Take “One” Cialis And Call Me In The Morning-A New Treatment For Both Erectile Dysfunction and The Enlarged Prostate Gland

This past week the FDA has approved the use of Cialis, a drug commonly used in the treatment of erectile dysfunction, will also be approved for the management of benign enlargement of the prostate gland. Cialis, manufactured by Eli Lilly and Co., was approved for the treatment of erectile dysfunction (ED) in 2003. It can now be used to treat ED AND prostate gland enlargement, or both if symptoms of the two conditions occur together.

Benign prostatic hyperplasia (BPH), a condition in which the prostate gland becomes enlarged, is common in older men. Symptoms include difficulty starting urination, a weak urine stream, a sudden urge to urinate and more frequent urination including awakening at night to empty the bladder. BPH can have a big impact on a patient’s quality of life if a man gets up more than a couple of times each night. Cialis offers these men another treatment option, particularly those who also have ED, which is also common in older men affecting nearly 33 million men in the United States.

In two clinical trials, men with BPH who took 5 milligrams of Cialis once daily experienced a significant improvement in their urinary symptoms of BPH compared to men who were treated with placebo.
Cialis should not be used in patients taking nitrates, for example nitroglycerin, because the combination can cause an unsafe decrease in blood pressure, the FDA said. And the use of Cialis in combination with alpha blockers for the treatment of BPH as there is a risk of lowering blood pressure.

Bottom Line: If you are experiencing both difficulty with urination and also have inability to successfully engage in sexual intimacy as often as you would like, you should speak to your doctor about the use of daily Cialis, 5mg, which is effective in treating both conditions with a single pill.

Lasers For the Prostate Gland-Makes An Old Man Pee Like A Young Boy

Meg Farris, the health and science reporter at WWL, did a nice segment on the use of lasers for treating the enlarged prostate gland.  For more information go to:

http://bit.ly/f2wYjR

“Just Say No” to Sex…Before Your Next PSA Test

For men over age 50 who are going to have a PSA test for prostate cancer, ejaculation within the past two days may artificially raise PSA levels. Men should be aware of the time of their last ejaculation and tell their doctors the last time they had an ejaculation in case results are high. Finally, while the digital rectal exam or other aspects of a prostate exam shouldn’t interfere with PSA levels, I suggest that blood be drawn before the rectal exam as a precaution.

The French Have Done It Again- Dogs Can Use Their Noses to Sniff Out Prostate Cancer

Dogs can be trained to detect prostate cancer by smelling urine samples and signaling the presence of certain volatile organic compounds produced by cancer cells, according to French researchers.

Jean-Nicolas Cornu, MD, of Tenon Hospital in Paris, and colleagues obtained fresh urine samples that had been frozen for preservation from 66 men referred to a urologist because they had an elevated PSA level or abnormal findings on digital rectal examination. Of the 66 men, 33 had prostate cancer and 33 did not, as determined by prostate biopsy.

The dogs used in the study were trained in three phases. In the first phase, which lasted five months, dogs were trained to recognize cancer urine. In the second phase, which lasted 11 months, dogs were trained to discriminate cancer urine from control urine. In the final phase, dogs were presented with five urine samples and prompted to select the one sample that was cancer urine.

Dogs correctly classified 63 of 66 samples.  These results suggest that volitle organic compounds  produced by cancer cells can be detected in urine samples.

So if you come to a French doctor’s office and you find a dog in the exam room, don’t be alarmed.  The dog may just be one of the doctor’s helpers used to diagnose your illness!  For my office, I’m going to “go standard” and suggest for all men over the age of 50 that they have an annual PSA blood test and a digital rectal exam.  It’s the American way!

To your good health.  Dr. Baum

Bladder Testing-Urodynamics

Urodynamics are simply a combination of several useful tests which provide information about your lower urinary tract. This information is obtained much in the same way that an electrocardiogram (EKG) proxies information about your heart. Urodynamics “draws a picture” for your doctor and helps to determine the diagnosis and what will be the appropriate treatment of your urinary problem(s).

Urodynamics testing is done at the office and usually takes 30-45 minutes.

During the test you will be catherized at least once. Your bladder will be filled one or more times with carbon dioxide gas or water or both. You may have a very small tube placed in the rectum. The nurse will tell you beforehand whether you are to have this done. Muscle activity in your pelvis will be recorded during the tests by small electrodes which are placed on the skin near the rectum. These electrodes are very similar to those used for an EKG.

Preparation for Urodynamics

It is important to have a full bladder when you arrive for the studies; please be ready to urinate! There are no other special preparations or food restrictions for this test. If you wear padding, external catheters, etc., you may wish to bring extra supplies for replacement after the test. You can help to make the test easier by remaining relaxed. Each step of the evaluation will be explained to you throughout the test by the experienced nurse who performs the studies. Every effort will be made to make you as comfortable as possible during the procedure. A urodynamics evaluation usually includes the following tests:

CystometrogramlElectromyogram (CMG\EMG)

This test involves filling your bladder through a catheter with sterile gas or water. The nurse will ask you when you feel the urge to urinate, and when your bladder feels completely full. Pelvic muscle activity will be recorded as already described.

Flow Rate

A flow rate is done simply by asking you to void into a special toilet which records the pattern of your urine stream on a graph and the amount of urine you void. Muscle activity in your pelvis will usually be recorded while you void via the electrodes already described. The amount of urine left in your bladder after you void (the residual urine) will also be measured at this time.

Cystoscopy

Cystoscopy is a test that allows your doctor to look at the interior lining of the bladder and the urethra. The cystoscope is a thin, lighted viewing instrument that is inserted into the urethra and advanced into the bladder.

The cystoscope is inserted into your urethra and slowly advanced into the bladder while your doctor looks through the scope to examine the inside of the urethra. Your doctor then examines the inside of your bladder for stones, tumors, bleeding, and infection. Cystoscopy allows your doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be advanced through the cystoscope that allow your doctor to remove samples of tissue (biopsy) or samples of urine from each kidney.

Cystoscopy can also be used to treat some bladder problems. Small bladder stones and some small growths can be removed by using tiny surgical instruments that slide through the cystoscope. This may eliminate the need for more extensive surgery.

After Urodynamics:

After urodynamics, you may experience some burning on urination or some increased frequency of urination for a short time. If you drink plenty of fluids afterwards, it will help to alleviate this sensation. You may also have some blood in your urine for a short while, which should be minimal. To decrease the risk of urinary tract infection, you will be given a few days of antibiotics to take by mouth.

You should notify your doctor if you experience fever, chills, severe bleeding or severe discomfort after your urodynamic study.

Treatment of the Enlarged Prostate Gland With Laser Therapy

The prostate gland is a walnut sized organ below the bladder, which surrounds the urethra.  For reasons not completely understood, the prostate gland begins to grow around age 50 and causes symptoms affecting urination.  The enlarged prostate gland is a non-cancerous condition that affects nearly 14 million men over age 50.

The symptoms of the enlarged prostate include frequency of urination, getting up at night to urinate, urgency to urinate, decrease in the force and caliber of the urine stream and feeling that the bladder is not emptying.

The treatment for enlarged prostate includes medication to shrink the prostate gland or to relax the muscles in the prostate to relieve the obstruction.  Surgical therapy includes transurethral resection of the prostate (TURP) or open surgery for very large prostate glands. Recently laser therapy has become available for treating the enlarged prostate gland and is considered minimally invasive therapy.

Laser therapy is a procedure performed with a small fiber that is inserted into the urethra, the tube in the penis that allows urine to go from the bladder to the outside of the body.  The fiber delivers high-powered laser energy, which quickly heats the prostate tissue, which causes the tissue to dissolve or vaporize.  This process is continued until all of the enlarged prostate tissue has been removed. The end result is a wide-open channel for urine to pass through the urethra.

Laser therapy can be performed in a hospital outpatient center or an ambulatory treatment center.  Usually no overnight stay is required.  However, in some cases when a patient comes from a great distance, has associated medical problems such as heart disease, diabetes, or severe hypertension, or is in frail condition, an overnight stay may be recommended.

After the procedure

Most men will go home within a few hours after treatment. If a tube or catheter was inserted after the procedure, it will usually be removed the next day after the procedure.

Most patients experience marked improvement in their urinary symptoms immediately after the procedure.  This improvement typically occurs within the first 24 hours after the procedure.  However, the past medical history, health condition and other factors can influence treatment recovery.

Some men may experience mild discomfort such as slight burring during urination and small amounts of blood in the urine for a week or two.  Also, depending upon the condition of a man’s bladder, he may experience greater frequency and urge to urinate.  This will resolve over time as the bladder adjusts now that the obstruction has been removed.

There is no change in a man’s sexual function after the procedure.  His ability to engage in sexual intimacy after the procedure is unchanged.  Most men can begin sexual activity two weeks after the procedure.  Approximately 25% of men will have a decreased or absence of ejaculation at the time of orgasm.  The fluid is still there but goes backwards into the bladder and passes in the urine the next time the man urinates.

What are the risks of the laser procedure?

Every medical treatment may have side effects.  The same is true for the laser treatment.  The most common side effects include:  blood in the urine, bladder spasms, and urgency of urination.  These symptoms are usually temporary and will subside in a few days or weeks.

Bottom Line: Enlarged prostate gland is a common condition that affects most men after age 50.  Treatment options include medications, surgery and minimally invasive treatment using lasers.  The laser treatment produces a rapid improvement in urine flow, a quick return to normal activities, short or no hospitalization.