to urinate every half hour, in spite of not having the urge. Slowly try to increase the time in between the bathroom breaks.
5. You need to flex your muscles to gain control over urinary incontinence. Kegel exercises can be practiced as these boost the strength of your pelvic muscles. You should find the right muscles that are required to stop the passing of gas.
6. Pads and disposable undergarments can be used by men. These help in preventing leaks and also protect the skin from irritation and odor.
7. There are several medicines, which help in the treatment of urinary incontinence in men. Some of these work to relax muscles for preventing unwanted bladder contractions, while others help in blocking the nerve signals to the bladder. Drugs used for the shrinking of an enlarged prostate may also be used in some cases.

Surgery is the ultimate option for the treatment of urinary incontinence. Options include a male sling for urinary incontinence. A type of material is wrapped around the urethra for compressing it. Leaks because of coughing, sneezing or laughing are prevented. Artificial sphincter implants may also be used for treatment of urinary incontinence. A cuff is used in order to close the urethra. Urine is released by squeezing the pump to open the cuff. A device similar to a pacemaker is used to stimulate nerves, which help in relaxing the bladder and pelvic floor.

Urinary incontinence is a condition which causes reduced self confidence in men. But there are several ways to treat this condition which include home remedies as well as medications and surgery.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The presence of blood in urine is known as Hematuria. It is categorized under 2 types:

1. Macroscopic haematuria, which means the patient has seen blood.
2. Microscopic dipstick haematuria, which means blood is identified by urine microscopy or by dipstick testing either in association with other urological symptoms (symptomatic microscopic haematuria) or during a routine medical examination. It has been variably defined as 3 or more , 5 or more or 10 or more Red Blood Cells (RBCs) per high - power field.

Urological and other Causes of Haematuria

1. Cancer: Bladder, Kidney and Prostate Cancer
2. Stones: Kidney, Ureteric
3. Bladder Infections: Bacterial tuberculosis, infective urethritis Inflammation
4. Interstitial Cystitis Trauma : Kidney, bladder, urethra, pelvic fracture causing urethral rupture
5. Renal cystic disease: (e.g. medullary sponge kidney)
6. Other urological causes: Benign prostatic hyperplasia, vascular malformations
7. Other medical causes of haematuria: anticoagulation therapy (e.g. asprin, antiplatelet therapy) Nephrological Causes: more likely in children and young adults, proteinuria; red blood cell casts.
8. Urological investigations: Urine culture, urine cytology, cystoscopy, renal ultrasonography and intravenous Urography and CT Urography.

Management of haematuria depends on the cause as determined by the urologist.

Bladder cancer can be caused by a variety of factors, which include genetic factors, inheritance, drugs, chemicals, environment related factors and smoking. In fact, smoking tobacco is one of the major causes of bladder cancer around the world. The chemicals present in tobacco can irritate the bladder lining which ultimately leads to bladder cancer. Besides smoking other important environmental factors might be chemotherapy, exposure to chemicals from newspaper, dye, leather, paints industries.

Symptoms of bladder cancer are as follows:

Most often it occurs in people more than 50 years of age. It can present in different ways, but common symptoms being :

1. Painless hematuria - reddish or brownish colored urine with or without clots Increased frequency of urination Pain while passing urine .
2. Difficulty in passing urine

Diagnosis:

The diagnosis requires a proper imaging workup including ultrasound, CT scan and urine examinations. Following the initial imaging, a biopsy is required to confirm the diagnosis and stage the disease. This is done by cystoscopy (inserting a tube to see the inside of the urinary passage) under anesthesia.

Treatment Options:

Treatments for bladder cancer depend on the stage of cancer. Broadly bladder cancers can be categorised into Non-invasive and Invasive cancers.

1. For non-invasive cancers: It requires recurrent cystoscopic surveillance and resection. For those with high risk of tumor recurrence or progression, intravesical chemotherapy or immunotherapy might be required.
2. For invasive cancers the various treatment choices are:
   1. Surgery: For localised tumor which are amenable to resection perhaps surgery is the best possible treatment. This is a major undertaking where in whole of bladder along with accessory organs is removed. The surgeon may offer choices for reconstruction between neobladder (refashioning bladder with patient's gut) or ileal conduit (fashioning a stoma over which bag can be worn to collect urine). Following surgery a regular follow up is required and the prognosis is good.
   2. Chemotherapy: This modality is reserved for patient's where surgery is not possible or they have metastatic disease (disease spread to other body parts).In this method, medications are used to target and destroy cancer cells.
   3. Radiation Therapy: This might be and option for patient's that are not suitable for surgery. Radiation therapy uses gamma rays to destroy cancer cells in the body The key to good prognosis in bladder cancers is early detection timely intervention and good follow up. If you wish to discuss about any specific problem, you can consult a Urologist.

One of the most common problems faced by ageing men is benign prostatic hypertrophy. Prostate is the gland at the base of the urethra near the bladder and when it enlarges it can lead to symptoms, mostly related to urination.

1. Frequent urge to pass urine
2. Prolonged urination
3. Frequent nocturnal visits to the toilet
4. Intermittent urination
5. Difficulty to start urinating
6. Inability to completely empty the bladder
7. Urinary tract infections

There are medications available to manage this, but offer only temporary relief. Many men therefore prefer to have the surgery undergone to manage these bothersome symptoms. However, like any surgery, the risks and benefits need to be considered along with other conditions like age, overall health status, other comorbid conditions, etc.

Surgical removal of the enlarged prostate gland is a more definitive approach to manage these symptoms. In addition to providing a quick cure, it also is used in the following cases:

1. Patients who do not respond to medications
2. Presence of blood in the urine
3. Associated bladder stones
4. Frequent infections of the urinary tract
5. Associated damage to the kidneys

Procedure of Surgery
During the procedure, a tube is passed through the tip of the penis into the urethra towards the bladder neck. Once it is in the desired position, laser is passed through it to deliver energy that acts on the prostate to either completely or partially destroy it. There are two methods by which laser acts on the enlarged prostate and making way for free flow of the urine.

1. Ablation: Excess prostate tissue is melted away by the laser by using photosensitive vaporization of the prostate. This is also known as Greenlight laser therapy or KTP laser vaporization. Alternately, Holmium can be used as the source of laser energy to ablate the prostate tissue.

2. Enucleation: Excess prostate tissue is cut and teased out through the urethra. Holmium laser is used to resect the prostate into smaller pieces, which are then removed out through a resectoscope. Another technique uses a tissue morcellator which grinds the enlarged prostate into smaller pieces to enable easy retrieval.

More men now opt for laser prostate removal as it has the following advantages:

1. Reduced risk of bleeding: This becomes essentially important in patients who are on blood thinners.
2. No hospitalization: This can be done either as an outpatient or with minimal one day stay at the hospital
3. Immediate symptom relief: As compared to medications, the relief is felt almost immediately after the surgery
4. No catheter: With laser surgery, a catheter may be required for less than 24 hours unlike in open surgical cases.

As noted above, as with any surgery, once enlarged prostate symptoms set in, have a detailed discussion with your doctor to identify if you are a suitable candidate for laser surgery. In case you have a concern or query you can always consult an expert & get answers to your questions!

Prostate cancer is a cancerous tumor in a man’s prostate gland, a small gland that is responsible for producing the seminal fluid which transports and nourishes the sperm. It is a very common type of cancer among men. A few cases of prostate cancer tend to develop slowly while others may progress very fast.

Symptoms

In the initial stages, prostate cancer may not show any symptom. However, in the latter stages, there may be symptoms such as:

1. Pain in the bones.

2. Erectile dysfunction.

3. Urination can get troublesome.

4. Presence of blood in the semen.

5. Pain and discomfort in the pelvic region.

Causes-

The exact causes of prostate cancer are not known. It starts to develop when certain cells in the prostate gland start to mutate. These mutations cause these cells to multiply at a very fast rate and thus, soon form tumors. Although the causes are not known, certain factors tend to aggravate this condition; them being:

1. Color: According to certain medical reports, a darker skin may mean increased chances of suffering from prostate cancer.

2. Age: The risk of developing prostate cancer tends to increase with age.

3. Genetics and Family History: Faulty genes could be another cause of this condition. Also, having some member in the family who is diagnosed with this type of cancer only increases the risks of you suffering from them.

4. Obesity: If you are obese, then you are more likely to develop prostate cancer.

Treatments-

The treatments for prostate cancer include:

1. Radiation Therapy: In this procedure, high energy rays are used to target and destroy cancer cells. Usually X-rays or protons are used to treat the cancer cells.

2. Hormone Therapy: Hormone therapy is a type of treatment wherein certain medications are administered to prevent your body from producing testosterone.

3. Surgery: If the other treatment methods do not produce desired results, then a surgery is carried out for the removal of the prostate gland. In addition to the prostate gland, some adjoining lymph nodes and tissues are also removed.

4. Chemotherapy: Chemotherapy is method of destroying cancer cells by injecting chemicals into the body. The medicines are injected into the veins in the arms. If you wish to discuss about any specific problem, you can consult an urologist.

The prostate gland, an essential part of the male reproductive system grows throughout your life. As you grow older, it becomes imperative to keep this organ healthy.

Here's what you can do to maintain a healthy prostate:

1. Workout to stay fit: Exercising regularly and maintaining an optimum weight can help to keep your prostate gland at an optimal health. Several types of research have revealed the beneficial aspects of exercising. It's said that physically active men are less likely to suffer from enlarged prostate if they performed a physical activity of low to moderate intensity. Likewise, physically active men who ran for 90 to 108 minutes are 20% less likely to develop erectile dysfunction.

2. Eat fruits and vegetables: Including fruits and vegetables in your diet can help to maintain a healthy prostate. Guava, papaya, tomato and watermelon are some of the options that spell good for your prostate. Vegetables like cabbage, cauliflower, broccoli and Brussels sprouts should also be included to boost the health of the gland. Ideally, you should have about 5 servings of fruits and vegetables daily.

3. Have more soy products: Eating more soy products like tofu, soy flour, soy nuts can help to keep cancer of the prostate at bay. A study published in the British Journal of Urology International revealed that men who had soy products saw a 40% decrease in their risk of developing an enlarged prostate.

4. Have selenium-rich foods: Having foods rich in selenium (a powerful trace mineral) like tuna, eggs, cashews, onions, garlic, etc can reduce your risk of developing prostate cancer.

5. Say yes to healthy fats and no to trans and saturated fats: Choosing healthy fats like avocados, nuts, and olive oil can aid in boosting prostate health. At the same time, limiting saturated fats and trans fat intake are vital for keeping the prostate gland healthy. If you wish to discuss about any specific problem, you can consult an urologist.