Cancer, Bladder
1. What is Bladder Cancer?
Bladder cancer is the sixth most common cancer in the United States. It is cancer
of the bladder. The cancer may be only in the lining of the bladder, or more extensive
would be in the muscular wall of the bladder. The most aggressive type of bladder
cancer may grow through the bladder wall and spread to nearby organs. Bladder cancer is
more common among whites and men and usually occurs among people in their 60's.
There are a number of risk factors that are attributed to bladder cancer.
Here are the most common risk factors:
- Smoking
- Industrial chemicals
- Chronic bladder inflammation
2. What are the signs and symptoms of Bladder Cancer?
Bladder cancer often doesn't produce signs or symptoms in its early stages.
The first warning sign is usually blood in the urine. However, signs and symptoms
of bladder cancer may be:
- Blood in urine
- Pelvic Pain
- Frequent urination
- Sensation for the need to urinate without results
- Slowing of the urinary stream
These signs and symptoms are the same as other diseases, so you should see
your physician.
3. How is Bladder Cancer diagnosed?
The physician will ask for a medical history and perform a physical exam.
In addition, a urine sample will be examined, and possibly sent on to a laboratory
for the testing of blood cells and cancer cells. An intravenous pyelography (IVP)
will be ordered, and a cystoscopic procedure will be performed. The cystoscopy will
enable the urologist to look inside the bladder and perform a biopsy.
4. How is Bladder Cancer treated?
Treatment for bladder cancer is dependent upon the degree of the cancer. For very
superficial cancer, i.e. just the lining of the bladder, biological therapy would be used.
- Biological Therapy- is a form of treatment that uses the body's natural ability to
fight cancer. Biological therapy may be used alone or after surgery to help prevent the
cancer from recurring. This treatment consists of placing a solution into the bladder.
The bladder is stimulates the immune system. The medicine stays in the bladder for about
2 hours before the patient is allowed to empty their bladder. The treatment is continued
for approximately 6 weeks, once a week.
- Surgery- There are basically two types of surgery for bladder cancer. The less extensive,
is where the physician will burn away the cancer cells. The patient will be done on an outpatient
bases for the most part, with anesthesia.
There is also the surgery to remove the bladder
called a Cystectomy. This surgery may be done when the bladder cancer invades the muscle wall.
- Chemotherapy
- Radiation Therapy
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Cancer, Kidney
1. What is Kidney Cancer?
The majority of kidney cancers are of the type known as renal cell carcinoma, which are
the "meat" of the kidney, rather than the drainage system of the kidney. A number of the
kidney cancers have a heredity influence associated with diseases such as von Hippel-Lindau,
adult polycystic kidney disease, tuberous sclerosis and a few others. Men are twice as likely
to have kidney cancer than women.
2. What are the symptoms?
- Blood in urine
- Pain
- Mass
- Fever
- Weight loss
- Hypertension
- Varicocele ( Abnormal dilation of the veins of the spermatic cord)
3. How is Kidney Cancer diagnosed?
The most common way to diagnose kidney cancer is with contrast studies such as intravenous
pyelogram (IVP) and CT scans. The diagnosis can also be made with a renal ultrasound. The MRI
is a useful diagnostic test that may also be used.
4. What are the treatments for Kidney Cancer?
Treatment options are almost exclusively surgical, the removal of the entire or partially
affected kidney.
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Cancer, Prostate
1. What is Prostate Cancer?
Prostate cancer begins inside the prostate and may grow to involve the entire gland and
then spread outside the gland. Cancer of the prostate is the second most common cancer in
men, after skin cancer. It is the second leading cause of cancer deaths in men, after lung
cancer.
2. Who is at higher risk?
Prostate cancer is the most common type of cancer found in American men. Here are some
facts that may increase the risk of prostate cancer:
- Prostate cancer is most likely to develop after the age of 55, with the highest incidence
after age 65.
- African-American men have the highest rate of prostate cancer.
- Family history (father, brother, uncle) of prostate cancer increase one's risk.
- Exposure to cadmium in the workplace (welding, battery making, electroplating) increases
one's risk for prostate cancer.
The cause of prostate cancer is unknown.
3. What are the symptoms of Prostate Cancer?
In its earliest stage, prostate cancer may produce no signs or symptoms. As the tumor grows,
certain signs or symptoms may be noticed,
including:
- Difficulty starting or stopping urinating
- Decreased strength of urinary stream
- Dribbling at the end of urination
- Painful or burning urination
- Frequent urination, especially at night
- Painful ejaculation
- Blood in the urine
- An inability to urinate
- Continuing pain in the lower back, pelvis, or upper thigh
4. Is early detection important?
As with many types of cancer, early detection and treatment of prostate cancer increase
the chance of a cure. The five-year survival rate for prostate cancer patients whose cancers
are discovered while in a localized stage (cancer remains in a contained area of the prostate)
is 85%.
Cancer of the prostate is often a slow-growing type of cancer. When it develops very late
in life, as is frequently the case, the impact of the disease is often minimal. In fact,
many men with prostate cancer eventually die of causes unrelated to the prostate cancer itself.
5. How is Prostate Cancer diagnosed?
The only way to determine whether or not a suspicious lump or an elevated
prostate specific antigen (PSA) is associated with prostate cancer is to
microscopically examine a sample of tissue taken from the prostate. This tissue
sample may be removed by a needle placed directly in the prostate gland. Laboratory
tests and bone scans may be useful in determining the extent of the disease.
6. How is Prostate Cancer treated?
Treatment of prostate cancer is highly individualized. Many factors must be
considered before a physician recommends a course of action. These factors include
the severity of the cancer; the patient's general health and medical history;
anticipated side effects the patient may experience from various treatments; the
patient's age and expected life span.
Surgery:
Radical Prostatectomy- This surgery is considered the preferred choice of therapy
for localized disease and in theory, if the cancer is completely confined, then
surgically removing the prostate should result in a cure. There are limitations to
surgery and its ability to cure the patient of cancer, which are related to the severity
and aggressiveness of the cancer.
The side effects of prostate removal are usually temporary, but in some cases can
be permanent. They may include impotence (The inability to have or maintain an erection.)
and urinary incontinence (The inability to control urinary function.).
Brachytherapy/Seed Implants- This is another surgical option for the treatment of
prostate cancer. A urologist works with an oncologist to implant radioactive seeds
into the prostate to stop or slow the growth of cancer cells. This treatment is still
considered experimental.
If your urologist feels surgery is not the best option for your care, there are
alternative choices.
Non-Surgical Therapies:
Radiation Therapy- Patients who elect to have some form of radiation therapy
which is intended to cure their prostate cancer should have cancer that is confined
to the prostate and/or the surrounding tissues. So-called "definitive" radiation
therapy is delivered using an external beam of x-rays carefully directed to the areas
of the pelvis that includes the prostate.
Like surgery, all forms of radiation therapy have complications including inflammation
of the bladder, rectum and intestines. In addition, many radiation therapy patients
have side effects like urinary and sexual problems.
Hormone Therapies- This therapy is primarily used to treat patients who have prostate
cancer which is not confined to the prostate or a recurrence of cancer. It is not
curative. The intent of hormone therapy is first to delay the progression of the
cancer and second, increase the patient's survival while improving his quality
of life. There are an increasing number of options available as methods for
implementing hormone therapy. These are as follows:
- The surgical removal of the testes to prevent the production of testosterone.
- The use of various hormonally active drugs called LHRH agonists. These drugs
lower the levels of testosterone in the bloodstream.
- The use of "antiandrogens" to suppress the activity of a male hormone
known as dihydrotestosterone.
- The use of other techniques or drugs to suppress the hormones made by the
adrenal gland.
- The combined use of LHRH agonists and antiandrogens.
- Use of hormonal therapy prior to surgery or radiation therapy.
The important factors in choosing a particular form of hormone therapy
can include the cost of the treatment, the effectiveness and safety of the
various treatment options, and the patient's quality of life.
Cryotherapy: This is an old technique that is having a come back due to
the advances in technical capability. Cryotherapy is a method of freezing
the prostate and other appropriate nearby tissues to extremely low temperatures
with liquid nitrogen. This technique is designed to kill all prostate cancer
tissue without having to take the risks involved in carrying out surgery.
While cryotherapy is certainly an interesting and potentially important
addition to the options which physicians can offer patients with prostate
cancer, it should still be considered an experimental technique at this
time, and used mostly as salvage treatment for recurrence.
The known side effects of cryotherapy can include impotence, scarring of
the urethra and urinary system, and irritation of the bladder, the urethra,
the rectal wall and the genitalia. This last group of side effects can
include pain on urination, a burning sensation during urination, frequent
and unexpected urination, blood in the urine, and swelling of the penis
or the scrotum.
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Cancer, Testicular
1. What is Testicular Cancer?
Testicular cancer is cancer of the testes. Usually only one testicle is
involved. The risk factors associated with testicular cancer are as follows:
- Undescended testicles in infants and young children.
- An identical twin with testicular cancer or family history of testicular cancer.
- Atrophy of testicles due to mumps or viral infection.
2. How is Testicular Cancer diagnosed?
The best way to diagnose testicular cancer is through self-examinations.
The first finding is usually a painless lump in or on the testis, a
hardness or enlargement of the testis. Less commonly there is associated
pain and tenderness. Upon seeing the urologist, the urologist will usually
order a testicular ultrasound.
3. How is Testicular Cancer treated?
After the diagnosis of a solid testicular mass has been made, the
initial management is to remove the testis and its associated cord, an
orchiectomy. Depending on the type of cancer cells that are present,
other therapies such as additional surgery, radiation therapy or possible
chemotherapy may be indicated.
Using a combination of these therapies, testicular cancer has one of the
highest cure rates of all cancers. Cures from testicular cancer can even
be achieved in individuals who have had it spread into other parts of
the body.
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Enlarged Prostate (BPH)
1. What is Benign Prostatic Hyperplasia (BPH)?
As men get older, the prostate gland commonly enlarges. This enlargement
is called Benign Prostatic Hyperplasia (BPH). Occasionally, this enlargement
may represent cancer but usually is related to a benign, non-cancerous,
growth. BPH is the most common benign tumor in men and is responsible for
some urinary symptoms in most men over the age of 50.
2. What are the symptoms of BPH?
- Hesitancy upon the start of urination
- Weak stream while urinating
- The sensation of not completely emptying the bladder
- Stopping and starting while urinating
- Frequent urination
- Frequent nighttime urination
- Urgency to urinate
- In extreme cases, the inability to urinate at all
3. What are the causes of BPH?
As men get older, the prostate gland routinely enlarges and therefore can
constrict the passage of urine coming out of the bladder to the penis. This
may cause difficulty voiding and the other symptoms of BPH.
4. How is BPH diagnosed?
Your physician may ask you questions about how you void or to fill out a
questionnaire to help evaluate the severity of your symptoms. Some additional
tests may be ordered to see if you have an obstruction. A rectal examination
and a blood test to check for prostate cancer will most likely be done on the
initial visit to the urologist.
5. How is BPH treated?
The urologist will consider the best option for the individual patient.
Medications can be prescribed to help alleviate the symptoms of BPH. However,
there are surgical options for BPH.
The "standard" treatment is the Transurethral Resection of the Prostate (TURP).
This procedure has been done for years. It involves inserting a scope into
the urethra (the tube inside of the penis) and surgically removing a portion
of the obstructing prostate tissue.
In recent years, several alternative surgical techniques have been developed
which employ laser, special tools or microwave therapies. The laser procedure
although effective in certain cases, is still not covered by several insurance
companies. With the laser therapy, the physician uses a cystoscope to view
the prostate. Then the laser tip is inserted into the prostate to destroy
a precise area of the enlarged gland. The tissue that is destroyed is absorbed
naturally by the body, decreasing the symptoms of BPH. The microwave therapy
is a less effective alternative, but most insurance companies are starting
to pay for this therapy. It works about the same as the laser, by increasing
the temperature of the prostate to destroy the enlarged gland. It is not as
precise.
Individuals should not suffer with BPH. There are many options available,
and certainly each patient's needs may be met in choosing one of the alternatives.
It is important to be evaluated by an urologist in order to make the right choice.
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Epididymitis
1. What is Epididymitis?
Epididymitis is an inflammation or infection of the epididymis.
The epididymis is the structure of tubes that transport sperm from the
testicle. These tubes merge to form the vas deferens. The vas deferens
is the tube that is cut during a vasectomy to prevent pregnancy.
2. What are the symptoms of Epididymitis?
- Discomfort in the region of the testicle.
- Swelling
- Firmness
3. How do you diagnosed Epididymitis?
The physician will do a testicular exam, and possibly a scrotal
ultrasound.
4. How do you treat Epididymitis?
Treatments for epididymitis include antibiotic therapy, anti
inflammatories and scrotal support. In the cases of acute epididymitis,
cold therapy is recommended.
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Hydrocele
1. What is a Hydrocele?
A hydrocele occurs when fluid fills the membrane covering the front
and sides of the testicle and epididymis in the scrotum. This is usually
not painful, but is often uncomfortable due to the increased size of
the scrotum. A hydrocele commonly affects one side of the scrotum, but
in some instances both sides may be affected.
2. What are the symptoms and causes of a Hydrocele?
As mentioned, a swollen scrotum is the first sign of a hydrocele, seldom
associated with pain. Possible causes of a hydrocele are: trauma to the
scrotal area, or inflammation or infection of the epididymis.
3. How do you treat a Hydrocele?
Some hydroceles do not need to be treated, as they will correct themselves
or remain unchanged. Indications for hydrocele repair include pain, discomfort
due to the size and/or location of the hydrocele. The most common procedure is
a surgical procedure under anesthesia to correct the hydrocele. If surgery is
not the best choice due to health or other reasons, the hydrocele can be
aspirated. Hydroceles that are aspirated often re-occur.
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Incontinence
1. What is Urinary Incontinence?
Urinary incontinence is the inability to stop the loss of urine. This is not
"normal" at any age beyond the toilet training stage. Loss of bladder control is
a common problem, shared by millions of Americans.
2. What are the different types of Incontinence?
Urge Incontinence: The inability to hold urine long enough to reach a toilet.
There is a strong and sudden urge to urinate followed by an involuntary loss of
urine. People who suffer from urge incontinence say the need to void comes with
little warning and may be present both day and night.
Stress Incontinence: The involuntary loss of urine during coughing, sneezing,
laughing or other physical activities. The amount of urine lost may vary from
dribbling to gushes of urine.
Factors associated with stress incontinence include weak pelvic muscles due to:
- Lack of exercise
- Overweight
- Strain of continuous coughing
- Injury to the pelvic muscles
- Complications of surgery involving the pelvic muscles or urethra
Overflow Incontinence: The bladder is unable to empty completely. A
relatively large amount of urine is left in the bladder after urinating
and may "overflow" causing leakage.
3. How is Urinary Incontinence diagnosed?
A thorough medical history and a complete physical exam will be conducted
by your doctor. The doctor will need a detailed account from you to accurately
diagnosis your problem. The physician will order laboratory and imaging tests.
Further diagnostic testing may be done with Urodynamics testing.
4. How is Urinary Incontinence treated?
Treatment of incontinence, non-invasive or surgical is dependent upon what
type of incontinence a patient has.
Non-invasive
Healthy bladder habits: The following are steps that can be taken to add in
proper bladder function:
- Practice healthy toilet habits. Try not to go to the toilet "just in case."
This may result in perpetuating the need to go to the bathroom more frequently.
Avoid straining when you are passing your urine. Maintain healthy bowel habits.
Constipation can adversely affect your bladder.
- Maintain an adequate fluid intake. Try to drink 6 - 8 glasses of fluid per
day. Do not drink large quantities of caffeine and alcohol.
- Try to maintain an ideal body weight.
Bladder Training Program: Bladder training can help individuals with the
symptoms of urgency and frequency. The idea behind a bladder-training program
is to gain control over your bladder. It involves a variety of components,
including maintaining a voiding diary to assess baseline bladder habits and
capacity. One technique applies delaying exercises over a period of time. This
is a program that works best with regular meetings with a healthcare professional
for guidance and education.
Biofeedback & Electrical Stimulation: This involves using a small vaginal or anal
probe that allows the patient to see that activity of their pelvic muscles on a
computer screen. The patient is then taught to physically identify the pelvic muscles
and methods to strengthen and prolong their contractions. Low-grade electrical
stimulation, utilizing the same type of probe, may also be utilized to help re-train
the bladder.
Oral Medications: Due to the different types of incontinence there are many medications
that can be prescribed to the patient. Medications can be used in conjunction with other
treatment options or by themselves. These are often prescribed for urge incontinence.
Surgical
Surgical Procedures: Varied types of procedures will be dependent upon the need of
the individual with incontinence. Some of the procedures restore the bladder function
by lifting the bladder neck and urethra into its normal position. While other procedures
create a seal that stops the leaking of urine by injecting material into the urethra.
The urologist will determine the appropriate surgical procedure. The following are some
of the surgical procedures:
- Bladder Neck Suspension
- Sling Procedure
- Retropubic Suspensions
- Contigen Treatments
- Carbon Treatments
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Impotence/Erectile Dysfunction
1. How does an erection occur?
An erection is an involuntary reaction in response to sexual, psychological sensory
and nerve stimulation. This stimulation causes a rapid increase in the amount of blood
flowing into the penis. An erection occurs when blood becomes trapped. As the shaft of
the penis rapidly fills with blood, the penis becomes firm and elongated, resulting in
a successful erection.
2. What is Impotence/Sexual Dysfunction?
Impotence/Sexual Dysfunction refers to the inability to have or maintain a satisfactory
erections, or the inability to achieve successful sexual intercourse. Impotence can be
total or partial and it can affect men of different age groups. Some of the symptoms
of impotence are:
- Decreased sexual drive
- Early loss of erection
- Inability to have a full erection
- Premature ejaculation
3. What can cause Impotence/Sexual Dysfunction?
Impotence/Sexual Dysfunction can be the result of medical, surgical, or
psychological factors. The medical problems include illnesses like:
- Alcohol or substance abuse
- Arteriosclerosis (hardening of the arteries)
- Diabetes
- Hormonal Imbalances
- Kidney Disease
- Neurological Diseases
- Injuries or Pelvic Fractures
Some medications can cause impotence/sexual dysfunction. These drugs include:
- High Blood Pressure Medications
- Depression Medications
The surgical procedures that contribute to impotence/sexual dysfunction are:
- Removal of the Prostate for cancer
- Colon surgeries
- Blood vessel surgery
The psychological causes may include:
- Marital Problems
- Mental Problems
4. How is Impotence/Sexual Dysfunction evaluated?
The urologist will need to obtain a complete history of the patient's
problem and information about previous operations, illnesses, injuries,
and medications. It is important to understand the patient's development
and social history. There may be some aspects of a person's life that
would be affecting their impotence/sexual dysfunction. The physical
examination of the penis and scrotal area may help find physical underlying
problems. In some cases, blood tests, ultrasounds, and x-rays may be ordered.
5. How is Impotence/Sexual Dysfunction treated?
The good news is that most men with impotence/sexual dysfunction can
have their sexual function restored with proper treatment. There are many
different treatments for impotence/sexual dysfunction. They are as follows:
- Pills taken orally: to help achieve an erection.
- Directly injected medication into the penis: the patient can use a self
injection treatment to achieve an erection. These require the patient to
inject the drug directly into the penis. It is surprisingly almost pain-free
and well tolerated by patients.
- Inserted medication into the penis: Medical urethral suppository is a newly
developed treatment that consists of a very small medicine pellet inserted
into the urethra (tube inside the penis).
- Hormone replacement therapies: if the blood tests indicate there is a decrease
in testosterone then hormone treatment may help.
- Vacuum erection device (VED): which is a mechanical device that allows for the
expansion of the penis using an external vacuum pump and then when an erection is
achieved, placement of a rubber ring at the base of the penis to sustain the erection.
- Surgical procedure: is to use implants that offers predictable erections using
mechanical methods. It requires a brief stay in the hospital.
- Sexual and Marital counseling: is important for those individuals and
couples where an underlying emotional or relationship problem is a major
contributor to sexual problems.
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Kidney Stone
1. What are Kidney Stones?
Kidney stones are abnormal collections of mineral salts which form
in the kidney and then can move down the ureter (tube connecting the
kidneys and the bladder) and into the bladder. The movement of the
stone can cause the following symptoms:
- Severe pain in the mid to lower back
- Nausea & vomiting
- Bloody urine.
- Fever
2. What can cause Kidney Stones?
The causes of kidney stones vary, men develop them twice as often
as women. If someone else in your family has or has had kidney stones,
then the likelihood to form stones is increased. Once a person has
their first kidney stone they have approximately a 50% chance of
developing another stone sometime later in life. A change in diet
may decrease the chance of forming stones, if diet was a contributor
to the formation of the stone originally.
3. How can Kidney Stones be prevented?
The primary way to prevent kidney stones is to drink plenty of
fluids, ideally water. Some types of foods may be eaten in moderation
and may decrease the chance of forming another stone, i.e. foods high
in calcium. (Totally avoiding calcium, even if the stones are
composed of calcium may do harm, since calcium is important in the
body's function.) There are medications that help prevent the development
of certain kidney stones. Catching the stone so it may be analyzed
for its composition is very helpful in knowing how and what to do to
prevent further stones.
4. How are Kidney Stones evaluated?
When the symptoms are suspicious for a kidney stone, tests are done
to determine if a stone is present. A urinalysis will be taken to look
for blood, crystals or infection. An intravenous pyelogram (IVP) or CT
Scan will be ordered to confirm the diagnosis of a kidney stone, and
also to check the location of the stone. If an individual is allergic
to iodine, an ultrasound of the kidney will be ordered.
5. How are Kidney Stones treated?
The good news is that the majority of stones do not require surgical
intervention. The most common way to treat stones that will not pass on
their own is Extracorporeal Shock Wave Lithotripsy (ESWL). ESWL is an
outpatient procedure performed under intravenous (IV) sedation, using a
high energy machine that delivers shock waves directed by live X-ray
to the stone, resulting in the stone breaking into smaller pieces. These
smaller pieces of the stone will pass into the bladder, and the patient
will pass the fragments when urinating.
About 20% of the stones will not break into smaller pieces or will fail
to pass out of the patient, then surgery will be needed. The two most common
surgical interventions are:
- Ureteroscopy- This procedure may be performed if the stone is located
in the ureter. An instrument, like a small telescope, is passed through
the urethra and bladder up to the stone. Then the urologist can use a laser
to break up the stone, a small wire "basket" to grab and remove it,
or other methods may be better suited for the location and size of the stone.
These procedures do require anesthesia, and the patient is usually an outpatient
at a hospital.
- Percutaneous nephrolithotripsy- A surgical approach less commonly done,
a stone breaking laser instrument is passed directly into the kidney
through an incision and tube placed in the patient's back. This is
usually done for very large stones that can not be treated in any other
fashion. The patient is usually admitted into the hospital and will stay
1-2 days depending on recovery.
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PenileWarts/Condyloma
1. What is Condyloma?
Condyloma is commonly called genital warts. It is a sexually transmitted
disease (STD). It is spread by skin to skin contact. Condylomas can be
found on the external or internal genital areas of men and women.
Some condylomas can be pre-cancerous or even cancerous, so it is
important to see a physician.
2. What are the signs and symptoms of Condyloma?
Condylma may not be apparent for 2-3 months or even longer after
being infected by the virus. Condyloma usually starts out as small
bumps either singularly or in a group and may have a "cauliflower"
look. Most of the time the individual will have no symptoms unless
the virus has been active without treatment for some time. The most
common symptoms if present are:
- Pain
- Itching
- Burning with intercourse
If the condyloma is in the anal area, there may be rectal
bleeding and itching.
3. How is Condyloma treated?
Condyloma can only be treated, not cured. There are treatments
that destroy the majority of contaminated cells and decreases the
rate of recurrence. Some common treatments are as follows:
- Topical Solutions: are often used on external condyloma as the
first line of treatment.
- Surgical Procedures: are used if the area failed to respond to
the topical solutions or if the warts are large. The condyloma
can be removed by burning or freezing the infected area, and is
done as an outpatient procedure.
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Peyronie's Disease
1. What is Peyronie's disease?
Peyronie's disease is an unnatural curvature in the penis,
most noticeable during an erection. The disease may prevent a
complete erection due to the plaque or scar tissue that develops
in the penis. The curvature can cause painful erections and may be
so severe that intercourse is impossible.
2. What are the signs and symptoms of Peyronie's disease?
The cause of the plaque is unknown, but may develop due to a trauma
to the penis or in the groin area. Some of the symptoms of Peyronie's disease are:
- Painful Erectionss
- Soft Erections
- Curvature in the Penis
- Fibrous area under the Skin of the Penis
Peyronie's disease is not cancerous and is not sexually transmitted.
3. How is Peyronie's disease treated?
There are many options in treating Peyronie's disease depending
on the severity of the disease. In some cases, there is no need for
treatment. However, if the curvature becomes much worse, treatment
may be indicated. There are non-surgical and surgical treatments.
Non-surgical
- Oral medication used to decrease the pain, soften and reduce the plaque.
- Medication is injected directly into the plaque to soften and
dissolve the plaque.
Surgical
- Excision of the plaque with repair by graft.
- Surgically shorten the unaffected side of the penis,
to straighten the penis.
- Penile prosthesis may be implanted to straighten the
penis and provides enough rigidity for intercourse.
After treatment, Peyronie's disease may return and may be
a chronic problem. All of the risks and complications should
be taken into consideration before a treatment is selected.
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Prostate
1. What is the Prostate?
The prostate is a male sex gland that is important for
reproduction in that it produces the majority of ejaculate
fluid. It is a small walnut, shaped gland that is located
above the rectum and at the bottom of the bladder. The prostate
surrounds the urethra (the tube that carries urine from the
bladder) like a doughnut, at the point where the urethra connects
to the bladder.
2. How can Prostate abnormalities be detected?
A rectal examination should be considered as part of the annual
physical checkup for men beginning at age 50. Unless there are
factors that increase the risk of cancer such as Afro-American,
family history of prostate cancer, then the rectal exam should
start at age 40.
Next, men should also have a Prostate Specific Antigen (PSA) test.
The PSA is an effective tool available to physicians to help monitor
the prostate gland.
3. What are some common Prostate abnormalities?
- Prostate Cancer
- BPH
- Prostatitis
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Prostate Specific Antigen (PSA)
The PSA test has revolutionized the detection of prostate cancer
and the monitoring of the effects of treatment. It has enabled the
medical community to allow early detection of prostate cancer.
However, prostate cancer may be present in a person with a normal PSA.
Therefore, it should not be used as the sole method of prostate
examination but should be performed in combination with the digital
rectal examination.
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Prostatis
1. What is Prostatitis?
Prostatitis is the inflammatory condition of the prostate gland.
2. What are the symptoms of Prostatitis?
The patient may show a variety of symptoms. They often include:
- Low back pain
- Burning upon urination
- Frequent urination
- Urgent urination
- Pain deep in the rectum or scrotal areas.
At times the symptoms may also include joint and muscle aches,
fever or pain almost anywhere within the pelvis and scrotum. The
symptoms may be mild or may be overwhelming.
3. How is Prostatitis diagnosed?
The urologist will perform a digital rectal exam. This may reveal
a very tender prostate gland. Urine and/or prostate secretions may be
examined.
4. How is Prostatitis treated?
Prostatitis is most commonly treated with antibiotics.
Anti-inflammatory drugs and sitz baths are often helpful. In very rare
cases, surgery can be done to remove part of the prostatic tissue.
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Testicular Self Examination (TSE)
Testicular self-exam is an important part of a routine, health
maintenance for men and should be done once a month.
- Start by holding your scrotum in the palm of your hands. Then
feel one testicle. Apply a small amount of pressure. Slowly roll it
between your fingers. Try to find hard, painless lumps.
- Now examine your epididymis. This comma-shaped cord is found behind
your testicles. Its job is to store and transport sperm. Tender when touched,
it is the location of most non-cancerous problems.
- Continue by examining the vas deferens, the sperm-carrying tube that
runs up from your epididymis. Normally, the vas deferens feels like a firm,
movable, smooth tube. Now repeat the exam on the other side.
Most scrotal or testicular masses are not cancer but if one feels
an abnormality, a consultation with a urologist should be made as soon
as possible.
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Urethral Stricture
1. What is a Urethral Stricture?
A urethral stricture is a narrowing of the urethra. Urethral strictures
are more common in men. Some possible causes are: trauma in the pelvic area,
sexually transmitted diseases, tumors in the area, swelling or scar tissue.
2. What are the signs and symptoms?
- Slow stream of urine
- Painful urination
- Difficulty urinating
- Blood in urine
- Abdominal pain
- Discharge
3. How are Urethral Strictures treated?
Once the urologist has diagnosed a urethral stricture, the stricture may
need to be dilated. This is accomplished by passing a urethral dilator or
possibly incising the stricture with a small blade using a cystoscope. More
severe cases my require open surgery. A dilation may have to be repeated if
the stricture re-occurs.
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Urinary Tract Infections (UTI)
1. What are the causes of a UTI?
An infection occurs when bacteria enter the urethra and start
multiplying. If the infection stays within the urethra, it is called
urethritis. If the infection enters the bladder, the infection is called
cystitis. The infection will sometimes involve the prostate, this is
called prostatitis. Last, the infection can go into the kidneys, this
is called pyelonephritis. Also, other microorganisms can cause infections.
Some of these are sexually transmitted and require treatment of both partners.
Normally, the act of urination will wash the bacteria out of the urethra
to help prevent infections.
2. What are the symptoms of a UTI?
- Frequent urination
- Urgency of urination
- Burning during urination
- Pain in the lower abdomen
- Pain in back or side
- Frequent urination at night
- Pelvic discomfort
The urine may appear:
- Discolored
- Cloudy
- Brownish or reddish
If the kidneys are involved:
- High fever
- Overall bad feeling
- Nausea
- Vomiting
3. How is a UTI diagnosed?
A "Clean Catch" or catheterized urine sample
4. How is a UTI treated?
Urinary tract infections usually require treatment with antibiotics
that are often selected according to the sensitivity test done in the
office. Most UTI's are treated with short courses of antibiotics usually
only one to three days. However, some infections require treatment for
one to two weeks.
Treatment of urinary tract infections involve not only an antibiotic but
also measures to alleviate the discomfort that may be caused by a UTI.
Warm tub baths or sitz baths can often be beneficial as can heating pads.
Avoidance of urinary tract irritants such as caffeine, alcohol and spicy
foods can also help alleviate some of the symptoms.
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Varicocele
1. What is a Varicocele?
A varicocele is the enlargement of the veins that drain the testicles.
A left varicocele is more common. A varicocele affects fertility due to
the decrease in circulation of blood in the testicular area.
2. What are the signs and symptoms of a Varicocele?
Some varicoceles may cause pain and/or the decrease in size of the
testicle.
3. How is a Varicocele diagnosed?
A varicocele is usually diagnosed during an infertility work up.
4. How is a Varicocele treated?
Once diagnosed, a surgical procedure can be done to correct the problem.
The procedure may be needed because of the decreased size of the testicle,
infertility, or because of the size and discomfort related to the varicocele.
If the varicocele is the cause of infertility, in many cases fertility will
improve in a few months.
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Vasectomy
1. What is a Vasectomy?
A vasectomy is the most effective means of permanent birth control.
A vasectomy does not affect the production of male hormones nor does it
alter sexual function. The vasectomy involves surgically cutting and closing
off or blocking the vas deferens (the tube that carries sperm from the
testicle). After the vasectomy, the testes continue to produce sperm cells
that are simply absorbed by the body.
2. What to expect during surgery?
The urologist will make one or two small openings into the scrotum. The
vas deferens will be cut and a section of the tube will be removed. Even
with the local anesthesia, the patient will experience a tugging or pulling
sensation in the scrotum or groin area. The two ends of the vas deferens
will be tied or cauterized; the opening(s) will be closed with small sutures
which will dissolve on their own; and a surgical dressing will be applied
to the incision.
An athletic supporter or a brief type underwear should be worn following
surgery to immobilize the scrotum and minimize discomfort.
3. What to expect after surgery?
The patient should make arrangements to have a family member drive him
home following surgery. The patient may experience some discomfort within
the first 24 hours. If necessary, the urologist will prescribe pain medication.
The patient should avoid any heavy lifting or vigorous exercise for 24-48
hours following surgery. To protect the incision, do not bath or shower
for the first 24 hours following surgery. Sexual activity with birth
control protection can be resumed within one week.
After the vasectomy, it is necessary to continue to use some form of
birth control until all stored sperm are cleared from your system.
This usually takes at least 8-10 weeks. Two separate semen specimens
should be taken to the urologist's office to confirm that the specimen's
are free from sperm.
4. What are the possible complications?
No surgical procedure is without risk. However, the majority of
complications associated with vasectomy are minor.
- Up to one week following surgery: Internal bleeding in the scrotum
which may cause pain and swelling. There is always the risk of infection
after a surgical procedure. Swelling, redness, pus, or pain are symptoms
of a possible infection.
- Up to several months following surgery: Sperm granuloma- which is a
lump at the site where the vas deferens is tied off. This will usually
disappear in time.
- Congestion- this is caused by sperm within the epididymis which may
cause aching. This symptom usually disappears without treatment.
- Spontaneous regrowth- although rare, spontaneous formation of a new
vas deferens through the scar tissue can occur. This is usually detected
by a post-operative semen test.
5. Can a reversal of the Vasectomy be performed?
Although a vasectomy should be considered a permanent surgical procedure,
there is a surgical procedure that can reverse a vasectomy. It is called a
"Vasovasostomy." A vasovasostomy involves surgical reconnection of the vas
deferens to re-establish the flow of sperm. A patients are cautioned that
fertility is not guaranteed.
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