Are You at Risk for Bladder Cancer?

Bladder cancer is a common type of urological cancer that begins in cells of the bladder. The bladder is a hollow muscular organ in the lower abdomen where urine is stored. 

The cancer starts when cells of the bladder undergo changes, called mutations, in their DNA. Due to the changes, the cells multiply rapidly and uncontrollably. And they are also able to survive when normal and healthy cells die.

As a mass of abnormal cells builds forming a tumor, the resulting tumor invades and destroys normal bladder tissues and may even break away and spread through the body.

What are the different types of bladder cancer?

  1. Urothelial carcinoma (transitional cell carcinoma)

This is the most common type of bladder cancer. It occurs in the cells of the inner lining of the bladder, called urothelial cells. After cancer begins in these cells it often spreads to adjacent tissues and can even invade distant organs.

  1. Squamous cell carcinoma

This is a rare type of bladder cancer that tends to occur after an infection or long-term use of a urinary catheter. It is associated with chronic irritation of the bladder and can be caused by certain parasitic infections, such as schistosomiasis.

  1. Adenocarcinoma

This is also a less common type of bladder cancer. Adenocarcinoma occurs in the cells that form mucus-secreting glands in the bladder before invading adjacent tissues.

Who is at risk of bladder cancer?

  1. A smoker

Smoking of cigarettes is the most common association and causes of bladder cancer. In fact, smoking generally including cigars and pipes can also increase the risk of cancer. Cigarette and tobacco smoke contains harmful chemicals that reach the bloodstream and are excreted in urine.

When the chemicals linger in the bladder, they damage or cause changes in cells. This increases the risk of cancer. In fact, cigarette smokers have three times more risk of bladder cancer than non-smokers.

  1. A person over the age of 55 years

While bladder cancer can occur at any age, it is more often diagnosed in people above the age of 55 years. And with up to 90-percent of those with the cancer being aged 55 years or older, aging is a major risk factor for bladder cancer.

  1. Being male

Being male predisposes you to a higher risk of bladder cancer than being female. In fact, men are four times more likely to develop cancer than women. However, women have a higher likelihood of late diagnosis of the cancer, which makes them more likely to die of the disease than men.

  1. Being white

Race is a factor in bladder cancer. Generally, white people are twice as likely to be diagnosed with bladder cancer than black people. Nevertheless, black people are twice as likely to die from the disease as white people.

  1. Being frequently exposed to certain harmful chemicals

Frequent exposure to certain chemicals increases the risk of bladder cancer. For example, in places where arsenic is found in drinking water, there is a higher incidence of cancer.

Also, people repeatedly exposed to aromatic amines, such as benzidine and beta-naphthylamine, often used in the dye industry, have a higher risk of cancer.  Likewise, chemicals used to manufacture dyes, rubber, leather, paint, and textile products increase the risk of bladder cancer.

That is why painters, printers, machinists, hairdressers (due to heavy exposure to hair dyes), truck drivers (exposure to diesel fumes), and industrial workers in rubber, leather, textile, and paint factories have greater risk of bladder cancer.

The chemicals reach the bloodstream and get filtered by the kidneys, allowing them to be present in urine. Once in urine, they may cause mutation of bladder cells, which eventually triggers cancer.

  1. A person with chronic bladder inflammation

Repeated bladder inflammation causes changes in bladder cells and may result in cancer. Hence, conditions such as kidney and bladder stones, recurrent urinary tract infections, chronic inflammation (cystitis), and long-term use of a urinary catheter increase the risk of bladder cancer.

  1. A person with personal or family history of bladder cancer

If you have had previous bladder cancer, you’re more likely to get it again. Also, if you have blood relatives—a sibling, parent or child—who has had the cancer, you have a greater risk of the cancer, though it is rare for the disease to run in families.

  1. A person who has previously been treated for cancer

When you have been treated with the anti-cancer drug cyclo-phosphamide, you have a higher risk of bladder cancer. Similarly, if you have received radiation treatment aimed at your pelvis for a previous cancer, then you have a greater risk of developing bladder cancer.

How can you prevent bladder cancer?

While there is no guaranteed way of preventing bladder cancer, taking certain steps can reduce your risk of the disease. Useful preventative steps include:

  1. Avoiding smoking

If you’re not a smoker, just don’t start.  And if you smoke, speak with your doctor about a tailored plan to help you stop. Medications, support groups, and other methods may help.

  1. Taking precautions when around certain chemicals

When working with various chemicals, follow the necessary safety precautions to avoid exposure.

  1. Eating a diet rich in fruits and vegetables

A diet rich in vegetables and fruits will provide antioxidants that help reduce the risk of bladder cancer.

  1. Drinking enough fluid

When you drink a lot of fluid, particularly water, you lower your risk of bladder cancer. More fluid intake helps you to empty your bladder more frequently and ensures harmful chemicals do not linger in your bladder long enough to cause damage.

Compassionate, patient-centered cancer care

If you see blood in your urine, you could have bladder cancer and should be seen by a board certified urologist. 

Would you like to undergo timely and accurate screening and diagnostic tests for bladder cancer? 

Through our compassionate, patient-centered approach, Advanced Urology Institute ensures that all patients get quality time with urology oncologists, have their concerns addressed and undergo comprehensive screening and diagnostic testing. 

For more information on bladder cancer and other urological disorders, visit the site “Advanced Urology Institute.”

7 Signs You Might Have Kidney Stones

An elevated amount of salts and minerals in urine can cause kidney stones. Also called renal calculi, kidney stones are hard deposits made of crystal-forming substances such as calcium, uric acid and oxalate, found in urine.  The stones vary in size, with some being too small, some a few inches across, and others large enough to take up an entire kidney. 

For smaller renal stones, there are usually no associated signs. The stones can travel from the kidneys through ureters, bladder and urethra without causing any problems.  And drinking plenty of water really helps in passing these stones. 

But for larger kidney stones, signs appear as the stones move from one part of the urinary tract to another.  An example is when a moderate or large stone moves from the kidney to the ureter. It immediately causes obstruction and produces agonizing pain. Such stones require a procedure, such as shock wave lithotripsy, to break up and remove them. 

So what are the signs that you might have kidney stones?

  1. Pain in your lower back, side, or belly

Kidney stones produce one of the most severe types of pain—comparable only to getting stabbed by a knife or pain during childbirth. The pain tends to begin when the stone moves into the ureter, causing a blockage and pressure buildup in the kidney. This pressure activates nerve fibers to send pain signals to the brain.

The pain starts suddenly and changes location and intensity as the stone moves. It also comes and goes in waves, with each wave lasting a few minutes, disappearing, and then coming back. The pain usually occurs along the side and back, below the ribs, but can radiate to the belly and groin area as the stone moves down the urinary tract.

  1. Tossing and turning

The sudden episodes of kidney stone pain last 20-60 minutes. But they are so severe that they don’t allow you to sit still. So you’re forced to move around, toss and turn, in order to find a more comfortable position.

  1. Burning sensation during urination

When a kidney stone reaches the junction between the ureter and bladder, it causes sharp or burning pain during urination. It is quite easy to mistake the stone for a urinary tract infection (UTI).  Of course, it is also common to have an infection alongside a kidney stone.

Apart from pain during urination, kidney stones can cause urinary frequency and urgency as they pass to the lower part of the urinary tract. That’s because a stone irritates the walls of the bladder and causes contraction, resulting in the urge to pass urine. You may find yourself running to the bathroom frequently or feeling the urge to go throughout the day and night.

  1. Nausea and vomiting

Kidney stones can cause obstruction of urine flow. This makes urine to back up, stretching or swelling the kidneys.  Eventually, this may lead to nausea and vomiting. 

Also, due to the excruciating pain associated with kidney stones, you may experience nausea and vomiting as one of the responses.

Equally, due to the sharing of nerve connections between the kidneys and the gastrointestinal tract, the presence of stones in the urinary tract disrupts nerves in the intestinal tract, resulting in stomach upset. 

  1. Blood in urine

Kidney stones irritate the delicate tissues that line the urinary tract, including inside the ureter. As a result, there may be significant, microscopic, or moderate bleeding, which results in blood in urine (hematuria). 

So as a sign of kidney stones, your urine may look grossly red, pink, or brown. You may also have blood in urine, but in quantities that are too small to notice with the naked eye. In that case, a urine test may be necessary to detect the urine.

  1. Fever and chills

Though fever is not a common sign of kidney stones, it may occur when the stones block urine flow or if the stones cause conditions that allow for an infection.  Like fever, chills tend to occur due to an infection that arises as a complication of kidney stones.

When they occur, fever and chills are usually a medical emergency. And so, the obstruction should immediately be dealt with through a procedure such as shock wave lithotripsy to enable antibiotics to pass through the obstructed area.

  1. Smelly or cloudy urine

Urine that is healthy tends to be clear and without a strong odor, but turbid, smelly urine might indicate an infection. So, while foul-smelling or cloudy urine does not directly indicate kidney stones, it may point towards an infection that arises as a complication of renal stones.

Generally, more than 16-percent of people with acute kidney stones tend to have UTIs. And whether it occurs with or without fever, the combined presence of a UTI and kidney stones is a surgical emergency.

When should you see a doctor?

You should see your doctor when you have agonizing pain, nausea, vomiting, bloody, turbid or smelly urine, fever or chills. It is advisable to seek immediate medical attention when you have pain that is so severe that you can’t get comfortable. For more information on kidney stone treatment, visit the site “Advanced Urology Institute.”

Testosterone Therapy May Lower Prostate Cancer Incidence

Testosterone replacement therapy (TRT) may help to reduce the risk of prostate cancer. According to a case-control study authored by Stacy Loeb, MD, MSc, of New York University, men who undergo testosterone replacement therapy (TRT) have lower risk of prostate cancer than those who do not undergo the therapy. Plus, the study found that testosterone therapy decreases the risk of aggressive prostate cancer, which is the form of the cancer that usually requires treatment.

Linking testosterone level to prostate cancer

The New York University study was based on the National Prostate Cancer Register of Sweden and included all the 38, 570 cases of prostate cancer diagnosed in Sweden from 2009 to 2012, together with 192,838 age-matched men without prostate cancer.

During the research, 284 prostate cancer patients (1%) and 1378 healthy men (1%) completed prescription forms for TRT. Then following a multivariable analysis, it was established that exposure to TRT did not produce increased prostate cancer risk.

On the contrary, TRT exposure resulted in reduced risk of the cancer within the first year and decreased the risk of the aggressive type of the disease after the first year of therapy.

Need for more studies

While the above study by New York University into the link between TRT and risk of prostate cancer was not conclusive, it demonstrated a reduced risk of the cancer after testosterone therapy. Besides, due to the increased administration of TRT in recent years, this study generated more issues that need further studies.

For instance, due to the more favorable-risk of prostate cancer in men who receive the therapy, the study pointed to the need for increased prostate cancer screening in men undergoing TRT. Also, it pointed to several possible biologic mechanisms involved in aggressive disease, including the role of testosterone in normal functioning of the prostate and epithelial cell differentiation.

Efficacy of testosterone therapy in several studies

Another study presented at the Sexual Medicine Society of North America 18th Annual Fall Scientific Meeting in San Antonio, Texas reported that hypogonadal men who receive TRT have reduced incidence of prostate cancer than those not receiving the therapy. The study also found that the form of prostate cancer diagnosed in recipients of testosterone therapy is less severe than the form diagnosed in men unexposed to the therapy.

The study was conducted in 400 hypogonadal men (those with testosterone level of 350 ng/dL or less) and who received testosterone undecanoate 1000 mg every 3 months for up to 10 years. It also involved a control group of 376 hypogonadal men who were not receiving TRT. A median follow-up of 8 years was done, where 9 men in the TRT group (2.3%) were diagnosed with prostate cancer compared to 26 men (6.9%) in the control group.

The diagnosed men in the TRT group underwent radical prostatectomy (RP). All of them except one patient had a Gleason score of 6 or less. In fact, most had a predominant Gleason score of 3 and all had tumor grade G2 and tumor stage T2.
On the contrary, in the control group, 18 required radical prostatectomy alone, 6 required both RP and radiation, while 2 required radiation. Plus, 26 patients in the control group had a Gleason score above 6, 2 had a score of 3, 20 had a score of 4, and 4 had a score of 5. The tumor grade was G2 in 6 patients and G3 in 20 patients; while in terms of tumor stage, 1 patient had stage T2 with 25 were at stage T3.

In the testosterone group, all the cancer cases were diagnosed within the first year. This suggested that the tumors had been present before the therapy was initiated. Since low testosterone is linked with low PSA, the cancer was probably not detected before testosterone therapy due to hypogonadism. The detection within one year of treatment was due to increasing levels of testosterone, which brought out occult cancer.

There are several other studies that have produced similar reports. For example, a population-based matched cohort study of men aged 66 years or older by the University of Toronto demonstrated that testosterone exposure reduces the risk of prostate cancer by up to 40-percent.

The research in Ontario, Canada by Christopher J.D. Wallis, MD, PhD, and colleagues was published in the Lancet Diabetes Endocrinology (2016;4:498-506) and involved exposure of the men to the highest tertile testosterone and comparing the results with controls. During the study 10,311 men received TRT while 28,029 men did not. Follow-up was made after 5.3 years in the TRT group and after 5.1 years in the control group.

Prompt prostate cancer diagnosis and treatment

Are you a man over the age of 50 years and would like to begin prostate cancer screening? Or are you having urinary issues and suspect you could be developing a prostate-related disorder?

At Advanced Urology Institute, we have assembled a skilled, experienced team of board-certified urologists to help diagnose and treat prostatic issues, including prostatitis, enlarged prostate and prostate cancer.

Our state-of-the art prostate cancer center is supplied with the latest equipment and technology to deliver prompt diagnosis and safe, effective treatment of prostatic problems. For more information on prostate cancer and other urologic disorders, visit the site AdvancedUrologyInstitute.com

A color-coded guide to urine

Normal urine has a yellow color, thanks to the pigment urochrome.  Urochrome is a yellow pigment formed when urobilinogen produced during the breakdown of hemoglobin is exposed to air. 

The pigment is specific to urine, but the intensity of its yellow color depends on the amount of water present in the urine. So generally normal urine can be straw-colored, yellow, or amber, depending on how dilute it is.

What color is abnormal?

Pale yellow to amber urine is normal. But the intensity of the color depends on whether it is dilute or concentrated.  Healthy urine may be clear or colorless if you drink a lot of water. But when you drink less, your urine becomes more concentrated and darker. That is why normal urine may appear honey or golden when you drink less water or are dehydrated.

Apart from fluid intake, several other factors determine the color of urine. For instance, urine color is affected by diet, vitamins, exercise, and medicines. A bright yellow pee color may be due to a high dose of vitamin B. 

When your pee color turns from the normal pale yellow to colors such as red, blue, brown, orange, or green, something may be wrong.  Of course, the usual causes of such changes may be diet, exercise, or medications, but these colors may also signal a serious health issue that requires urgent medical attention.

Here is a color-coded guide to urine appearance

  1. Clear urine

Clear urine indicates that you’re probably drinking more water than the daily recommended amount. Of course, being well-hydrated is good, but drinking too much can rob your body of some essential electrolytes.

If your urine is only occasionally clear, you shouldn’t be bothered. However, when it is always clear, then you should cut back on how much water you drink. 

Persistently clear urine even after reducing the volume of water you drink may indicate viral hepatitis or liver cirrhosis. Hence, if your urine is clear for a while and you’re not drinking large amounts of water, then you should see your doctor.

  1. Pink or red urine

Your urine can have a pink or red color after you eat foods with naturally deep pink or magenta colors, such as beets, rhubarb and blackberries. But certain medications may also give a red or pink color. For instance, medications like senna or senna-containing laxatives, phenazopyridine (Pyridium), and antibiotic Rifampin, can give a red or pink color to urine.

If you can rule out these foods and medications, then a red color indicates hematuria (blood in urine). Hematuria can be due to a range of health problems, such as kidney or bladder stones, urinary tract infections, an enlarged prostate, and tumors of the bladder and kidneys.

 Extreme exercise can also cause hematuria if it produces muscle damage, a condition called “runner’s bladder.”

  1. Light brown or orange urine

Urine can be orange when you are dehydrated. But your urine can also be light brown or orange when it has a high amount of blood due to urinary tract infection or bleeding from the bladder (especially in bladder cancer). 

Some medications, such as phenazopyridine (Pyridium), the anti-inflammatory drug sulfasalazine (Azulfidine), chemotherapy drugs, and some laxatives can equally cause urine to appear reddish-orange.

  1. Dark brown urine

If your urine looks like cola, it may be due to dehydration or to some foods, such as fava beans, aloe and rhubarb. Some medications, like laxatives, antibiotics, and muscle relaxants may also give urine a dark brown color.

When these are ruled out, then the dark brown color may be due to hepatitis, other liver disorder, or kidney malfunction, especially if you also have yellowing skin and eyes and pale stools.

  1. Blue or green urine

Food dyes can turn urine green or blue. For example, methylene blue dye found in many types of candy gives urine a bluish tinge. Also, some dyes used to test kidney or bladder function can turn urine blue. 

Besides, your urine may be blue or green due to medications, such as pain-relievers, anti-depressant drugs, urinary tract infections (green), or the rare inherited disorder called “blue diaper syndrome” that occurs in children.

When should you seek medical attention?

You should generally be proactive in seeking medical attention when your urine maintains an alarming color that gets your attention. Colors such as red or pink may be due to a serious health condition requiring urgent medical attention.

At Advanced Urology Institute, we work with our patients to ensure they appreciate the importance of a healthy urinary system on their overall health. For more information on the prevention, diagnosis and treatment of urologic disorders, visit our website “Advanced Urology Institute.”

Dr. Samuel Lawindy Talks About How to Treat Urge Incontinence in Women

KEY TAKEAWAYS:

  • Urge incontinence is a condition characterized by a strong, sudden uncontrollable urge to pass urine, which often results in urine leakage. It is often caused by dysfunction of the bladder or pelvic floor muscles due to factors such as pregnancy, childbirth, and hormonal changes around menopause.
  • The treatment for urge incontinence often involves a combination of medications, such as anticholinergics and beta adrenergics, and behavioral treatments like bladder training, pelvic muscle exercises, biofeedback, or urge suppression. If medications don’t work, minimally invasive procedures may be recommended.
  • At Advanced Urology Institute, prompt, reliable, and effective treatment is provided to patients suffering from urge incontinence, emphasizing that it is a treatable medical problem and should not be accepted as a normal part of aging.

At Advanced Urology Institute we see an increasingly high number of women presenting with urge incontinence. Urge incontinence is a condition where you are unable or have difficulty holding urine in your bladder long enough to reach the bathroom.  And so, it is characterized by a strong, sudden uncontrollable urge to pass urine, which often results in urine leakage.

What are the signs that a woman has urge incontinence?

  1. Urine leaks associated with a sudden compelling desire to pass urine
  2. Strong urge to urinate frequently
  3. Changing multiple incontinence pads through the day
  4. Awkward leaks of urine that cause embarrassment
  5. Organizing life and activities around bathroom locations when in new environment

What causes urge incontinence?

Even though up to 50-percent of women may have urge incontinence at some point in their lifetime, roughly 10-20 percent experience extremely bothersome urge-related urine leakage. 

Incontinence may occur as a separate condition, but in some women, it presents alongside other forms of incontinence due to an underlying medical condition. 

Urge incontinence is often caused by dysfunction of the bladder or pelvic floor muscles. 

Generally the dysfunction is due to:

  1. Pregnancy
  2. Childbirth
  3. Hormonal changes just before or after menopause

How is urge incontinence treated?

If you have persistent urge-related urine leaks, consider seeking a board certified urologist for a prompt diagnosis.  During your visit, the doctor will take your medical history and conduct a complete physical examination focused on your urinary system, reproductive organs and nervous system. The doctor will also order various tests which will likely include an analysis of your urine sample.

If urge incontinence is diagnosed, your doctor will prescribe medications to relax your bladder and pelvic muscles as a way of relieving the symptoms. The medications may be used alone or in combination with behavioral treatments, such as bladder training, pelvic muscle exercises, biofeedback, or urge suppression.

The two major classes of medications used for urge incontinence are: anticholinergics and beta adrenergics.  

The anticholinergic drugs include:

  • Darifenacin (Enablex)
  • Fesoterodine (Toviaz)
  • Oxybutynin (Ditropan, Oxytrol, Gelnique)
  • Solifenacin (VESIcare),
  • Tolterodine (Detrol),
  • Trospium (Sanctura). 

The beta adrenergic medications include:

  • Mirabegron (Myrbetriq)
  • Vibegron (Gemtesa)

Your doctor may also recommend vaginal estrogen (creams, pellets or rings) as a form of estrogen replacement therapy to help you if the incontinence is due to menopause, particularly if the incontinence occurs alongside vaginal atrophy (dryness).

If medications don’t work, your urologist may consider minimally invasive procedures. A procedure such as percutaneous tibial nerve stimulation, electrical stimulation, sacral neuro-modulation therapy (Interstim), or Botox bladder injection may be recommended.

Prompt, reliable and effective treatment

At Advanced Urology Institute, we encourage patients to believe that urine leakage does not have to be a normal part of aging.  Incontinence is a medical problem that can be treated effectively to reduce symptoms or eliminate the problem completely.  So we strongly insist that no woman should tolerate or endure this kind of discomfort, especially when it is bothersome and is affecting their quality of life.

If you’re struggling with embarrassing urine leakage, please get in touch with us to schedule your consultation and find out how we can help you. At AUI, we offer some of the latest and best interventions in treating urological disorders.  For more information on the diagnosis and treatment of urinary incontinence and other urologic disorders, visit the site “Advanced Urology Institute.”

TRANSCRIPTION:

So my name is Samuel Lawindy.
I’m a board certified urologist at Advanced Urology Institute.
So there is urgency and urgent incontinence for women.
That occurs when someone feels that they have the desire to go to the bathroom and they
can’t quite make it in time and then they’ll be leaking urine before they get there, wearing
multiple pads throughout the day, always aware of where the bathroom is and that commercial
everyone knows about got to go, go, go to the bathroom.
That’s urgent incontinence.
Very easily treated with medications and multiple different medications can be utilized.
If that doesn’t work, then there is some minimally invasive surgical procedures that can help you.

REFERENCES:

Can Dr. Samuel Lawindy provide treatment for large kidney stones?

KEY TAKEAWAYS:

  • Percutaneous nephrolithotomy or nephrolithotripsy (PCNL) is a specialized procedure designed to remove larger kidney stones (2 cm or bigger) or complex stones, where minimally invasive procedures such as ureteroscopy and shock wave lithotripsy are not effective.
  • PCNL is performed under general anesthesia with a tiny incision made in the back of the kidney, using ultrasound or fluoroscopy guidance, and involves breaking the stone into smaller fragments with a laser or ultrasound, which are then safely flushed out of the kidney.
  • While PCNL carries some risks, such as injury to nearby organs, infection, and bleeding, it is generally a safe and effective minimally invasive procedure that provides immediate relief from symptoms and fast recovery times.

 A kidney stone that is 2 cm or larger in size causes more severe symptoms. Unfortunately, for such a large stone, the usual minimally invasive procedures such as ureteroscopy and shock wave lithotripsy do not work.

So you’ll need a more specialized procedure called percutaneous nephrolithotomy or nephrolithotripsy (PNCL).

PCNL is a surgical technique designed to remove kidney stones located in the kidney or upper ureter, where shock wave lithotripsy or ureteroscopy are not effective. Also, it is the ideal procedure for stones that are too large.

How is PCNL performed?

With percutaneous nephrolithotomy or nephrolithotripsy, a tiny incision is made through the back of the kidney directly to where the stone is.  To gain access to the exact location of the stone in the kidney or upper ureter, the surgeon relies on the guidance of ultrasound or fluoroscopy.

Once the stone is reached, the surgeon uses a power source, such as laser or ultrasound, to break the stone into smaller fragments. The resulting smaller pieces are safely flushed out of the kidney through an external tube or an internal stent.

Typically, your surgeon passes a nephroscope—a miniature fiber-optic camera—together with other small instruments through the incision and into the kidney area where the stone is located. These instruments allow the surgeon to see the stone and to then use high frequency sound waves to break it.

If the resulting pieces of the stone are removed via the tube, the procedure is called percutaneous nephrolithotomy (PCNL). But if the stone is broken up and removed by other means, the procedure is called percutaneous nephrolithotripsy (PCNL).

Depending on the position of the stone in the kidney, the surgeon will take 20 to 45 minutes to complete the procedure. The goal of the procedure is to remove all of the stone, so that no pieces are left to pass through your urinary tract.

When is PCNL recommended?

Percutaneous nephrolithotripsy or nephrolithotomy is used for:

  1. Larger stones, 2 cm in diameter or bigger
  2. Complex stones
  3. Lower pole renal stones, larger than 1 cm
  4. Irregularly shaped stones
  5. Removing kidney stones in people with infections
  6. Stones that have not broken up enough by SWL (extracorporeal shock wave lithotripsy)
  7. Kidney stones in individuals who are not candidates for ureteroscopy

Is the procedure safe?

Percutaneous nephrolithotomy does have risks but is generally a safe, effective minimally invasive procedure. Most often, it successfully removes larger kidney stones and results in immediate relief of symptoms.

During PCNL, a hole is created in the kidney that should eventually heal without other forms of treatment. However, since the procedure is done around the back or abdomen, it comes with a small risk of injury to other nearby organs, like the ureter, bladder, liver, or bowel. 

Also, like other surgical operations, PCNL comes with some risk of infection and bleeding. And because all surgeries on the kidney have a relatively rare long-term risk of high blood pressure or reduced kidney function later in life, the procedure carries these risks and should be conducted by an experienced, specially trained urologist.

What is the recovery like after PCNL?

Percutaneous nephrolithotomy is done under general anesthesia. So after the procedure, you will need a short stay in hospital to be monitored before you can go home. 

Often, an overnight stay in the hospital after the surgery is enough and you can go home the very next day. Recovery is fast and generally smooth. You should be off work for just a week. 

Safe, successful PCNL

At Advanced Urology Institute, we consider percutaneous nephrolithotomy one of the most effective techniques for stones larger than 2 cm in diameter. From our experience, patients leave the hospital stone-free after the procedure and are usually completely freed from any stone-related symptoms.

At Advanced Urologist Institute, we have a talented and skilled pool of urologists that perform the procedure frequently. For more information on the diagnosis and treatment of kidney stones, visit the site “Advanced Urology Institute.”

TRANSCRIPTION:

So my name is Samuel Lawindy, I’m a board certified urologist at Advanced Urology Institute.

So if you have a large stone in the kidney, usually two centimeters or larger, minimally invasive procedures such as a ureteroscopy or shockwave will not work.

So a PCNL or long term is percutaneous nephrolithotripsy would work very well for that.

That is where the procedure goes through the back of the kidney, directly to where the stone is and we can break it up and pull those pieces out safely and it’s a one night overnight stay at the hospital and you go home the very next day and usually patients tolerate it very well.

It’s a good option for patients who have that stone, it’s important to recognize that it is done here and does not require a tertiary care center, we do take care of it here at this facility.

 REFERENCES:

When do you need a PSA test?

The prostate-specific antigen (PSA) test is a blood test performed to screen for prostate cancer. It measures the level of PSA in blood—a protein made only in the prostate gland. After production in the prostate, the PSA finds its way into blood. But the level of PSA in blood depends on age and on the health of the prostate.

What is the normal level of the PSA in blood?

The amount of PSA in blood is measured in nanograms per milliliter of blood (ng/ml).  For men aged 40 to 50 years, a PSA level above 2.5 nanograms per milliliter is considered abnormal. The normal range for men of this age is usually 0.6 to 0.7 nanograms per milliliter. 

And for men aged 50 to 70 years, a PSA score greater than 4.0 nanograms per milliliter is considered abnormal.  The normal PSA range for men in this age is 1.0 to 1.5 nanograms per milliliter.

Besides, any rapid increase or a continuous rise in PSA level over a period of time is considered abnormal. For instance, a rise of more 0.35 nanograms per milliliter of blood within one year is abnormal. 

Nevertheless, not every increased PSA level is an indicator of prostate cancer. In fact, 3 in 4 men with elevated PSA do not have the cancer. Apart from prostate cancer, an elevated PSA level in your blood may be due to prostatitis, an enlarged prostate, and urinary tract infection.

So when should you get screened for prostate cancer?

The time to begin having PSA tests depends on a number of factors. According to new guidelines, men with no family history or known illness should undergo the PSA test starting from age 54 to 70 years. The reason for this is that it is at this age that they can benefit the most from screening. 

It is from the age of 54 to 70 when:

  1. You are more likely to develop prostate cancer.
  2. Treatment of diagnosed prostate cancer makes most sense—the benefits of treating the cancer outweigh any possible risks of treating side effects.

However, there are some men who may need screening earlier, between the ages of 40 and 54 years. Your doctor may recommend that you get screened this early if you:

  1. Have a positive family history of prostate cancer. That is if you have at least one first-degree relative, like a brother or father, who has had the cancer.
  2. Have at least two extended family members who have had prostate cancer.
  3. Are African-American; an ethnicity that has a higher risk of developing a more aggressive form of prostate cancer. 

But for men who are 70 years or older, taking the PSA test is not usually recommended. That’s because the benefits of treatment may not outweigh the adverse effects. Also, the cancer may not grow or spread to a life-threatening stage in the patient’s lifetime. Though, men above 70 years may undergo the PSA test if they have a life-expectancy greater than 10 years.

Choosing to get the PSA test

As you grow older, your risk of having prostate cancer increases. Hence, you will need to undergo screening to help you detect the cancer early should you have it. For most men, it is recommended that they undergo regular PSA tests after the age of 54 years.

However, you should ask your doctor for advice on when to start having screening tests and how frequently you should be screened. If you are 54 years or older, your doctor may advise that you have a PSA test every 2-3 years. The doctor will also explain to you the harms and benefits of screening for prostate cancer.

What next after an abnormal PSA test?

If your PSA level falls in the abnormal range, your doctor may make the following recommendations:

  1. Repeat the PSA test. If the level is still higher after the repeat, your doctor may recommend monitoring the PSA level over a period of time to see how it changes.
  2. A digital rectal examination to feel for the changes in your prostate gland that may help to detect prostate cancer.
  3. A biopsy, which involves taking small samples from the prostate and checking them for cancer cells.

If it is confirmed that you have prostate cancer, your doctor will want to know whether the cancer is indolent or aggressive. An indolent cancer is slow-growing and has only a minimal chance of spreading to other organs.  With such a cancer, you may not be treated, but may be placed under watchful waiting and active surveillance.

An aggressive cancer grows rapidly and has the potential to spread to other parts of the body. Your doctor will consider your age and other factors when weighing the risks and benefits of treatment.  Eventually, you’ll undergo a personalized treatment that may include radiotherapy and radical prostatectomy.

Do you have fears that you may be at risk for prostate cancer? Would you like to speak with a knowledgeable, experienced urologist to know your risk level and when to begin your prostate cancer screening? Contact Advanced Urology Institute today to book your consultation session with a urologist who will give you the best possible advice. For more information on prostate cancer screening, diagnosis and treatment, visit the site “Advanced Urology institute.”

BPH Enlarged Prostate Symptoms & Treatment

Benign prostatic hyperplasia (BPH) is a non-cancerous increase in the size of the prostate gland and surrounding tissue. As the gland enlarges, it squeezes the urethra and causes the bladder wall to become thicker. Over time, the bladder muscles weaken and the bladder loses the ability to empty fully, resulting in urinary symptoms.

The most common complaints in people with BPH include:

  1. Difficulty starting urination
  2. Having to strain or push in order to pass urine
  3. Weak stream due to a weak urine flow
  4. Dribbling at the end of urination
  5. Urgent or frequent need to urinate
  6. Nocturia—increased urinary frequency at night
  7. Intermittency—the need to stop and start many times when passing urine

In some men, rare symptoms may occur, including:

  1. Inability to urinate
  2. Blood in urine
  3. Urinary tract infections

The size of the enlarged prostate gland does not determine the severity of the symptoms. Actually, some men with only a slightly enlarged prostate have significant symptoms while others with a massive enlargement have only minor urinary symptoms. Plus, in some men, symptoms tend to stabilize and even improve with time.

Besides, an enlarged prostate shares urinary symptoms with a number of conditions, including:

  1. Inflammation of the prostate (prostatitis)
  2. Narrowing of the urethra (urethral stricture)
  3. Urinary tract infection
  4. Kidney or bladder stones
  5. Problems with nerves controlling the bladder
  6. Scarred bladder neck after surgery
  7. Bladder or prostate cancer

Therefore, it is advisable that you see a urologist as soon as possible if you are having persistent urinary symptoms. Regardless of whether the urinary symptoms are bothersome or not, seeing a doctor will help to identify or rule out any underlying causes. 

How is benign prostatic hyperplasia treated?

When your urologist is certain that you have benign prostatic hyperplasia, you’re typically started on an alpha blocker—a medication that relaxes your bladder neck muscles and the muscle fibers in the prostate, making urination easier.  

Commonly prescribed alpha blockers include alfuzosin (Uroxatral), tamsulosin (Flomax), doxazosin (Cardura), and silodosin (Rapaflo).  For men with only slightly enlarged prostates, alpha blockers work really quickly and relieve urinary symptoms effectively.

Another option is to prescribe medication that can shrink the prostate by preventing hormonal changes behind prostate enlargement. The medications, called 5-alpha reductase inhibitors, such as Finasteride (Proscar) and Dutasteride (Avodart), can shrink the prostate by as much as 50-percent over a period of six months. You can rely on these drugs to relieve urinary symptoms within a few weeks of usage.

In some cases, your doctor may opt for a combined therapy using an alpha blocker together with a 5-alpha reductase inhibitor. This is done if either medication isn’t effective when used alone.

If your symptoms fail to respond to these medications, your doctor may recommend a minimally invasive surgical procedure. Such a procedure may also be necessary if your symptoms are severe or if you have a urinary obstruction, bladder stones or kidney problem.

Some procedures your doctor may consider include:

  1. Transurethral resection of the prostate (TURP)

This is a minimally invasive procedure that involves inserting a lighted scope into the urethra and using it to guide the removal of all but the outer part of the prostate.

  1. Transurethral incision of the prostate (TUIP)

Just like TURP, this procedure involves inserting a lighted scope into the prostate. The difference is that during TUIP, the surgeon makes 1-2 small incisions in the prostate gland, which enable urine to pass through the urethra.

  1. Transurethral microwave thermotherapy (TUMT)

As opposed to using a lighted scope, this procedure uses a special electrode inserted through the urethra into the prostate. The electrode provides microwave energy that is directed to the inner portion of the enlarged prostate. As a result, the prostate shrinks and urine flow improves.

  1. Transurethral needle ablation (TUNA)

This is another minimally invasive procedure that involves passing a scope into the urethra to allow the surgeon to place needles into the prostate gland. Radio waves are directed through the needles, which help to heat up and destroy excess prostate tissue.

  1. Laser therapy

During this procedure, high-energy laser is used to remove or destroy overgrown prostate tissue. It is preferred in men who are taking blood-thinning medications and who shouldn’t undergo the other minimally-invasive prostate procedures stated above.

  1. Prostate urethral lift (PUL)

This is a minimally invasive procedure that involves using special tags to compress the sides of the prostate in order to enhance urine flow. It is recommended in men who are wary about the impact of treatment on erectile and ejaculatory function. Prostate urethral lift causes minimal adverse effects on ejaculation and sexual function compared with TURP, TUIP, TUMT, and TUNA.

  1. Robot assisted prostatectomy

As a last resort or in cases where the prostate is too much enlarged, the bladder is damaged or there are other complicating factors, the surgeon may opt for da Vinci robot-assisted prostatectomy. The procedure involves making an incision in the lower abdomen to reach the prostate gland, which is then removed.

Reliable, unbeatable care

Are you 50 years or above and are having a frequent urge to urinate, a weak urine stream, leakage or dribbling of urine, or trouble beginning urination? You may be having benign prostatic hyperplasia.

At Advanced Urology Institute, we offer safe, timely and reliable diagnosis and treatment of BPH. Our urologists are skilled in doing physical examination, patient history, symptom evaluation, and ordering tests that form the basis for diagnosing the condition and ruling out other problems, including prostate cancer.

We also make sure that our patients understand the full range of treatment options available to them, and guide them on making an informed decision and on pursuing the treatment that is best for their individual medical situation. For more information on benign prostatic hyperplasia diagnosis and treatment, visit the site “Advanced Urology Institute.”

Can you still have an orgasm after vasectomy?

Rest assured, in virtually every case, you will have normal orgasms after a vasectomy. And you’ll also continue to ejaculate during those orgasms. 

A vasectomy is specifically surgically elected to stop sperm from being part of the ejaculate in order to prevent pregnancy. But in all other respects, it doesn’t change anything about sexual function.  It doesn’t stop you from ejaculating during sexual intercourse or masturbation. Neither does it stop you from achieving orgasms.

How does a vasectomy work?

The vasectomy procedure involves either cutting or blocking off two sperm-carrying tubes called the vas deferens that lead directly from the testicles. This procedure disrupts the flow of sperm to the penis during sexual activity preventing sperm cells from leaving the body. 

But having a vasectomy doesn’t stop your body from working normally. Your testicles will continue to produce sperm as usual. And your prostate gland and seminal vesicles will continue to produce semen. The only difference is that the sperm will no longer mix with the semen.

After a vasectomy, the sperm produced by the testicles doesn’t leave the body. Neither are the cells stored in your body. Instead, the sperm cells are broken down and reabsorbed by your body with no adverse effect on your sexual desire, erections, and performance.

Even without a vasectomy, sperm is usually produced and reabsorbed if they don’t leave the body during sexual intercourse or masturbation. So the process is normal and natural and has no effect on your sexual drive or performance.

No noticeable change in the ejaculate

Since your prostate gland and seminal vesicles will continue to produce the fluid that is predominant in your ejaculate, you’ll still have unaltered orgasms and unchanged ejaculations. The reason for this is that a typical ejaculate before a vasectomy is 95-99 percent semen and only 1-5 percent sperm. 

So when sperm is stopped from being part of the ejaculate, there is no significant reduction in the volume, quality or other characteristics of the ejaculate other than the absence of sperm.  You’ll still produce more or less the same quantity of fluid during orgasm with the same amount and texture of semen.

No effect on testosterone

A vasectomy has no effect on your ability to produce the male sex hormone testosterone. Once testosterone is produced in your testicles the hormone is transported through your body via the bloodstream. Since a vasectomy doesn’t change the flow of blood from your testicles to the rest of the body it won’t affect your testosterone levels.

So the good news is that a vasectomy will not affect your sexual performance. Sex will be the same as before but without the risk of making your partner pregnant. 

After a vasectomy, your sex drive and ability remains intact and there is no change in your erections or on the feeling and sensation you have during ejaculation. In fact, neither you nor your partner will notice a change in the ejaculate and in the orgasms.

No effect on muscle contractions

Orgasms are usually associated with a series of intense muscle contractions. Since a vasectomy does not interfere with the pelvic and sphincter muscles that contract during orgasm, you’ll still reach powerful and pleasurable orgasms. Plus, the procedure doesn’t interfere with the nerve impulses received from the penis.

Safe and secure vasectomy

Are you looking for a safe and permanent form of contraception? At Advanced Urology Institute, we offer vasectomies for men interested in the highest and most reliable form of birth control. 

All vasectomies are completed on an outpatient basis with the procedure taking 20-30 minutes. Afterward, expect to go home and rest for about 48 hours, then engage in lighter activities for the next 7 days followed by going back to your routine after a week.

We are proud that our vasectomy procedure:

  1. Is 99.99 percent effective in helping you prevent pregnancy
  2. Has no long-term effects on your health
  3. Does not affect your hormone levels, sex drive, erections, ejaculations, and orgasms
  4. Does not interfere with sex or the spontaneity of sex
  5. Gives you a simpler, safer and more reliable alternative to female sterilization

We also provide vasectomy reversals. 

For more information on vasectomy and vasectomy reversals, visit the site “Advanced Urology Institute.”

What is the primary symptom of bladder cancer?

Blood in the urine is the primary symptom of bladder cancer.  In fact, 8 in 10 people with bladder cancer will have blood in their urine, a condition doctors call hematuria. 

Generally, if you have visible blood in the urine there is an elevated chance that bladder cancer might be a concern. 

Non-specific sign of bladder cancer

Blood in the urine is the most common but not a very specific sign of bladder cancer. Blood in your urine could suggest common conditions such as urinary tract infection, benign (non-cancerous) tumors, kidney stones, or other benign kidney diseases.

So it’s important you tell your doctor if there is blood in your urine so that other conditions can be ruled out. 

What is the color of urine when there is bladder cancer?

Due to the presence of blood, urine can be rusty or deep red in color. In some cases, the urine may be dark brown. 

However, when the blood in urine is microscopic, it may not be detectable to the naked eyes so a urine test will be essential as a first order diagnostic tool. 

Bladder cancer and its symptoms can be subtle and oftentimes there’s little to no pain initially. 

As your bladder cancer progresses, you may experience the following:

  1. Urinate more often than usual (urinary frequency)
  2. Pain or burning sensation during urination
  3. Uncontrollable urge to urinate (urinary urgency)
  4. Pain in your pelvis or lower back
  5. Difficulty beginning urination (urinary hesitancy)
  6. Getting up several times at night to urinate
  7. Weak urine stream or trouble urinating

These symptoms may also be caused by other conditions, such as bladder stones, urinary tract infection (UTI), an overactive bladder, or an enlarged prostate (in men). You’ll need to have the symptoms checked by your doctor so that the cause can be found and treated.

What are the signs of advanced bladder cancer?

When bladder cancer has grown larger or has spread to other parts of the body, it can cause other more severe symptoms.  

Some of the symptoms include:

  1. Pain in the side or lower back
  2. Being unable to pass urine
  3. Feeling weak or tired
  4. Swelling in the feet
  5. Bone pain
  6. Weight loss
  7. Loss of appetite

Again, many of these symptoms can be caused by other conditions. So it is important that you get checked by your doctor.  If your doctor suspects that you have bladder cancer, the physician will order more specific tests and exams to confirm the cancer. 

At Advanced Urology Institute, we offer diagnostic and treatment services for bladder cancer. 

For more information on the diagnosis and treatment of bladder cancer, visit our website AdvancedUrologyInstitute.com

How long does radiation treatment take?

Key takeaways

  • Radiotherapy is a cancer treatment that uses high doses of radiation to destroy cancerous tumor cells. It can be administered externally or internally, and the length of treatment depends on the type, location, and characteristics of the tumor.
  • External radiotherapy is typically given daily, from Monday to Friday, for five to eight weeks, with breaks on the weekends to allow healthy cells to recover. The length of treatment may vary depending on the specific tumor and the location.
  • External radiotherapy is a painless process that typically takes 30-45 minutes, including set-up time, but the actual treatment only takes 2-5 minutes. The patient lies on a treatment table and is positioned under the radiation machine while special shields or blocks are used to protect healthy tissues.

Radiation therapy delivers controlled, safe and effective doses of radiation to cancerous tumors. The tumor cells are exposed to high doses of radiation that destroy their genetic material and eventually damage or kill them. Hence the cancer can no longer grow, multiply or spread after the treatment. Though the radiation affects all the cells, healthy ones are able to recover fully from the effects of the treatment.

Radiotherapy is generally administered either externally or internally. During external radiation therapy—the most common form of the treatment—a machine is used to direct high-energy rays at the cancer. In contrast, internal radiotherapy (also called brachytherapy) uses a radioactive source that is temporarily or permanently implanted directly into the cancerous area.

So how long does the radiation therapy take?

The exact duration of the treatment depends on the type, characteristics, and location of the tumor.  The length of treatment also depends on the dosage to be delivered, the number of fractions to be given, the treatment plan created by the radiation oncologist, and whether it is external or internal radiotherapy.

For example, if you have a deeper tumor, then you may require a more-focused beam delivered for a shorter period of time. But if you have a larger, shallow tumor, then you may need treatment for a longer period.

Equally, since the radiation must be given in a way that has minimal adverse effects on healthy cells, a shorter length of exposure is necessary if the tumor is located in more delicate organ (like the brain) or is in close proximity to very sensitive body tissues.

Your radiation oncologist will assess your tumor and make the necessary prescription. Then, by working with your radiation oncology team, the oncologist will determine how best to deliver the prescribed dosage, how many treatments are necessary, and how long it should take.

Next, your radiation oncologist will oversee the simulation of treatment to ensure that appropriate dose is given to the right location and that as little as possible reaches normal tissue. The simulation is followed by the testing of the delivery set-up to check the performance and positioning of the equipment to be used to give the treatment. After that, your treatment visits begin with the radiation therapist in charge of administering the daily fractions.

How long does external radiation therapy take?

External radiotherapy is typically delivered daily, from Monday through Friday, for five to eight weeks. Weekend breaks are factored into the treatment schedule to allow healthy cells to recover. Each treatment is offered on an outpatient basis.

But there are exceptions to this schedule.  Some tumors may require treatment for less than five days per week and only need treatment for one to two weeks. Specifically, shorter durations of two or three weeks in length are commonly used in palliative care—the use of radiation to relieve cancer symptoms. Still other tumors, such as certain brain cancers, may require just a single treatment.

External radiation therapy is a painless process and is almost like having a regular x-ray. You’ll be in a room for 30-45 minutes because of the time it takes to set up equipment and place you in the correct position, but the actual treatment takes 2-5 minutes.

Once in the room, you’ll lie on the treatment table. You’ll then be positioned under the radiation machine. Your radiation therapist will place special shields or blocks between the machine and other parts of your body to protect normal tissues. Thereafter, you’re expected to remain still, though you don’t have to hold your breath.

After you’re in the correct position, your radiation therapist will move into a separate, nearby room to turn on the machine and begin the actual treatment. The therapist will watch you on a monitor and you’ll be able to communicate with the therapist through an intercom.

How long does internal radiation therapy take?

Brachytherapy uses radiation implanted inside the body to treat cancer. The radiation implant is placed as close as possible to the tumor in order to concentrate the radiation on the cancer cells and minimize radiation damage on normal tissue around the tumor.  The radioactive material is sealed in a thin wire or hollow tube (catheter) and implanted directly into the cancer affected area on a temporary or permanent basis.

Internal radiation therapy is used when the oncologist decides that the best way to treat the tumor is to expose it to a higher radiation dose. The radioactive implant is closer to the cancerous cells and delivers a higher dose over a shorter period of time. The treatment is ideal for several types of cancers, including breast cancer, brain tumor, gynecological cancer (like ovarian and cervical cancer), lung cancer, and head and neck cancer.

The time taken for brachytherapy and whether it is done on an inpatient or outpatient basis depends on the type of therapy used and the nature of the cancer. In some cases, internal radiotherapy can be completed within three to five outpatient treatments of a few minutes each. But in other cases, the radioactive implant may be left in place for up to a week and there is need for a hospital stay during that period.

Finishing your radiation therapy sessions

It is important to finish all sessions of radiotherapy. And never to miss or delay treatments because this may reduce the effectiveness of the radiation in killing the tumor cells.

You should remember that your doctors are not just bothering you with making several hospital visits. There is need for different sessions because radiation is destructive and should not be delivered all at ago. In fact, if the recommended dosage was to be given once, it would pose a greater risk to healthy tissues and produce more adverse effects.

At Advanced Urology Institute, we spend the necessary time, effort and expertise to design a detailed treatment plan for radiation therapy. We offer the treatment in conjunction with other therapies and with the help of experienced oncologists and a multidisciplinary cancer care team.

We are also committed to reducing the time our patients take in treatment and often implement maximized aggressive treatments when necessary. Contact us today to learn whether radiotherapy is right for you and the various options available for you. For more information, visit the site “Advanced Urology Institute.”

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