Dear DR. ROACH: I am 85 and in superior wellbeing despite acquiring had open coronary heart medical procedures 10 years ago. I have been working with a catheter a few instances a day for two a long time to drain urine, mainly because my enlarged prostate distorts my bladder. It appears to be like I will use an intermittent catheter for the relaxation of my existence.
I am now using Flomax and finasteride, but it does appear to be to assist really substantially. Can I keep on to use the catheter for the remainder of my lifestyle without the need of any result? Do these medicines have any aspect consequences on my kidney? Twenty years back, I had prostate operation, with my urology health practitioner working with microwaves to melt away and open up up the prostate canal. I am really hesitant to have an additional prostate operation. — T.L.
Answer: The urethra in males goes from the bladder to the close of the penis, and goes suitable by way of the prostate. Enlargement of the prostate blocks the stream of urine, primary to signs or symptoms of inadequate bladder emptying and accompanying recurrent journeys to the toilet, such as at nighttime.
In addition to the troublesome indicators, critical prostate enlargement sales opportunities to elevated tension inside of the bladder, which is transmitted straight to the kidneys. With no prosperous procedure, possibly surgical or clinical, that increased stress progressively damages the kidneys. This harm gets to be everlasting if the tension is not promptly relieved.
Intermittent catheterization — a catheter is a plastic or steel tube that is inserted in the urethra and passed upward toward the bladder — is a way to bypass the blockage at the prostate and, if finished as usually as it wants to be, guards the kidneys and bladder from destruction. Even so, catheterization procedure requires to be meticulous to avoid introducing micro organism.
Tamsulosin (Flomax) and equivalent medicines function on the compact muscle tissues in the prostate and can be extremely productive in relieving indications from moderate enlargement of the prostate. Finasteride (Proscar) and related medicines operate by blocking a type of testosterone. Around months it lessens the size of the prostate. These medicines are very risk-free for the kidney — it’s the stress, not the drugs, that most frequently brings about injury.
In additional severe prostate enlargement, drugs may not be enough, and a single of quite a few diverse kinds of surgical procedures is deemed. Whilst most people today have a good final result, some folks have worsening of signs and symptoms following surgery, necessitating intermittent or lasting catheterization. 10 p.c or so of gentlemen involve a next surgery inside 5 several years of the most popular form of prostate medical procedures. Microwave therapy has a much better threat of needing reoperation than classic surgeries or some more recent options.
Expensive DR. ROACH: For some yrs I have been suffering from discomfort and numbness in the very first two fingers and thumb of equally hands. I have described it to my physicians and have gotten no answers. These days the very same matter is commencing on the past two fingers of my correct hand. I have been diabetic for a lot more than 20 a long time. — J.K.
Reply: The location in the fingers is remarkably suggestive of carpal tunnel syndrome. A lot of people also see that section of the ring finger might also have pain or numbness. Diabetic issues is a regarded chance issue for development of carpal tunnel syndrome.
A physical exam can frequently make the diagnosis with acceptable precision. A check of the nerves (EMG and nerve conduction exam) may well be important if the diagnosis is unsure or if surgical treatment is thought of. For delicate situations, conservative remedy with anti-inflammatories, a wrist splint or an injection can be helpful. If hand strength is impacted or if nonsurgical cure is ineffective, then surgical treatment can be regarded.
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