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Undescended Testicle
Definition:
An undescended testicle is one that is not present in its normal position (the scrotum). In early foetal age, the testicles are located near the kidneys in the abdominal cavity. They "descend" gradually down the abdomen, through a channel (the inguinal canal) in the groin into the scrotum shortly before birth. An undescended testicle may be found anywhere higher up in the route of migration, or may have wandered further away.
Who is at risk?
Undescended testicle can occur in about four percent of full-term male infants. It is even more common in boys born prematurely - up to nearly 30 percent. A testicle outside the scrotum is not an ideal place for its development. It may not be able to produce sperms later, and has a higher risk of developing testicular cancer. An undescended testicle is also more susceptible to trauma and could twist on its blood vessels, resulting in an acute surgical emergency. A hernia frequently coexists on the side of the undescended testicle.
Symptoms:
The scrotum would look asymmetrical and the affected side is empty to the feel. Most cases would be picked up by paediatricians performing routine newborn examinations. The undescended testis can be felt in the groin (the inguinal canal) in most patients. In about 10 percent of cases, it cannot be located anywhere. This may mean that the testicle is in the abdomen, or there may not be a testicle at all. The doctor would need to look inside the abdominal cavity through a small tube called laparoscope to determine if a testicle is present or not, since no radiological examination can definitively tell whether a testicle is present or not.
Treatment:
Undescended testicles can be treated surgically. The operation is called an orchidopexy. This would require general anaesthesia, but the baby can often go home soon afterwards. Surgery can be carried out anytime from 6 to 18 months old. Hormonal treatment has been tried in the past, but the cure rate is as low as 10% to 15%.
Prevention:
There is no way to prevent this congenital abnormality. For those patients who have undergone surgery, the risk for testicular cancer is still higher compared with the normal. They should be taught how to perform self-examination of the testicle when teenagers.
Urethral Stone
Definition:
The urethra is the tube through which urine is passed from the bladder out of the body. A urethral stone is a stone that comes from upper part of the urinary tract but get stuck in the urethra.
Who is at risk?
Urethral stones are more common in man over the age of 40. Inadequate fluid intake and dehydration increase the chance of urethral stones. People who have past history of kidney stones and those with a positive family history of stone disease in the urinary tract are more prone to have urethral stones.
Patients who have obstruction to the flow of urine and recurrent urinary tract infections are prone to have urethral stones. Some patients may have high blood or urine concentration of calcium or other chemicals, such as uric acid and oxalic acid, that predispose them to develop urethral stones.
Symptoms:
Whereas bladder stones may be asymptomatic, urethral stones often cause excruciating pain in the lower abdomen and the genital region. The urine flow is blocked. The patient cannot void and have distending discomfort caused by the full bladder. The urine stream is weak and dribbling.
Treatment:
Surgeons can sometimes push out a small urethral stone with their fingers. If this fails an operation may be needed. Usually this can be done through the urinary orifice.
Prevention:
Drinking large amounts of fluids-8 to 10 ten-ounce glasses a day-is recommended. Prompt treatment of urinary tract infections or other urologic conditions may help prevent urethral stones. Special diets are only necessary for patients with known metabolic problems.
Uterine Cancer
Definition:
Uterine cancer usually refers to malignant tumors involving the body (the corpus) of the uterus. About 95% of the cases the cancerous growth comes from the cells lining the uterus, called the endometrium. These are called endometrial carcinoma. Less than 5% of malignant tumors of the uterus arise out of muscles cells, and are called sarcomas or leiomyosarcomas. Very often the term uterine cancer is loosely taken as equivalent to endometrial carcinoma. It is the fourth most common cancer in women, following breast, lung, and colorectal cancer.
Like all cancer growths, uterine cancer can invade and destroy nearby healthy tissues and organs, and can also metastasize, or spread, to other parts of the body and form new tumors through the bloodstream or lymphatic system.
Who is at risk?
Cancer of the uterus occurs most often in women between the ages of 55 and 70.
- Obesity: It is found that women more than 50 lb overweight are more than 10 times more likely to have uterine cancer;
- Women who have few or no children;
- Women who began menstruating at a young age;
- Women who had a late menopause;
- Women of high socioeconomic status;
- Women who have diabetes, hypertension and those with high dietary fat intake;
- Women who have received radiation to their pelvic region;
- Woman who are on estrogen without progestogens (estrogens and progestogens are two kinds of female hormones commonly present in contraceptive pills. Pills may contain different combinations and some may have only one of the two hormones ) are also at higher risk;
- Woman on a drug called Tamoxifen (which is a name of a drug, sometimes used in breast cancer, but may be prescribed for other purposes for other indications)
It appears that most of the risk factors for cancer of the uterus are related to hormones, especially excess estrogen. Estrogen is stored in fatty tissues, and women who are obese tend have higher estrogen levels.
Symptoms:
Abnormal bleeding after menopause is the most common symptom of cancer of the uterus. Bleeding may begin as a watery, blood-streaked discharge. Later, the discharge may contain more blood. The reappearance of bleeding after menopause should not be considered as normal; it should always be checked by a doctor.
Other symptoms of uterine cancer include pelvic pain, painful sexual intercourse and difficult or painful urination.
When doctors suspect uterine cancer, a pelvic examination is necessary. A speculum is used to widen the opening of the vagina so that the doctor can look at the upper portion of the vagina and the cervix. The doctor may perform 'endometrial biopsy' by surgically removing a small amount of uterine lining tissue to be examined under a microscope.
Sometimes, a D and C surgical procedure may be necessary. In a D and C, the doctor dilates (D) the cervix and inserts a spoon-shaped instrument called a curette (C) to remove pieces of the lining of the uterus. A sample of the uterine lining also can be removed by applying suction through a slender tube (called suction curettage). The tissue is then examined thoroughly for evidence of cancer.
A Pap smear is often done in women's examinations to detect cancer of the cervix. Cancer of the cervix and uterine cancer are two different entities. A Pap smear cannot detect uterine cancer.
Treatment:
A number of factors are considered to determine the best treatment for cancer of the uterus. Among these factors are the stage of the disease, the growth rate of the cancer, and the age and general health of the woman.
When diagnosed early, surgery gives the best hope of cure in uterine cancer. The uterus and cervix are removed (hysterectomy), as well as the fallopian tubes and ovaries (salpingo-oophorectomy).
When the tumor is bulky, doctors may recommend radiation therapy before surgery to shrink the cancer.
Others prefer radiation therapy after surgery for patients whose tumors appear likely to recur.
When the tumor is too large to be removed surgically, radiation therapy becomes the prime method of treating uterine cancer. Radiation therapy uses high-energy rays to kill cancer cells. Radiation may be given from a machine located outside the body (external radiation therapy), or radioactive material, called an "implant", may be placed inside the body (internal radiation therapy).
Hormone therapy or chemotherapy may be used to treat uterine cancer. These methods are usually reserved for a later stage but some doctors may recommend a combination of methods to treat a particular patient.
Prevention:
Knowing the risk factors as described above, you can minimize your risk of having uterine cancer by avoiding such:
- Control your weight: Exercise and diet regimens that result in significant weight loss can markedly decrease your risk of developing uterine cancer and other illnesses such as heart disease.
- Eat a diet low in animal fat.
- Control your blood pressure.
- Have an annual pelvic exam:
- Although a Pap smear does not detect uterine cancer, a consultation and careful examination by professionals would help to detect abnormalities early.
- Avoid "unopposed estrogen": When use of female hormones is necessary, prescriptions that contain estrogens and/or progestins can reduce the risk of uterine cancer.
- Oral contraceptives:
- Several studies have demonstrated that use of the combined pill for five to 10 years decreases the risk of both these cancers by about 50 percent.
Early diagnosis and treatment are keys to recovery from uterine cancer, so report abnormal bleeding promptly to your health care professional.
Uterine Myoma (Fibroid)
Definition:
Uterine myomas (fibroids) are tumors made of muscle tissue and arised from the overgrowth of the uterine muscle. The fibroids start off very small and generally grow slowly over years before they cause any problems. Most fibroids are benign; malignant fibroids are rare. The cause of fibroids is unknown, although it is known that fibroids have a tendency to run in the family. Fibroids are very common, with an estimated 30-40% of women having them by the age of 40. Fibroids tend to enlarge with pregnancy and do not usually cause any further problems once the women go through menopause.
Who is at risk?
- Race: African woman has higher propensity of having fibroids;
- Family history: Increased occurrence due to inherited genes;
- Hormonal imbalance: Estrogen and progesterone appear to promote the growth of fibroids;
- Overweight: Obese women have a greater risk of developing fibroids.
Symptoms:
- 50-65% of women are asymptomatic
- Abnormal uterine bleeding manifested as menorrhagia (heavy periods with clots), leading to anaemia
- Pressure related symptoms (pelvic pressure, fullness, heaviness and cramps), constipation, urinary retention
- Infertility: Fibroids distort canal and tubes
- Pain: When blood supply of the uterus is compromised
Treatment:
It is very important to rule out other causes of pelvic masses (i.e. cancer). Methods of treatment depend on the severity of symptoms, general health and age of patient, pregnancy status, desire for future pregnancies and characteristics of the fibroid(s).
- Watchful waiting:
Most do not require treatment and can be managed expectantly by following the mass size and growth with periodic pelvic exams or ultrasound. - Medical treatment:
- Non-steroidal anti-inflammatory medications (like ibuprofen or Ponston) may be recommended for lower abdominal cramping or pain with menses. Iron supplementation will help to prevent anaemia in women with heavy periods. These methods are usually sufficient in pre-menopausal women.
- Hormonal treatments such as Medroxyprogesterone, danazol, GnRH agonists all shrink fibroids by decreasing the estrogen. They may be used temporarily in peri-menopausal women until endogenous estrogen decreases naturally.
- Surgical treatment:
Indications for surgery include:
- Abnormal uterine bleeding causing anaemia.
- Severe pelvic pain secondary to amenorrhea.
- Size > 12 wks gestation or rapid increase in size.
- Urinary frequency or retention.
- Growth after menopause.
- Myomectomy: A surgical procedure to remove just the fibroids, especially for pre-menopausal women who want to preserve fertility.
- Hysteroscopic resection: For women with fibroids largely growing within the uterine cavity.
- Hysterectomy is the definitive treatment that is often chosen by older women.
- Uterine artery embolization:
Small particles injected into the arteries supplying the uterus and to cut off blood flow to fibroids and made them shrink. - MRI-guided focused ultrasound surgery:
MRI technology is used to pinpoint the fibroid and use the focused ultrasound waves to destroy the tissue.
Prevention:
- Body weight tends to increase estrogen production and thus aggravating fibroid growth. Exercise can help control your weight.
- Schedule routine health visits with your provider to allow for early detection.
- If you take birth control pills, you and your doctor may want to consider another birth control method because the estrogen in the birth control pills sometimes stimulate the fibroids to grow more quickly.
Urinary Tract Infection
Definition:
Urinary tract infection occurs when one or more organs in the urinary system are infected by microorganisms. The urinary system can be divided into the upper and lower parts. The upper urinary tract includes the kidneys and the ureters, and the lower urinary tract includes the bladder and the urethra.
Who is at risk?
- Sexually active women
- Elderly
- Patients with diabetes
- Patients with kidney stones
- Children with congenital abnormality of the urinary system
- Patients with voiding problems
Symptoms:
The following symptoms can occur when the upper part of the urinary system is affected:
- Fever and shaking chills
- Headache, nausea and vomiting
- Pain in the back or flank
Patients with infection of the lower urinary tract (bladder and urethra) may experience the followings:
- Pain in passing urine
- Urging sensation in voiding
- Pressing discomfort or pain in lower abdomen
- Passing blood in urine
Treatment:
Urinary tract infection is often caused by bacteria normally living in the large bowel, and can be effectively treated with antibiotics. In addition, patients should drink plenty of fluids to increase the urinary flow. Patients may need to be treated in the hospital with intravenous antibiotics for upper urinary tract infections since the kidneys are often affected. The doctor may also order tests or imaging studies to find out if there is any underlying cause for the infection. The patient must follow doctor's advice to complete the course of antibiotic treatment.
Prevention:
- Drink plenty of liquids, especially water.
- Go to toilet promptly when the urge arises.
- Women should wipe from front to back after voiding and after bowel motion.
- Empty the bladder as soon as possible after intercourse.
- Some studies suggest that cranberry juice may help prevent urinary tract infections.
