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Frequently Asked Questions

Prostate Cancer

A: Although highly specific, the sensitivity of PSA in detecting prostate cancer has room for improvement. Multiple forms of PSA have been developed to increase the sensitivity and thus the detection rates for prostate cancer. Use of free PSA increases the detection rate of aggressive prostate cancer more than PSA alone.  The new 4Kscore combines four prostate-specific biomarkers with clinical information to provide men with a measure of their risk for aggressive prostate cancer.  This can be used prior to biopsy, or after a negative biopsy, and can predict the likelihood of cancer spreading to the other parts of the body in the next 20 years.

A: The standard number of biopsies is 12; however, more biopsies do detect more organ-confined prostate cancer. When the standard biopsies do not detect prostate cancer in the face of an elevated PSA, then (saturation biopsies) 18-26 should be done.

A: The treatment choice takes into account the patient’s age, overall health, grade, stage, and Gleason score of the prostate cancer. In-general for organ-confined cancer the choices are active surveillance, surgery (robotic or open), radiation (external beam, internal brachytherapy), hormonal and cryotherapy. Each modality has advantages and disadvantages. Outcomes for surgery and radiation are similar for low stage and grade disease. Cryotherapy has primarily been reserved for radiation failures. Hormonal therapy has primarily been used for advanced disease or as adjuvant therapy.

Enlarged Prostate

Enlargement of the prostate is a normal consequence of ageing. As the population ages, more men are presenting with symptoms of BPH. Transurethral Resection of the Prostate (TURP) is the gold standard for treating BPH when medications fail.  Medications used to initially treat symptomatic prostatic obstruction fall into two categories: alpha blocker (ex. Flomax) or 5-alpha reductase inhibitor (ex. finasteride, dutasteride).

Kidney Stones

Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys or ureter, down to your bladder.  Stones often form when the urine becomes concentrated, allowing minerals to crystallize and stick together.  The etiology of kidney stones is multi-factorial and there are many different types of stones.  A variety of image modalities are used to assess degree of stone burden of which the helical CT scan is used in setting of symptoms.

In the United States, kidney stone affects 1 in 11 people.  Once an individual has formed a stone, the likelihood of recurrence is 50 percent or greater at five years and up to 80 percent at 10 years.

A: Pain in the lower back and sides, abdomen and genital area; blood in the urine; frequent urination with urgency and sometimes pain; fevers, chills, nausea, vomiting, etc.

A: Dehydration; diets rich in salt and animal protein; obesity, diabetes, inflammatory bowel disease (ulcerative colitis, Crohn’s disease); bariatric weight loss surgery; family history of stone disease; and a variety of medical conditions such as elevated PTH, urinary tract infections, or elevated cystine in urine.

A: Treatment is individualized and depends on how many stones are present as well as the size and location of each stone.  This can include observation with dietary modification, a trial of passage with hydration, pain control, and alpha blocker medications, or surgery (ESWL, ureteroscopy or PCNL).

A: It has been estimated that kidney stones occur in one in 1500 pregnancies. Most stones are diagnosed during the second and third trimesters of pregnancy. Most of these stones will pass (70%), therefore, conservative therapy should be the initial approach. If initial conservative therapy fails, then intervention is required. The most common type of intervention is ureteral stent or percutaneous nephrostomy tube placement. In few cases ureteroscopy with stone removal is done. In all cases x-ray exposure should be minimized.

Shockwave lithotripsy has not been approved for use in pregnancy. The imaging modality of choice is ultrasound.

Female Urology

Urinary incontinence affects approximately 20 million individuals in this country. Unfortunately, many Americans do not seek treatment due to embarrassment and lack of understanding of the condition.

A: Yes: total incontinence, urge incontinence, stress incontinence, overflow incontinence and transient incontinence. It is very important to identify the type of incontinence so that the appropriate treatment can be selected.

Kidney Diseases

Kidney cancer occurs in approximately 30,000 Americans per year.

Approximately 12,000 of these individuals will die this year. Survival rates are good (95%) when detected early and surgically removed. Those with advanced kidney cancer have a 20% two-year survival.

A: Treatment of kidney cancer is individualized.  The physician will need to order several staging studies to determine the optimal approach.  Small renal tumors may be closely observed until change is seen (active surveillance).  When therapy is indicated, nephron-sparing surgery such as partial nephrectomy should be considered for smaller lesions or ablative therapy (cryoablation, radiofrequency) in non-surgical candidates or those with significant co-morbidities.  Radical nephrectomy (removal of entire kidney) may be required for larger tumors or locally advanced disease.

A: A UPJ obstruction is a narrowing at the junction of the ureter and kidney. Most common etiology is congenital. Common symptoms are intermittent flank or abdominal pain. This may be associated with hematuria and urinary tract infection. Management of UPJ obstruction depends upon the presence of symptoms, deteriorating renal function, presence of stones or infection.

Office Cystoscopy

A: It is often used to find causes of bleeding or blockage, or any abnormalities of the bladder and its lining.

 

A: Cystoscopy is most often done as an outpatient procedure. Before the procedure you will empty your bladder. Then you will be placed on an exam table. A liquid or gel local anesthetic may be used on your urethra. The average cystoscopy takes about 5 to 10 minutes.  The cystoscope is inserted through the urethra into the bladder. The cystoscope is a thin, bendable, lighted tube with lenses. Water or saline is infused through the cystoscope into the bladder. As the fluid fills the bladder, the bladder wall is stretched so the urologist can see clearly.

A: The bladder wall should appear smooth, and the bladder should be normal size, shape and position. There should not be any blockage

After the cystoscope is removed, your urethra may be sore and you may have a burning feeling for up to 48 hours. You may find some blood in your urine at first, but this should go away within 12 to 24 hours. If you still have pain, or if you get a fever or your urine is bright red, tell your health care provider.