Brief Answer:
Please find details below

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. Prostate is a small potato sized gland in the base of urinary bladder. It usually enlarges in size after 60 years of age and causes difficulty in passing urine or increased frequency of urine. In your report prostate size is given as 39 cc (normal less than 25 cc) but however there is no post void residue which means that the enlarged prostate is not causing significant obstruction to the passage of urine and the urinary bladder is getting completely evacuated. It is suggested that you consult the urologist for this problem and take medications to reduce prostate volume. These must be taken for a few months and your ultrasound scan has to be repeated again to know response to treatment. If the prostate does not reduce by medications taken for 3 months to a year with subsequent ultrasound scan showing increase in size with symptoms of urinary obstruction then surgery might be required. It is also suggested that you get PSA level in blood tested.

2. The gall bladder shows small stones and polyps (growths) in the gall bladder. The stones can get stuck in common bile duct and cause pain and jaundice. The growths can also grow with time. It will help to know if you have any pain in right upper abdomen due to gall bladder stones. Though the stones are few in number, they can cause block of bile duct. A surgeon has to be consulted for this and most likely you might require a gall bladder removal surgery. This surgery is done by laproscopy and has high success rate.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

---

Brief Answer:
Please find details below

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

Please find my observations below
1. For the presence of gall bladder polyps, recent medical literature says the following
(i) Even though most of the gallbladder polyps are benign in nature, malignant polyps are present in some cases, and early detection and appropriate early measure is important for curative treatment and long-term survival. The primary goal in the management of gallbladder polyps is to prevent the development of gallbladder carcinoma.

(ii) For polyps 6–9 mm in diameter without signs of malignancy, a new ultrasound is recommended after 6 months. If the does not show any significant changes a new ultrasound is recommended after another 12 months and if no changes is found than no further imaging studies are made. Gallbladder polyps smaller than 6 mm are not followed up, if there are no indications of malignancy.


If your gall bladder polyps are less than 6 mm then nothing needs to be done for it.

Should the polyps be between 6 and 9 mm then two more scans are to be done at 12 months and 2 years from first scan to see for any change or growth in polyps. If no change then nothing to worry.

If the polyp is 10 mm or more then surgery is required.

As you have small stones, therefore even that should be discussed and treatment taken for reducing stones and treating any elevated cholesterol level in your blood. If your stones are many and they are growing in size in the next scan and if you develop pain in abdomen and jaundice then thought must be given to surgery keeping gall bladder stones in mind.

2. For the prostate enlargement
(i) The size of prostate taken as normal on ultrasound scanvaries with different doctors. In XXXXXXX most doctors consider any size above 25 cc to be enlarged. In the USA a size of more than 30 cc is considered enlarged and in some places doctors give enlarged prostate even above 20 cc. With this variation, I usually follow more than 25 cc as enlarged as with most radiologist.

(ii) Prostate enlargement of mild degree is not a concern unless there is block of urine and difficulty to pass urine. Block of urine is assessed by doing scan after passing urine and measuring the post void residue urine volume.

In your Lilavati scan dated 16-12-2009, there is prostate measurement 29 cc (mildly enlarged according to me) with post void residue of 35 cc. This shows that out of 180 cc urine 145 cc was ejected and 35 cc remained. This is a small amount and not to be considered significant if you did not have any urinary symptoms at that time.

In the scan report dated 09-03-2015, the prostate measures 39 cc and is mildly enlarged. However this time there is no residual urine when scan was done after making you pass urine. This clearly means that the enlarged prostate is not causing any block in passage of urine at the time of doing the scan.

Now you will ask me how the prostate was 29 cc in 2009 with 35 cc residual urine and now it is 39 cc in volume with no residual urine.

The answer to the above will be that the residual urine depends on many factors like how much time you had to wait after passing urine to get scan repeated and how much water you drank before going for scan. So if you had to wait for even 5 minutes after passing urine and before getting post urination scan done at Lilavati then in those 5 minutes, 35 cc urine got collected and that is a false recording as it collected after passing urine and when you were waiting for the scan. In the scan done on 09-03-2015, the post urination residual volume is nil and therefore it is unlikely that you have any blockage in the urinary passage due to an enlarged prostate.

Talking about the different measurements of prostate and if you have not taken any medications, it appears that there might have been an overestimation in the measurement of prostate gland in the scan dated 09-03-2015. This can happen as the bladder volumes differed at the two occasions and also some doctors tend to overestimate the size of prostate gland.

Your PSA level is normal and that is not a concern. In conclusion, if you are having urinary symptoms like difficulty in passing urine or increased frequency with getting up more than once at night to pass urine then you might require to take medications for your probable prostate enlargement.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

---