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RAJESH LAUNGANI MD FACS |
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For Patients BPH results from the natural, noncancerous growth of the
prostate. The prostate encircles the urethra, the tube through which urine travels from the bladder to the penis and then
to the outside. This growth leads to obstruction to the flow of urine and brings about a constellation of obstructive and
irritative urinary symptoms. Obstructive symptoms include a slow starting and interrupted stream, decreased strength of stream,
straining to urinate and incomplete bladder emptying. Irritative symptoms include daytime and nighttime urinary frequency,
urinary urgency, and occasionally urgency incontinence. Treatment options range from medical management, minimally invasive
office-based therapies and surgical intervention. Bladder cancer
begins in the cells that line the inside of the bladder and typically affects older adults, though it can occur at any age.
Smoking is the #1 risk factor for the development of bladder cancer. Bladder cancer often causes painless hematuria (blood
in the urine). This can present as bright red or cola colored urine but can also appear on a microscopic examination of your
urine in the doctor’s office. Frequent urination, painful urination, recurrent urinary tract infections, abdominal pain
and back pain can be other presenting signs and symptoms. Diagnosis is based upon inserting a scope into the urethra
to see inside the bladder (cystoscopy), sending a sample of urine to be analyzed under a microscope to check for
cancer cells (urine cytology), and imaging tests such as a CT scan that allows your doctor to better see
the urinary tract and the surrounding tissues. If an abnormal growth is identified, your doctor may
pass a special scope through your urethra and into the bladder to remove the mass. This procedure is called transurethral
resection of bladder tumor (TURBT). The specimen is then examined under the microscope to determine the extent of disease
and to decide whether any further treatment is indicated. The great majority of bladder cancers are diagnosed at an early
stage when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason,
bladder cancer survivors often undergo follow-up screening tests for years after treatment. Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection
sufficient for satisfactory sexual performance. It affects as many as 30 million American men, with more than 50% of men 50
to 70 years. Erectile dysfunction is more often caused by physical (organic) problems than psychological (non-organic) ones.
It is important to undergo evaluation for ED as it can be an indicator of underlying heart disease, diabetes or other serious
medical conditions. Erectile dysfunction treatment ranges from oral medications, vacuum erection devices, injection therapies
and surgical implantation of a penile prosthesis to help restore sexual function. Hematuria is the presence of blood in the urine. It can be visible and present as red or cola-colored
urine known as gross hematuria. The urine may otherwise appear normal to the naked eye but have red blood cells seen under
the microscope and is termed microscopic hematuria. Several conditions can cause hematuria and are divided into either painful
or painless processes. Painful hematuria can result from kidney, bladder or prostate infection, stone passage or trauma and
the workup is generally limited to treating the condition potentiating the blood. Etiologies for painless hematuria can include
benign conditions such as medical renal disease, benign prostatic bleeding and strenuous physical exertion to more concerning
causes such as kidney, ureteral or bladder cancer. Painless hematuria, whether visible or microscopic, requires a thorough
evaluation. The urine is sent for cytology, a microscopic evaluation of the bladder cells looking for malignancy. The kidneys
and ureters are imaged with either a CT scan, intravenous pyelogram (an x-ray test where contrast is injected into the vein,
travels to the kidney and is excreted in the urine, outlining the urinary system) or renal ultrasound. The bladder is evaluated
with cystoscopy, a procedure where a camera is advanced through the urethra into the bladder and the bladder is visualized
directly. In a majority of cases, no specific source of the blood is identified and the cause is termed idiopathic, meaning
that no concern for a detrimental medical condition is present. If a pathologic process is identified, then treatment based
upon the cause is discussed. Incontinence is the involuntary
loss of urine. This can occur with maneuvers that increase abdominal pressure such as coughing, bending or exercising. This
is known as stress urinary incontinence (SUI). Others may feel a strong, sudden urge to urinate just before losing a large
amount of urine. This is known as urge incontinence. Many may experience a combination of each. This is known as mixed urinary
incontinence. Incontinence occurs because of problems with the muscles and nerves that help to control and release
urine appropriately. Treatment options depend upon the cause. Stress incontinence generally requires surgical intervention
ranging from periurethral collagen injection to sling procedures that restore the normal support structure to the urinary
system. Stress incontinence in men whom have undergone prostate surgery can be managed with sling procedures and collagen
but may require placement of an artificial urinary sphincter. Urgency incontinence is managed with behavioral modification
as well as medication. Urge incontinence that does not respond to these therapies is considered refractory and may require
a special procedure called Interstim or sacral neuromodulation. Infertility
affects ten to fifteen percent of US couples and is defined as being unable to conceive despite having frequent, unprotected
intercourse for at least one year. Most pregnancies occur within the first six episodes of intercourse during the mid-cycle.
Approximately 85% of couples will become pregnant during the first year with 50% of the remaining couples conceiving within
the next three years. Infertility can result from male factors, female factors or a combination of each. Male factors include
defects in sperm production or delivery, environmental and lifestyle factors such as excessive alcohol intake or stress, health
status, age and genetic issues. Initial evaluation includes a detailed history and physical exam, two semen analyses and a
blood test to measure male hormonal levels. Depending upon the findings, a transrectal or scrotal ultrasound may be ordered
to look for evidence of abnormalities within the male reproductive system or a genetic evaluation may be obtained to look
for chromosomal abnormalities. The female factor evaluation is undertaken by gynecologists specializing in infertility. Treatment
depends on the cause and duration of infertility as well as the age and personal preferences of the partners. Options vary
from medical management to increase sperm production to surgical interventions that relieve obstruction or treat anatomic
abnormalities such as a varicocele and assisted reproductive technology ranging from in- vitro fertilization, intra-cytoplasmic
sperm injection and epididymal or testicular sperm aspiration. The American
Cancer Society estimates that almost 51,000 people in the United States are diagnosed with kidney cancer
each year. Many kidney cancers are detected incidentally with imaging techniques such as computerized tomography
(CT) or ultrasound during evaluation for other diseases or conditions. Kidney cancer rarely causes signs or symptoms early
on but can present with blood in the urine, persistent pain in the upper back just below the ribs, weight loss, fatigue or
intermittent fever. Treatment options include removing either the entire kidney or if possible, removing the tumor from the
kidney. This can be accomplished either through an open incision, laparoscopically or robotically. Other options include the
utilization of freezing or heating techniques to kill the cancer cells by placing specialized needles into the tumor. Your
doctor can explain each operation and discuss which is most suitable. The need for further treatment is based upon evaluating
the extent of disease, also known as pathologic staging, after the tumor has been removed. Kidney stones are one of the most painful of the urologic disorders. Stones form in the kidney
and sometimes travel from the kidney down the ureter (the tube that carries the urine from the kidney) into the bladder. This
can obstruct the flow of urine, thereby putting pressure on the kidney, leading to pain, nausea and vomiting. Most kidney
stones pass out of the body without intervention. Stones that cause lasting symptoms, severe pain and vomiting or other complications
may be treated by various techniques. Treatment options include extracorporeal shock wave lithotripsy (ESWL), a procedure
that entails placing a machine on the outside of the body and focusing sound waves on the stone to fragment it, and ureteroscopy,
placing a camera through the urethra into the bladder and then up the ureter, breaking the stone and removing it under direct
vision. Some stones may be treated medically, specifically uric acid stones. For very large stones within the kidney, a more
aggressive surgical intervention called a percutaneous nephrolithotomy (PCNL) is performed. This procedure entails developing
a tract from the back directly into the kidney, then utilizing a larger camera and larger instruments to fragment and remove
the stone through this tract. Dietary and lifestyle modifications can be made so as to decrease your risk for developing kidney
stones. These include increasing daily water intake, decreasing salt intake and decreasing red meat intake. Chronic pelvic pain refers to any pain in the pelvic
region (the area below your belly-button and between your hips), which lasts six months or longer. The pain may vary from
mild to severe, from annoying to disabling. Diagnosing the etiology your chronic pelvic pain often involves a process of elimination.
Determining the cause can many times be a puzzling and frustrating endeavor. Urologic evaluation includes a thorough history
and physical examination, laboratory tests to rule out infection, cystoscopy (looking into the bladder with a camera) with
possible biopsy, radiologic imaging, bladder function tests known as urodynamics, and in some cases, exploratory surgery.
If your doctor can determine the source of your pain, then treatment can focus on eliminating that cause. If no cause can
be found, then treatment focuses on managing the pain. Interstitial cystitis (IC), also called painful bladder syndrome,
is a chronic condition characterized by a combination of uncomfortable bladder pressure, urinary urgency, urinary frequency,
bladder pain and sometimes pelvic pain. The pain can range from mild burning or discomfort to severe pain. IC is a potential
cause of chronic pelvic pain (above). The severity of symptoms caused by interstitial cystitis often fluctuates and can be
affected by diet, exercise and stress. Some people may experience periods of remission. Although no treatment reliably eliminates
interstitial cystitis, a variety of medications, lifestyle modifications and other therapies offer relief. Prostatitis,
an infection or inflammation of the prostate, is divided into acute or chronic and bacterial or nonbacterial. When no bacteria
are present, it is termed nonbacterial prostatitis. Nonbacterial prostatitis accounts for ninety to ninety-five percent of
all prostatitis. When it continues to recur, it is termed chronic prostatitis. A physical exam includes checking the abdomen
and pelvic area for tenderness and a digital rectal exam to palpate the prostate. Urine and prostate fluid may be collected
to look for bacteria and white blood cells. Acute bacterial prostatitis presents may with sudden fever, pelvic/perineal/low
back pain, burning and frequency of urination, and at times, the inability to urinate. Pain relievers and several weeks of
antibiotics are typically needed for acute prostatitis. A catheter may need to be placed into the bladder if the patient is
unable to void. Chronic bacterial prostatitis develops more slowly than acute prostatitis with less severity of symptoms.
Possible treatments include prolonged courses of antibiotics, anti-inflammatories and prostate relaxing medications called
alpha blockers. The signs and symptoms of nonbacterial prostatitis are similar to those of chronic bacterial prostatitis,
although generally without a low-grade fever. Treatment of nonbacterial prostatitis is less clear and mainly involves relieving
symptoms. Other treatment options include pelvic floor physical therapy, muscle relaxants, and at times, minimally invasive
heat therapies. One out of six men will be diagnosed with prostate
cancer in their lifetime. Prostate cancer is the second leading cancer diagnosis in men. Screening for prostate cancer
includes a simple blood test called a PSA test as well as a digital rectal exam (DRE). PSA (prostate specific antigen) is
a protein the prostate makes that is secreted into the bloodstream. It can be elevated in prostate cancer, but an elevated
PSA is not diagnostic. A prostate biopsy, an office procedure, is performed for abnormalities found in the PSA test or on
the DRE. If prostate cancer is detected, treatment options include active surveillance, medical management, surgical removal,
radiation therapy, and cryoablation (freezing the prostate). Discussions with your physician will direct the proper treatment
choice for your specific situation. Many processes can present as masses
in the scrotum; fortunately, most are noncancerous. Testicular cancer is always a concern and needs to be ruled out. Other
common conditions include hydrocele, varicocele and spermatocele. A hydrocele is a fluid filled sac that develops around the
testicle. A varicocele is pooling of blood in the veins that drain the testicle and is often described as a “bag of
worms” in the scrotum. A spermatocele is an out-pouching of the epididymis, the tube that lies atop the testicle and
stores sperm. Most of these conditions do not cause problems, but at times, a hydrocele can be large and cumbersome and a
varicocele can lead to fertility issues. A new onset or right-sided varicocele can be indicative of a more concerning intra-abdominal
problem and requires evaluation. Scrotal masses are evaluated with a physical exam, and if necessary, a scrotal ultrasound.
Treatment when necessary involves surgically correcting the abnormality, whether it be removing the hydrocele sac (hydrocelectomy)
or ligating the offending veins (varicocelectomy). Testicular
cancer arises from cells in the testicle that produce either sperm or male sex hormones. While testicular cancer
is rare, it is the most common tumor in men aged 15-34 years. Presenting signs and symptoms include a lump or enlargement
of the testicle, a feeling of heaviness, dull ache or pain in the scrotum/testicle, a sudden collection of fluid around the
testicle and rarely, breast tenderness or enlargement. Evaluation includes a physical exam, a scrotal ultrasound and blood
tests to check for specific substances that the tumors may produce in excess (called tumor markers). If a mass is detected,
then surgery is performed to remove the testicle. Once the diagnosis is confirmed, then a staging workup to evaluate for disease
spread includes a CAT scan of the abdomen and pelvis, a chest x-ray and a repeat of the tumor markers if they were initially
elevated. Upon completion of staging, the physician will determine whether any further therapy is indicated. Testicular cancer
is fortunately very sensitive to radiation and chemotherapy, and men with disease that has spread still have a high likelihood
for cure. A urinary tract infection is an infection
which is localized to the genito-urinary system. This system is composed of the kidneys, ureters, bladder and urethra. Any
part of the system can become infected, but most infections involve the bladder. Women are at greater risk than men. A urinary
tract infection limited to the bladder is also known as acute cystitis and presents with burning with urination (dysuria),
frequency and urgency of urination with small volume voids, pelvic/suprapubic pressure and at times blood in the urine. The
elderly or immune compromised may present with confusion or altered mentation. Diagnosis is based on performing a chemical
and microscopic analysis in the office. A urine culture confirms the diagnosis while also providing the type of bacteria and
a listing of antibiotics to properly treat the infecting organism. A short course of oral antibiotics are the typical treatment.
A urinary tract infection involving the kidneys can be quite serious, causing high fevers, chills, and upper back pain. This
type of infection may require hospitalization and intravenous (IV) antibiotics to resolve. Recurring bladder infections
are not uncommon and the workup includes radiologic imaging to rule out kidney stones or obstruction, bladder imaging to ensure
complete bladder emptying and cystoscopy to exclude abnormal bladder anatomy. |