Month: September 2018

Urinary Tract Infection (UTI)

A urinary tract infection is an infection involving part or all of the urinary tract. The effects of the infection depend on the interaction between the bacterium and the host’s defence mechanisms.

If the brunt of the infection is situated in the bladder, the symptoms tend to be of a local nature and the disease is called cystitits, or a lower urinary tract infection. Infection involving mainly the kidney is called pyelonephritis, or an upper urinary tract infection. In pyelonephritis the symptoms tend to be of a more systemic nature, such as fever, chills and a fast heart rate.

Most bacteria reach the urinary tract via the ascending route, traversing the urethra, bladder and sometimes the ureters up to the kidneys. The main source of these bacteria is the patient’s own large intestine. The female urethra is short and situated close to the faecal reservoir, explaining the much higher incidence of urinary tract infections in females compared to males.

Escherichia (E.Coli) is responsible for 85% of community acquired and 50% of hospital acquired urinary tract infections. Other organisms include Klebsiella, Proteus, E faecalis and Staphylococcus saprophyticus.

Urinary tract infections don't always cause signs and symptoms, but when they do they may include:

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Urine that appears cloudy
• Urine that appears red, bright pink or cola-coloured (a sign of blood in the urine)
• Strong-smelling urine
• Pelvic pain, in women, especially in the center of the pelvis and around the area of the pubic bone

Complications of a UTI may include:

• Recurrent infections, especially in women who experience two or more UTI’s in a six-month period or four or more within a year.
• Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
• Increased risk in pregnant women of delivering low birth weight or premature infants.
• Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
• Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

You can take these steps to reduce your risk of urinary tract infections in:

• Drink plenty of liquids, especially water. Drinking water helps dilute your urine and ensures that you'll urinate more frequently, allowing bacteria to be flushed from your urinary tract before an infection can begin.
• Drink cranberry juice. Although studies are not conclusive that cranberry juice prevents UTI’s, it is likely not harmful.
• Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
• Empty your bladder soon after intercourse. Also, drink a full glass of water to help flush bacteria.
• Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
• Change your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.
• Urinate when you feel the need. Don’t “hold it in.”
• Keep your genital area clean and dry.

URETHRAL SLING PROCEDURE

Your minimally-invasive sling procedure is estimated to only take 30–45 minutes. A small incision will be made in the vaginal area. Next, the synthetic mesh is placed to create a “sling” of support around the urethra.When your doctor is satisfied with the position of the mesh, he or she will close and bandage the small incisions in the groin area (if applicable for  your sling type) and the top of the vaginal canal.Before your discharge from the hospital, you may be given a prescription for an antibiotic and/or pain medication to relieve any discomfort you may experience. You will be instructed on how to care for your incision area.At the discretion of your physician, most patients resume moderate activities within 2 to 4 weeks, with no strenuous activity for up to 6 weeks.Most women see results right after the procedure. Talk with your physician about what you should expect. You will need to abstain from sexual intercourse for 6 weeks post op.

         

RISKS

These are the commoner risks. There may be other unusual risks that have not been listed here. Please ask you surgeon if you have any general or specific concerns.There are risks associated with any anaesthetic, you may have side effects from any drugs used. The commoner sideeffects include light-headedness, nausea, skin rash and constipation.         

Some potential adverse reactions related to surgical correction for stress urinary incontinence include:

• Pain/Ongoing Pain/Discomfort/Irritation
• Inflammation (redness, heat, pain, or swelling resulting from surgery) 
• Edema (swelling caused by fluid retention) and erythema (redness of the skin) at the wound site
• Infection, including abscess
• Bleeding (vaginal) and hematoma formation (pooling of blood beneath the skin)
• Scarring/scar contracture
• Mesh erosion (presence of mesh material within the organs surrounding the vagina)
• Mesh extrusion (presence of mesh materials within the vagina)
• Fistula formation (a hole/passage that develops between organs or anatomic structures that is repaired by surgery)
• Foreign body response and allergic reaction to mesh implant
• Urinary incontinence (involuntary leaking of urine)
• Urinary retention/obstruction (involuntary storage of urine/blockage of urine flow)
• Voiding dysfunction (difficulty with urination)
• Vaginal discharge
• Dehiscence of vaginal incision (opening of the incision after surgery)
• Nerve damage
• Detrusor instability (involuntary contraction of the detrusor muscle while the bladder is filling)
• Device migration, complete failure of the procedure
• Dyspareunia (pain during intercourse)

Some of the above risks are more likely if you smoke, are overweight, diabetic, have high blood pressure or have had previous heart disease.

When you are discharged, take care of the following:

• You may have pain or discomfort in your vaginal area or legs for a few moths
• Light bleeding or discharge from the vagina is normal
• Keep a dry dressing over the incision, change the dressing as needed (as instructed by your doctor) (mini sling does not have any dressing)
• You may shower after your surgery, showers are better than baths for a few weeks until your incision has healed.
• Refrain from sexual activities for 6 weeks.
• Refrain from exercise, physical activity & straining; driving for 4 – 6 weeks
• Try to prevent constipation by eating foods with a lot of fibre.
• Use stool softeners as prescribed by your doctor, straining during bowel movements will put pressure on your incision
• Drink extra fluids to help keep your stools loose

Please call the doctor if you experience any of the following:

• Severe pain
• Fever
• Heavy vaginal bleeding
• Vaginal discharge with an odour
• A lot of blood in your urine
• You have signs of infection (a burning sensation when you urinate, fever or chills)

         

Radical Prostatectomy

Most often, Radical Prostatectomy is done to treat localised Prostate cancer. It may be used alone, or in conjunction with Radiation, chemotherapy and hormone therapy.Radical prostatectomy options to treat prostate cancer includeOpen radical prostatectomy, laparoscopic radical prostatectomy And robot-assisted radical prostatectomy.

RISKS

These are the commoner risks. There may be other unusual risks that have not been listed here. Please ask you surgeon if you have any general or specific concerns.There are risks associated with any anaesthetic, you may have side effects from any drugs used. The commoner side effects include light-headedness, nausea, skin rash and constipation.

 

In addition to the risks associated with any surgery, risks with radical prostatectomy include:

• Bleeding
• Urinary tract infection
• Urinary incontinence
• Erectile dysfunction (impotence)
• Injury to the rectum (rare)
• Narrowing (stricture) of the urethra or bladder neck
• Formation of cysts containing lymph (lymphocele)

Some of the above risks are more likely if you smoke, are overweight, diabetic, have high blood pressure or have had previous heart disease.

After surgery you should expect that:

• You'll be given intravenous (IV) pain medications. Your doctor may give you prescription pain pills to take after the IV is removed.
• Your doctor will have you walk the day of or the day after surgery. You'll also do exercises to move your feet while you're in bed.
• You'll likely to go home 5 days after surgery. When your doctor thinks it's safe for you to go home, the pelvic drain is taken out. You may need to return to the doctor in one or two weeks to have staples taken out.
• You'll return home with a catheter in place. Most men need a urinary catheter for 14 days after surgery.
• Make sure you understand the post-surgery steps you need to take, and any restrictions.
• You’ll need to resume your activity level gradually. You should be back to your normal routine in about four to six weeks.
• You won’t be able to drive for at least 6 weeks after going home. Don’t drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it’s OK.
• You’ll need to see your doctor a few times to make sure everything is OK. Most men see their doctors after about six weeks and then again after a few months. If you have problems, you may need to see your doctor sooner or more often, although it’s unlikely.
• You’ll probably be able to resume sexual activity after recuperating from surgery. After simple prostatectomy, you can still have an orgasm during sex, but you’ll ejaculate very little or no semen.

When you are discharged, take care of the following:

• Prevent constipation
• Maintain high fluid intake: water, coffee, tea – normal diet
• Avoid lifting anything heavy
• Avoid driving of being driven in a vehicle. Limit mobility
• Try not to sit or walk too much, especially during the first 3-4 weeks
• Monitor would site for abnormal redness/swelling – report changes immediately
• Notify your doctor if your temperature reaches 38°C or higher (hot flushes/shivers)
• You will go through a bladder rehabilitation period until sufficient control is gained.  There may be a measure of incontinence, this condition can be cleared up with medicine and exercise.
• Complete your prescribed medication
• A leg bag and night urine bag will be supplied with the necessary information on how to use them
• Catheter care with water and soap to be done at home until the removal of the catheter

Please call the doctor if you experience any of the following:

• Excessive blood in urine
• Redness, swelling, offensive wound smell or odour
• Leakage of urine at the catheter due to bladder spasms
• No urine drainage through the urethral catheter
• fever

POSTERIOR PROLAPSE REPAIR

A posterior vaginal wall prolapse occurs when the thin wall of tissue that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior vaginal prolapse is also called a rectocele.

Childbirth and other processes that put pressure on pelvic tissues can lead to posterior vaginal prolapse. A small prolapse may cause no signs or symptoms.

If a posterior vaginal prolapse is large, it may create a noticeable bulge of tissue through the vaginal opening. This bulge may be uncomfortable, but it's rarely painful.

The muscles, ligaments and connective tissue that support your vagina become stretched and weakened during pregnancy, labour and delivery. The more pregnancies you have, the greater your chance of developing posterior vaginal prolapse.

The surgery uses a vaginal approach and usually consists of removing excess, stretched tissue that forms the posterior vaginal prolapse. A mesh patch might be inserted to support and strengthen the fascia. It’s common to be on a liquid diet after this surgery. Once you are able to urinate and have normal bowel movements, you can resume a regular diet.

RISKS

These are the commoner risks. There may be other unusual risks that have not been listed here. Please ask you surgeon if you have any general or specific concerns.

There are risks associated with any anaesthetic, you may have side effects from any drugs used. The commoner side effects include light-headedness, nausea, skin rash and constipation. 

The following general complications can happen after any surgery:                 

• Bleeding. Serious bleeding requiring blood transfusion is unusual following vaginal surgery (less than 1%) Post operative infection. Although antibiotics are often given just before surgery and all attempts are made to keep surgery sterile, there is a small chance of developing an infection in the vagina or pelvis.
• Bladder infections. (Cystitis) occur in about 6% of women after surgery and are more common if a catheter has been used. Symptoms include burning or stinging when passing urine, urinary frequency and sometimes blood in the urine. Cystitis is usually easily treated by a course of antibiotics.

The following complications are more specifically related to posterior vaginal wall repair:

• Constipation is a common postoperative problem and your doctor may prescribe laxatives for this. Try to maintain a high fibre diet and drinking plenty of fluids helps as well.
• Some women develop pain or discomfort with intercourse. Whilst every effort is made to prevent this happening, it is sometimes unavoidable. Some women also find intercourse is more comfortable after their prolapse is repaired.
• Damage to the rectum during surgery is a very uncommon complication.

Some of the above risks are more likely if you smoke, are overweight, diabetic, have high blood pressure or have had previous heart disease. Discuss these risks with your doctor before having an anterior vaginal wall repair.

What to expect after surgery:

It is normal to get a creamy discharge for 4 to 6 weeks after surgery. This is due to the presence of stitches in the vagina; as the stitches absorb the discharge will gradually reduce. If the discharge has an offensive odour contact your doctor. You may get some blood stained discharge immediately after surgery or starting about a week after surgery. This blood is usually quite thin and old, brownish looking and is the result of the body breaking down blood trapped under the skin.

Upon discharge:

• You may have a watery blood-stained discharge for the first couple of weeks. As healing takes place you may experience some dark spotting as the internal sutures dissolve.
• You may feel fatigued.
• You may need to take some simple analgesia e.g. Panadol for pain or discomfort— especially on waking and settling at night.

When can I return to my usual routine?

In the early postoperative period you should avoid situations where excessive pressure is placed on the repair, i.e. lifting, straining, vigorous exercise, coughing and constipation. Maximal strength and healing around the repair occur at 3 months and care with heavy lifting >10kg needs to be taken until this time.

It is usually advisable to plan to take 2 to 6 weeks off work; your doctor can guide you as this will depend on your job type and the exact surgery you have had.

You should be able to drive and be fit enough for light activities such as short walks within 3 to 4 weeks of surgery.

You should wait five to six weeks before attempting sexual intercourse. Some women find using additional lubricant during intercourse is helpful. Lubricants can easily be bought at supermarkets or pharmacies.

Please call the doctor if you experience any of the following:

• Severe pain
• Fever
• Heavy vaginal bleeding
• Vaginal discharge with an odour
• A lot of blood in your urine
• You have signs of infection (a burning sensation when you urinate, fever or chills)

Kidney Stone manipulation: ESWL

Kidney stones form in your kidneys. As stones move into your ureters (the thin tubes that allow urine to pass from your kidneys to your bladder) signs and symptoms can result. Signs and symptoms of kidney stones can include severe pain, nausea, vomiting, fever, chills and blood in your urine.

Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. The sound waves create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you will be under light anaesthesia to make you comfortable.

ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.

The JJ stent is inserted during the procedure to relieve swelling and promote healing and to drain any loose fragments.

 

 

 

 

 

 

 

 

RISKS

These are the commoner risks. There may be other unusual risks that have not been listed here. Please ask you surgeon if you have any general or specific concerns.There are risks associated with any anaesthetic.You may have side effects from any drugs used. The commoner side effects include light-headedness, nausea, skin rash and constipation.

Factors that increase your risk of developing kidney stones include:

• Family or personal history. If someone in your family has kidney stones, you're more likely to develop stones, too. And if you've already had one or more kidney stones, you're at increased risk of developing another.
• Dehydration. Not drinking enough water each day can increase your risk of kidney stones. People who live in warm climates and those who sweat a lot may be at higher risk than others.
• Certain diets. Eating a diet that's high in protein, sodium (salt) and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
• Being obese. High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
• Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhoea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.
• Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections.

Some of the above risks are more likely if you smoke, are overweight, diabetic, have high blood pressure or have had previous heart disease.

When you are discharged, take care of the following:

• You can continue with your normal daily activities (eg. Driving, sexual activities, walking, exercise & travel)
• Drink enough fluids (1-2 litres per day)
• Take your medicine as prescribed
• You can relax in a hot bath or shower if you experience discomfort
• Rest when you can
• If urine becomes blood stained, increase your fluid intake
• Make sure you attend to your follow-up appointment to remove the JJ-stent: usually within 2 weeks of stent placement if removed in theatre. +/- 2 day’s if to be removed in the rooms (your doctor will confirm whether it will be taken out in theatre or in the rooms)
• Contact your doctor if you experience any of the following:

constant, unbearable, persistent pain;

fever-like symptoms;

nausea or vomiting;

difficulty in passing urine;

if your stent falls out;

if you notice a significant increase of blood in the urine

You may reduce your risk of kidney stones if you:

• Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend passing about 2.5 liters of urine a day. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water. If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you're likely drinking enough water.
• Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper and soy products.
• Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose non-animal protein sources, such as legumes. Consider using a salt substitute.
• Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn't influence your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise. Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.

BRACHI THERAPY

Prostate brachytherapy is a form of radiation therapy used to treat prostate cancer. Prostate brachytherapy involves placing devices containing radiation in the prostate gland close to the cancer cells.Permanent prostate brachytherapy involves placing radioactive seeds in the prostate gland permanently, where they slowly release radiation.The goal of prostate brachytherapy is to place the radiation close to the cancer cells, where the radiation can kill the cancer cells while causing less damage to healthy tissue nearby.After prostate brachytherapy, you can expect some pain and swelling in the perineum where the radiation needles were inserted. You may find relief by placing an ice pack over the area or taking acetaminophen (Tylenol, others). Tell your doctor if these measures aren't controlling your pain.You can resume normal activities when you feel up to it. Avoid strenuous activity, such as running, or activities that may irritate the perineum, such as riding a bike, until the area where the radiation was inserted is no longer tender.

         

RISKS

These are the commoner risks. There may be other unusual risks that have not been listed here. Please ask you surgeon if you have any general or specific concerns.There are risks associated with any anaesthetic, you may have side effects from any drugs used. The commoner side  effects include light-headedness, nausea, skin rash and constipation.                   

Some potential adverse reactions related to Brachi Therapy include:

• Difficulty starting urination
• Frequently feeling an urgent need to urinate
• Feeling a burning sensation when urinating
• Blood in urine
• Needing to urinate at night
• Not being able to empty your bladder completely
• Narrowing of the tube that carries urine from your bladder to the outside of your body (urethra)
• Erectile dysfunction
• Bleeding from the rectum
• Blood in stool
• Diarrhoea

Some of the above risks are more likely if you smoke, are overweight, diabetic, have high blood pressure or have had previous heart disease.

When you are discharged, take care of the following:

• You can expect swelling and bruising of the scrotum and perineum (the area between the scrotum & anus) this should resolve in 1-2 weeks.
• Ice packs and over the counter medications such as Panado, Advil or Aleve may lessen your discomfort
• You may resume sexual relations two weeks after the procedure, a condom should be used for the first 2 weeks.
• Your semen may be dark brown or black, this is normal and is related bleeding that may have occurred during the implant
• Most men experience burning on urination and/or urinary frequency, continue to take the Flomax as directed
• It is normal to have some blood in your urine for a few days after the implant

Special instructions & info regarding the Iodine seed:

• It is unlikely that you will pass an Iodine-125 seed in your urine, however, as a precaution, please urinate through the strainer for the next week (you would have received this item on discharge)
• The seeds are silver in colour and are the size of a rice grain
• If you do pass a seed, follow the directions in your discharge kit
• Your prostate will absorb the radiation, objects that are touched will not become radioactive
• Body wastes & fluids are not radioactive
• Children & pets should not sit on the patient’s lap for the first 2 weeks after the implant.

Contact your doctor if you experience fever or chills, have increasing pain or unable to urinate

ANTERIOR PROLAPSE REPAIR

Anterior prolapse, also known as a cystocele, occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder.

Straining the muscles that support your pelvic organs may lead to anterior prolapse. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Anterior prolapse also tends to cause problems after menopause, when estrogen levels decrease.

For a mild or moderate anterior prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.

Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic floor muscles and ligaments can weaken over time, as a result of trauma from childbirth or chronic straining of pelvic floor muscles. When this happens, your bladder can slip down lower than normal and bulge into your vagina (anterior prolapse).

You will most likely remain in the hospital for 1 - 2 days after anterior vaginal wall repair. Your bladder may be affected by the surgery, and you may need to use a catheter for one to two days. A catheter is a small tube that’s placed in your bladder to remove urine from your body.

It’s common to be on a liquid diet after this surgery. Once you are able to urinate and have normal bowel movements, you can resume a regular diet.

RISKS

These are the commoner risks. There may be other unusual risks that have not been listed here. Please ask you surgeon if you have any general or specific concerns.There are risks associated with any anaesthetic, you may have side effects from any drugs used. The commoner side effects include light-headedness, nausea, skin rash and constipation. 

                 

Some potential adverse reactions related to surgical correction for anterior prolapse repair include:

Most often, the benefits of anterior vaginal wall repair outweigh the risks. In some cases, you may experience the following after surgery:

• painful urination
• a frequent, sudden urge to urinate
• a leakage of urine
• damage to your urethra, vagina, or bladder

Some of the above risks are more likely if you smoke, are overweight, diabetic, have high blood pressure or have had previous heart disease. Discuss these risks with your doctor before having an anterior vaginal wall repair.

Supporting your wound when coughing, sneezing or vomiting

Sit forward in a chair if possible. If in bed, bend your knees up. Place both hands over your wound, with your forearms resting firmly across the abdomen. It may help you to use a pillow across your abdomen as you cough, sneeze or vomit.

Mobilising correctly using your deep abdominal muscles

When you move from sitting to standing, and when you walk, try to gently

activate your deep abdominal muscles. Gently draw in the abdominal muscles

below your underwear. Placing your hands on your lower abdomen beneath

your navel will help you to check the activity of these muscles.

Moving in bed correctly

Slide one heel at a time along the bed towards your buttocks to bend both your knees. Keep

your head flat on the pillow. Lift your bottom off the bed as you push through your heels and

elbows to move yourself up the bed.

Positioning yourself to avoid straining your repair

When going to the toilet, remember to keep the curve in your back as you lean

forward at the hips. Lean your forearms or hands onto your knees

(refer to picture on right).

Upon discharge:

• You may have a watery blood-stained discharge for the first couple of weeks. As healing takes place you may experience some dark spotting as the internal sutures dissolve.
• You may feel fatigued.
• You may need to take some simple analgesia e.g. Panadol for pain or discomfort— especially on waking and settling at night.

What to avoid

• Avoid strenuous activity and heavy lifting for six to eight weeks.
• You should mobilise around the house and yard initially then go for short walks. Aim to gradually increase your activity everyday.
• Avoid sexual activity for six to eight weeks to allow time for healing to take place. Avoid straining when opening your bowels.
• Avoid constipation by eating a diet high in fibre and drinking two to three litres of fluid a day.

Please call the doctor if you experience any of the following:

• Severe pain
• Fever
• Heavy vaginal bleeding
• Vaginal discharge with an odour
• A lot of blood in your urine
• You have signs of infection (a burning sensation when you urinate, fever or chills)