Important, Practical Varicocele Information

When To Contact Your Physician 

Contact your doctor if you've any of the following problems following treatment:

•   Recurring soreness not reduced by pain medicine
•   Black and blue across the cut, bleeding through the incision, or puffiness in the scrotum
•   A fever over 100.2 degrees Fahrenheit, or chills

Blood vessels Within The Scrotum

The scrotum is a sac of skin that covers the testicles—the male sex organs that produce sperm and the male hormones. Blood vessels in the scrotum carry blood to and from the testicles. The vessels that carry blood out from the testicles are called veins.

When There Is An Issue In The Veins

The veins that take blood from your testicles extend up into the groin. This means the blood will have to move upward a long way. Valves within the veins behave like gates to keep the blood from flowing back to the testicles. In many males, these valves do not shut completely. Or the muscles in the walls of the veins might be weak. Then some blood moves back into the scrotum. The blood gathers in the veins above the testicles. This will make the veins expand.

With or Without Treatment

A varicocele is rarely a severe condition. Should you have pain, treatment is likely to relieve your symptoms. If a varicocele is causing infertility, treatment can improve your sperm count. Regardless of whether you have treatment, you can lead a typical, active life.

If you've got any other questions relating to urological services provided by Metropolitan Urological Specialists, head over to one of their offices in St. Louis, Washington,  or Florissant, Missouri.

What Is A Varicocele?

A varicocele is a swelling in the blood vessels over the testicles. It really is similar to having varicose veins within the legs. The swelling develops when too much blood collects within the veins. A varicocele oftentimes takes place around the left testicle.

Exactly what are the symptoms?

A varicocele in many cases causes no symptoms whatsoever. Or it might create an achy or heavy feel in the scrotum. The pain could be more intense later on during the day or after standing for a long time. You may even observe inflamed veins underneath the skin within the scrotum.

How Is it recognized?

Commonly a varicocele is clinically diagnosed during a physical exam. A testicle with enlarged veins may be more sensitive. A varicocele may also be clinically determined during the course of evaluation for fertility concerns. If you have got soreness but your physician cannot feel any enlarged veins, an ultrasound could be done.

A varicocele can decrease sperm count.

Whenever blood accumulates in the veins over the testicles, changes occur that can lessen the amount and the quality of the sperm. For men who're infertile, about forty percent to fifty percent may have a varicocele. Oftentimes, sperm count heightens after treatment.

Treatments

About 1 in 6 guys have a varicocele. In most situations, a varicocele is not serious. Your doctor might wait and watch the problem. If you have pain, if the veins become unsightly, or should you and your partner are having trouble conceiving a child, your physician may recommend surgical procedures or another procedure to shut off the enlarged blood vessels.

Watchful waiting

If you don’t have any discomfort and your partner and you aren't wanting to have a baby, your doctor might advise just observing the problem for a time. Make sure to keep all of your appointments. If the veins don’t get bigger and they don’t bother you, you possibly will not need additional treatment.

Surgery (Varicocelectomy)

The doctor might advise that you get surgery somewhere in the St. Louis, Missouri area to take care of enlarged veins near the testicles. In some cases, surgery is carried out with a laparoscope (a lengthy, thin, telescope-like device).

•   First you are offered anesthesia to keep you relaxed. You might be asleep.
•   One or more tiny lacerations are made in the groin or mid-section.
•   The blood vessels are then tied up or sealed off.
•   The incision is closed with sutures, staples, or surgical tape.

Varicocele Embolization

Instead of surgery, your doctor may advocate varicocele embolization.
•   Firstly you are given anesthesia so you remain comfortable.
•   Then a tiny incision is made in the groin or side of the neck.
•   A small tube is moved through the incision.
•   Led by x-rays, the physician passes the tube into the varicocele.
•   A tiny coil is sent through the tube. This is to block blood flow to the varicocele.
•   The tube is completely removed. In most cases, stitches are not necessary.

Metropolitan Urological Specialists is proud to offer this and other informational materials about urological health. If you have any more questions for them, stop by one of their offices in St. Louis, Washington, or Florissant, Missouri.

What Else Can You Tell Me About Percutaneous Nephrolithotomies?

What is a ureteral stent? 

A ureteral stent is a small plastic tube which is put in your urinary tract to help reduce swelling and allow the kidney to drain urine. The stent ordinarily remains in the body for four to fourteen days and is then removed in a follow-up appointment.

What is a nephrostomy tube?

A nephrostomy tube is a catheter placed into your kidney that links to a drainage bag to accumulate urine outside of your body. The nephrostomy tube is generally gotten rid of prior to hospital discharge. At times patients return home with the nephrostomy tube and it is taken out several days afterwards during a follow-up appointment.

What can I do to deter additional stones?

There are steps you can follow to keep stones from coming back:
•   Consume lots of liquids.
•   Control your sodium ingestion.
•   Keep a healthy weight.
•   Take medicine. Some patients need medication to help decrease their risk of developing another kidney stone.
•   Make dietary changes,  like reducing your intake of soft drinks, animal protein, and salt.
Your doctor will discuss a prevention plan with you following your procedure.

To find out more, contact Metropolitan Urological Services.

What Should I Expect After A Percutaneous Nephrolithotomy Procedure?

Lots of individuals in cities like St. Louis, Chesterfield, Florissant, Washington, Creve Couer, Kirkwood, and Chesterfield, Missouri have percutaneous nephrolithotomies each year. We have looked into some of the more frequent questions about recovery below.

Prevalent side effects include:

•   Nausea and occasional vomiting.
•   Pain frequently occurs for the first 24 to forty-eight hours in your kidneys, abdomen, lower back, and sides. Hurting might increase whenever you urinate. Take medicine as prescribed by doctors.

If you go home with a nephrostomy tube and drainage bag:

•   Bloody urine is typical. However, if the bleeding grows significantly, speak to your health care provider right away or return to the hospital for additional assessment.
•   Empty the drainage bag before it gets full. If the bag no longer drains urine and you experience back pain, call your doctor immediately. The tube may be clogged or loose.
•   You may see leakage of urine around the tube and might need to change the dressing.
•   It’s fine to shower with the bag. It may become damp. However, you should keep your incision site covered with a watertight dressing.
•   A few days after release from the hospital, you need to go to your doctor’s office for removal of the tube.

If you go back home with a ureteral stent, your health care provider will remove it in a follow-up appointment four to fourteen days following your procedure.

Should you go back home with a stent, typical side effects include:

•   Blood in the urine. Drinking fluids minimizes blood clots from forming within your urine.
•   A feeling of fullness and a continual need to urinate (urgency and frequency).
•   A burning sensation during urination or whenever you move around.
•   Bladder muscle spasms.

In a follow-up appointment, typically 4 to 14 days following the procedure, your physician takes out the stent. Patients are usually conscious whenever a stent is removed. Your physician may apply a local anesthetic jelly to the opening of your urinary tract (urethra) before the procedure. If it has a string affixed, the physician pulls on the string to take out the stent. Or, your doctor may use a little scope placed within your bladder to pull out the stent.

When should I call my physician?

Call if you:
•   Have a temperature greater than 100 degrees or chills
•   Realize that the pain medicine is not relieving your pain.
•   Can't tolerate food or fluids.
•   If you've got excessive blood within the urine, which is typically red, thick, and cannot see through it (like ketchup), or if you have blood clots within your urine which render it challenging to urinate, please get hold of your physician straight away.

A little blood in the urine is common after a PCNL procedure. Urine colors can vary from light pink to reddish and sometimes can even have a brownish hue – but you can for the most part see through it. Medications to help with the burning feel can occasionally turn the urine into an orange or blue color.

Metropolitan Urological Specialists in St. Louis, Florissant, and Washington, Missouri are ready and willing to answer your questions regarding percutaneous nephrolithotomy.

What Is A Percutaneous Nephrolithotomy?

A percutaneous nephrolithotomy, or PCNL, is a kidney stone surgery for large or multiple stones. The doctor carries out the operation in a medical center operating room. It customarily calls for a hospital stay of one or two nights.

What takes place during the procedure?

A PCNL customarily lasts 1 to 3 hours. Once you are under anesthesia, your doctor will make a small surgical incision in your back. The doctor places a protective sleeve called a sheath through your back and into your kidney. Your doctor then passes a video scope referred to as a nephroscope through the sheath to locate and remove the kidney stones.

To help your kidney heal and drain urine while in the recovery process, your doctor may place a nephrostomy tube or a ureteral stent at the conclusion of the process.

A number of patients require a second procedure to remove all of the stone. In that case, the nephrostomy tube and stent could be left in position until the next operation.

What do I have to do before the operation?

There are actually 3 significant things to do prior to your procedure:

Consult with your personal doctor. 

Let your doctor know:
•   All of your prescription medications, vitamins, and supplemental herbs and natural remedies, and over-the-counter medications.
•   Any known allergies you have got to medicines and the contra agent found in some x-rays.
•   If you may be pregnant.

Review the pre-operative information.

Make time to analyze these instructions offered by your doctor. For instance, you might need to:
•   Go to appointments for medical tests before the procedure like an electrocardiogram (EKG), x-rays, and blood and urine tests.
•   Discuss with your doctor medication that might raise your danger of bleeding, for instance: aspirin, ibuprofen, warfarin, clopidrogel, and non-steroidal anti-inflammatory drugs. You may have to stop taking a lot of these medicines before the procedure.
•   Take antibiotics, if prescribed, to help you avoid infection.
•   Check with your physician on which of your regular drugs to take the morning of surgical procedure. On that day, take these drugs with just a sip of water.
•   Do not have anything to eat or drink after midnight the night prior to operation (except for the drink of water with the morning medicine).

Plan for a ride home.

After the operation, you cannot drive yourself home. Before the procedure, ask a relative or a dependable friend to pick you up and get you home. Most hospitals and surgery centers in the St. Louis, MO area won't permit you to take a taxi home following your operation.

Should you have any additional queries about Percutaneous Nephrolithotomy, Metropolitan Urological Services would love the opportunity to assist you. Their offices have locations at St. Louis, Washington, and Florissant, Missouri.

Potential Bladder Cancer Medical Treatments

The medical treatments used to prevent recurrence of superficial bladder cancer consist of medicines that are instilled into the bladder—a strategy known as intravesical therapy. These medicines include chemotherapy agents such as Mitomycin C and Thiotepa (medications that stop malignant cells from dividing), as well as immunotherapy agents like BCG and Interferon (used to stimulate the body’s immune system and motivate its natural defense against cancer). Based on your likelihood of recurrence, your urologist may recommend one of these treatments.

Lifestyle Changes

Smoking cigarettes is the one greatest risk factor for bladder cancer, and over 50 percent of all bladder cancers are thought to be associated with tobacco smoking. Simply put, if you still smoke, you MUST quit. Studies have revealed that when tobacco smokers quit smoking, their bladder cancer chance drops in 2 to 4 years.

Occupational exposure to specific solvents or chemicals can also increase the risk of bladder cancer. If you suspect this is a factor for you, talk about the issue with the doctor.

Nutrition

Our familiarity with the connection between nutrition and bladder cancer is consistently enlarging. Current data supports a higher consumption of veggies and fruits and a reduction in animal fat. Also, an ever-increasing body of evidence implies that certain vitamins and nutritional supplements may substantially limit the threat of superficial bladder cancer recurrence for people in the St. Louis Metropolitan area.

Nutritional Supplementation

Early in the 1990s Donald Lamm, M.D., a leading bladder cancer researcher, performed a prospective, randomized, double-blind clinical trial examining the effectiveness of high-dose nutritional supplementation in the prevention of bladder cancer recurrence. The participants in the trial were women and men with superficial bladder cancer, who were randomized into one of two groups. The treatment group was given BCG therapy and a daily multivitamin supplement, plus high amounts of vitamins A, B6, C, E, and zinc. The control group was given BCG therapy and a daily multivitamin only. The outcomes were definitely encouraging—the “high-dose” vitamin group had a cancer recurrence rate of just half that of the multivitamin group.

A recent clinical trial, displayed at the 2008 American Urological Association meeting, revealed that including this same mixture of high-dose nutrients (this time with additional vitamin D and folic acid) to BCG therapy was as good in reducing bladder cancer recurrence as adding interferon to BCG therapy.

To find out more, contact Metropolitan Urological Specialists.

An Introduction To Bladder Cancer

Bladder cancer is the fourth most typical cancer in males in the United States. It also occurs in females, although it is less common than in males. Though numerous elements are thought to elevate the risk of developing bladder cancer, using cigarettes is definitely the principle single risk factor. Symptoms of bladder cancer can include blood within the urine, painful urination, and greater frequency of urination.

Diagnosis and Preliminary Treatment

Most bladder cancers are recognized by using cystoscopy, a process where the urologist views the inside of the bladder using a fiberoptic scope. When a tumor has been seen, it will usually be gotten rid of with a procedure referred to as Transurethral Resection of Bladder Tumor or TURBT.

Superficial or Invasive?

Whenever a bladder cancer is completely removed, the urologist and pathologist decide whether the tumor is superficial (restricted to the lining of the bladder) or invasive (the cancer extends underneath the lining into the wall of the bladder). It's an important distinction, since a superficial cancer cannot disperse past the bladder, whilst invasive bladder cancers can very quickly spread to other parts of the body. Thankfully, four out of 5 bladder cancers are superficial whenever first diagnosed.

The Chance of Recurrence

Even though a superficial bladder tumor presents no immediate threat of spread, it may, if unattended, come to be invasive. Total elimination of a superficial bladder cancer thoroughly cures that specific tumor, but the bladder remains at risk for repeated cancers in other places. Once the bladder lining has cultivated one superficial cancer, there is a 60 % to 80 percent risk that additional cancers will emerge down the road. Your individual danger of recurrence is based on a number of factors, including the tumor grade (speed of growth), number (single versus multiple tumors) and dimensions of the first cancer.

Monitoring for Recurrence

After a superficial (non-invasive) cancer has been removed, the urologist will from time to time perform cystoscopy to check out the bladder for recurrences. In the first two years following the removal of a tumor, the cystoscopies are usually performed every three months. If no recurrences can be found in those two years, the time interval is raised to six months for the following two years. If four years pass with no recurrences, most urologists suggest that the procedure be done yearly thereafter.
 
Lessening the Chance Of Recurrence

There are actions that can be taken to decrease your danger of superficial bladder cancer recurrence. These include medical treatments provided by your urologist, as well as nutritional supplements and lifestyle changes you can pursue yourself.

Kidney Stones: Diet and Lifestyle Changes

Dilution is the greatest solution 

The one more effective step to protect yourself from recurrence is to add to your fluid consumption. By consuming 8 to 10 glasses of liquid a day, you will dilute your urine, to make it less concentrated. This can help to keep crystals from developing and lower the likelihood of stone development. In one study individuals taking in more than 8 cups of water on a daily basis were less inclined to have a kidney stone recurrence.

A minimum of 50% of your fluid intake ought to be water. Although one cup of coffee or tea every day has been shown to slightly reduce the chance of stone formation, excessive ingestion of caffeinated beverages like coffee, tea, or soft drinks is shown to raise risk. To find out your fluid status, pay attention to your urine. Darker urine usually means that you're not getting adequate fluid. The objective is to consume enough so that your urine is pale in color.

Lower your protein consumption

Eating plans rich in animal protein (like meat, eggs, cheese, and so forth) can increase levels of calcium, uric acid,  and oxalate in the urine, which can increase the possibility of calcium stone formation. Eating plans lower in animal protein and salt have been proved to lower calcium and oxalate within the urine. Low-carb diets, generally full of protein and fat, are not suitable for people with a history of calcium kidney stones. To help to lower your chance of calcium stone development, consume less meat, and substitute a vegetarian meal maybe once or twice every week.

Reduce your sodium intake

Researchers have continuously proven that higher sodium (salt) intakes result in greater calcium within the urine.

Decreasing sodium in the diet decreases urinary calcium levels. Countless specialists believe decreasing sodium to two thousand mg a day while raising fluid consumption is among the more effective ways of cutting down on calcium stone recurrence. High quantities of sodium, however, are found in many prepared foods, and not just in the salt shaker. Reduce your consumption of canned or processed foods, seek out reduced-sodium products, and steer clear of introducing extra salt to food.

Eat calcium-rich foods

The calcium we get from eating calcium-rich foods, like low fat milk and yogurt, is not a problem for calcium kidney stone formers. Restrained intake of calcium-containing foods in fact protects against stone development by binding dietary oxalate and minimizing oxalate levels in the urine. So don't remove calcium-rich foods from your diet.

Taking high doses of some calcium supplements may improve your likelihood of stone creation. If your healthcare provider has suggested you take a calcium supplement for bone health, pick one with calcium citrate. Because citrate helps inhibit stone formation, this form of calcium is the preferred choice for individuals susceptible to kidney stone formation.

Watch your oxalate intake

The amount of oxalate in the diet affects the amount of oxalate in the urine, which can be a key factor in kidney stone development. Your urologist might suggest you reduce your ingestion of oxalate-rich foods. Foods very full of oxalates include chocolate or cocoa, spinach (and other dark, leafy greens), beets, strawberries, wheat germ, peanuts, pecans, and soy.

Stay away from high-dose vitamin C supplements

Avoid high-dose vitamin C (ascorbic acid) supplements except if otherwise suggested by your healthcare provider. Usually, the volume of vitamin C seen in a multivitamin is safe, but higher amounts (over five hundred milligrams) from supplements could raise the risk of kidney stones by increasing urinary oxalate levels.

Raise your consumption of stone inhibitors

Some chemicals found in the urine are said to reduce calcium-based kidney stone formation. Two of the biggest are citrate and magnesium.

Lemon juice has been seen to raise the amount of citrate within the urine. Real lemonade (not from a powder mix) is a superb way to raise both your citrate and fluid intake.

Nutritional supplements that contain magnesium, potassium, and citrate also may help to increase the concentration of stone inhibitors inside the urine.

Vitamin B supplements

Vitamin B6 works well in decreasing oxalate production, and therefore vitamin B6 supplements are believed to decrease the danger of calcium oxalate kidney stones.

One study revealed that a mix of magnesium oxide and vitamin B6 increased urinary magnesium and citrate and diminished urinary oxalate in calcium oxalate stone formers.

For additional information, contact Metropolitan Urological Specialists.

Can Kidney Stones Be Avoided?

Getting Your Kidney Stone Looked At 

The initial step in prevention is to know which chemical type of kidney stone you're making. So it is crucial to send your stone or stone piece to the lab for testing. When you are seeking to pass a kidney stone, you should employ a strainer cup to trap any stone or gravel that appears and bring it to your urologist’s office. When you have had your stone taken out with an extraction operation, your urologist will dispatch it to the lab for investigation. Finally, people who undergo shockwave lithotripsy, a procedure that breaks the stone up with sound waves, should carefully strain their urine in the days (and even weeks) after the procedure and bring any fragments or gravel that come out to their urologist.

Lab Tests

Depending on the chemical composition of your stone and the number of stones you have had in earlier times, your physician may indicate that you undergo specific medical tests. These tests are designed to measure the amount of certain chemicals in your blood and urine and detect the specific imbalance or excess that may be causing stones to form. The results of these lab tests may indicate the need for daily use of a nutritional supplement or prescription medication to promote normal urine chemistry and reduce the risk of stone recurrence.