Archive | September, 2010

Diabetic Women at Greater Risk of Suffering from Urinary Incontinence

A recent large population-based study conducted by Kaiser Permanente Medical Care Program of Northern California revealed that urinary incontinence was more of a problem in diabetic women than in non-diabetic women.

Urinary incontinence, as it stands, is already an issue in female health care.  Many women feel embarrassed discussing urinary leakage and some physicians do not even ask the questions necessary to bring up the issue.  Yet a group at the American Urological Association 2010 Annual Scientific Meeting stated that 35% of the population reports at least weekly urinary incontinence episodes.  The group’s individual study also found that diabetic women with weekly urinary incontinence episodes seek treatment less often than non-diabetic women with UI, have less understanding of UI, and experience greater UI-related depression.  As a result, they are recommending that doctors pay closer attention to the problem, especially in these diabetic patients.

“Given that diabetic women with UI may not report their symptoms to their physician, coupled with the fact that their UI may lead to depression, we believe that it is extremely important that physicians who care for women with diabetes routinely screen them for UI,” Michelle Y. Morrill, MD, director of urogynecology for Kaiser Permanente in San Francisco, California, explained.

But treatments for urinary incontinence do exist and are easily distributed, assuming that physicians are talking to their patients about UI.  Dr. Morrill explains that questionnaires are “cumbersome when trying to address all general health issues for patients at a check-up,” and, instead, she believes that physicians should directly bring up UI issues during office visits.  Dr. Morrill suggests saying to the patient:  “Many women experience urinary urgency or leakage.  For women who are bothered by these symptoms, there are a variety of treatments, ranging from exercises to medications and surgery.  Are you interested in learning more about these treatments?”

Kaiser Permanente’s study contained 488 diabetic women with UI and 1784 non-diabetic women with UI.  Each participant was drawn from the Reproductive Risks for Incontinence Study and was evaluated for their treatment-seeking for, knowledge of, and beliefs about urinary incontinence.  The average results for the diabetic women with UI were compared with the average results for the non-diabetic women.

The findings show that urinary incontinence was more problematic in diabetic women than in non-diabetic women.  The prevalence of weekly UI was 25% in non-diabetic and 35% in diabetic women.  Further, diabetic women were less likely than non-diabetic women to even discuss their UI with their spouse/partner or with a doctor or nurse.  And among women with urinary incontinence who did seek treatment, diabetics were more concerned that they had a more serious disease, were more depressed about their UI, and were more likely to report that it made them feel older.

Given the results, the goal of Dr. Morrill and her team of researchers is to “reduce the medical, psychosocial, and economic costs of this chronic disorder that affects many women with diabetes.”

“This study helps identify a high-risk group for UI, which tells us that we need to target this population for more rigorous UI screening and treatment, if indicated,” Alayne Markland, DO, assistant professor of medicine at the University of Alabama at Birmingham said.  “Since the study showed that diabetic women are less likely to seek care for UI symptoms, we as physicians need to be more proactive in asking patients about UI and other lower urinary tract symptoms, with a goal of improving their overall quality of life.”

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Kidney Stones Cause and Treatment

What is a kidney stone?

A kidney stone is a solid mass found in the ureter, and is made of tiny crystals. Kidney stones form when the urine contains an improper balance of minerals, salts, and water. One or more stones can be present at the same time.

What causes kidney stones?

-Dehydration

- Familial and personal history: Some types of stones run in families, and if you have developed a kidney stone before, you are at an increased risk of developing one again.

- People with bowel disease, cystinuria, renal tubule defects, or an ileal bypass for obesity are at a higher risk.

- Gout, chemotherapy, and urinary tract infections can also cause kidney stones.

Some types of stones tend to run in families. Certain kinds of stones can occur with bowel disease, ileal bypass for obesity, or renal tubule defects.

What is the treatment for kidney stones?

Most kidney stones are small enough to pass on their own, but people with severe symptoms may need to be hospitalized. The pain is often intense. Pain relievers and anti-inflammatory medication such as ibuprofen can help control your discomfort. For severe pain, you may need to take narcotic pain killers.

Your doctor may also prescribe medication to remove the material in the stone, and to decrease the stone’s formation.

If the stone is too big to pass on its own, growing, causing infection, or causing kidney damage, surgery may be needed.

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Weight Loss and Urinary Incontinence in Women

Millions of women in the United States have been diagnosed with urinary incontinence.  Urinary incontinence is a urological problem described as a loss of control over the bladder.  As a result, urine may occasionally leak during coughing, sneezing, or other strenuous exercises.  The problem is not dangerous; however, patients who have been diagnosed with urinary incontinence or who experience these symptoms often feel embarrassed about the disorder.

Several studies have been conducted to determine the link between obesity and the severity of urinary incontinence in women.  According to The New England Journal of Medicine, the study conducted by Dr. Leslee L. Subak et. Al, discovered a definite link between weight loss and the number of episodes of loss of bladder per week.  In Dr. Subak’s study, over 330 overweight and obese women with at least 10 urinary-incontinence episodes per week were subjected to a 6-month weight-loss program.  The program was designed so that the subjects would diet, exercise, modify their behavior, and they were given an education program.  The results were clear.  After 6 months, those who were in the group that lost about 8.0% of the group’s mean weight experienced a decrease of incontinence episodes by 47%.  And those in the group that lost 1.6% of the group’s mean weight experienced a 28% decrease.

The Journal of Urology published a similar study lead by Dr. Wing et. al.  This study showed that if the diet program and behavior modification was extended for 18 months, the women experienced an even greater decrease in urinary incontinence episodes.  The 18-month group experienced a 70% decrease in the episodes.  Both groups of researchers explain that a healthy weight is necessary for all aspects of your health.  Urological health is no exception, and a reduction in incontinence is yet another benefit of moderate weight loss in women.

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How Cranberry Juice prevents Urinary Tract Infections

It is common knowledge that cranberry juice can help ward off urinary tract infections, but until now, the exact mechanism has remained a mystery. However, a new study by scientists at Worcester Polytechnic Institute has shed light on this mechanism, showing that cranberry juice changes the thermodynamic properties of harmful urinary tract bacteria. This creates an energy barrier that prevents the bacteria from initiating an infection.

Terri Camesano, associate professor of chemical engineering at WPI, elaborated on the findings. “Our results show that, at least for urinary tract infections, cranberry juice targets the right bacteria–those that cause disease–but has no effect on non-pathogenic organisms, suggesting that cranberry juice will not disrupt bacteria that are part of the normal flora in the gut,” Camesano said. “We have also shown that this effect occurs at concentrations of cranberry juice that are comparable to levels we would expect to find in the urinary tract.”

Fortunately for people concerned about their weight, the study has also shown the effects of regular cranberry juice and diet (sugar-free) cranberry juice to be identical.

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Urologists’ Growing Concern for 2010

Urology is the surgical specialty of urinary tracts and the male reproductive system.  Nearly forty-three million men are affected by some form of urological disorder, whether it is bladder incontinence, urinary tract infections, benign prostatic hyperplasia, cancer, or congenital abnormalities.  Some urologists will further specialize to treat either non-surgical conditions or the surgical conditions.  This is generally uncommon in smaller hospitals and practices, but found in large urban centers.

This year, urologists across the country are expressing concern over urological health.  Several factors have been specifically noted, such as urology demographics, a weak economy and aging population, and healthcare reform.

In regards to the growing concern over demographics, the National Kidney Foundation, NKF, has stated that over 5% of the United States population is affected by urologic disorders.  And more than 260,000 deaths from these urological problems are reported each year.  Ethnic populations are at a higher risk, and age is one of the largest contributing factors.

With the worsening economy, paired with an aging population, the field of urology has witnessed an overburdening effect.  Many patients have lost jobs and their access to healthcare, and a significant number of doctors are refusing new Medicare patients.  As a result, urology clinics are over flooded with patients with little to no insurance.  Emergency medicine, urgent care, family practice, and internal medicine specialties are also witnessing this effect.

And as the baby boomers age and reach retirement years, a severe influx of older patients will be seen.  Urological problems are a huge problem for patients over the age of 45.  Urologists document that 90% of men over the age of 70 are afflicted with benign prostatic hyperplasia alone.

More urologists will be needed.  If economic principles are taken into account, the supply-demand curve will indicate a rise in services as more patients will be seeking relatively few urologists.  Because higher prices will be associated with urological visits and treatments, many patients will begin to ignore urological disorders far longer than they should.  Permanent damage will ensue, leading to even more costly and intensive treatments.  The already flooded emergency rooms will continue to increase its burdens.

Finally, healthcare reform will also be affecting most urology specialists.  The reforms suggested will deem Medicare patients unprofitable.  Potential physicians will reconsider going into the medical field, and those who are already in the field may look to other careers as they can no longer afford their practices.  The quality of care for Medicare patients will decrease because of the overburdening effect from too few physicians compared to the number of Medicare patients.  Urologist specialists, as well as other specialists in the medical field, may specifically be hurt because of the preferential treatment of certain specialties like internists and family practitioners.  Internists and family practitioners will automatically receive 5-10% increases in reimbursements under the healthcare reform plan, and the remaining specialties will only qualify for the reimbursements if 50% of their patients are Medicare patients.

Overall, the urologists and specialists in this country fear for their careers.  Not only are their jobs and profits on the line, but also their patients may experience a decrease in the quality of their care.  This year has truly been a telling year for the field of urology.

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The Importance of Knowing Your Baseline PSA For Prostate Health

If you have been recently diagnosed with prostate cancer, then your urologist most likely provided you with a PSA score.  The PSA baseline score is your prostate specific antigen at the time of your first measurement of the antigen.  This baseline is important because subsequent PSA values that are higher than the baseline may indicate a disease of the prostate, such as prostate cancer or benign prostatic hyperplasia.  Further, your oncologist or urologist may consider your PSA before treatment has been administered.

One of the first questions patients who have been diagnosed, or re-diagnosed, with metastatic prostate cancer ask is, “How long do I have to live?”  The answer to this question has changed over the years.  While in the 1980s and early 1990s men were given an estimated 18 to 36 months from the time of diagnosis to live, the current understanding and estimation of survival is 5 to 6 years, maybe longer.  The difference in survival rates is, in part, due to treatments; however, the major factor is the inclusion of PSA scores, velocity numbers, etc.  These numbers allow researchers to form a clearer picture of the individual cancer and a closer estimation of survival.

And for those who have already been diagnosed with prostate cancer and have been treated, recurrence is a reality.  According to the Prostate Cancer Foundation, out of those who have undergone treatment for prostate cancer, 20-30% will relapse after the five-year mark and begin to show signs of disease recurrence.

But survival for recurrence has also been extended.  Many men in the United States are actually diagnosed at an earlier stage of the disease because of wide-spread PSA testing.  Further, we now have a better understanding of cancer therapies, including hormone manipulation and taxane chemotherapy.

According to Duke University Medical Center researchers, men with a baseline PSA value of 10 or higher are up to 11 times more likely to die from prostate cancer than are men with lower initial values.  In the study conducted by Duke University, 4,568 men over the past 20 years who have had PSA tests and were eventually diagnosed with prostate cancer were followed.  With age and race taken into account, the risk of death from prostate cancer was calculated.

The study released showed a median age for their study as 65 years.  The median baseline PSA was 4.5.  Nearly 3.5% of the men died from prostate cancer during the study period, while more than 20 percent died from other causes.  The analysis showed that men with a baseline PSA of less than 4 had a very low risk of death from prostate cancer, but those with 4 to 9.9 baselines were three times more likely to die from prostate cancer.  And men with a baseline PSA value of greater than 10 were 11 times more likely to die than were men with PSAs under 2.5.

Given these results, it is evident that early diagnosis of prostate cancer, when the baseline PSA is lower, will decrease the mortality rate from prostate cancer.  With PSA screenings and digital rectal exams, men may be saved from early, unnecessary death.

Baseline PSA scores are important in determining predicted survival rates for men who have been diagnosed with prostate cancer.  Ping Tang, MD, a member of the Duke Prostate Center and the department of urology at Guangzhou First Municipal People’s Hospital, Guangdong, China comments, “It’s commonly held that men over the age of 75 don’t need to bother with PSA screening any longer, but [this study] tells us that chronological age alone may not be enough.  Patients need to take into account their initial baseline value, and if it’s over 4, continuous screening may be beneficial.”

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Should Women Take Phytoestrogens?

Phytoestrogens are sometimes referred to as dietary estrogens and are made up of a diverse group of naturally occurring non-steroidal plant compounds.  Due to phytoestrogens’ structural similarity with estradiol, they have the ability to cause estrogenic and/or anti-estrogenic effects.  They are often used by women to treat the symptoms of menopause.  Some studies have indicated health risks associated with hormone replacement therapy for menopausal symptoms, so many women have turned to phytoestrogens in recent years.

Three major groups of phytoestrogens exist.  Flavonoids, such as genistein, naringenin, and kaempferol make up the first group.  The second group consists of coumestans, such as coumestrol.  And the third group contains lignans, such as enterodiol and enterolactone.

Isoflavones are among the most popular and studied phytoestrogens.  Isoflavones are found in red clover and soy and include genistein, formononentin, biochanin, and daidzein.

For years, urologists have understood a link to exist between Asian diets high in soy and a protective effect against prostate cancer.  Some researchers have recently attempted to carry this analysis over and study the effects of diets rich in soy products on breast cancer protection.  The evidence is conflicting.  Some in vitro studies differ on whether they hinder or increase tumor cell growth.  Further, although some phytoestrogens are weakly estrogenic and bind the estrogen receptor, they are approximately 1,000 times weaker than the body’s actual chemical, estradiol.  And other phytoestrogens even block the estrogen receptor.  The main group of phytoestrogen which shows the most promise, the isoflavones found in soy, acts mainly as an agonist and produces a weak estrogen effect.

Clinical trials conducted on phytoestrogens have focused on various side effects concerning gastrointenstinal, gynecological, urinary, neurological, and musculoskeletal health.  Gastrointestinal complaints were the most common and included nausea, vomiting, heartburn, gastric irritation or pain.  Further, women who were above the age of 55 experienced these symptoms more often than younger patients.  But fewer side effects overall were experienced when the women were on the phytoestrogen therapy treatments for longer periods of time.

The more potentially dangerous side effects, such as breast pain or enlargement, breast cancer, nipple discharge, endometrial hyperplasia, and pelvic pain were also studied.  One study noted a higher rate of endometrial hyperplasia with atypia after five years of phytoestrogen therapy.  Yet no increased risk of endometrial or breast cancer was found in any of the studies.

Researchers have published studies indicating that phytoestrogen supplementation may be safely used for a two year period; however, the efficacy in controlling menopausal symptoms remains unclear.  Despite the relatively safe treatment of natural supplements, more research needs to be conducted when using hormone therapies over a longer period of time, or over five years, before they, including phytoestrogen therapies, may be considered completely safe.

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Surgery may not be the answer for low-grade prostate cancer

A study conducted by Swedish researchers and published in the Journal of Urology shows that there is little evidence that men who delay surgery are in worse shape once they do have the surgery.  The new study tested men who have cancer confined to the prostate gland and who have put off surgery for over a year.

Researchers found that 99.1 percent of men in the study who delayed radical prostatectomy surgery survived after an eight year follow-up.  This is nearly identical to the results of those men who opted for immediate surgery with 99.3 percent of those men surviving.

The cancer specifically considered by the researchers was non-aggressive prostate cancer, which is determined by lower PSA levels and the presence of low-grade tumor pathology.  The results of this study indicate that men with low-grade cancer can safely postpone surgery.

“Our findings show that if a man is diagnosed with a localized low-risk prostate cancer, there is no rush to decide which treatment choice (is) best,” comments Dr. Benny Holmstrom, lead researcher from Gavle Hospital in Sweden.  Dr. Holmstrom explains that some men “can safely opt for active surveillance—where prostate cancer treatment is deferred,” and is instead monitored.

Prostate cancer is slow-growing and often non-aggressive.  Many of the men who are being diagnosed with early-stage tumors are now faced with the dilemma of potential, unnecessary immediate surgery: cut it out now, or rely on your chances of survival until a later date?

Nearly half of the men who have been diagnosed with prostate cancer in the United States in 2009 fall into the category of low-risk cancer.  These are the men who are safe to wait before jumping into any one treatment.  The current society surrounding cancer healthcare in America is one filled with anxiety and fear of cancer morbidity.  Millions of dollars go into publicizing cancer screening and awareness every year, but is it worth it?  Due to the heightened emotions surrounding cancer, men who have been diagnosed with low-grade prostate cancer may unnecessarily opt for prostectomies.  If you have been diagnosed with prostate cancer, talk to your urologist; get a second opinion and explore all of your options.

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Laser treatment may reduce sexual side effects of prostate surgery

After prostate cancer surgery, many men will experience sexual side effects. In fact, scientists estimate that half of men will experience long-term sexual dysfunction after surgery.

However, a recent study from the surgeons at the New York-Presbyterian Hospital and Columbia Medical Center shows that a new laser technology in conjunction with robotic prostate surgery can reduce damage to nerves crucial for urinary continence and erection.

This laser technology, produced by OmniGuide of Massachusetts, is a CO2 low-heat laser. Traditionally used for cancer treatment of the head and neck, new advances in medical technology have made this treatment suitable for robotic prostate cancer surgery.

“Traditionally, we cut, clip or cauterize the tissue around the prostate nerves. However, these techniques can cause irreversible damage due to traction or heat injury,” explained Dr. Ketan Badani, director of robotic urologic surgery and assistant professor of urology at Columbia University College of Physicians and Surgeons. “The CO2 laser may reduce this risk because it is low-heat and doesn’t require much manipulation of the nerves.”

Although more research is needed to determine whether this technology holds promise for long-term cancer recurrence, researchers describe the preliminary reports as “extremely encouraging”.

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Urologists Wary of New Prostate Cancer Prevention Drug

Physicians are refusing to prescribe finasteride to men for prostate cancer prevention.

According to the New England Journal of Medicine study conducted in 2003, finasteride reduces the risk of prostate cancer by 25% when used correctly.  But another study published in the September issue of Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, states that nearly 64% of urologists and 80% of primary care physicians are not prescribing the medication.

In the study, participating physicians were asked why they were not prescribing finasteride as a preventive tool.  Fifty-two percent of primary care physicians claimed they did not know finasteride was a chemopreventive drug.  And 55% of the urologists surveyed were actually concerned that it would increase the risk for high-grade tumors.

The mistrust of finasteride actually originated from the New England Journal of Medicine’s study itself.  In it, an editorial that accompanied the study noted a 27% increase in risk for high-grade tumors when patients took finasteride.  A 2008 report in Cancer Prevention Research attempted to explain these results by claiming finasteride simply made the tests available for the tumors more sensitive.

Chemoprevention has recently undergone scrutiny.  As healthcare improves, men and women are living longer, which puts them at a higher risk of dying from long-term diseases such as cancer.  As a result, a trend in the Western World has occurred toward strongly advocating cancer prevention.  But often, researchers, physicians, and patients alike wonder if the cost and negative effects of preventative cancer treatment outweigh the benefits.  Whether or not the millions of dollars put into chemoprevention are worth it is still being debated.

In the case of finasteride, severe side-effects such as irreversible sexual dysfunction, erectile dysfunction, decreased ejaculate, testicular pain, and even hair loss have been reported.  These side-effects, when combined with the uncertainty that it even prevents prostate cancer, are leading patients toward alternative solutions such as natural supplements.  Many natural supplements have been reported to promote a health prostate, and healthy lifestyle choices are largely recognized as the first step toward cancer prevention.  If you are currently concerned about the health of your prostate, contact your urologist for further information, diagnosis, or treatment.

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