Urologist Dario Vasquez-Martul answers questions from readers

Dr. Dario Vasquez-Martul is a specialist in urology and also holds the European title of specialist (Council of Urology). He currently works as a urologist and tutor for CHUAC Urology Residents and is a surgeon in the Renal Transplant Department of the same center, an activity that he combines as a specialist in robotic surgery, prostate cancer and oncological urology in the group furtherUrology in the hospitals of San Rafael and Quironsalud-Coruña.

On this occasion, he answered questions from readers of the Tu Especialista Responde initiative in the “Ideal Health” section of the headlines of Editorial La Capital. Galician ideal, Diary of Bergantinos, Ferrol newspaper And Arusa’s diary

I have recurring urinary tract infections every 2 months or so. I am taking all the necessary precautions and have been taking probiotics and blueberries for a long time, what else can I do?

Recurrent urinary tract infections in women may be due to various causes such as a history of childhood episodes, new sexual partners, estrogen deficiency in postmenopausal women, or the presence of pelvic organ prolapse, among others.

In the case of repeated cases of urinary infection, it is important to conduct a urine culture in order to identify the microorganism and be able to apply effective antibiotic treatment with an adequate regimen. In cases of properly treated and recurrent urinary tract infections, an imaging test is recommended if we suspect other predisposing factors such as urinary tract disease or the presence of stones.

In any case, we must follow some recommendations: adequate water intake, elimination of possible risk factors, initiation of non-antimicrobial measures (probiotics, hormone replacement therapy or targeted vaccines) and, finally, regular antibiotic prophylaxis.

My son is 35 months old, he just had bronchitis, I have ever noticed that he makes one urine all day thicker or cloudy, I attribute this to the fact that he did not drink water for hours and I give him and it goes away. These days, I noticed bronchitis every day, but it was only once, I told my pediatrician, and he sent a urine test and culture after 15 days, but I am very worried, can this be normal?

Urinary tract infections are rare in children under 5 years of age and are more common in girls than boys. In cases where the suspicion of urinary tract infection in children is high, antibiotic treatment should be initiated without necessarily waiting for the results of a urine culture.

If they are available, we also have rapid urine tests that can help us manage the case. We must remember that children under the age of three have several warning signs such as fever, vomiting, irritability, refusal to eat, urine with bad smell or blood in the urine; these symptoms usually persist or worsen until the infection is properly treated.

The presence of cloudy or whitish urine may be a sign that we should not confuse urine with urine of a more intense or dark color, which may be associated, as he very well points out, with low water intake. Most infections clear up 24 to 48 hours after starting antibiotic treatment.

I am a 68-year-old man, and for some time now, when I want to urinate, I notice that the stream becomes weaker, and soon after I finish I want to again.

Benign prostatic hyperplasia is a common condition in men over the age of 50-60 (it is estimated that up to 75% of 80-year-old men may show symptoms) and is associated with growth in the central region of the prostate. prostate.

The prostate is located under the bladder and its growth can cause symptoms of obstruction such as difficulty urinating (thin stream, need for abdominal pressure…) or a feeling of incomplete emptying of the bladder causing the need to urinate again after a short time. There are other pathologies that can give similar symptoms, such as blockage of the urethra or a change in the contractility of the bladder.

Before this clinic, an examination by a urologist is recommended in order to establish the true origin of the problem and prescribe the most appropriate treatment in each case.

How often after the age of 50 is it advisable to undergo an examination?

Screening of asymptomatic men mainly focuses on monitoring PSA (prostate specific antigen) levels for opportunistic screening for prostate cancer, the most common malignancy in men (1 in 9). Early detection increases the chances of a complete cure with treatment.

The recommended age for initiating these controls is 50 and 45 if certain risk factors are present, such as direct relatives with prostate cancer or patients of African American descent. This age drops to 40 for men who have more than one direct relative with prostate cancer.

Based on the control of some baseline PSA values, the urologist will establish recommendations and control intervals, it is recommended to carry out an annual control.

At night I go 3 to 4 times to urinate, is this normal?

The need to wake up at night with a constant desire to urinate is not a normal situation and requires knowledge of the cause. We must keep in mind that drinking a lot of fluids at dinner or before bed can cause this problem, which is also aggravated by drinking alcohol. Some diuretic drugs for hypertension, for example, can also cause these disorders.

Apart from these situations, in men, the most common cause of nocturia (an urge to urinate during sleep) is benign prostatic hyperplasia due to bladder filling symptoms that this growth of the prostate can cause, making it difficult to empty the bladder properly. .

In many women, this symptomatology is associated with a change in the dynamics of urination with a more active bladder than usual (overactive bladder), which leads to more frequent urination.
In the various scenarios presented, improvement or resolution of symptoms can be achieved after proper assessment, advice and treatment by a specialist.

What do you recommend for a good sexual relationship, can I take something natural to keep my pallor and improve my erection?

The best recommendation for preventing erectile dysfunction in men is to lead a healthy lifestyle. Erection problems appear over the years and are closely related to risk factors for cardiovascular disease: obesity, smoking, hypertension, sedentary lifestyle… as they contribute to blockage of the arteries involved in the erection mechanism.

In situations where a certain degree of erectile dysfunction is established for this reason, there are medications and other alternatives to improve erections in addition to lifestyle changes.
In cases where there is a decrease in libido, it is also advisable to know the level of testosterone in the blood.

In some cases, psychogenic or pharmacological factors may coexist that interfere with and reduce libido and make sexual intercourse difficult, such as stressful situations or antidepressant treatment.

Is it normal or is it normal for you to feel very tired after 20 sessions of radiation therapy for prostate cancer?

Radiation therapy is one of the therapeutic options for prostate cancer, but depending on its characteristics and aggressiveness at the time of diagnosis, the addition of hormonal treatment with an effect of 6 months to 3 years is indicated. This treatment results in pharmacological castration, markedly lowering testosterone levels, with fatigue or muscle weakness being a common side effect. These symptoms of fatigue should disappear as testosterone levels in the blood return after the end of treatment.

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