MEN’S AND WOMEN’S HEALTH

BENIGN PROSTATE HYPERPLASIA

OVERVIEW

Benign prostatic hypertrophy (BPH) is a non-cancerous condition affecting men caused by an enlarged prostate gland. 

The enlarged prostate compresses on the urine channel leading from the bladder outwards – the urethra, and as a result, affects the flow and passage of urine.

SYMPTOMS

Patients suffering from BPH may have symptoms affecting their lifestyle considerably. Some of these symptoms include:

  • Frequent or urgent need to urinate, especially at night (nocturia)
  • Difficulty starting urination
  • Weak urine stream or a stream that stops and starts
  • Dribbling at the end of urination
  • Urinary tract infection
  • Inability to urinate/empty the bladder
  • Blood in the urine

CAUSES/RISK FACTORS

  • Older age 
  • Family history of prostate problems
  • Higher BMI/low levels of physical activity

OUR TREATMENTS

Prostate Artery Embolisation

PAE is a minimally invasive procedure that treats the enlarged and troublesome prostate by blocking off the arteries that feed the gland and making it shrink. PAE was first performed in 2009, and since then, many men worldwide have been treated successfully with this method. In PAE, a puncture is made in the groin artery under local anaesthesia, and a guidewire and catheter are passed under X-ray guidance to the arteries that supply the prostate. Tiny microspheres/ particles are then injected into the small arteries that supply the prostate to block off the blood supply to the prostate. As a result, the prostate shrinks and the urethra is less compressed.

PAE can be done as a day surgery procedure under local anaesthesia and some mild sedation. Most patients experience minimal pain and discomfort from the procedure, recover within 4–6 hours post-procedure and can be discharged home.

PAE does not have any risk of urinary incontinence or impotence. Studies have shown that after PAE is done, the majority of patients report an improvement in their troublesome symptoms. Many men also can stop taking oral medication long term. This makes PAE very cost-effective for such patients. 

Patients who are particularly suitable for PAE:

1) Patients taking oral medication but still having symptoms

2) Patients who have undergone other procedures (see above) but have not seen improvement in their symptoms

3) Elderly patients with severe symptoms and who are considered at significant risk for general anaesthesia and surgery

4) Patients not suitable for TURP due to bleeding risks

5) Patients who wish to maintain their urinary continence and sexual potency

UTERINE FIBROIDS

OVERVIEW

Uterine fibroids are common, non-cancerous tumours of the uterus. It is estimated that by the age of 35, up to 40-50% of women have uterine fibroids. There are four basic types of uterine fibroids, classified according to their location in the uterus:

  1. Subserosal Fibroids: These develop in the outer portion of the uterus and continue to grow outward
  2. Intramural Fibroids: These are the most common type and develops in the uterine wall and expands.
  3. Submucosal Fibroids: These are the least common and develop within the uterine cavity, causing excessive and prolonged menstrual bleeding

Pedunculated fibroids: These grow on stalks or stems. The stems are attached to the uterine wall and can grow either outside the uterus or inside the uterine cavity

SYMPTOMS

In some women, the fibroids can produce mild or no symptoms at all. For others, symptoms of uterine fibroids include: 

  • Abnormal menstrual cycle (heavy or frequently occurring)
  • Painful menstrual periods
  • Pain during or after sexual intercourse
  • Pressure on the bladder causing frequent urination
  • Acute or severe pelvic pain
  • Bloating

CAUSES/RISK FACTORS 

  • Age
  • Heredity 
  • Onset of menstruation at an early age
  • Obesity
  • Vitamin D deficiency
  • Excessive alcohol consumption
  • Smoking
  • No pregnancy history

DIAGNOSIS

  • Ultrasound scan of the uterus
  • A CT scan is ordered especially if there are multiple fibroids.

OUR TREATMENTS

Uterine Fibroid Embolisation

  • UFE is done via a groin or radial artery access puncture.  
  • A catheter is then guided using fluoroscopy, a type of x-ray technology, to the arteries that supply the uterus and the fibroids specifically
  • Small particles or microspheres are then injected into the arteries supplying the fibroids, thus cutting off the blood supply to the fibroids. Post-procedure, these fibroids should start to shrink and reduce in size. 

You are the right candidate for UFE if you:

  • Are a woman who is over 35 years old
  • Are not currently pregnant
  • Have been diagnosed with uterine fibroids
  • Are experiencing symptoms such as excessive heavy bleeding, cramping, pelvic pain, bloating or frequent urination

You are also a candidate if you prefer a non-surgical uterine fibroid treatment option that will preserve your uterus. Make sure to discuss all options with your physician before making a decision.

Some of the benefits of UFE include:

  • A minimally invasive procedure that effectively shrinks uterine fibroids
  • Requires only local (rather than general) anaesthesia; numbing only one area of the body rather than full sedation
  • Does not cause scarring like most other surgical techniques 
  • While there will be some moderate pain after a UFE procedure, it is typically less than post-surgical pain
  • A good option if you would like to preserve your uterus as compared to  a hysterectomy
  • 85-90% of women experience significant relief of their symptoms
  • Faster recovery time compared to traditional surgery
  • Same day procedure typically with no overnight stay
  • Reduced risk of infection as compared to conventional open surgery

PELVIC CONGESTION SYNDROME

OVERVIEW

Pelvic Congestion Syndrome is a chronic condition that affects women and is caused by varicose veins in the lower abdomen or pelvis. Valves in the veins become weakened and do not close properly. As a result, blood begins to flow backwards and pools in the pelvic veins and also the connecting veins to the legs. 

SYMPTOMS

  • An aching pain with heaviness in the pelvis that may extend to the lower back.  
  • Pain during intercourse
  • Heavy menstrual bleeding
  • Heaviness and swelling in their legs, especially on standing for long periods.  

CAUSES/RISK FACTORS

This condition typically affects women 20-50 years old who have had previous pregnancies. 

DIAGNOSIS

  • CT scan of the abdomen and pelvis

Pelvic venogram – a procedure that is performed by inserting a catheter through the groin vein and injecting a contrast agent (a type of dye) into the veins of the pelvic organs.

  • LIVER AND KIDNEY TUMOURS AND CANCERS

OVERVIEW

Normally, there are chemical signals in the body that control when cell division will take place, such as during growth, repair and cell replacement. However, if cells divide to produce higher numbers than necessary, they can accumulate to form masses of cells known as tumours. Tumours may be benign, meaning that they only grow in one specific location. Such tumours are considered non-cancerous and can produce no symptoms at all unless they compress essential structures such as blood vessels or nerves. In these situations, even tumours that remain in one area of the body can cause significant damage.

Cancer is the abnormal, uncontrolled division of cells that have the potential to affect normal function of organs at the site of disease. Cancerous tumours are those with the ability to move around the body and grow in new locations, causing considerable damage in the process.

SYMPTOMS

Patients will experience different symptoms depending on the location of the primary site of a tumour. Some general symptoms include:

  • The presence of a lump under the skin that may/may not be felt
  • Fatigue
  • Unexpected weight loss/gain
  • Fever
  • Pain

In addition to benign tumours, we provide treatment for liver and kidney cancer, which can produce more specific symptoms.  

Liver cancer symptoms:

  • Loss of appetite
  • Pain in the upper abdomen
  • Nausea
  • Vomiting
  • Easy bruising/bleeding
  • Yellowing of the skin and whites of the eyes (symptoms of jaundice)

Kidney cancer symptoms:

  • Blood in the urine
  • Pain in the side of the body/lower back
  • The presence of a lump in the side of the body/lower back
  • Swelling in the ankles/legs
  • Loss of appetite

CAUSES/ RISK FACTORS

There are no known direct causes that trigger the growth of benign/cancerous tumours. Instead, many risk factors that may influence the process have been identified. These include:

  • Genetics (family history)
  • Smoking
  • Exposure to ionising radiation 
  • Infection (by some viruses, e.g. HPV and hepatitis B/C)

DIAGNOSIS

A biopsy is performed, using CT and Ultrasound guidance for cancer diagnosis.

OUR TREATMENT

Ovarian Vein Embolisation

  • Involves inserting a thin catheter into the femoral vein in your groin. The catheter is guided to the affected vein with the assistance of fluoroscopy, a type of x-ray technology. Tiny titanium coils with a sclerosing agent (also used for varicose veins) are inserted through the catheter to close off the affected vein(s).
  • In most cases this is done as a day surgery procedure, allowing patients to be discharged on the same day of the procedure.
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