Erectile Dysfunction after Prostatectomy for Prostate Cancer

Erectile Dysfunction (ED), also commonly referred to as impotence, is defined as the repeated inability to produce or maintain an erection firm enough for sexual intercourse. Prostatectomy, or the removal of the prostate, is one of the main interventions for treating prostate cancer, however as with all treatments and interventions, there are side effects, ED being one of them. In a recent article from Medscape (http://www.medscape.com/viewarticle/726779) the topic was explored with a focus on re-establishing blood flow; “Erectile dysfunction after radical prostatectomy remains one of the most common adverse side effects of treatment. After prostate surgery, nitric oxide synthesis is diminished due to nerve trauma to the cavernosal nerve (Carrier et al., 1995). The lack of nitric oxide and neuropraxia lead to diminished blood flow and oxygenation of the penile tissue, which leads to cavernosal fibrosis and collagen synthesis (Leungwattanakij et al., 2003). Atrophy and penile fibrosis cause further erectile dysfunction after radical prostatectomy; therefore, re-establishing blood flow to the penis is important to preserve and promote optimal erectile function in these men.” Our team of dedicated urologist will work with you to understand the cause of your ED and determine the best course of action to return your previous quality of life. As prostate cancer continues to be prevalent, the urologist at Academic Urology & Urogynecology of Arizona lead the way in diagnosing and treating prostate cancer, along with its associated outcomes.

 MEDSCAPE REFERENCE:

Albaugh, Jeffrey. Addressing and Managing Erectile Dysfunction after Prostatectomy For Prostate Cancer. Urol Nurs. 2010;30(3):167-177,166.  Website: http://www.medscape.com/viewarticle/726779

Male Hypogonadism

Hypogonadism refers to the underproduction hormones, in men this production occurs in the testes. A recent Medscape article (http://www.medscape.com/viewarticle/721069) focused on an article that addressed the issue of male hypogonadism in the older population; “There is a high prevalence of hypogonadism in the older adult male population and the proportion of older men in the population is projected to rise in the future. The main symptoms of hypogonadism are reduced libido/erectile dysfunction, reduced muscle mass and strength, increased adiposity, osteoporosis/low bone mass, depressed mood and fatigue.” There are many reasons to be experiencing symptoms such as reduced libido or erectile dysfunction, of which hypogonadism is one of them. The specialist at Academic Urology & Urogynecology specialize in the diagnosis and treatment of male urologic issues, and are here to meet with you if you would like to discuss your male health issues.

MEDSCAPE REFERENCE:

Dandona, P., Rosenberg, M.T. A Practical guide to male hypogonadism in the primary care setting. International Journal of Clinical Practice, Volume 64, Issue 6, pages: 682-696. Website: http://www.medscape.com/viewarticle/721069

Robots and Surgeons Equally Safe for Prostatectomy

When a prostate is removed by an experienced robotic surgeon, like the urology specialist at Academic Urology & Urogynecology of Arizona, patients not only can expect less blood loss during the procedure, but also reduced damage to surrounding tissue, nerves, muscles, and even shorter post-op hospital stays and recovery times. Medscape Urology recently published an article (http://www.medscape.com/viewarticle/824165) highlighting a study from the Journal of Clinical Oncology (http://bit.ly/14da0MG) regarding the safety of patients undergoing prostatectomy in regards to robotic versus classic techniques; “A comparison of robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) in more than 5000 Medicare patients has found that the 2 procedures are equally safe. The study results also show a similar rate of complications with the 2 procedures, although when early results from the study were presented at the 2012 annual congress of the European Association of Urology, the results favored RARP superiority. However, the researchers caution that the latest results showing no difference between the 2 procedures could be subject to selection bias. There has been concern recently that complications after robotic surgery are under-reported.” Here at Academic Urology & Urogynecology of Arizona, we believe that physician-controlled robotics and 3D imagery of the operating site, is the next era of prostate cancer surgery. Our urologist are able to achieve precision and significantly reduce the risk associated with traditional surgery. To read further about the qualifications of our team, click on the links: Jeffrey A. Stern, Aaron LaTowsky, David Kaplan

 

MEDSCAPE REFERENCE:

Waknine, Yael. Robots and Surgeons Equally Safe for Prostatectomy. Website:

http://www.medscape.com/viewarticle/824165

Strong Association between Vaginal Childbirth and Pelvic Floor Disorders

It is well known that the physical stress of childbirth has lasting effects on female physiology. A recent article by Medscape (http://www.medscape.org/viewarticle/803448) highlights the relationship between Pelvic Floor Disorders (PFDs) and Vaginal Childbirth. Specifically, stress urinary incontinence which deals with the unintended release of urine usually during physical activity, and vaginal prolapse which refers to the vagina and its associated area falling out of their normal position. “Current literature suggests a strong association between vaginal delivery and both stress urinary incontinence and prolapse. Observational studies have identified certain obstetrical exposures, which appear to be more traumatic to the pelvic floor, particularly forceps delivery, prolonged second stage of labor and sphincter lacerations. Trauma to the pelvic support system, denervation injury, ischemia, combined neurovascular injury and defective soft-tissue remodeling are some of the mechanisms that may explain the association between vaginal delivery and PFDs.” The professionals at Academic Urology & Urogynecology understand that your health is both important to you and a personal matter, which is why comfort and confidentiality at every stage of intervention is taken. Please do seek help if you experience any symptoms suggestive of Incontinence or prolapse such as: urine leakage; inability to pass urine or empty your bladder completely; pressure in the vagina or pelvis; protruding vagina.

MEDSCAPE REFERENCE:

Memon, Hafsa; Handa, Victoria. Vaginal Childbirth and Pelvic Floor Disorders: Executive Summary. Website: http://www.medscape.org/viewarticle/803448

FDA Approves Radium-223 for Advanced Prostate Cancer

A recent Medscape article (http://www.medscape.org/viewarticle/805117) highlights a new treatment for patients with advanced prostate cancer. “A novel radiopharmaceutical agent has been approved by the US Food and Drug Administration (FDA) for use in the treatment of prostate cancer. The product, radium-223 dichloride (formerly known as Alpharadin), will be marketed as Xofigo for use in men with symptomatic metastatic castration-resistant prostate cancer that has spread to the bone but not to other organs. It is intended for men whose cancer has spread after medical or surgical therapy to lower testosterone levels, according to the FDA.”

The professionals at Academic Urology & Urogynecology of Arizona are dedicated to diagnosing and treating prostate cancer, and as such stay up-to-date on the latest treatment modalities and research studies. Prostate cancer is a very prevalent issue, and as with all cancers, early detection and treatment is key. If you feel you are having issues with your prostate or would like to discuss your overall prostate health, please make an appointment to see us.

MEDSCAPE REFERENCE:

Chustecka, Zosia; Barclay, Laurie. FDA Approvals: Radium-223 for Advanced Prostate Cancer. Website: http://www.medscape.org/viewarticle/805117

Saw Palmetto Extract Shows No Benefit in Improving BPH Outcomes

When the non-malignant growth of cells occurs within the prostate, it is referred to as Benign Prostatic Hyperplasia (BPH). As the prostate size increases due to this growth, it has various symptoms that arise most dealing with urine outflow. There are various treatment strategies for BPH, and the following article from Medscape (http://www.medscape.org/viewarticle/750888) highlights a popular natural remedy used for BPH and its associated outcomes; “A meta-analysis of controlled trials of saw palmetto by Tacklind and colleagues, which appeared in the April 15, 2009, issue of The Cochrane Database of Systematic Reviews, found that saw palmetto was not superior to placebo or active comparators in reducing symptoms of BPH. Saw palmetto also did not improve prostate size or objective measurements of peak urine flow. One deficiency of previous trials of saw palmetto has been a failure to examine any dose-response effect associated with treatment. The current randomized controlled trial by Barry and colleagues examines this issue. Saw palmetto fruit extract was no better than placebo in the treatment of lower urinary tract symptoms in men with enlarged prostates, according to a study published in the September 28 issue of JAMA (http://jama.jamanetwork.com/article.aspx?articleid=1104439).” Even though Saw palmetto is a popular complimentary and/or alternative therapy in men with BPH, the review failed to show any benefits in improving outcomes for BPH patients. At Academic Urology the diagnosis and subsequent treatment of BPH and its associated lower urinary tract symptoms is something we pride ourselves in. Protecting your prostate means protecting your quality of life and that is the mission behind our work at Academic Urology & Urogynecology of Arizona.

MEDSCAPE REFERENCE: King, Jim. Saw Palmetto Extract Shows No Benefit in Improving BPH Outcomes. Website: http://www.medscape.org/viewarticle/750888

Computational Analysis Identifies New Prostate Cancer Gene Combination

1 in 6 men will receive a diagnosis of prostate cancer during their lifetime, making it one of the most prevalent forms of cancer in men. Of particular interest, it is also one of the most treatable when detected early. Recently, Cancer Cell published an online article (http://bit.ly/1nHE9ez) highlighting some of the new prostate cancer research in genomics and its potential future implications to early detection; “Computational analysis of genome-wide regulatory networks has identified a two-gene combination that appears to drive prostate cancer malignancy. The computational analyses identified FOXM1 (a regulator of cell cycle progression) and CENPF (a regulator of mitosis) as the only master regulator genes predicted to be both synergistic and of potential clinical relevance. Silencing either of these genes in four human prostate cancer cell lines reduced cellular proliferation, but cosilencing both genes synergistically abrogated prostate tumor growth. Coexpression of FOXM1 and CENPF in human prostate cancer specimens was associated with higher biochemical recurrence and worse prostate cancer-specific survival. Moreover, coexpression of FOXM1 and CENPF dramatically improved the prediction of disease-specific survival and time to metastasis over Gleason score alone.” The physicians at Academic Urology & Urogynecology of Arizona stand at the forefront of prostate cancer care in Phoenix, Arizona and the surrounding region.The form of recommended prostate cancer therapy varies by patient and is discussed in detail with each patient individually to ensure the chosen approach is best in terms of lifestyle and circumstance.

MEDSCAPE REFERENCE: Boggs, Will. Computational Analysis Identifies New Prostate Cancer Gene Combination. Cancer Cell 2014, http://bit.ly/1nHE9ez. Website: http://www.medscape.com/viewarticle/825142

Urinary Incontinence in the Young and Old Woman

Incontinence refers to the unintended or accidental release of urine. There are 3 main types of chronic incontinence in women: Stress, Urge, and Overflow. According to a recent Medscape Article (http://www.medscape.org/viewarticle/821292); “The incidence of urinary incontinence increases with age and while stress urinary incontinence is more common in younger women, symptoms suggestive of overactive bladder are more common with increasing age.” As the article highlights, even though older women may be more prone, women of all ages can be affected. At Academic Urology & Urogynecology of Arizona, we know that it can be difficult to talk about your bladder control and/or vaginal problems, and in doing so many women choose to suffer in silence rather than face their problems and seek treatment. We encourage you to seek help if you experience any one (or a combination) of the following symptoms: urine leakage; frequent need to urinate; inability to pass urine or empty your bladder completely; pressure in the vagina or pelvis.

Medscape Reference: Robinson, Dudley; Cardozo, Linda. Urinary Incontinence in the Young Woman; Treatment Plans and Options Available. Website: http://www.medscape.org/viewarticle/821292