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In this episode, we have two of the Urology Care Foundation's Humanitarian Grant Program Recipients with us to talk about their passion for helping bring care to others. The work these doctors do across the world helps the lives of patients and their families. Listen along as Rajiv K. Singal, MD, FRCSC and Dana Weiss, MD share their stories. For more information about Humanitarians in Urology, check out our website here: https://www.urologyhealth.org/humanitarianism/humanitarians-in-urology. For more information about urology, please visit www.urologyhealth.org/ and don't forget to subscribe to our free digital magazine, UrologyHealth extra at https://www.urologyhealth.org/healthy-living/urologyhealth-extra. **** November 9, 2023
Our guest is Dr. Aaron Potretzke, an Associate Professor of Urology at the Mayo Clinic in Rochester, Minnesota. He is here to talk with us about Upper Tract Urothelial Carcinoma (UTUC). The goal of this podcast is to help patients diagnosed with UTUC and their caregivers navigate their personal care and feel empowered to make informed decisions about their treatment and care. Short on time? Use the below timestamps to jump to any topic section: 0:55 - Introduction 1:07 - What is UTUC? 2:25 - How common is UTUC? 3:16 - Who is at risk and at what age do symptoms start? 4:42 - What are common symptoms of UTUC? 5:38 - What are the types of UTUC? 6:42 - What is the risk of recurrence with low-grade UTUC? 7:35 - How is UTUC diagnosed? 8:58 - What are the treatments for UTUC? 11:50 - Advice for patients and caregivers 12:25 - Final thoughts UroGen® Pharma is proud to support the Urology Care Foundation in its quest to educate patients. For more information, please visit www.UrologyHealth.org and don't forget to subscribe to our free digital magazine, UrologyHealth extra® at https://www.urologyhealth.org/healthy-living/urologyhealth-extra. **** May 18, 2023
February is Black History Month and The Urology Care Foundation is bringing more awareness to information that is of great value to Black men and women. We have four doctors with us to share their knowledge on Black men and women's health and how they can stay healthy in their lives. Stay tuned as Dr. McNeil, Dr. Stork, Dr. Sutherland and Dr. Moses talk about this important topic. Short on time? Use the below timestamps to jump to any section: 0:38 - Introduction 1:40 - What do you think is important for people know about the Black community as it relates to urology? 3:43 - Why are people in the Black community at higher risk for some conditions? 8:21 - How can we bring more awareness of the importance of Black men and women's health and seeing a doctor regularly? 12:40 - During Black History Month, what health advice do you think is important to share? For more information, please visit www.urologyhealth.org/ and don't forget to subscribe to our free digital magazine, UrologyHealth extra at https://www.urologyhealth.org/healthy-living/urologyhealth-extra. **** February 17, 2022
Our guest is Dr. Yahir Santiago-Lastra, the Associate Professor of Urology at UC San Diego Health and she talks with us about all things urinary tract infections (UTIs). Dr. Santiago-Lastra gets real about the basics around UTIs including what they are, why they happen, how they are treated and how to prevent them. We've got you covered on the basics whether it's your first UTI or a recurrent UTI. Short on time? Use the below timestamps to jump to any section: 0:47 - Introduction 1:30 - What is a UTI? 2:38 - Main symptoms & diagnosis 5:56 - Can both men & women get UTIs? Are they transmitted sexually? 7:29 - Can UTIs go away on their own? 8:28 - Treatment for UTIs 10:07 - Recurrent UTIs & why they happen 13:09 - Preventing UTIs 15:54 - Debunking UTI myth 18:48 - Final thoughts For more information, please visit UrologyHealth.org and don't forget to subscribe to our free digital magazine, UrologyHealth extra. This podcast is brought to you by the Urology Care Foundation in partnership with the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. **** November 4, 2021
Erectile Dysfunction: Common Causes and natural solutions – Dr. Jason Jones Elizabeth City NC, Chiropractor Erectile dysfunction (ED) is one of the common health conditions recorded among men. In fact, According to the Urology Care Foundation, it is estimated that 30 million Americans experience ED. Many patients in our Chiropractic Office at Elizabeth City, NC have reported how erectile dysfunction has affected their sex drive, and how it resulted in depression and low self-esteem. So it is important that we discuss this problem, which is common in men. What is Erectile Dysfunction? Erectile dysfunction (ED) is simply the inability to get or maintain a firm enough erection to have sexual intercourse. This condition is sometimes referred to as “impotence.” Many men experience ED during times of stress, but when it becomes frequent, it is a clear sign of health problems that need medical attention. An erection is normally achieved when there is an increased blood flow into your penis. And this happens when a man is sexually excited. The muscles in your penis relax and blood flows into your penile arteries, resulting in the filling of two chambers inside the penis. This makes the penis grow hard. What are the causes of Erectile Dysfunction? There are many possible causes of ED, including physical and emotional conditions. However, the common causes of ED include: Cardiovascular disease High blood pressure Diabetes Obesity Kidney disease Anxiety Stress Depression High cholesterol Low testosterone levels Increased age Sleep disorders Certain prescription medication Prescription Medications that Can Cause Erectile Dysfunction Numerous prescription medications have been implicated in erectile dysfunction. That's why it is important to always consult your doctor before changing or stopping your medications. Some medications that can cause erectile dysfunction include: Heart medications such as digoxin Drugs that work on the central nervous system, including amphetamines and sleeping pills Drugs to control high blood pressure Anxiety treatments Some diuretics Prostate treatment drugs Opioid painkillers Antidepressants, including monoamine oxidase inhibitors (MAOIs). Tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) Anticholinergic drugs Some cancer drugs The peptic ulcer medication cimetidine Hormone drugs Natural Solutions for Erectile dysfunction There are many treatment options available for ED such as drugs, surgical treatments, and more. But the natural solutions are advisable to avoid unpleasant side effects. Here are some natural solutions that have been used to treat erectile dysfunction: Exercises Certain exercises have been shown to help with erectile dysfunction. You can try the following: Kegel exercises: These exercises involve simple movements that help to strengthen your pelvic floor muscles. Start by stopping your pee midstream to identify your pelvic floor muscles. Contract these muscles for at least 3 seconds, and then release them. You can do this exercise three times a day, and 10 to 20 times in a row. Aerobic exercise: You can try moderate to vigorous exercises like swimming and running. These exercises increase your blood flow and improve your overall health Yoga: This helps to relax your mind and ease every form of stress and anxiety. Eating a healthy diet You can prevent or treat erectile dysfunction by eating a healthy diet. This helps to maintain your blood vessels and increase your blood flow. Eat whole grains, fruits, and vegetables Limit your consumption of processed sugars, full-fat dairy, and red meats Limit or quit alcohol consumption Natural herbs You can improve erectile dysfunction by using certain herbs, including: Asparagus racemosus Ginseng, such as Korean ginseng Dehydroepiandrosterone (DHEA) Yohimbe Horny goat weed Acupuncture Acupuncture is a traditional treatment measure that involves inserting needed at specific parts of the skin. This method works for erectile dysfunction through nerve stimulation, and it has an effect on the release of neurotransmitters. Prostatic massage A prostatic massage is an effective form of massage used for ED. During this method, the practitioner massages the tissue in and around the groin to promote the flow of blood to your penis. You may need to undergo this massage several times a week, but it all depends on your symptoms. In conclusion, erectile dysfunction is one of the most common health conditions in men. It is sometimes called impotence and its risk increases with age. There are several factors that can cause ED, including prescription medications. This condition can lead to depression, lower, sex drive, low self-esteem, and stress. Several treatment measures are available for ED, including medical interventions, lifestyle changes, and natural remedies. We however recommend the natural solutions listed above. However, you should consult your doctor before using any of those methods.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Dr. Kurt McCammon joins us for today's interview. Dr. McCammon is a reconstructive urologist in Virginia. He has been doing humanitarian work in urology for the past 15 years.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Dr. Kurt McCammon joins us for today's interview. Dr. McCammon is a reconstructive urologist in Virginia. He has been doing humanitarian work in urology for the past 15 years.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Dr. Suzette Sutherland joins us for today's interview. Dr. Sutherland is the Director of Female Urology and Associate Professor in the Department of Urology with the University of Washington School of Medicine in Seattle.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Dr. Suzette Sutherland joins us for today's interview. Dr. Sutherland is the Director of Female Urology and Associate Professor in the Department of Urology with the University of Washington School of Medicine in Seattle.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Today, we are interviewing Dr. Mitchell Humphreys, a urologist with Mayo Clinic in Arizona.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Today, we are interviewing Dr. Mitchell Humphreys, a urologist with Mayo Clinic in Arizona.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Today, we are interviewing Dr. Jessica DeLong, a urologist with Urology of Virginia in Hampton Roads, Virginia.
The Urology Care Foundation has launched a series of Humanitarian Endowments to support urologic health care missions in the U.S. and around the world. This podcast series spotlights some extraordinary humanitarians in urology who volunteer to serve patients in underserved areas across the globe. Today, we are interviewing Dr. Jessica DeLong, a urologist with Urology of Virginia in Hampton Roads, Virginia.
The Living Healthy Cookbook with Information about Urologic Cancers is published by the Urology Care Foundation as a service to patients, health care professionals and the public. Part of managing cancer includes a healthy diet and lifestyle. This educational cookbook has recipes from celebrity chefs and much more. Learn about this brand new resource on today's podcast and download your free copy today by visiting UrologyHealth.org.
September is Prostate Cancer Awareness Month. On today's episode we are joined by Dr. Ben Ristau as he discusses the differences between active surveillance and watchful waiting when it comes to prostate cancer. Dr. Ristau is a urologist with UConn Health in Connecticut. He is also the chair of the Urology Care Foundation's Technology and Publications Committee.
This educational series is supported by an independent educational grant from: AstraZeneca; Merck; Pfizer Inc. CME Available: https://auau.auanet.org/node/29200 Course Description: Over the last several years, there has been a dramatic increase in our understanding of the role of genetic testing in prostate cancer. Urologists are suddenly being confronted with new information surrounding screening guidelines for men at high genetic risk of prostate cancer, genetic testing in men with both localized and metastatic prostate cancer, and the impact on treatment decisions in men with prostate cancer and inherited DNA damage repair gene mutations. To increase urologists understanding related to the newest treatment options for prostate cancer, the featured 60-minute panel discussion led by experts in their field, will explore how to translate the latest scientific advances into routine clinical practice, improving the care of patients who are at a markedly-elevated risk of progressions and death from prostate cancer. The Genetic Testing in Prostate Cancer: Considerations for Urologists and their Patients Webinar will be recorded and available in webcast format on AUAUniversity and AUA’s YouTube channel. Additionally, the content will be released as an episode on AUA’s podcast. Learners will also be provided with links to access a patient and caregiver video and fact sheet produced by the Urology Care Foundation to increase patient understanding of genetic testing as it relates to prostate cancer, and facilitate enhanced patient – physician communications in regards to treatment options. Learning Objectives: At the conclusion of the activity, participants will be able to: 1. State the criteria for genetic testing of prostate cancer patients, the gene panels available, and options for testing these men. 2. Interpret results of genetic testing and relay this information to patients in order to facilitate shared-decision making based on the test results. 3. Explain the importance of testing for germline mutations and their implication for novel therapies such as PARP inhibitors. 4. Counsel men with BRCA1/2 mutations, Lynch syndrome, and other key inherited syndromes regarding their prostate cancer risk and appropriate strategies for cancer screening.
Dr. Brian Stork joins the Urology Care Podcast with information about visiting a urologist during COVID-19. He also answers other miscellaneous questions a urology patient may have during COVID-19. Dr. Stork is a urologist in Muskegon, Michigan. He is also the Chair of the Urology Care Foundation's Patient Education Council.
Anne E. Calvaresi, DNP, CRNP, RNFA, joins the Urology Care Podcast to discuss what prostate cancer patients need to know during the COVID-19 pandemic. Dr. Calvaresi is the chair of the Urology Care Foundation's Prostate Health Committee. She works in Philadelphia and specializes in urology and prostate health.
Dr. Brian Stork joins the Urology Care Podcast with some advice for our listeners about how to best prepare for a urology visit. Dr. Stork is a urologist in Muskegon, Michigan. He is also the Chair of the Urology Care Foundation's Patient Education Council.
May 31 is world no tobacco day sponsored yearly, since 1987 by the Member States of the World Health Organization. World No Tobacco Day every year informs the public on the dangers of using tobacco, the business practices of tobacco companies, what the world Health organization is doing to fight the tobacco epidemic, and what people around the world can do to claim their right to health and healthy living and to protect future generations. This year's theme is prevention of smoking by our youth and awareness of how tobacco companies market to younger generations. This year, the World Health Organization is encouraging efforts that empower young people to stand up to big tobacco companies by resisting their ads and marketing and refusing to use any tobacco or nicotine products including e-cigarettes and other vaping devices. Here are 5 reasons your urologist may tell you not to smoke according to the Urology Care Foundation: Bladder Cancer: May is bladder cancer awareness month. This year over 80,000 will be told they have bladder cancer. Smoking causes harmful chemicals to collect in the urine. These chemicals affect the lining of the bladder and significantly raise your bladder cancer risk. Erectile Dysfunction impacts 20-30 million American men. Erectile Dysfunction is most commonly a result of poor blood flow to the penis. Smoking harms blood vessels, mostly arterial health, which impacts the blood flow to the penis with the result in not being able to get or keep an erection firm enough for sexual intercourse. Kidney Cancer. Kidney Cancer is in the top ten most common cancers for men and women, combining for more than 70,000 cases of kidney cancer expected this year. When smoking, carcinogens are drawn into the lungs and then into the bloodstream where they are filtered by the kidneys. The harmful chemicals increase your risk of getting kidney cancer. Incontinence, urine leaking, and Overactive Bladder (OAB), impact more than 33 million men and women. The chemicals from smoking and vaping bother the bladder and can contribute frequent urination. Smoking can also cause coughing spasms that can lead to urine leakage. Smoking can harm the eggs in the female and sperm in the male. The infertility rate for smokers is twice the rates for those who do not smoke. You don't have to do it alone. Your family, your friends, and your doctors will help you. Get ready. Set a date to quit. Get support and seek help. The national tobacco quit line: 1-800-QUIT NOW (1-800-784-8669). Free smartphone and tablet apps are available. Try the National Cancer Institute's QuitPal. Websiters such as Smokefree.gov offers a ton of support and resources including a text messaging program called SmokefreeTXT.
Nicole Ramey joins the Urology Care Podcast this week to discuss our highly popular resource, the Living Healthy: Fight Kidney Stones with Food Cookbook. Nicole is the Patient Education & Grants Project Manager with the Urology Care Foundation. The cookbook is available to download for free by visiting https://www.urologyhealth.org/educational-materials/kidney-cookbook
We explore sexual dysfunction with Dr. Akanksha Mehta on today's episode of the Urology Care Podcast. Dr. Mehta is Assistant Professor of Urology at Emory University School of Medicine in Atlanta. She is also a member of the Urology Care Foundation's Reproductive and Sexual Health Committee.
Today's episode of the Inside Tract Podcast is an excerpt from the recently released IMPACT research publication from the Urology Care Foundation. The inaugural issue of IMPACT highlights how AUA and Foundation supported research has made a difference in reducing the burden of urologic disease. To read IMPACT visit http://www.AUAnet.org/IMPACT.
En este episodio del Podcast de Urology Care Foundation se habla acerca de la vejiga hiperactiva. Este podcast ofrece información sobre cómo manejar el síndrome de la vejiga hiperactiva. Este es el nombre que se da a una serie de problemas de la vejiga.
The Urology Care Foundation is the official foundation of the American Urological Association (AUA). On this episode of the AUA's Inside Tract podcast, Sanford J. Siegel, M.D., discusses the importance of the Foundation and why he supports it. Dr. Siegel is the Chairman of United Urology Group, he is also an At-Large member of the Foundation's Board of Directors.
Happy Halloween from the Urology Care Podcast and Urology Care Foundation! Today's episode exams the "spookiest" instruments in the history of urology in a discussion led by Tupper Stevens. Tupper is an archivist at the William P. Didusch Center for Urologic History at the American Urological Association (AUA) headquarters in Linthicum, Maryland.
Dr. Brian Stork, a urologist with the University of Michigan, joins the Urology Care Podcast to celebrate our 100th episode. He interviews podcast host Casey Callanan about the podcast, and its mission and history. Dr. Stork chairs the Urology Care Foundation's Technology and Publications Committee.
September is Prostate Cancer Awareness Month. This episode of the Urology Care Podcast is based on the popular Prostate Health Playbook. The Playbook is the Urology Care Foundation's most comprehensive resource for patients on prostate health. It reviews prostatitis, BPH, prostate cancer screening, prostate cancer treatment options and information about life after prostate cancer.
Our podcast host, Casey Callanan, is joined by Nicole Ramey and Jennifer Kennedy of the Urology Care Foundation to discuss their recent MX Award win for video marketing. Nicole is the Patient Education and Grants Project Manager, and Jennifer is a Senior Graphic Design Coordinator with the Foundation. The Urology Care Foundation is the official Foundation of the American Urological Association (AUA). You can watch the entire award-winning video here.
Dr. Brian Stork and a recent kidney stones patient, Taylor Titus, discuss stones on this new episode of the Urology Care Podcast. The two discuss Taylor's journey as a patient and her experience with the use of a ureteral stent. On this episode Dr. Stork sheds some additional light on what we can learn from Taylor's story. Dr. Stork is a general urologist in Muskegon, Mich., and Taylor is a colleague of Dr. Stork at the Urology Care Foundation and is not one of Dr. Stork's patients.
To encourage consistent, high quality, evidence-based treatment of patients with Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC), the AUA and Urology Care Foundation are producing a series of online activities and educational resources for healthcare professionals, patients and caregivers. One of those such activities is this complimentary AUA Castration-Resistant Prostate Cancer Guideline Amendment webinar. This 60-minute, knowledge-based, live webinar is offered at two different dates and times for the learner's convenience.. The goal of this complimentary webinar is to improve clinicians’ understanding of the 2018 update to the 2013 AUA Guidelines on CRPC. During this webinar, expert Faculty will: Explore the rigorous process used in the development of these evidence-based guidelines. Discuss new developments and future research needs for this topic. Showcase clinical scenarios in urological practice and the correct application of the new AUA guidelines in those instances. CME Available: https://auau.auanet.org/node/19903
In honor of Prostate Cancer Awareness Month, Mike Haynes, prostate cancer survivor and hall of famer with the NFL's New England Patriots and Oakland Raiders, talks with the Urology Care Foundation about his personal journey with prostate cancer.
September is Prostate Cancer Awareness Month. In honor of this month, Dr. Brian McNeil of SUNY Downstate Medical Center in Brooklyn, New York answers 5 key prostate cancer questions. This podcast has been brought to you by the Urology Care Foundation, visit UrologyHealth.org/ProstateCancer to learn more.
To encourage consistent, high quality, evidence-based treatment of patients with Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC), the AUA and Urology Care Foundation has produced a series of online activities and educational resources for healthcare professionals, patients and caregivers. One of those such activities is this complimentary Emerging Treatment Options for Non-Metastatic CRPC Podcast (2018). https://auau.auanet.org/node/20087
Dr. Brian Stork discusses the vast patient education resources that are available from the Urology Care Foundation and how he uses them in his everyday practice. Dr. Stork is a urologist with the University of Michigan.
Medical illustration has always been important in Urology. The Urological history museum is named after a foremost illustrator in the field of urology, William P. Didusch. In my office, I have also drawn many pictures over the years to help illustrate for patients what their urological problem is. Pictures that I have drawn over and over again have become permanently laminated and I pull them out as I am speaking with patients rather than search for a blank piece of paper and poorly reproduce the drawing. As I look for solace about my drawing ability I find it in the words of two illustrators, Walt Disney (yes, that Walt Disney…maybe you have heard of him?) and aforementioned Max Brodel, considered to be the father of medical illustration. A bladder diverticulum is an outpouching/herniation through the bladder wall through a weak part in the bladder wall. A bladder diverticulum may either be congenital (something you are born with) or acquired (something you get later in life). A congenital diverticulum is most often found when you are still a child, and there is often only one diverticulum in the bladder. A congenital diverticulum often does not need to be treated. Acquired bladder diverticula are most often caused several different factors: 1) by a block in the bladder outlet (such as from a swollen prostate or urethral stricture), 2) a dysfunctional or neurogenic bladder, or, more rarely, 3) from prior bladder surgery. With acquired diverticula, many pockets often form, with one or two growing over time to become larger, sometimes larger than the bladder itself. Bladder diverticula are most often seen in older men as a result of BPH, benign enlargement of the prostate, who tend to get trabeculation of the bladder, cellules and saccules of the bladder and, ultimately, diverticula. I use the following mental image a lot. People seem to remember those dolls that look like martians where you squeeze the body and their eyes and ears pop out. The toy is called Bug Out Bob squeeze toy or Panic Pete online today and you can still purchase one to relieve your stress if you want. Most often, bladder diverticula have no direct signs or symptoms. They are most found while looking for causes of other urinary problems: urinary tract infections, blood in the urine, bladder stones, urine flowing backwards into the kidneys ("reflux"), bladder tumors, difficulty emptying the bladder. Bladder diverticula can be found with an x-ray test of the bladder and/or a cystoscopy. The xray test is done by filling the bladder with a dye that shows up well in x-rays (called a "contrast") and taking pictures, either with plain xray or with a CT scan. A cystoscope, a long, thin flexible scope with a light at the end is used to check the lining of the diverticulum, primarily to check for bladder tumors in the diverticulum. Other tests may also be performed. A "urodynamics" test may also be done to see how well the bladder works and ultrasound tests can determine if the bladder is emptying or if the diverticulum is affecting the kidneys. Bladder diverticula don't always need to be treated if they're not causing any problems. If the diverticulum is causing problems though, surgical removal is usually required. It is also very important to treat the underlying cause of the diverticulum as well. In the case of a man with BPH, treating the underlying prostate enlagement and obstruction prevents further diverticulum from forming. We usually use the da Vinci robot to perform the surgery for removal of the diverticulum. This surgery may be hard if the diverticulum has been infected and is swollen, but in general the procedure ca be performed in an hour or two with a single night's stay in the hospital afterward. A patient will have to wear a catheter for five to seven days after the surgery, but can begin urinating normally once the catheter is removed. Most surgeries are very successful but some risks of diverticulum surgery are damage to the intestines or ureters, urine leaking from the bladder after surgery, blood in the urine, and bladder infections. YouTubevideo link: https://www.youtube.com/watch?v=BH8zyzBk3s0 Washington Post Article link: http://www.washingtonpost.com/wp-dyn/articles/A40150-2002Jul8_5.html Urology Care Foundation link: http://www.urologyhealth.org/urologic-conditions/bladder-diverticulum
In the wake of new United States government recommendations on prostate cancer screening, the Urology Care Foundation speaks with Dr. John Lynch, urologist and prostate cancer expert, to learn about what patients need to know. Learn more and see the video at UrologyHealth.org/PSATest
Do you suffer from the quintessential "dad bod," have difficulty losing weight, have low muscle tone and/or experience feelings of depression? It's possible that you could have low testosterone. Low-T is becoming increasingly common, currently affecting 4 in every 10 men over the age of 45 according to the Urology Care Foundation. If this sounds like you or someone you know, then check out my podcast with Ali Gilbert. Ali is a trainer and fitness expert who specializes in men's health. She is highly sought after for her unique approach to training that includes a combination of nutrition and hormone optimization to improve body composition. Ali is a Golf Digest top 50 golf fitness professional and is the founder of the personal online coaching brand Metabolic Golf, where she trains busy professionals who are aiming to improve their golf game through strength, nutrition and lifestyle changes. She is also a partner at Greenwich DX Sports Lab and the director of performance at CLAY Health Club + Spa in Port Chester, NY. During our show today Ali and I dive deep into the importance of measuring testosterone levels in men, especially those over 40, why so many men are suffering from low T, how our environment, lifestyle, sleep, nutrition and training affect testosterone and what we can do to overcome some of these obstacles through lifestyle changes. If you're over 40 or simply just interested in understanding more about testosterone and how to improve your hormones through lifestyle, then this podcast will provide you with immense value. In This Podcast We Also Discuss: - Why Ali became an advocate for men's health [5:15] - How our environment and obesity contribute to the low-T epidemic [7:57] - Whether or not our body is actually able to detoxify itself [11:27] - Telltale signs of low-T [12:28] - The relationships between stress and low-T [15:12] - Some first steps men can take if they suspect they have low testosterone [17:56] - Blood markers of low-T that conventional doctors may be overlooking [20:35] - Lifestyle, nutrition and training factors that can help improve testosterone levels [30:12] - Subjective and objective tools Ali uses on her clients before each training session [41:22] Follow Ali Gilbert Here: http://metabolicgolf.com/ https://www.insideclay.com/ https://www.greenwichdxsportslabs.com If you're interested in finding out more about testosterone optimization, check out my podcast with Jay Campbell, the author of TRT Revolution. You'll learn a ton of great information regarding hormone replacement therapy and techniques for improving physique. You can also check out my podcast with Dr. Jade Teta who recently wrote a book called Lose Weight Here: The Metabolic Secret to Target Stubborn Fat and Fix Your Problem Areas. During our interview, Dr. Teta shares his revolutionary approach to sustained weight loss and muscle growth through caloric restriction and hormonal balance.
November is National Bladder Health Awareness Month. According to the Urology Care Foundation the cost of treating bladder problems in the United States is 70 billion dollars annually. For National Bladder Health Awareness Month, we are talking about bladder cancer. Bladder cancer is the 5th most common non-skin cancer in the United States. It is the 4th most common cancer diagnosed in men and by the Veterans Affairs Health System. Nearly 600,000 Americans live with bladder cancer today and 75-80,000 people will be diagnosed in the United States with bladder cancer this year. An estimated 16-17,00 people will die from bladder cancer this year. In the last episode, we talked about bladder cancer growing as a papillary tumor. It begins on the surface of the bladder, in the lining cells of the bladder called transitional cells. Most bladder cancers then grow into the inside of the bladder on a stalk. As tumors grow, however, they can grow roots and invade into the deeper layers of the bladder. As tumors invade the chance that the cancer metastasizes and spreads to organs beyond the bladder increases. Superficial tumors can be resected from the surface of the bladder as their only treatment. Higher stage and recurrent tumors will need to be treated with other treatments such as instillation of BCG, chemotherapy, or even removal of the bladder. This year the American Urologic Association, in collaboration with other oncologic societies, published guidelines for the treatment of muscle invasive bladder cancer. The guidelines were presented at the 2017 Annual Meeting. You can find the guidelines as well as other AUA guidelines at http://www.auanet.org/guidelines/muscle-invasive-bladder-cancer-new-(2017). Muscle invasive bladder cancer is a challenging problem in urology. The introductory paragraphs of the AUA guidelines gives the scope of the problem that muscle invasive bladder cancer is for patients and physicians: “Although representing approximately 25% of patients diagnosed with bladder cancer, muscle-invasive bladder cancer (MIBC) carries a significant risk of death that has not significantly changed in decades…In patients who undergo cystectomy, systemic recurrence rates vary by stage…Most recurrences will occur within the first two to three years…and…most patients with recurrence after cystectomy are not curable. …There is also a significant impact of treatment choices on outcome with the type and timing of therapy playing an important role.” I am going to repeat that statement. “There is also a significant impact of treatment choices on outcome with the type and timing of therapy playing an important role.” Losing one's bladder, even if it is lifesaving, causes significant impact in a person's quality of life, and many patients and physicians choose to delay or defer surgery when it could be curative. Urologists, as we will discover, have always sought ways to restore or retain the quality of life for patients whose bladder must be removed because of cancer. If we choose the right treatment at the right time we can make progress in treating muscle invasive bladder cancer. I am going to go through the AUA guidelines. There are 35 of them. Don't worry, I will not be going through each guideline individually but rather group them together into brief discussion points that patients who have muscle invasive bladder cancer and their physicians must think about before, during, and after the removal of the bladder. Guidelines 1-5 concern the initial evaluation and counseling. Full history and physical examination should be performed, the patient should have a staging evaluation with imaging and laboratory evaluation, and the patient should have a full discussion of curative treatment options. A complete discussion with regard to implications for quality-of-life should be discussed with the patient, including the type of urinary diversion. A multidisciplinary approach including surgical, chemotherapy and/or radiotherapy options should be discussed with patient. Guidelines 6-9 discuss either preoperative or postoperative chemotherapy. Chemotherapy should be offered to eligible patients prior to radical cystectomy although the best regimen for neo-adjuvant chemotherapy remains undefined. Guidelines 10-12 concern the radical cystectomy operation. Radical cystectomy should be offered to patients along with bilateral lymphadenectomy for surgically eligible patients. Standard radical cystectomy in the males includes removal of the bladder, prostate, and seminal vesicles. In females, the operation includes removal of the bladder, uterus, fallopian tubes, ovaries and anterior vaginal wall. The potential impact of sexual function and other quality of life issues after surgery for both men and women should be discussed prior to the operation. Guidelines 13 and 14 relate to urinary diversion. When the bladder is removed, an alternative to store and drain the urine must be created. Options for urinary diversion after removal of the bladder including ileal conduit, continent cutaneous diversions and ortho-topic neo-bladders. The choice of urinary diversion has a significant impact on long-term quality of life for patients who undergo radical cystectomy. Each type of diversion is associated with its own unique potential complications. Your surgeon will help you decide what type of urine diversion is right for you. I am not trying to be cute here but speaking of diversion, I want to take a step away from the guideline statements at this time and look at one of the articles from the 100th anniversary of the Journal of Urology published this year, a collection of reprints that highlight different eras and advances in Urology over the last 100 years. You can find the articles at JU100.org. I've highlighted some of these reprinted articles over my last few episodes. We have also been highlighting how “otherwise cautious urologists are also adventurous surgeons,” a phrase that struck me from the editor's introduction to the anniversary edition. One of the articles that was reprinted was a 25-year retrospective for one type of procedure for urinary diversion no longer used today called the Camey procedure. The original article was published in the Journal in 1984. Camey began doing his procedure in the late 1950s. The Camey procedure is a type of urinary diversion isolating a 40-cm segment of ileal small bowel, attaching the ureters to either end and sewing the mid-segment of the isolated ileum to the remaining urethra after the bladder is removed. 84 patients were reviewed by Camey in his 25 year-experience. Dr. Camey's review paper is fascinating to read. In his paper Dr. Camey gives details about his experience, both his success as well as his failures. Let's hear him tell us about his first five patients. “The historical evolution of the current technique of bladder replacement can be divided into intervals of error, analysis, and correction. The first patient bladder replacement was attempted achieved continence. The second patient, operated upon a few days after the first, died within 15 days postoperatively…. The first functional enterocystoplasty in which total continence was a seen was performed in 1959 (patient #3). Pelvic lymphadenectomy revealed positive nodes and the patient died of carcinoma in 18 months… In an attempt to minimize infection, foreign body reaction and so forth, ureteral were not used in patient number four. This procedure proved disastrous when the patient became anuric secondary to edematous obstruction of the bilateral implants. As a consequence, bilateral ureteral stents delivered through the urethra and held in place by attachment to an indwelling urethrovesical 22 French straight catheter sutured to the penis have been used in all subsequent procedures. As a consequence of patient 5 the final U-shaped enterocystoplasty emerged. The error in this case was a graph design in which both ureters where anastomosed to the isoperistaltic end of the ileal loop with the distal end anastomosed to the urethra. This procedure resulted in peristaltic waves abutting against the urogenital diaphragm causing urinary frequency and leakage. Despite this deficiency the patient was the first long-term survival (15 years) with preservation of excellent renal function and electrolyte balance.” I will stop reading from Camey's article. It just gives us some idea of how this otherwise cautious urologist needed to be an adeventurous surgeon to make his breakthrough. As I said, the Camey procedure is no longer performed. This has been replaced by other types of urinary diversion and neo-bladder with other names such as Indiana, Hauttman, Studer, and Koch. The newer diversions use de-tubularized segments of bowel. The bowel is designed to contract in a coordinated peristalsis and move contents through it. Because of the coordinated peristalsis the pressures within a tubular segment of bowel will push urine through it rather than store the urine. By de-tubularizing the bowel, we disrupt the peristaltic waves of the bowel and it begins to store the urine under low pressure. The different types of diversion deserve a whole podcast to themselves. Let's return to this podcast and the guidelines. Guidelines 15-18 relate the perioperative management of patients. Optimization of patient performance status and health prior to cystectomy and optimized recovery pathway protocols will enhance recovery. Guidelines 19 and 20 discuss the role of extended lymphadenectomy during the procedure. Guidelines 21through 29 discuss bladder sparing protocols for those patients not eligible for radical cystectomy or who choose to keep their bladder. For these patients, maximal trans-urethral resection of the bladder tumor should be performed. This is typically combined with a combination of radiation along with chemotherapy and close follow-up. Recurrences after bladder sparing techniques should be treated aggressively. Guidelines 30-34 relate to patient surveillance and long-term quality of life issues. Frequent imaging and laboratory assessment are appropriate for those who have undergone treatment to check for recurrence. For those patients struggling with their diagnosis there are number of bladder cancer support groups that would love to speak with you. The last guideline number 35 relates to unique, less common cancer types that may require variance from any of the above guidelines. Your surgeon will help you understand if you fall into one of these categories. The radical cystectomy, lymphadenectomy and the urinary diversion is one of the longest and most complicated procedures that a urologist does. In his conclusion, Dr. Camey wrote, “As a cautionary note the successful performance of this operation depends on an unusual degree of commitment to meticulous technique. The procedure is tedious and stressfully long, and requires a team approach that is logistically complex and not universally feasible.” Dr. Camey's operations routinely took 9 hours. He employed two sets of surgeons for the operation, one to remove the bladder and the other to do the urinary diversion. As urologists have gained surgical experience, operative times have improved. For my partners and I it takes 2-4 hours to remove the bladder, perform the lymphadenectomy, and create the simplest urinary diversion, the ileal conduit. The current standard in my practice is to perform the removal of the bladder robotically using the daVinci system. But the urologic oncologist's long-term success and survival for patients with muscle invasive bladder cancer have not changed in the last 30 years. In his conclusion Dr. Camey writes, “The ancillary modalities, such as chemotherapy, immunotherapy, radiotherapy, antibiotic prophylaxis and nutritional supplementation, which may improve survival further must be perfected….” By creating the guidelines listed above the AUA and other various societies have for the first time come to an agreement about the best approach for these patients to give the highest chance of long-term success. I will end with some of the websites where you can find more information or support if you find yourself with this disease. Helpful websites include the Bladder Cancer Advocacy Network (http://www.bcan.org), Cancer Support Community (https://www.cancersupportcommunity.org), Cancer Care (https://www.cancercare.org), the American Bladder Cancer Society (https://bladdercancersupport.org), the American Cancer Society (https://www.cancer.org), and the Urology Care Foundation (http://urologyhealth.org). Support groups help reduce the three most significant stressors associated with cancer: unwanted aloneness, loss of control, and loss of hope. For those patients who are not interested in a support group, individual counseling may be available through an oncology social worker, psychologist, or local religious organizations. Lastly, if you have any questions, need my support, or have any feedback you can contact me at drbrandt@whyurologypodcast.com.
November is National Bladder Health Awareness Month. According to the Urology Care Foundation the cost of treating bladder problems in the United States is 70 Billion dollars annually. Nursing home costs due to urinary incontinence are estimated at 6 billion dollars annually. Urinary tract infections create more than 8 million doctor visits every year (5.3 of those 8 million visits are women with infections, 1.3 and 1.2 of those 8 million are children and men respectively). Millions of Americans have neurogenic bladder from a spinal cord injury, multiple sclerosis, Parkinson's disease, stroke, spina bifida, or nerve problems caused by diabetes or major pelvic surgery. More than 1 in 10 military service members injured in Afghanistan and Iraq have urologic trauma injuries, damaging the urinary tract or reproductive organs. For National Bladder Health Awareness Month, we are talking about bladder cancer. Bladder cancer is the 5th most common non-skin cancer in the United States. It is the 4th most common cancer diagnosed in men and by the Veterans Affairs Health System. Nearly 600,000 Americans live with bladder cancer today and 75-80,000 people will be diagnosed in the United States with bladder cancer this year. An estimated 16-17,00 people will die from bladder cancer this year. You are at risk for bladder cancer if you are over 55 years of age and you have one of the following five risk factors: 1. You smoke tobacco, either in the past or currently. 2. you are exposed to chemicals in the workplace used to make plastics, paints, textiles, leather and rubber, 3. you have had prior pelvic radiation, 4. you have chronic urinary tract infections associated with neurologic disease and chronic catheterization 5. you are a patient taking medications linked with increasing bladder cancer risk. In the last episode, we talked about how bladder cancer grows as a papillary tumor within the bladder. It begins on the surface of the bladder, in the lining cells of the bladder called transitional cells. Most bladder cancers then grow into the bladder on a stalk. As tumors grow they can grow roots and invade into the deeper layers of the bladder. As tumors invade the deeper layers of the bladder the stage increases and the chance that the cancer metastasizes or spreads to organs beyond the bladder also increases. Superficial tumors can be resected from the surface of the bladder as their only treatment. Recurrence rates for bladder cancer are at least 50% after initial diagnosis. Careful, scheduled followup cystoscopy in the office on a routine basis is required to check for recurrent tumors. Higher stage tumors that are invading into the bladder muscle or beyond often will need to be treated with other treatments such as chemotherapy, radiation or even removal of the bladder. A bladder cancer can also grow in another way that we did not touch on during the last episode, the tumor can also grow up along the surface of the bladder. When the cancer behaves in this way it does not create a papillary lesion but rather takes up a large surface area of the bladder or is even present in several patches within the bladder. That type of growth is called carcinoma in situ (CIS). I want to illustrate this with an analogy. Picture an empty room stripped of all furniture and decoration. Pretend that is the inside of the bladder. Take a lamp and place it in the middle of the floor. That's a papillary tumor. Now let's carpet the floor. That's carcinoma in situ. In the case of bladder cancer growing as carcinoma in situ it is nearly impossible to resect or cut away all of the tumor both because of the large surface area of the bladder that may be involved. Microscopic changes may also be found within other parts of the bladder that cannot be seen by the cystoscope that will become carcinoma in situ. To treat carcinoma in situ we then need to treat the entire surface of the bladder. We are fortunate that the bladder is a hollow cavity. We can simply place the treatment in a fluid within the bladder itself and it will naturally get to the entire bladder surface if we can hold the treatment in the bladder for a time. There are currently two forms of treatment that can be instilled into the bladder, chemotherapy and immunotherapy. Our most effective and most common treatment is called BCG, Bacillus Calmette-Guerin. (BCG). It is a form of immunotherapy, stimulating the body's natural immune response to recognize and kill cancer cells. Immunotherapy uses the body's natural defense cells to fight a cancer. Cancer grows hiding in plain sight from the body's immune system. Cancer cells are abnormal cells but the body does not kill the cancer in the same way that it tries to kill a bacterium or a virus. A cancer cell is derived from the body's normal cells within an organ. Bladder cancer cells, as are all cancer cells, created when normal cells get faulty DNA instructions and grow aggressively, without organization, and without stopping. The cancer cell is allowed to grow because the body does not see it as foreign because it comes from the body's cells in the first place. If we can make a body recognize a cancer cell as foreign, then the body has incredible tools in the immune system to kill a cancer on its own. That is the essence of immunotherapy. There is currently a lot of research being done using immunotherapy to treat all kinds of cancer including bladder, kidney, colon, skin, lung and others. To date nothing has surpassed BCG. The odd and interesting thing about BCG and putting it into the bladder is that it BCG was originally developed and is still used as a vaccine for tuberculosis. How urologists began to use BCG in the bladder is a bit of a convoluted tale that I will tell at the end of this episode. BCG is used in several circumstances. It is employed: (1) to treat carcinoma in situ or occasionally residual papillary tumors; (2) to reduce the number and frequency of recurrent high grade superficial tumors; and (3) to prevent disease progression (although this remains a controversial point, on which there is no consensus view). BCG treatment is usually started a few weeks after an initial resection and biopsy of the bladder tumor to allow the bladder time to heal. The usual treatment is given once a week for 6 weeks. In the office patients are given live attenuated BCG mixed in 50 ml of normal saline instilled into the bladder via a urethral catheter. Before instillation urinary tract infection is excluded and the catheter is introduced in an atraumatic way. The patient retains the fluid within the bladder for an hour or two. This is to ensure that all the bladder mucosa comes into contact with the BCG. There is a small risk of infection with BCG, therefore the staff administering the BCG are suitably protected with masks, goggles, gloves, and gowns. Patients are advised to bleach their toilets after urinating, so as to neutralize and kill any BCG from the urine. BCG works about 50-60% of the time after its first treatment. The initial 6-week treatment can be repeated if needed, providing an additional 20-30% benefit. Sometimes longer treatment regimens are used. An immune booster called interferon can be added. Long-term maintenance BCG therapy where short courses of three weeks given every few months is also used to try to prevent recurrent bladder cancer. Patients not responding to BCG need to have alternative treatments and have a high risk of disease progression and metastatic disease. Treatment with BCG can cause symptoms and side effect that feel like having the flu, such as fever, chills, and fatigue. It can also cause a burning feeling in the bladder that may increase through the course of a treatment. Rarely, BCG can spread through the body, leading to a systemic infection. How does BCG work? The exact mechanism of action of BCG is not completely understood. It is known that an intact immune system is important for the antitumor activities of BCG. The body's immune system cells are attracted to the bladder and activated by BCG, which in turn affects the bladder cancer cells. But how the body suddenly recognizes and kills a bladder cancer that it did not previously recognize is not well understood. Now let's take a bit of a diversion. BCG is a tuberculosis vaccine. Let's talk about tuberculosis. We don't hear about tuberculosis much in the United States. There are between 9-10,000 cases of tuberculosis reported in the United States annually, with HIV-positive immunocompromised patients being the most susceptible. But tuberculosis recently has made the front page of our local newspapers here in Minnesota because of a small outbreak of difficult to treat tuberculosis within our community. According to the World Health Organizations, Tuberculosis (TB) is one of the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with tuberculosis, and 1.7 million died from the disease (including 0.4 million among people with HIV). Over 95% of tuberculosis deaths occur in low- and middle-income countries. Seven countries account for 64% of the total, with India leading the count, followed by Indonesia, China, Philippines, Pakistan, Nigeria, and south Africa. in 2016, an estimated 1 million children became ill with tuberculosis and 250 000 children died of tuberculosis (including children with HIV associated tuberculosis). Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. tuberculosis is spread from person to person through the air. When people with lung tuberculosis cough, sneeze or spit, they propel the tuberculosis germs into the air. A person needs to inhale only a few of these germs to become infected. About one-quarter of the world's population has latent tuberculosis, which means people have been infected by tuberculosis bacteria but are not (yet) ill with the disease and cannot transmit the disease. People infected with tuberculosis bacteria have a 5–15% lifetime risk of falling ill with tuberculosis. Worse yet, strains of tuberculosis that are resistant to the most common therapy are becoming more common. The World Health Organization estimates that there were 600, 000 new cases last year with resistance to rifampicin – the most effective first-line drug, of which 490 000 had Multiple drug resistant-tuberculosis. The cost or treating drug resistant tuberculosis is very high, as much as $134,000 per patient. By comparison, first-line therapy requires at least six months of drugs at a cost of $17,000. Here is where our story begins to take on a local note. According to a recent article in the MPLS paper the Star Tribune at least 17 people have been diagnosed within our community recently with active drug resistant Tuberculosis. Health officials are scrambling to identify those closest to those diagnosed to see if those people have either active or latent infections. Testing on 125 people has already turned up 58 cases of latent tuberculosis infection, meaning they carry the disease, and may go on to develop symptoms and become infectious, especially if they have chronic health conditions or as they age and their immune systems weaken. Like those who show symptoms, those with latent infections are being urged to take the second-tier antibiotics for up to 18 to 24 months. Another 150 potential contacts known to investigators of our local outbreak had incomplete date of birth or address information, complicating the efforts to track them down. That means there are potential latent infections in our community left untreated. This is especially chilling as we enter the cough and cold season here in Minnesota. On a positive note, The World Health Organization believes Tuberculosis is curable and preventable. Globally, tuberculosis incidence is falling at about 2% per year. An estimated 53 million lives were saved through tuberculosis diagnosis and treatment between 2000 and 2016. Ending the tuberculosis epidemic by 2030 is among the health targets of the Sustainable Development Goals for the world Health Organization. One goal of the strategy is to immunize against tuberculosis. The United States does not actively immunize against tuberculosis, but many other countries do. The tuberculosis vaccine used is BCG. It was first given as a vaccine in 1921. Development of the BCG vaccine goes back many years prior to 1921. In 1904, scientists isolated Mycobacterium bovis from a cow with tuberculous mastitis. Bovine tuberculosis was a significant cause of death among cattle in the early 20th century and remains a risk today. Scientists quickly got to work studying bovine TB in the lab. But initially working with bovine TB in the laboratory proved difficult. The mycobacterium culture in the laboratory showed a strong tendency to clump. In order to prevent adhesion, in 1908, working together at the Pasteur Institute Albert Calmette, a physician by training and research bad-ass who, according to Wikipedia, had invented the first anti-venom for snake venom and Camille Guérin, a veterinarian by training added bovine bile to the bovine TB culture medium to prevent clumping. After this culture, the M bovis showed a loss of virulence for animals. With each subsequent culture the bovine TB would show less virulence. In 1920, after a period of 13 years and 231 culture passages through the laboratory the culture was regarded as being avirulent or noninfectious. This special M bovis strain was named Bacillus of Calmette and Guérin (Bacille de Calmette et Guérin, BCG), and a vaccine for tuberculosis was born. BCG was first used in humans in 1921 when it was given to a child in Paris. The baby's mother, who had tuberculosis, had died just after the baby was born, and the baby was due to be brought up by its grandmother who also had tuberculosis. The baby developed into a perfectly normal boy. During the next three years (up to July 1924) a further 317 infants were also vaccinated. The story of BCG then takes a cloudy turn when, in 1930, when 72 vaccinated children developed tuberculosis in Lübeck, Germany, due to a contamination of some batches of the vaccine. Mass vaccination of children was stopped after the disaster but then reinstated in many countries after 1932, when new and safer production techniques were implemented. Strains of BCG are still used today in vaccination programs around the world. BCG vaccine has a documented protective effect against meningitis and disseminated tuberculosis in children. It does not prevent primary infection and, more importantly, does not prevent reactivation of latent pulmonary infection, the principal source of bacillary spread in the community. The impact of BCG vaccination on transmission of Human TB is therefore limited. Next in our tale about how BCG came to be used for bladder cancer comes thanks to Dr. Raymond Pearl, a prolific writer and biologist from Johns Hopkins. Pearl reported in 1929 that among the first autopsy studies at Johns Hopkins there was a negative association of patients with tuberculosis and cancer and he proposed that tuberculosis infection somehow prevents cancer. That assertion is false. Later analysis of his data by others showed that his data had significant selection bias. Criticism of this paper and his analytical methods at the time in particular was to be a stumbling block in his career advancement when Dr. Pearl was being considered for a position at the Bussey Institute at Harvard. The most vociferous critic considered Pearl's work superficial, self-promoting, and a nuisance likening it to “boyish whittling.” But that initial analysis by Pearl sparked interest in the immunobiology of tuberculosis infection as a way to stimulate the immune system to treat cancer. Interest in BCG and tuberculosis as a cancer treatment waxed and waned between 1930 and 1970 but the story continues after intra-lesion injections of BCG for melanoma of the skin proved successful. After the melanoma treatments proved successful for the skin an adventurous urologist injected and successfully treated a melanoma of the bladder through cystoscopic injection, published in the Journal of urology in 1975. This success sparked an interest in BCG treatments of other forms of bladder cancer. In 1976 the first report of BCG treatment for transitional cell carcinoma was published by Dr. A. Morales in the Journal of Urology. This paper is included in a series of papers in an anniversary edition of the Journal of Urology now celebrating its 100th year of publication. You can find it at www.JU100.org. The author was applauded for his “courage as well as his results” by the editorial accompanying the initial publication. It's still not clear if the appropriate animal modeling had been performed prior to clinical experimentation on people, but the successful treatment created the spark that ignited larger research studies that proved the efficacy of BCG and resulted today in many of our patients being treated with BCG. More “academic” studies followed. Dr. Donald Lamm was awarded the initial NIH-funded contract to evaluate BCG immunotherapy of superficial bladder cancer in a randomized clinical trial (1978). This work, accruing an eventual 231 patients, resulted in the first controlled trial demonstrating the efficacy of intra-vesical BCG immunotherapy. Urologists have been using BCG as a treatment for superficial bladder cancer ever since. Let's stop there. I have really taken us on a journey in this episode. I wonder what Drs. Calmette and Guerin would have thought in 1908 as they were adding bile to a bovine TB culture medium if you told them we would eventually use a tuberculosis vaccine they would develop to treat bladder cancer. To get from there to here otherwise cautious urologist had to become the adventurous surgeons and scientists that we have talked about in previous podcasts, the phrase that caught my eye from the editorial introducing the 100th anniversary edition of the Journal of Urology. You can read the article at http://www.ju100.org/. Bibliography/Reference: https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=US&LAN=EN&outtype=html https://www.cancer.org/cancer/bladder-cancer/treating/intravesical-therapy.html http://www.startribune.com/tb-outbreak-has-health-officials-on-alert/455468773/ https://www.researchgate.net/publication/11202692_BCG_use_of_bacille_Calmette-Guerin_in_superficial_bladder_cancer [accessed Nov 11 2017]. https://en.wikipedia.org/wiki/Albert_Calmette https://en.wikipedia.org/wiki/Camille_Guérin
November is National Bladder Health Awareness Month. According to the Urology Care Foundation the cost of treating bladder problems in the United States is 70 Billion dollars annually. Nursing home costs due to urinary incontinence are estimated at 6 billion dollars annually. Urinary tract infections create more than 8 million doctor visits every year (5.3 of those 8 million visits are women with infections, 1.3 and 1.2 of those 8 million are children and men respectively). Millions of Americans have neurogenic bladder – a lack of bladder control due to a brain, spinal cord or other nerve problem such as spinal cord injury, multiple sclerosis, Parkinson's disease, stroke, spina bifida, or nerve problems caused by diabetes or major pelvic surgery. An estimated 33 million adults in the U.S. may have overactive bladder. As if that weren't enough, here is a humbling statistic. More than 1 in 10 military service members injured in Afghanistan and Iraq have urologic trauma injuries, damaging the urinary tract or reproductive organs. In preparation for National Bladder Health Awareness Month today we are going to talk about bladder cancer. Although it doesn't make the newspapers much bladder cancer is the 5th most common non-skin cancer in the United States. It is the 4th most common cancer diagnosed in men and by the Veterans Affairs Health System. Nearly 600,000 Americans live with bladder cancer today and 75-80,000 people will be diagnosed in the United States with bladder cancer this year. An estimated 16-17,00 people will die from bladder cancer this year. According to the American Cancer Society bladder cancer is more common as a person grows older. 90% of patients with a new diagnosis of bladder cancer are over age 55, with the average age at diagnosis being 73 years old. Bladder cancer is three times more common in males than females. Whites are diagnosed with bladder cancer about twice as often as African or Hispanic Americans, but African-Americans present more commonly with advanced disease. You are at risk for bladder cancer if you are over 55 years of age and you have one of the following five risk factors: 1. You smoke tobacco, either in the past or currently. Smoking tobacco may be the cause of half of all bladder tumors. If you need another reason to stop smoking if you are a smoker, please add bladder cancer to your list, 2. You are at risk for bladder cancer if you are exposed to chemicals in the workplace used to make plastics, paints, textiles, leather and rubber, 3. you have had prior pelvic radiation, 4. you have chronic urinary tract infections associated with neurologic disease and chronic catheterization and less commonly 5. you are a patient taking some medications linked with increasing bladder cancer risk such as the chemotherapy cyclophosphamide, the diabetes drug Actos, or dietary supplements containing aristolochic acid (mainly in herbs from the Aristolochia family). I have recently diagnosed patients with bladder cancer without significant risk factors other than age and gender. One gentleman I saw recently had come in for a routine follow up appointment for his enlarged prostate and elevated PSA number. The day before his appointment, however, he had seen blood in his urine and mentioned it casually at the end of his appt. He was having no other symptoms. Urologists take blood in the urine very seriously. Blood in the urine is the most common symptom of bladder cancer. When bleeding occurs because of bladder cancer it is generally painless, and is seen in the entire urine stream. If you see blood in your urine you should tell a healthcare provider so they can refer you to a urologist. Even if the blood goes away, you should still talk to your doctor about it. When you see blood in the urine, it is called "gross hematuria." Often, however, you cannot see the blood in your urine but it is detected by the laboratory with a microscope during routine checks of the urine such as during an annual physical exam. A very small amount of blood might be normal in some people and not lead to a medical condition, but ALL patients require evaluation when the amount of blood detected on the urinalysis is more than just a trace amount. Blood in the urine does not always mean that you have bladder cancer either. There are a number of other more common reasons why you may have blood in your urine: urinary tract infection, enlarged prostate or prostate infection, kidney or bladder stones, kidney disease, kidney trauma, or kidney cancer, blood thinning drugs and even a tough workout (what we call runner's hematuria) can cause blood in the urine. When blood is found in the urine, even if it's a small amount, you need to make sure there is not a tumor in the kidney or bladder, or a kidney stone or infection. We have to evaluate the kidneys, ureters, bladder, and the urethra to try to identify a source for the bleeding. A CT scan or ultrasound is ordered to look at the kidneys and ureters, with a CT scan with and without IV contrast dye being the recommended test in most cases. We can run a urine cytology or other bladder tests on the urine to see if there are changes that would indicate bladder cancer. But to evaluate specifically for bladder cancer, unfortunately, the best test is to actually look inside the bladder with a scope. We have to perform a cystoscopy, a procedure to look inside the bladder. A cystoscope is a thin flexible instrument that has a light and camera or fiberoptics at the end of it allowing us to see directly inside the bladder. To get into the bladder we have to pass the cystoscope through the urethra. Cystoscopy is done as an outpatient procedure in the clinic. The average cystoscopy takes just a minute or two. As you would expect the procedure is uncomfortable, and carries with it a small risk of infection from the introduction of the scope into the bladder. A cystoscopy is the most common procedure done in our office. There are many reasons we perform cystoscopy, to rule out cancer of course but also to evaluate the urethra, prostate, and bladder anatomy. Other symptoms of bladder cancer as well as many other urologic problems may include changes in urination. Frequent urination or pain when you pass urine called dysuria are less common symptoms of bladder cancer and often indicate other problems such as infection or overactive bladder. But to evaluate these symptoms more completely we will often perform cystoscopy, even if cancer is not suspected. Cancer is when your body cells grow out of control when the normal DNA instructions for cell growth are disrupted. Most cancers form a lump called a tumor. In the case of bladder cancer that growth occurs inside the bladder and we can visualize it directly with the scope. A review of anatomy is appropriate. The bladder is a hollow organ in the pelvis with flexible, muscular walls. The bladder is where the body stores urine before it leaves the body. The bladder can get bigger or smaller as it fills with urine and empties. When you go to the bathroom, the muscles in your bladder will contract. They then push urine out through a tube called the urethra. In addition to the muscular layer of the bladder the bladder wall has other layers, made up of different types of cells. The inner lining is called urothelium lined by a special type of cells called transitional cells. Transitional cells are designed to make a transition are able to change shape from very bunched up and contracted when the bladder is empty to being very stretched out and thin when the bladder is full. In a word, they “transition.” Because most bladder cancers start in the urothelium or transitional epithelium, bladder cancer is often called transitional cell carcinoma. Other types of bladder cancer exist but are much less common and include squamous cell carcinoma (cancer that begins in thin, flat cells lining the bladder) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). Transitional cell carcinomas grow typically as a polypoid growth, with a stalk and are referred to as being papillary. A person with bladder cancer will have one or more tumors in the lining of the bladder that, if I would have to describe it, appear like mini cauliflower floret, or like a sea coral waving from the ocean floor. Bladder cancers attach to the bladder wall on the lining or the surface. That is called a non-invasive tumor. As the polyp grows it can begin to invade through the top most part, the transitional epithelium to the layers underneath. Bladder cancer gets worse when it grows into or through other layers of the bladder wall. The first layer it invades is a connective layer called the lamina propria. If the cancer begins to invade into the lamina propria layer it becomes a stage 1 cancer. If the cancer is just on the surface it is not considered a stage 1 cancer but rather is referred to as superficial or a stage A cancer. Underneath the lamina propria is a muscle layer called the detrusor muscle. When the tumor reaches the muscle layer it becomes a stage 2 cancer and has a much higher chance of spreading. Beyond the muscle is the fatty connective tissue holding the bladder in place. If the cancer reaches that level it becomes a stage 3 caner. Over time, the cancer becomes a stage 4 bladder cancer grows outside the bladder into tissues close by. Bladder cancer may spread to lymph nodes, lungs, liver, bones and other parts of the body. Stage 2, 3, and 4 cancers require more surgery, radiation, and chemotherapy. Superficial and Stage 1 tumors may need more surgery or treatments instilled into the bladder. When we look inside a bladder and see a tumor or growth we can't officially call it a cancer until we have a biopsy. Diagnosis of bladder cancer is confirmed and staged most commonly during a transurethral resection of a bladder tumor (TURBT). For many patients, the resection of the bladder tumor will be the only treatment they need. The tumor is resected under anesthesia in the hospital or surgery center. A scope is placed in the bladder that has a working element that can cut the tumor off of the surface of the bladder. At this time, your doctor will stage your cancer and try to cut it away completely to get rid of the cancer. The surgeon will resect or remove all of the visible tumor if possible and send the biopsy to a pathologist who will review the specimen and assign it a stage and grade. What is left in the bladder can best be described as a divot, much like a golfer leaves his mark on the fairway, because the urologist has to get deep enough to cut the tumor completely out if possible. The bladder heals very fast, relining itself quickly with healthy urothelium. Grade and stage describe a cancer's development and guide future treatment. A tumor grade tells how aggressive the cancer cells are. A tumor stage tells how much the cancer has spread. We have already reviewed the tumor stages above. The pathologist will review the specimen and also assign a grade to the cancer. Tumors can be low or high grade. High-grade tumor cells are very abnormal, poorly organized and tend to be more serious, faster growing cells that are more likely to recur after they are removed and to invade the other layers of the bladder. A low-grade tumor has cells that are abnormal, but less aggressive looking and more uniform in character. They tend to behave less aggressively in terms of putting patients at risk for recurrence or invasion to other layers of the bladder. As I said before many patients are treated with simple resection of the bladder tumor. If the bladder cancer is superficial and low grade the treatment is most often just the removal and routine follow-up cystoscopy in the office. 50% of bladder cancers will recur. Just like dandelions in the yard, the seeds for next year's growth may lie somewhere else in the bladder already at the time of removal. Careful follow-up is critical to finding tumors early if they recur and treating them before they advance. Routine cystoscopy is initially performed usually on a 3 months basis to make sure we catch bladder cancers early, increasing that interval as appropriate. Our story today ends on a happy note. My patient with the blood in his urine fortuitously just one day prior to his routine f/u with me had superficial bladder cancer and I was able to remove it during the transurethral resection of his bladder tumor. Although he doesn't need further treatment at this time we will need to follow him carefully because of the high rate of recurrence of tumors. Although we don't hear much about bladder cancer, it is a very common disease. Fortunately, many patients can simply have a procedure done in the hospital without further treatment. For patients needing more treatment we will have the opportunity to talk about other options for more aggressive tumors in future episodes. Let me leave you with this thought. It's best to just not get bladder cancer in the first place. There are risk factors that we can't do anything about but the biggest risk factor for bladder cancer is smoking. If you are smoker quit today.
Business, Life, & Coffee | Entrepreneurship, Life Hacks, Personal Development for Busy Professionals
The NFL Puts Together Winning Game Plan Against Prostate Cancer Ft. Michael Haynes – Pro Football Hall of Famer and Prostate Cancer Survivor and Benjamin Lowentritt, M.D. - Director, Prostate Cancer Care Program, Chesapeake Urology Associates Business, Life, and Coffee Powered by Jumpstart:HR, LLC (www.jumpstart-hr.com) Join the conversation on social media: Twitter: @BizLifeCoffee | @JoeyVPriceHR Instagram: @BusinessLifeAndCoffee | @JoeyVPriceHR About This Episode: Prostate cancer is the second most common cancer in men. On any given Sunday 1 in 7 men watching an NFL game will be diagnosed with this disease, but the odds increase to 1 in 5 if they are African American and 1 in 3 if they have a family history. These are stats that no one wants to see up on a scoreboard. An estimated 181,000 new cases will be diagnosed in 2016 – that’s one father, brother or loved one being told every three minutes that they have prostate cancer. Prostate cancer is also the second leading cause of cancer-related death among men, and there are often no symptoms. Early detection for prostate cancer is key, which is why, for the eighth year, the National Football League has teamed up with the Urology Care Foundation—the official foundation of the American Urological Association—on the Know Your Stats About Prostate Cancer® campaign, an initiative to encourage men to know their prostate cancer risk and to talk to their doctor about whether prostate cancer testing is right for them. The campaign is led by Pro Football Hall of Famer and prostate cancer survivor, Michael Haynes. About Michael Haynes: Michael is a former National Football League cornerback who played for the New England Patriots and the Los Angeles Raiders. His professional football career began when he was selected in the 1976 NFL Draft by the New England Patriots. He is elected to the Pro Football Hall of Fame in 1997. Haynes, a prostate cancer survivor, is the spokesperson for the Know Your Stats About Prostate Cancer® campaign and speaks on their behalf to educate and encourage men to be proactive about their prostate health. About Benjamin Lowentritt, M.D.: Dr. Lowentritt has been at the forefront of robotic urology procedures and was the first surgeon in Maryland to perform robot assisted surgery for bladder cancer. He has authored numerous articles and chapters on subjects including robotic surgery, erectile dysfunction, pediatric urology, female urology and the urological management of patients after renal transplantation. Dr. Lowentritt has been selected as a "Super Doctor" by his peers in The Washington Post magazine and as a "Top Doctor" in Baltimore magazine. Dr. Lowentritt serves on the Board of Directors for the Baltimore City Medical Society.
Business, Life, & Coffee | Entrepreneurship, Life Hacks, Personal Development for Busy Professionals
The NFL Wants You to Know Your Stats About This Men's Health IssueMichael Haynes, Pro Football Hall of Fame Member and Prostate Cancer SurvivorDr. Scott Eggener,Associate Professor of Surgery and Co-Director of the Prostate Cancer Program, University of ChicagoThis episode is presented by Jumpstart:HR, LLC: HR Outsourcing for Small Businesses and Start-Upswww.jumpstart-hr.comAbout This Episode:Prostate cancer is the second most common cancer in men. 1 in 7 will be diagnosed with this disease, but the odds increase to 1 in 5 if they are African American and 1 in 3 if they have a family history. Prostate cancer is also the second leading cause of cancer-related death among men, and there are often no symptoms. Early detection for prostate cancer is key, which is why, for the seventh year, the National Football League has teamed up with the Urology Care Foundation—the official foundation of the American Urological Association—on the Know Your Stats About Prostate Cancer® campaign, an initiative to encourage men to know their prostate cancer risk and to talk to their doctor about whether prostate cancer testing is right for them. The campaign is led by some of our favorite football heroes, including Pro Football Hall of Famer and prostate cancer survivor, Michael Haynes. On this episode of the Business, Life, and Coffee podcast, Urologist and Prostate Cancer Specialist, Dr. Scott Eggener will join Mike Haynes as they talk about the risks for prostate cancer and the importance of early detection. Michael’s story gives hope to those newly diagnosed or in treatment, and also reminds families to talk about their health history. Remember, one new case occurs every 2.4 minutes and a man dies from prostate cancer every 19.1 minutes. Don’t sit on the sidelines, join Haynes and Dr. Eggener as they team up to offer a winning game plan for prostate cancer and to save lives. This interview is brought to you by the American Urological Association.About Michael Haynes: Michael is a former National Football League cornerback who played for the New England Patriots and the Los Angeles Raiders. His professional football career began when he was selected in the 1976 NFL Draft by the New England Patriots. He was then elected to the Pro Football Hall of Fame in 1997. Haynes, a prostate cancer survivor, is the spokesperson for the Know Your Stats About Prostate Cancer® campaign and speaks on their behalf to educate and encourage men to be proactive about their prostate health. About Scott Eggener: Associate Professor of Surgery and Co-Director of the Prostate Cancer Program at the University of Chicago Medical Center, Dr. Scott Eggener is an experienced robotic and open surgeon who specializes in the care of patients with prostate cancer. His research focuses on prostate cancer screening and treatment patterns, evaluating novel tools to assist patients in treatment decisions, and clinical trials for active surveillance and focal therapy. He is a leading prostate cancer spokesperson for the American Urological Association (AUA) and presents on prostate cancer matters around the world.
Know Your Stats
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