MEN'S HEALTH MATTERS:The repair of a hernia using a mesh can be done in a number of ways, writes THOMAS LYNCH
Q I am 42 years old and have had some discomfort in my groin for the past year. I noticed a lump only in the past few weeks.
There is only slight discomfort and my doctor says that it is an inguinal hernia and will require an operation.
What exactly does this mean and what are my options? Is it possible to have this repaired with keyhole surgery?
A A hernia is an abnormal protrusion of an organ or other bodily structure through the wall that normally contains it.
The groin is the most common site for a hernia – known as an inguinal hernia – and although they can present in females they are more common in males due to a natural weakness in the muscles of the groin where the blood supply to the testicles pass from the abdomen to the scrotum.
Although an inguinal hernia is usually uncomplicated it is advisable in someone of your age to have it repaired.
Internal structures such as the bowel may protrude into the hernial sac causing a small bulge in the groin, which may or may not be associated with discomfort.
In this instance, the bowel may pass in and out of the hernial sac, however, on occasion, it can become trapped and not disappear back into the abdomen.
The most common method of repairing a hernia uses a synthetic mesh, which acts like a patch. Repair can be carried out via keyhole (laparoscopic) surgery or open surgery. Laparoscopic surgery has been shown to be particularly beneficial in those who have a hernia on both sides and those who have had a previous hernia repair on the affected side.
A simple analogy is to think of a tyre and a tube. The tyre represents the muscle and if there is a hole the tube will protrude. The tube represents the lining of the abdomen.
In carrying out a repair, the bulging tube is replaced and the tyre patched using a mesh. With conventional surgery the mesh is placed on the outside of the tyre and in keyhole surgery the mesh is placed between the tyre and the tube.
The surgery can often be done as a day case but in some circumstances you will need to be admitted overnight. The time it takes to resume full activity depends on the type of repair used.
Q I am 42 years old and have had a problem recently with discomfort passing urine and having to pass urine very frequently. I saw my doctor and he treated me with antibiotics.
The symptoms improved a little but I now have a discomfort between my scrotum and back passage. He feels that I may have had a bout of prostatitis. What is prostatitis and will it get better?
Is there a likelihood of long-term problems?
A Acute prostatitis is an inflammation of the prostate gland usually caused by a bacterial infection. Men with acute prostatitis often present with chills, fever, pain in the lower back and genital area, urinary frequency and urgency often at night.
They may also have burning or painful urination, body aches and a demonstrable infection of the urinary tract. As you describe, there may be a discomfort in the perineal area between the scrotum and the back passage.
Acute prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. The organism (bacteria) may be found in blood or urine, and sometimes in both. Common bacteria are Escherichia Coli (E Coli) and Klebsiella.
Antibiotics are the first line of treatment in acute prostatitis, which usually resolves in a very short time. Appropriate antibiotics will be used, based on the bacteria causing the infection and those that have a good penetration of the prostate gland.
The majority of patients can be treated at home with bed rest, analgesics, stool softeners and hydration. However, in some patients, acute prostatitis may warrant hospitalisation for intravenous antibiotics. Systemic infection from prostatitis is rare, but may occur in patients with a compromised immune system.
Patients who are unable to pass their urine will require a tube (catheter) to be passed into the bladder for a few days. Lack of clinical response to antibiotics (which rarely occurs) should raise the suspicion of an abscess and prompt an imaging study such as a transrectal ultrasound scan of the prostate.
Full recovery without sequelae is the norm.
This weekly column is edited by Thomas Lynch, consultant urological Surgeon, St James’s Hospital, Dublin, with a contribution from Martin Caldwell, consultant general surgeon, Sligo General Hospital