Commonly referred to as an Upper Gastrointestinal Endoscopy or EGD, it is a procedure that allows your doctor to look at your esophagus, stomach and the first part of the small intestine (duodenum) and is used to diagnose and treat conditions in the upper gastrointestinal tract.

The procedure is done using a long, thin, flexible viewing tool called an endoscope that has a small light and video camera at one end. The endoscope is inserted in your mouth and then slowly and gently pushed down your throat, through your esophagus and stomach, and into the beginning of your small intestine.

The endoscope sends images to a monitor in real-time, allowing your doctor to look for inflammation, bleeding, ulcers or infection.

Small tools may also be inserted into the endoscope. These tools can be used to:

• Take tissue samples for a biopsy.
• Remove things such as food that may be stuck in the upper GI tract.
• Inject air or fluid.
• Stop bleeding.
• Do procedures such as endoscopic surgery, laser therapy, or open (dilate) a narrowed area.

What are the Reasons for Doing an EGD?

An upper gastrointestinal endoscopy may be done to diagnose and treat problems in your upper gastrointestinal tract.

Many times it is used to identify the cause of unexplained symptoms such as:

• Trouble swallowing
• Unexplained weight loss
• Upper belly pain or chest pain that is not heart-related
• Continuous vomiting for an unknown reason
• Bleeding in the upper gastrointestinal tract

It can be used to identify problems such as:

• Inflammation of the esophagus (esophagitis) or the stomach (gastritis)
• Gastroesophageal reflux disease (GERD)
• A narrowing (stricture) or blockage of the esophagus
• Enlarged and swollen veins in the esophagus or stomach (Esophageal varices)
• Barrett’s esophagus, a condition that increases the risk for esophageal cancer
• Damage caused by swallowing caustic substances such as household detergents
• Infections of the upper gastrointestinal tract
• Crohn’s disease
• Celiac disease
• Hiatal hernia
• Ulcers
• Cancer

The procedure is also used to treat a variety of issues:

• Control bleeding
• Remove tumors or growths (polyps)
• Open (dilate) narrowed areas
• Remove things that may be stuck
• Perform laser therapy
• Insert a tube used for tube feeding into the stomach
• Band abnormal veins in your esophagus (esophageal varices)

An endoscope can also be used to take tissue samples (biopsies) or gastrointestinal fluid samples. An EGD may also be used to check your stomach and duodenum after undergoing a surgery.

Your healthcare provider may have other reasons to recommend an upper GI endoscopy.

What are the Risks of an EGD?

Complications are rare during an upper gastrointestinal endoscopy, though like any procedure there are certain risks, such as:

• Bleeding
• Infection
• There is a slight risk of perforation in your esophagus, stomach or upper small intestine. If this happens, you may need surgery to fix it.

There may be other risks that are unique to you, be sure to talk to your doctor about any concerns before the procedure.

How do you prepare for an EGD?

Before having an upper gastrointestinal endoscopy, be sure to inform your doctor if you:

• Are sensitive to or allergic to any medicines, latex, tape or anesthesia medicines
• Are pregnant or believe you might be pregnant
• Have a history of bleeding disorders; take any blood-thinning medicines such as aspirin or other medicines that affect blood clotting. You may need to suspend their use before the procedure.
• Have diabetes or take insulin
• Have had any surgery or radiation treatments in your esophagus, stomach or upper part of your small intestine
• Have any heart problems

You will be asked not to eat or drink anything for 8 hours before the test. Having an empty stomach allows your doctor a clear view of your stomach during the test.

You may be asked to sign a consent form stating that you understand the risks and agree to have it done.

You will be awake during the procedure, but you will be given a sedative to help you relax so you should arrange to have someone take you home after the test.

How is an EGD performed?

An upper gastrointestinal endoscopy may be performed in a doctor’s office, a clinic or a hospital; an overnight stay is usually not required.

The procedure is done as follows:

• You will be asked to remove any clothing, jewelry, dentures or anything else that might interfere with the procedure. You will be given a gown to wear.
• You will receivemedicine into a vein to help you relax. You should feel no pain and not remember the procedure.
• Your heart rate, blood pressure, respiratory rate, and oxygen level will be checked during the procedure.
• A local anesthetic may be sprayed into your mouth to prevent you from coughing or gagging when the scope is inserted. A mouth guard is used to protect your teeth and the scope.
• You then lie on your left side.
• You will not be able to swallow the saliva that may collect in your mouth during the procedure. This happens because the tube is in your throat. The saliva will be suctioned from your mouth from time to time.
• The scope is inserted through the esophagus (food pipe) to the stomach andduodenum. Air is put through the scope to make it easier for the doctor to see.
• The lining of the esophagus, stomach, and upper duodenum is examined.Biopsies can be taken through the scope. Biopsies are tissue samples that are looked at under the microscope.
• Different treatments may be done, such as stretching or widening a narrowed area of the esophagus.

After the test is finished, you will not be able to have food and liquid until your gag reflex returns (so you do not choke).

The test lasts about 5 to 20 minutes.

What happens after an EGD?

After the test, you will be observed for 1 to 2 hours until the medicines wear off. If your throat was numbed before the test, you should not eat or drink until your throat is no longer numb and your gag reflex has returned to normal. This is to prevent you from choking. You might experience a sore throat or pain when swallowing for a few days after the test, this is completely normal.

When you are fully recovered, you can go home. You will not be able to drive or operate machinery for 12 hours after the test. You may go back to your usual diet and activities, unless otherwise instructed by your doctor. Do not drink alcohol for 12 to 24 hours after the test.

Be sure to call your immediately if you have any of the following:

• Symptoms of infection, such as fever or chills
• Redness, swelling, or bleeding or other drainage from the IV site
• Shortness of breath of dizziness
• Belly pain, nausea, or vomiting
• Black, tarry, or bloody stools
• Trouble swallowing
• Throat or chest pain that gets worse

Your doctor may be able to talk to you about some of the findings right after your endoscopy. However, the medicines you get to help relax you may impair your memory, so your doctor may wait until they fully wear off.

A Colonoscopy is an endoscopic procedure that enables the examiner (usually a gastroenterologist) to check for changes or abnormalities in the large. The doctor will use a colonoscope, which is a four-foot long, flexible tube with a camera and a light at one end. The procedure usually take anywhere from 30 to 60 minutes.

Why is a Colonoscopy done?

A Colonoscopy is a standard procedure that may be performed to diagnose a variety of gastrointestinal conditions.

Your doctor may recommend a colonoscopy to diagnose:

• Colon Cancer
• Abdominal Pain
• Blood in the Stool
• Unexplained Anemia
• Diarrhea

Individuals with a family history of certain types of non-colonic cancer or problems associated with colon cancer may be advised to have regular colonoscopies because they are at greater risk of developing colon cancer.

However, it is recommended that even healthy individuals should undergo a colonoscopy at age 50 and every ten years thereafter.

How do you prepare for a Colonoscopy?

In order for the procedure to be complete and thorough, your colon must be completely clean. Your doctor will give you detailed instructions on how to prepare for the procedure.

These usually include limiting solid foods or going on a liquid diet for a few days before the procedure, you may also need to take laxatives or undergo an enema before the exam because your small intestine and rectum must be empty and clean for your doctor to see the walls of your intestine.

What to expect during your Colonoscopy?

You should arrive 1 to 2 hours before your colonoscopy and are accompanied by an adult or arrange to have someone take you home.

The procedure is done as follows:

1. You will be put on an intravenous line to administer fluids and sedatives.
2. Your doctor will perform a digital rectal exam, placing a gloved, lubricated finger inside your rectum.
3. The colonoscope will be inserted into your rectum, advancing it up the colon to the cecum. A video camera on the colonoscope transmits images to a nearby monitor.
4. Your colon will be inflated with air to improve visibility.
5. If an infection is suspected, a biopsy may be obtained, and should there be polyps they can usually be removed through the colonoscope. These additional procedures typically do no produce pain.
6. Treat any bleeding in the colon.

What happens after a Colonoscopy?

After the colonoscopy is finished, you will be kept in a recovery room until medications adequately wear off. If you received sedatives for the procedure your judgment will be impaired the rest of the day, so you should have someone to accompany you home.

You may experience some cramping or gas that usually passes quickly. You may return to your normal diet, unless you had polyps removed or other procedures.

Though complications are rare in colonoscopy, bleeding and puncture of the colon are possible. Be sure to call your doctor immediately if you experience:

• Excessive or prolonged rectal bleeding
• Severe abdominal pain, fever or chills

Breast implants allow women to have larger, fuller breasts. She may choose to do this for cosmetic reasons to enhance her self-image and self-confidence or for reconstructive purposes, such as after mastectomy for breast cancer.

In this article we will focus only on breast augmentation for now. If a woman has severely drooping breasts, a breast augmentation will not be able to correct this so a breast lift may be required for breasts to look fuller and lifted.

Breast lifting can often be done at the same time as your augmentation. Your plastic surgeon will help you decide what’s best for you.

Am I a Good Candidate for Breast Implants?

Getting a breast augmentation is a very personal decision, it’s important that the motivations behind getting implants be personal as well. If you decide to get a breast augmentation it should be because you want it and not because someone asks you to get it. Patients are usually very happy with the results, especially when they want the procedure themselves.

You may be a candidate for breast augmentation surgery if:

• You’re healthy and aren’t pregnant or breastfeeding
• It bothers you to have small breasts
• You have fully developed breasts
• You’re unhappy with your breasts losing shape and volume after pregnancy, weight loss, or with aging
• Your breasts are asymmetrical

If you’re considering surgery, you should review breast augmentation photos and learn what to expect during recovery, this way you will be able to have more reasonable expectations and a smoother recovery.

How do I choose the right type of Breast Implants?

If you’re considering breast implants, you’re probably wondering how to choose the right type of implants for you. Here’s some help to guide you in your decision.

What’s the difference between saline and silicone breast implants?

Saline and silicone breast implants both have an outer silicone shell. The implants differ in material and consistency, however.

Saline breast implants

Saline implants are filled with sterile salt water. They’re inserted empty, and then filled once they’re in place.

Saline breast implants are available to women 18 and older for breast augmentation and to women of any age for breast reconstruction.

Silicone breast implants

Silicone implants are pre-filled with silicone gel — a thick, sticky fluid that closely mimics the feel of human fat. Most women feel that silicone breast implants look and feel more like natural breast tissue.

Silicone breast implants are available to women 22 and older for breast augmentation and to women of any age for breast reconstruction.

What are the risks of Breast Implants?

Although it’s a cosmetic procedure, breast implant surgery poses certain risks, such as:

• Breast pain
• Changes in nipple and breast sensation, usually temporary
• Scar tissue forming and hardening in the area around the implant
• Scarring
• Bleeding
• Infection
• Problems with the size or shape of the implants (for example, the breasts may not be symmetrical)

It is also possible for implants to rupture and leak. If a saline implant ruptures, the leaking saline solution will be absorbed by your body without posing any health risks, but you’ll probably need surgery to remove the silicone shell. If you wish, a new implant can likely be inserted at the same time.

A silicone leak may stay inside the implant shell or leak outside of the shell. When a saline implant ruptures, it will deflate. But silicone breast implants may cause no obvious symptoms when they rupture. This is called silent rupture.

Recovery after Breast Implants

Your breasts will be wrapped with gauze dressings after the surgery. You may have drainage tubes, which will be removed in a few days. You will need to wear a support bra to minimize swelling and support your breasts as they heal.

You’ll need to take it easy for a few days and avoid any heavy lifting for up to six weeks after getting your implants.

Over-the-counter pain relievers such as acetaminophen may help relieve discomfort. Your doctor may also prescribe pain medication for you.

You will probably have some swelling in the area where the surgery was done. Over time, the swelling should ease and the scars will fade.

Considerations after Breast Augmentation Surgery

Breast implants are not guaranteed to last a lifetime. Some women will need to get them replaced if they have complications or if the size and shape of their breasts change over time.

Women who decide to get silicone gel-filled implants will need to get an MRI scan three years after the implant surgery and then MRI scans about every two years to check for silent rupture. If your implants rupture, you will need to have them removed or replaced.

Having breast implants can make it more difficult to get a mammogram, but special X-ray views can be done. There is a chance breast implants may make you more likely to get breast cancer. Breast implants also may make it harder for you to breastfeed.

Liposculpture is a minimally invasive body contouring technique that dramatically transforms your body, adding fine definition to treatment areas. Liposculpture precisely targets only the fat around muscle groups, so it is used to highlight and provide more defined contours through precise removal of the fatty deposits obscuring the muscles, leaving you with a more sculpted appearance.

The technology is so precise that it is able to distinguish nerves, blood vessels, and connective tissue from the targeted fat. The unwanted fat is removed through ultrasound body reshaping technology instead of the vacuum removal method utilized during traditional liposuction. Although, both liposculpture and liposuction are minimally invasive procedures, the former is used to reshape and create more muscle definition instead of solely removing unwanted fat.

What are the reasons for having Liposculpture done?

There are a variety of reasons for having liposculpture done, the most significant usually being that the patient can’t get rid of unwanted fat in spite of exercise and maintaining a healthy lifestyle.

• Single procedure. Provides optimal results in one procedure as opposed to having to sit through multiple procedures over time
• Minimal recovery period. You’re back on your feet in no time
• Improved body contours. Obtain the same results you’d have if you’d spent months working with a personal trainer
• Smoother, more youthful looking skin. In addition to more refined and accentuated muscles

Is Liposculpture a good way to lose weight?

You may lose a few pounds from the fat being removed, but it is not considered a form of weight loss. In fact, you need to be in good shape, exercise regularly and maintain a healthy lifestyle to be a good candidate for liposculpture.

Liposculpture Candidates

Liposculpture is best for people whose exercise regimen and healthy lifestyle have already provided some definition. It’s ideal for active people who need help shaping and tightening areas in with stubborn fat. For general body sculpting, liposuction is a more effective option.

In addition to being close to your ideal shape, a good candidate for liposculpture should be:

• A nonsmoker in generally good health
• Prepared for a minor surgical procedure
• Willing to rest during a short recovery period
• Prepared to take steps to maintain your results

Liposculpture can produce ideal contours and tone, but it cannot prevent future fat deposits from accumulating. To maintain your results you will need to be dedicated to healthy living.

What parts of the body can be sculpted?

Liposculpture is used on places where you have localized excess fat, as a means of achieving a more chiseled appearance; there are many areas that can be contoured.

These areas are:

• Cheeks, jowls and neck
• Upper arms
• Breast or chest areas
• Back
• Abdomen and waist
• Hips and buttocks
• Inner and outer thighs
• Inner knee
• Calves and ankles

What to expect after surgery?

There will be some discomfort to varying degrees. Some patients cope without painkillers. Some occasionally require stronger medication. This is left to your discretion and will be dealt with at the time of the procedure.

During the first two days, excess fluid will discharge from tiny holes in the skin from the procedure. The fluid will be pinkish, but actual blood loss will be minimal. Absorbent pads are supplied to help deal with this leakage and a plastic sheet is provided to place on the mattress. Towels can help contain the fluid. Patients are encouraged to take it easy for the rest of the day, but may go for a short walk. They are not permitted to drive at all for 24 hours.

Most patients can return to work on the second day. By the end of the first week, most patients will feel quite comfortable. Any bruising or swelling of tissue will gradually subside over the next three weeks.

 When will I see results?

In 48 hours you will see up to 70% of the final result. A month after the procedure, most patients look and feel completely recovered from the procedure.

It takes three months for the final result to be evident. Liposculpture to the calves and ankles requires a longer recovery period, with swelling of the ankles continuing for up to six months in some patients. Retraction of abdominal skin where excess fat has been removed will also show a slower recovery, taking up to six months.

My name is April Johnson; my friend came to Clinica San Juan, and recommended the clinic for my Gastric Sleeve surgery.

The staff is great, the doctors kind, the rooms clean and the service is great too.

Thank you.

An abdominal wall hernia is a weakness in the muscles of the abdominal wall, which may be congenital or acquired. When this occurs, it can cause pain, and sometimes fat or intestines from the abdominal wall can bulge out. Many hernias are asymptomatic, but some become incarcerated or strangulated, causing pain and requiring immediate surgery.
Abdominal hernias are very common, especially in men. Around 700,000 hernia operations are performed in the United States each year.

The abdominal wall is made up of muscle and tissues that attach those muscles to each other and to bone, it’s thick and tough in most places but sometimes there is an opening in the wall that allows what’s inside to push through to the outside. This is a hernia.

What are the Types of Abdominal Wall Hernias?
Abdominal wall hernias include:
• Umbilical hernias occur around the navel (umbilicus) and for the most part are congenital, but some are acquired in adulthood because of obesity, ascites, pregnancy, or excess fluid in the abdomen.
• Epigastric hernias occur through the linea alba.
• Spigelian hernias occur through defects in the transversus abdominis muscle lateral to the rectus sheath, usually below the level of the navel.
Incisional (ventral) hernias occur through an incision from previous abdominal surgery. This type of hernia may develop many years after the surgery.
Incarceration and Strangulation
Sometimes, a piece of intestine becomes trapped in the hernia, leading to a condition called incarceration. An incarcerated hernia can obstruct the intestine. On rare occasions, the hernia can trap the intestine so tightly that it cuts off the blood supply, a condition called strangulation. With strangulation, the trapped piece of intestine can develop gangrene in as little as 6 hours. With gangrene, the intestinal wall dies, usually causing rupture, which leads to inflammation and usually infection of the abdominal cavity (peritonitis), shock, and, if left untreated even death.
What are the Symptoms of Abdominal Wall Hernias?
Most people usually notice only a bulge at the site of the hernia, which may cause slight discomfort or show no symptoms. Sometimes the hernia appears only with lifting, coughing, or straining. Most hernias, even large ones, can be reduced manually by persistently applying gentle pressure.
Diagnosis
• A doctor’s examination
• Sometimes imaging tests
Because the hernia may be apparent only when abdominal pressure is increased, the patient should be examined in a standing position. If no hernia is palpable, the patient should cough or perform a Valsalva maneuver as the examiner palpates the abdominal wall. Examination focuses on the umbilicus, the inguinal area (with a finger in the inguinal canal in males), the femoral triangle, and any incisions that are present.

What Should You Do If You Have a Hernia?
If you have a hernia, it is best to avoid straining and heavy lifting and should be evaluated by a physician to determine if the hernia needs to be repaired.
Treatment
Hernias are surgically repaired. The surgeon will repair the hernia either by pulling the muscles at the edge of the hernia together with stitches (sutures) or by placing synthetic mesh material over the defect. Although most hernias should be repaired, if you are not experiencing any pain or there is little risk of damage to the intestines because of the hernia, surgery can be avoided.

However, an incarcerated or strangulated hernia of any kind requires urgent surgical repair.

Uterine myomatosis is the appearance of myomas or fibromas (benign tumors) in a woman’s uterus, it often affects women over age 30. If a single muscular tumor is found in the uterus, it is called a myoma, if there are more myomas present, they are referred to as myomatosis. In some women myomatosis can cause no issues and be left untreated, however, if any problems present themselves, a surgery is required.

Uterine myomas are the most common type of pelvic tumors. It’s present in up to 40% of women in the age of 30-50. Uterine myomas are different shapes and sized, they may be microscopic or grow slowly until they fill the whole uterus.

What are the Symptoms of Uterine Myomatosis?

Myomatosis is not dangerous by itself, in fact about one quarter of uterine myomas are asymptomatic. However, they can cause issues, especially if they are allowed to grow.

The most common symptoms are:
• Strong and prolonged menstrual bleeding.
• Pain or pressure in the lower abdomen.
• Painful sexual intercourse.
• Pelvic cramps.
• Infertility.
• Difficulty or even pain while urinating.
• Painful menstrual periods.

It is important to mention that symptoms depend on the size, number and location of the myomas. However, if you present any of the symptoms listed above you need to visit your gynecologist as soon as possible.

How is Uterine Myomatosis Diagnosed?

The most reliable method of diagnosing Uterine Myomatosis is through an ultrasound along with a standard gynecological exam.

The ultrasound provides the doctor with information about the uterus, the uterine cavity as well as the size of the individual myomas.

Treatment

If the uterine myomatosis is causing no issues, it’s possible to forego treatment and only undergo regular gynecological exams. In older women, who have significant issues, are on the verge of menopause and don’t plan any pregnancy, a hysterectomy or removal of the uterus may be performed.

A hysterectomy is a surgery that requires full anesthesia with several days of hospitalization. The uterus may be removed through an open incision in the abdomen; it can be removed laparoscopically or through the vagina. The ovaries and fallopian tubes are usually left, as their role in the production of hormones is important. If the woman has already undergone menopause, these organs are removed as well.

A different procedure is used for young women planning to have children. In this case it’s important to save the uterus and only remove the tumors that would prevent pregnancy.

Acute cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, beneath your liver that helps your body digest fat.

Gallstones are the main cause of cholecystitis by blocking the tube that leads out of the gallbladder. This results in a buildup of bile that leads to inflammation. Other causes of include bile duct problems and tumors.

This condition can become chronic if it persists for a prolonged period of time or if you are having recurring symptoms from the inflammation. If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder rupture.

Women get gallstones more often than men and also have a higher risk of developing acute cholecystitis.

Risk increases with age in both men and women, although the reason is unclear. The risk is also higher for people of Scandinavian, Native American, and Hispanic descent.

What are the Symptoms of Acute Cholecystitis?

The most common sign that you are suffering from acute cholecystitis is abdominal pain that lasts for several hours. It can be a sharp pain or dull cramps.

Other signs and symptoms of cholecystitis may include:

• Severe pain in your upper right abdomen
• Pain that radiates from to your right shoulder or back
• Tenderness over your abdomen when it’s touched
• Nausea
• Vomiting
• Fever

The signs and symptoms of acute cholecystitis often occur after a meal, especially a large or very fatty meal.

Diagnosing Acute Cholecystitis

Acute cholecystitis has symptoms that resemble other illnesses, so your doctor will have to review your medical history and check your abdomen for swelling or tender areas.

They may also order additional tests, such as:

• Abdominal ultrasounds. The most commonly ordered imaging test used to diagnose cholecystitis.
• Hepatobiliary scintigraphy. A procedure that creates an image of the upper portion of your small intestine, liver, gallbladder, and bile ducts.
• Cholangiography. In which dye is injected into your bile ducts to show the gallbladder and bile ducts on an X-ray.
• CT scans. Computerized images used to create images of your internal organs.

Treatment

First, it is very important to remember to always see a doctor if you are experiencing severe, unexplained abdominal pain. If you’re diagnosed with cholecystitis, you’ll likely be hospitalized. Your doctor will work to control your signs and symptoms and to control the inflammation in your gallbladder. Treatments may include:

• Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder. So that you don’t become dehydrated, you may receive fluids through a vein in your arm.
• Antibiotics to fight infection. If your gallbladder is infected, your doctor likely will recommend antibiotics.
• Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.

Your symptoms are likely to subside in a day or two.

• Surgery to remove the gallbladder. If the condition is recurring, your doctor may recommend surgery to remove your gallbladder. This is called a cholecystectomy, which can be done laparoscopically or through open surgery. You can still digest food normally without a gallbladder. Bile that normally flowed to your gallbladder will be redirected into your small intestine.

How can you Prevent Acute Cholecystitis?

You may be able to reduce your risk of cholecystitis by taking the following steps to prevent gallstones:

Lose weight slowly. Rapid weight loss can increase the risk of gallstones. If you need to lose weight, aim to lose 1 or 2 pounds (0.5 to about 1 kilogram) a week.
Maintain a healthy weight. Being overweight increases the amount of cholesterol in your bile. This raises your chances of developing gallstones.
Choose a healthy diet. Diets high in fat and low in fiber may increase the risk of gallstones. To reduce your risk of gallstones, choose a diet high in fruits, vegetables and whole grains.

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland, which can cause bothersome urinary symptoms. Untreated, prostate gland enlargement can block the flow of urine out of the bladder and cause bladder, urinary tract or kidney problems.

BPH is common in aging men. About half of all men between the ages of 51 and 60 have it and up to 90% of men over age 80 have BPH. BPH is NOT cancer. An enlarged prostate can be a nuisance. But it is usually not a serious problem.

What are the symptoms of BPH?

With BPH, the prostate gets larger and can irritate or block the bladder. A common symptom of BPH is the need to urinate often. This can be every one to two hours, especially at night.

Other symptoms include:

• Feeling that the bladder is full, even right after urinating
• Feeling that urinating “can’t wait”
• Weak urine flow
• Dribbling of urine
• The need to stop and start urinating several times
• Trouble starting to urinate
• The need to push or strain to urinate

In severe cases, you might not be able to urinate at all. This is an emergency. It must be treated right away.

What causes BPH?

The cause of benign prostatic hyperplasia is not well understood; however, it might be due to changes in the balance of sex hormones as men grow older.

BPH occurs mainly in older men as most men have continued prostate growth throughout their life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

What are the risk factors for BPH?

The risk factors for prostate gland enlargement include:

• Aging. Men under age 40 rarely present signs or symptoms of an enlarged prostate, yet approximately one-third of men experience moderate to severe symptoms by age 60, and about half experience them by age 80.
• Family history. Having a blood relative, such as a father or brother, with prostate problems means you’re more likely to have problems.
• Ethnic background. Prostate enlargement is less common in Asian men than in white and black men.
• Diabetes and heart disease. Studies have shown that diabetes, as well as heart disease and the use of beta blockers, might increase the risk of BPH.
• Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.

How is BPH diagnosed?

Your doctor will start by asking detailed questions about your symptoms and doing a physical exam that includes a Digital Rectal Exam (DRE), where the doctor inserts a finger into the rectum to check your prostate for enlargement.

You may also have:

• Urine test. This exam can help rule out an infection or other conditions that can cause similar symptoms.
• Blood test to check for kidney problems.
• Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.
• Post-void Residual Volume (PVR). Measures urine left in the bladder after urinating.
• Uroflowmetry to measure how fast urine flows.
• Cystoscopy to look at the urethra or bladder with a scope.
• Urodynamic pressure to test pressure in the bladder during urinating.
• Ultrasound of the prostate.

How is BPH treated?

Generally speaking, you don’t need treatment for BPH unless the symptoms bother you or you have other problems such as backed-up urine, bladder infections, or bladder stones.

Some things you can do that may help reduce your symptoms:
Practice “double voiding.” Urinate as much as you can, relax for a few moments, and then urinate again.
Avoid caffeine and alcohol. They can make you urinate more often.
If possible, avoid medicines that can make urination difficult, such as over-the-counter antihistamines, decongestants (including nasal sprays), and allergy pills. Check with your doctor or pharmacist about the medicines you take.

If home treatment does not help, BPH can be treated with medicine. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.

If your symptoms are severe, your doctor may suggest surgery to remove part of your prostate. But few men have symptoms or other problems severe enough to need surgery.

Can you prevent a recurrence of BPH?

Once you have been treated, taking medication continually can prevent BPH symptoms from returning or getting worse. In some men, a different treatment may be necessary. Some men will need repeated treatments to get rid of bothersome symptoms. In older men, it may be possible to control the symptoms of BPH to the end of life.

Some people believe that regular ejaculations will help prevent prostate enlargement. But there is no scientific proof that ejaculation helps.

Decompressive laminectomy is the most common type of surgery done to treat lumbar (low back) spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine. The surgery creates space by removing the lamina — the back part of the vertebra that covers your spinal canal.

Laminectomy is generally used only when more-conservative treatments — such as medication, physical therapy or injections — have failed to relieve symptoms. It may also be recommended if symptoms are severe or worsening dramatically.

This procedure is also used to treat other conditions, such as injuries to the spine, herniated discs, or tumors. In many cases, reducing pressure on the nerve roots can relieve pain and allow patients to resume normal daily activities.
Why is it done?
Your doctor may recommend surgery for spinal stenosis when:

• Severe symptoms restrict normal daily activities and become more severe than you can manage.
• Conservative treatment such as medication or physical therapy does not relieve pain and symptoms are getting worse.
• You experience loss of bladder or bowel control.
• You notice sudden changes in your ability to walk in a steady way, or your movement becomes clumsy.

Bony overgrowths within the spinal canal can narrow the space available in your spinal cord and nerves. This pressure can cause pain, weakness or numbness that can radiate down your arms or legs. Laminectomy is usually better at relieving these types of radiating symptoms than it is at relieving actual back pain.

The decision to have surgery is not based on imaging test results alone. Even if the results of imaging tests show increased pressure on the spinal cord and spinal nerve roots, the decision to have surgery also depends on the severity of symptoms and your ability to do normal daily activities.

Risks

Laminectomy is generally a safe procedure. But as with any surgery, laminectomy carries a risk of complications.

Possible complications include:

• Problems from anesthesia.
• Blood clots.
• An unstable spine.
• Nerve injury.
• Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord, sometimes requiring a second surgery.
• Trouble passing urine, or loss of bladder or bowel control.
• Long-term (chronic) pain, which develops after surgery in some cases.

What to Expect After Surgery

Depending on your health and the extent of the surgery, it may take several months or more before you are able to return to your normal daily activities.

Most people report measurable improvement in their symptoms after laminectomy, but the benefit may lessen over time as the spine continues to age or if there is a recurrence of arthritis. Laminectomy is more likely to improve leg pain caused by a compressed nerve than back pain. Because laminectomy can’t stop the buildup from osteoarthritis that caused the nerve compression in the first place from happening again, symptoms may come back over time. After a laminectomy and fusion, spinal stenosis may develop directly above or below the surgery site. Repeated surgeries for spinal stenosis increase your risk of complications and instability in the spine.

Age should not be a factor in deciding whether to have decompressive laminectomy. But if you have other medical conditions that will make this procedure and follow-up rehabilitation less successful, surgery may not be recommended.