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The kidneys benefit from a healthy diet, from a relatively high intake of water and from avoiding tobacco. Regular bowel and bladder movements are also essential. Constipation and delaying urination are both damaging to kidney function. Plain water without anything dissolved in it is necessary for good kidney function, apart from liquids such as milk and broth and drinks such as tea and coffee. The amount of urine a healthy person produces varies depending on how much water they drink, the air temperature, whether they are at rest or doing exercise, etc. A healthy adult would normally required 1 to 2 litres per day. Kidney function does not necessarily improve if excessive water is consumed.
Exercise and a diet rich in fibre encourage healthy bowel and bladder movements and improve kidney function. In terms of related conditions, often diabetes, good metabolic control of the diabetes is essential to preserve good kidney function. Controlling arterial pressure, which often has an unknown cause, is also vital to maintain good kidney function.
Multiple sclerosis is a progressive disease of the central nervous system, disabling, chronic and with a high degree of complexity and heterogeneity. Specialised multidisciplinary care is therefore required during diagnosis, follow-up and treatment.
Current evidence is insufficient to give advice on preventing multiple sclerosis. It is, however, advised that your have a healthy lifestyle and carry out activities as normal. Multiple sclerosis affects women more than men, often appears in young adults and is the second biggest cause of non-traumatic disability.
When agreeing with the patient to start them on a drug to treat symptoms or multiple sclerosis itself:
The symptoms of multiple sclerosis can vary greatly, so you are advised to consult specialists when you feel:
Although there is no scientific evidence that allows us to make concrete recommendations to prevent or change the course of the illness, there is a whole host of advice about diet, habits and physical exercise that patients and, in general, the entire population, should bear in mind:
You are also advised, should you suffer fatigue, to continue daily activity and stay active, combining moments of activity with moments of relaxation as well as to seek energy-saving strategies.
Vitamin D has an important role to play in relation to the illness, which is being researched intensively. Often, people affected present a deficiency of this vitamin, so you are advised to take a supplement under instructions and supervision by your specialist.
Multiple sclerosis is a complex and chronic illness, so it is recommended that those around the person affected are given adequate and comprehensive information. It is also a good idea to have access to ongoing advice whenever necessary.
The family or professional carer, where necessary, may need training and practical advice on topics such as diet, hygiene and the patient’s mobility.
Health education in the diagnosis, at the beginning of the treatment and for the mobilisation of the disabled patient.
Testicular cancer is the most commonly-found tumour in men aged between 15 and 35. More than 90% of testicular cancers develop in the germ cells, which are responsible for producing sperm.
Secondary testicular tumours are caused by cancer cells that spread to the testicles from other parts of the body (metastasis). These cancers are much less common than the other forms of testicular cancer mentioned above.
While these tumours originate in the testicles, they may also occasionally appear in the abdomen, chest or other parts of the body, either as a primary tumour or as distant involvement of a primary tumour in the testicle.
Testicular cancer usually presents as a unilateral, non-painful testicular mass or as an incidental finding in an ultrasound examination.
The causes of testicular cancer are not known, but there are factors that can increase the risk of this disease, such as:
There is no known connection between testicular cancer and testicular trauma, muscle tears, hot baths or tight-fitting clothing.
Once treatment is completed, vigilance is of vital importance. The doctor will recommend self-examinations and regular check-ups.
During check-ups, the urologist will examine the unaffected testicle for lumps or abnormalities; perform regular blood tests to quantify tumour markers; and perform imaging tests - such as chest x-rays or regular CT scans - to check for the recurrence of any tumours.
Testicular cancer is a type of cancer that can be effectively treated and potentially cured if it is diagnosed and treated on time. Advanced testicular cancer can also be cured with treatment.
Neither testicular cancer nor the surgical removal of a testicle should impair sexual function or fertility. The surgical removal of a testicle has a minimal impact on a man's fertility, as a single testicle produces large amounts of sperm on its own. For men who require further treatment, fertility may be temporarily affected.
Prostate cancer is the most commonly diagnosed tumour in adult men in developed countries where there is a long life expectancy. It is an atypical and uncontrolled growth of the cells that make up the prostate gland.
If left untreated, the cancerous prostate cells can end up spreading to and invading distant parts of the body - especially lymph nodes and bones - and cause secondary tumours through a process known as metastasis.
Due to widespread knowledge of this tumour in the general population and the ease with which suspicion is established, 90% of cases in Spain are diagnosed when the cancer is still at a localised stage. This diagnosis is established by means of a blood analysis and rectal examination.
Some of the risk factors for this disease include:
Many men with prostate cancer are asymptomatic.
Often, the first sign of the disease is a chance finding of elevated prostate-specific antigen (PSA) levels in a routine blood test. The disease may occasionally produce local symptoms related to prostate gland growth that may mimic those caused by benign prostatic hyperplasia (BPH). In these patients, bone pain is often related to more advanced stages of pancreatic cancer.
Experiencing urinary discomfort does not necessarily mean that you have prostate cancer. Consult your doctor if you have any of these symptoms to make sure that you receive a proper diagnosis and course of treatment.
Prostate biopsies can cause some complications, but most of the time there are no sequelae. The most frequent ones are:
Depending on the aggressiveness of the tumour, the urologist will order the necessary complementary imaging tests to ascertain the clinical stage of the cancer. These tests may be: a computed axial tomography (CT) scan, a bone scan, a multiparametric MRI scan of the prostate or a positron emission tomography (PET) scan.
A urinary tract infection is defined as the presence of invasive bacteria in the urinary system, together with signs of inflammation, such as high temperature and local pain.
Urinary tract infections may be located in the lower urinary tract (bladder and urethra), or the upper urinary system, affecting one or both kidneys. A kidney infection is also known as pyelonephritis.
Infections of the lower urinary tract are characterised by localised pain, which increases when urinating, and sometimes by cloudy or dark urine, usually without high temperatures.
Kidney infections (pyelonephritis) are characterised by high temperatures, acute local pain in the lower back, and pain or irritation when urinating.
Urinary tract infection is characterised by the presence of local pain (lower abdomen or lumbar region), which increases when urinating. The urine is often cloudy, or dark if it contains blood. There may be high fever, especially in the case of pyelonephritis (an infection of the upper urinary tract).
It can affect people at any age, from early childhood to old age. It is more frequent among women and there are factors that make people vulnerable to it (pregnancy for women and enlarged prostate for men) as well as urological anomalies (pre-existing malformation or presence of kidney stones).
Urinary infections are diagnosed by examining urine under the microscope (sediment) to see whether it contains white blood cells and/or bacteria, and by cultivating the bacteria in a microbiological culture to identify the strain and determine the most appropriate antibiotic for treatment (antibiotic susceptibility testing).
Urinary tract infections are usually treated with antibiotics. Treatment is oral in the case of lower-tract infection.
For upper-tract infections (pyelonephritis) it is usually intravenous, although in some cases outpatient oral treatment may be administered.
The standard tests are urine sediment and culture (urine culture with antibiotic susceptibility testing). An ultrasound scan may be indicated for examining the kidney and urinary tract and identifying obstructions or kidney stones that may have brought about the infection.
Ultrasounds are also used to assess the state of the kidneys. A general analysis may also be indicated to see how the urinary tract infection is affecting the rest of the body, and specifically the renal function.
Urinary tract infection can be prevented by frequent urination (every 2 to 3 hours) and, above all, by avoiding the habit of holding in urine, and by going to the toilet whenever the bladder feels full, without waiting too long.
The prostate is a glandular organ present in men and is crossed by the urethra. It is involved in semen formation (80% of its content) and is therefore a sexual organ. When it grows, especially after the age of 50, it results in benign hyperplasia, but there are some symptoms, as the prostatic urethra consequently becomes narrower and thus obstructs the normal passage of urine.
The urethra is the urinary passage that goes from the bladder to the outside. In men, it has two branches; the prostatic urethra (passing through the prostate) and the spongy urethra, which crosses the entire penis to the outside.
When the prostate grows in size (benign prostatic hyperplasia or BPH), the diameter of the urethra decreases and symptoms occur. The obstruction of the urethra by the prostate is progressive and causes repercussions in the bladder, which requires more effort to drain the urine. It can also lead to urinary infections and the formation of lithiasis (stony concretions or calculi) from the salts contained in urine because it is not emptied easily and thus sedimentation of salts takes place.
If the obstruction is very large, the difficulty in removing the urine can cause the kidneys to be damaged because the bladder cannot be emptied properly.
More frequently urinating than normal, urinating at night, loss of force in urine stream, urinary urgency (the patient feels an intense urge to urinate) and also episodes in which urine escapes.
Men over the age of 50, with an increase in incidence as they get older.
Diagnosis is reached through clinical history, where the patient’s symptoms are ascertained, and a rectal touch, where the doctor accesses the prostate to assess the size and any abnormalities. An ultrasound will give information on the kidneys, the size of the prostate and the degree of drainage of the bladder.
A PSA test allows us to investigate suspected prostate cancer.
It is initially based on oral medications that relax the prostate muscles and facilitate the passage and normal evacuation of urine, or others that reduce its volume. In more advanced stages, drainage of the central part of the prostate should be done through a transurethral resection or laser enucleation.
Physical examination, ultrasound, PSA test. Urine flow test and assessment of post-void residual urine
Not applicable. Periodic checks for the onset of symptoms are the key to early diagnosis.
Chronic pelvic pain is defined as "chronic or persistent pain in the structures related to the pelvis in both men and women". It commonly impacts on cognitive, sexual and emotional behaviour. It often manifests as gynaecological, sexual, intestinal or pelvic floor dysfunction. A MULTIDISCIPLINARY approach must therefore be taken to treatment.
Chronic pelvic pain lasts for six months or more and affects the pelvic area, the abdominal wall of the bellybutton and below, the lumbosacral area of the back and/or buttocks and is of sufficient intensity to cause disability in the patient and/or require medical attention.
This has a clear effect on the quality of life of people suffering from the condition.
Its origin is unknown, but we do know that it is exploited by multiple biological/organic, psychological and environmental conditions, which interact in a non-linear way and predispose the patient to present with the condition. There is a clear trend for patients to attend multiple specialists, with requests for complementary testing, which can become iatrogenic, with the patient often feeling misunderstood and ill-treated by the healthcare system.
As it is more of a clinical condition rather than a diagnosis as such, the symptoms can vary a lot, but they always centre around persistent pain. It has a major impact on women of reproductive age and its impact on quality of life varies depending on the causes. It is worth remembering that it gravely impacts on patients’ sex lives and this can cause very significant psychological issues.
According to research, the prevalence of pelvic pain in epidemiology is vary variable. This almost certainly has to do with sociocultural aspects. According to the latest studies, it could be as much as 6.4-25.4% in women and lower in men, at around 2-17%. It is very likely that in the case of men there is an underestimation of this prevalence as there is less willingness to look at problems that also affect the sexual sphere.
Diagnosis is clinical. An appropriate clinical history needs to be conducted with the patient and/or relatives by a specialised healthcare professional. There are different scales to assess the severity of symptoms or associated comorbid disorders, and neuropsychological tests that evaluate cognitive difficulties in terms of attention and concentration. There are also some useful complementary tests to rule out organic causes and make a good diagnosis.
A multi-modal approach is required: psychoeducation, psychological treatment and pharmacological treatment. If the condition is also affecting the patient’s sexuality, we must consider tackling the issue with the patient’s partner as a priority. Several drugs have been shown to help control the symptoms. It very important for treatment to create a good doctor/patient relationship, avoiding unnecessary and iatrogenic complementary testing.
Clinical history. Psychological interview. Neuropsychological examination. Blood test, vital signs, weight and height. Neuroimaging. Scans.
Work with healthcare professionals from the different specialisms that treat chronic pelvic pain. Schedule regular appointments and manage requests for complementary tests and medical interventions to prevent iatrogenic illness. Do regular physical exercise, try to rest well at night, stay active and take part in employment and/or leisure activities, practise relaxation therapies such as mindfulness and avoid consuming toxic substances. Rehabilitation physiotherapy.
Psiquiatría: Dr. J A Navarro Sanchis
The treatment for suspected testicular tumours is the surgical removal of the affected testicle. Surgery is an important part of the diagnosis and treatment of testicular cancer.
Radical orchiectomy consists of the surgical removal of one or both affected testicles via the inguinal route, followed by an anatomopathological analysis to identify the type of tumour. This information will help the medical professionals to choose the most appropriate form of treatment for the patient.
After surgery, some patients may require treatment with chemotherapy or radiotherapy, which generates an excellent response in the vast majority of cases. These treatments are often prescribed after surgery in order to target remaining cancer cells that may have spread to other parts of the body, such as lymph nodes.
A detailed initial extension study, appropriate early treatment and strict follow-up are the pillars that help to ensure high survival rate and quality of life for these patients.
Patients with localised cancer may be treated with curative intent, primarily surgery or radiotherapy in its various forms. However, these radical treatments are not harmless and can cause side effects that affect the quality of life of the treated patient, such as erectile dysfunction, urine leakage and/or digestive disorders.
Not all prostate tumours are highly aggressive or impact the patient’s survival. Some do not even affect quality of life. These are low or very low-risk rumours, which are not very aggressive and not very large in size. They can be controlled without the need for immediate active treatment, albeit with close monitoring.
This is the surgical procedure by which the prostate gland is removed. In this operation, the urologist removes the entire prostate and seminal vesicles. In some cases, nearby lymph nodes are also removed at the same time. The use of the DaVinci robotic system and the minimally invasive approach means that this procedure can be performed with greater accuracy and excellent results.
In this treatment, ionising radiation is administered from a source of external beam radiation that is integrated into devices called linear accelerators. The radiation is modulated and applied directly to the prostate, protecting the nearby organs (bladder, rectum and urethra) as far as possible.This consists of various treatment sessions that take place in the hospital on an outpatient basis.
In case of disseminated disease, treatment is based on the suppression of testosterone, new hormone molecules and chemotherapy depending on the stage of the disease.
There are four basic parts to treating renal insufficiency.
Controlling arterial pressure, if it is high; levels of urea; the balance of mineral salts (sodium, potassium, calcium, phosphorus, magnesium); acidity and anaemia. Analytical testing provides a lot of information which enables the origin and severity of the kidney disease to be established.
A kidney biopsy allows a microscopic study that is often essential. Genetic testing also provides very important information.
There are three different levels of treatment:
a) medical, with the use of medication or hormones to substitute the alterations mentioned. A diet that creates little urea or that contains low levels of potassium, drugs to control excess or lack of sodium, potassium, calcium, phosphorus, magnesium or acidity. And medication to treat anaemia.
b) extrarenal purification methods: haemodialysis (passing the blood through an external circuit to purify it and filter out toxic substances using a suitable filter), and peritoneal dialysis, during which a solution is circulated inside the patient's peritoneal cavity and is then extracted, taking the toxic substances usually expelled through urine with it.
c) kidney transplant from a living or deceased donor. In this instance, the new kidney takes over the functions of the diseased kidney. How long a kidney graft lasts varies and relies on controlling episodes of organ rejection that may occur after transplant. A young patient with kidney insufficiency may require more than one kidney transplant over their lifetime, although the useful life of these grafts is increasing day by day thanks to new immunosuppressant drugs.
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