Steam therapy for BPH-Does it cause ED?

images-1cccccc

Conclusions: Convective water vapor thermal therapy provides durable improvement to LUTS for 12 months and urinary flow while preserving erectile and ejaculatory functions.

Note: Most all of the treatments for enlarged prostate cause retrograde ejaculation. Because the prostate channel is opened with procedures to allow a better stream, in doing this the semen is not propelled forward and stays in the urethra. It is then voided out at the next urination. Medically this not an issue but some men do not like the fact that it happens. Retrograde ejaculation has not been noted in Rezum therapy. In addition Rezum in some cases improved sexual function which at this time is unexplained.

Convective Water Vapor Energy Tx (Rezum) of LUTS Preserves Sexual Function

Urology – October 30, 2016 – Vol. 34 – No. 9

Convective water vapor therapy provides durable improvement to lower urinary tract symptoms and urinary flow while preserving erectile and ejaculatory functions.

Article Reviewed: Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. McVary KT, Gange SN, et al: J Sex Med; 2016;13 (June): 924-933.

Background: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is a common condition concurrent with erectile dysfunction (ED). In recent years, the association between LUTS and ED has been escalating in level of concern by patients and health care providers, as treatment may impact sexual function (SF). The effectiveness of various treatments for LUTS-BPH has been defined, and most patients have some sexual side effects, although differing in type, severity, and frequency. An alternate,minimally invasive therapy utilizing convective water vapor (Rezum) has been shown to provide rapid relief in LUTS.

Objective: To determine whether therapy utilizing convective water vapor energy had any effect on erectile and ejaculatory function.

Design: Randomized controlled trial.

Methods: In the blinded group (active 136, control 61) comparison occurred at 3 months; the active arm was followed up for up to 12 months for International Prostate Symptom Score (IPSS), Qmax, and for sexual function using International Index of Erectile Function (IIEF) and the Male Sexual Health Questionnaire for Ejaculatory Function (MSHQ-EjD). The minimal clinically important difference (MCID) in EF for which subjects perceive as beneficial was determined for each EF severity category.

Results: No treatment- or device-related de novo ED occurred after therapy. The IIEF and MSHQ-EjD function scores were not different from controls at 3 months or from baseline at 1 year. The ejaculatory bother score improved to 31% over baseline (P =0.0011). Also, 32% of subjects achieved MCIDs in EF scores at 3 months and 27% at 1 year, including those with moderate to severe ED.

Conclusions: Convective water vapor thermal therapy provides durable improvement to LUTS for 12 months and urinary flow while preserving erectile and ejaculatory functions.

Reviewer’s Comments: The primary end point was the treatment of LUTS, and therefore, the endeavor to evaluate SF in this context presents an inherent limitation. The MCID suggests an improvement in ED in men with baseline ED is unexplored and a novel finding.(Reviewer–Kevin T. McVary, MD, FACS).

Northeast Georgia Urological Associates is now performing Rezum Therapy  as an out patient procedure in both the office setting and our accredited ambulatory surgery center. You can contact us 24/7 with your number below and we’ll call you to arrange your consultation.

Vasectomy follow up? Nearly one half of men never submit a post vasectomy semen specimen.

images-1

 

Patient Non-Compliance With Vasectomy Follow-Up

Urology – September 30, 2013 – Vol. 30 – No. 10

Nearly 50% of patients do not perform post-vasectomy requested semen analysis.

Article Reviewed: Compliance With Semen Analysis. Duplisea J, Whelan T: J Urol; 2013;189 (June): 2248-2251.

Background: Nearly half a million men undergo vasectomy in the United States each year. While this is generally a straightforward procedure, it is not 100% successful. Post-vasectomy semen analysis helps the physician confidently determine if the procedure was successful, but no consensus exists to guide post-vasectomy semen analysis routine; the 2012 AUA guidelines suggest a single negative sample performed 8 to 16 weeks post-procedure, and <100,000 sperm/mL (non-motile) is considered a success. Patient compliance with post-vasectomy semen analysis is low and few studies review the reasons for poor compliance.

Objective: To determine which men are more or less likely to comply with requested post-vasectomy semen analysis based on demographic data.

Design/Methods: The authors performed a retrospective review of 946 men undergoing vasectomy at a single institution/single surgeon performed between January 2002 and December 2009. For this particular surgeon, post-vasectomy semen analysis was requested for 2 samples 16 weeks after vasectomy. The information was reiterated during vasectomy and written instructions were provided. The surgeon removed a piece of vas for pathologic analysis.

Results: The mean age of vasectomy patients was 33.6 years and they had a mean of 2.15 children before vasectomy. Over 80% of men were married and the complication rate was 3.4%. Complications were mostly hematoma and sperm granuloma. Vasectomy was repeated in 4 men, 3 of whom requested the repeat due to persistent non-motile sperm. Nearly 50% of men submitted no samples (48%) and 16% only submitted 1 sample. Men who were noncompliant tended to be aged <34 years, had ≥3 children, and did not have complications. Based on further logistic regression analysis, only an increased number of children was predictive of noncompliance.

Conclusions: Men with more children, of younger age, and without complications tend to be less likely to submit a post-vasectomy semen analysis. While the best protocol for post-procedure evaluation remains to be determined, increasing compliance is in the best interest of the physician.

Reviewer’s Comments: The most recent AUA guidelines do not suggest that pathologic analysis is necessary during a vasectomy, making post-vasectomy semen analysis the determinant of success. Unfortunately, as nearly all urologists experience, the majority of patients are not compliant with post-vasectomy semen analysis. The authors requested 2 post-vasectomy semen analysis samples and this was only completed by 36% of patients. Based on the guidelines, only 1 patient truly required a repeat procedure. Even with low failure rates, vasectomy remains a frequently litigated urologic procedure and physicians want to ensure success. As much as can be reiterated to the patient, obtaining a single semen analysis at least 8 weeks post-procedure should be the goal of all physicians performing vasectomy.(Reviewer–Gregory Lowe, MD).

 

Minimally invasive prostate enlargement treatment vs. more minimally invasive treatment. GreenLight Laser vs. Rezum.

Georgia GreenLight Laser

popeye-the-sailor-bluto

The GreenLight uses laser energy to vaporize prostate tissue. The obstructing prostate tissue is destroyed or removed at the time of the procedure.

Rezum uses radio frequency generated steam injected into the prostate tissue to bring about changes that will over time shrink the prostate tissue away from the channel men urinate through.

The effect of the GreenLight procedure is for the most part immediate. The effect of the Rezum occurs over time.

The Rezum is “more” minimally invasive because it takes less time to perform, nothing is cut or destroyed and essentially very little risk of bleeding. There is usually 2-4 nine second treatments with Rezum and the steam is injected through a small catheter by way of puncturing the prostate.

So…who should choose which?

You can do the GreenLight with good results on most any obstructive prostate. However is a patient has been in retention (can not urinate…

View original post 202 more words

Popular Patient Educational Materials.

dsc_0135

Check out the AUA’s latest patient educational materials from the Urology Care Foundation!

We’ve been busy updating and adding new patient education materials to UrologyHealth.org.

Print and share our free materials below with your friends and family.

Pediatric Health

Bladder Health

Prostate Cancer

Kidney Health

Happy Valentines Day…From Mr. Prostate?

Dr. Fabrizio Dal Moro is an assistant professor of urology  in Padova, Italy. He is a connection of mine on Linkedin. He creates interesting anatomic drawings that pertain to the particular surgery  he may doing that day. Below is today’s submission by him. You can visit his website and see other drawings by him. Happy Valentines day from your little friend…the prostate!

61afb435-6d29-4872-bec5-382ef85d2db6-large

Two negative prostate biopsies, taking Proscar and Psa 13. What to do?

ds00043_%20hq01273_%20my00182_im00848_mcdc7_normal_prostate_glandthu_jpg

This is a real scenario and shows the complexity of managing certain situations about the prostate. Part of the problem is the common misconceptions about the prostate and prostate  cancer. As well all the things you read in the paper or hear on TV about new studies showing that the PSA is unreliable and is used too often by Urologists and in turn resulting in too many men being biopsied and then subsequently being treated…and subsequently as a result negatively affecting their lives with incontinence and impotence.

So imagine you are in the exam room with your doctor in the above situation and your urologist is walking you through the fine line of doing just the right amount of tests or procedures to determine if you have prostate cancer. The bottom line is that if you have cancer and this is found out a year after your office visit…you’d be quite disappointed and probably mad…probable the word “lawyer” may come to mind.

As Bart Simpson said when asked his thoughts on “why does increasing military might and expenditures on weaponry actually act a deterrent to war?”

Bart had wrongly been put in a genius class because the test scores of a brilliant student had been attributed to him. He said, “Well.. I guess you’re damned if you do and damned if you don’t!”

download-2-bart

So…in the conundrum I’ve described in the title of this post…the issues-

  • The two negative biopsies performed five years ago were negative however that was five years ago and things change. Just because a patient says, “But I have had a biopsy before and it was okay. Isn’t that enough?” Well a lot can happen or change in five years. Yes you didn’t have it then but that was then and this is now.
  • There is the issue of prostate cancer being in unusual places in the prostate that is not a easily sampled on a biopsy. If you look at a picture of a prostate the part that is examined by the urologist  on a rectal exam is the posterior lobe of the prostate. This does not examine the inner or anterior aspect of the prostate. The exam is a good exam and necessary but does not evaluate the “entire gland.”
  • Now you throw in the drug Proscar or generic name Finasteride. Five years ago the biopsies were negative and the PSA then was 15. Now the PSA is 13. The patient concludes that- I have had two negative biopsies and now my PSA is less than five years ago. Well Proscar lowers the PSA by about 50%. So off the Proscar this patient’s PSA could well be 20.
  • The patient stops going to the Urologist because his family doctor is doing the PSA now and it is less than five years ago but the family doctor and the patient are looking at a PSA that hasn’t changed appreciably and “stay the course.”
  • The PSA being the same or lower is not better. The Proscar is “masking” the true value.
  • So the feeling is that all is well with this patient. Well to the urologist who sees this patient…he is concerned. He also has to explain the above and put out there that some other sort of evaluation must be done to be sure the Proscar isn’t deceiving everyone.
  • If the patient for whatever reason  goes back to the urologist, the urologist will note the scenario above and recommend doing something to update the situation and hopefully show that there is indeed no prostate cancer. Again sitting on this situation and the patient is found to have an aggressive form of prostate cancer because it has been allowed to smolder undetected because of the masking effect of the Proscar…well that is a problem for all. I would think the urologist would found potentially at fault.
  • Again remember in the back drop…all the misconceptions that prostate cancer is the slow growing type and that people don’t die of it. And of course the old standby by the male not wanting a rectal exam or another biopsy, “I don’t have any symptoms.”
  • The channel that the male voids through is well away from the posterior aspect of the prostate and so for there to urinary symptoms the cancer would have to be extensive to cause voiding symptoms. In other words when found it is too late.

How about this added to the above scenario? The patient has seen the urologist and has had the two negative biopsies and his PSA is stable on the Proscar (which actually is worrisome..it should be half). The family doctor gets the PSA, and it is unchanged. The family doctor says to the patient, “I’ll leave your prostate exam to your urologist.” The patient however has not seen his urologist for five years. Uh oh! Do you see the perfect storm brewing…yes quite the opportunity for the late diagnosis of prostate cancer due to numerous factors and misconceptions on several layers. Of note in the above situation…the urologist is out of the loop. The patient has stopped going to him and being “checked up” by the family guy.

This is like in baseball the center fielder and the right fielder are both approaching a fly ball. The center fielder yells as they both close in on the ball, one in which it looks like both could catch but both struggling to get there. The center fielder says, “I got it.” The right fielder backs off, the center fielder realizes that he will not be able to get to the ball and then yells, “You take it.” The ball falls safely between the two fielders. Just as too many chefs spoil the soup so too it can be said of doctors “I got it, you take it” type arrangement in which things fall through the proverbial cracks of patient care.

So one day on the blood work of the family doctor the PSA does go up. “Hmmmm, your PSA is going up. Have you been seeing your urologist? You haven’t? Well it may time to go back to him and let him evaluate these numbers.” The doctor then remembers that the patient is on the Proscar. He becomes concerned.

The family doctor remembers the warnings that pop up on his medical record screen regarding patient’s taking Proscar: Proscar does not cause prostate cancer if prostate cancer is found in a patient taking Proscar it is further along and more aggressive, i.e. the “masking effect” in lowering the PSA delays the diagnosis.

The patient is now back with his urologist after five years and the options are discussed.

  • Of course now a rectal exam is done after five years of not checking it.
  • You could do another biopsy
  • You could do a prostate MRI
  • You could do various PSAs that predict the chances of a positive biopsy

If another biopsy is done it may be negative but it may not. And this is not a situation  the patient, the family doctor or the urologist wants to be in.

Summary-Negative biopsies, being on Proscar, reluctant male patients  not wanting to be messed with, misconceptions about prostate cancer, misunderstandings of the family doctor thinking the urologist is more involved in the care of a patient than the urologist actually is-all create a perfect storm of the late diagnosis of prostate cancer.

As my mother would say, “A word to the wise is sufficient”

Systematic counseling and rates of acceptance of active surveillance

If your doctor has not mentioned Active Surveillance as an option for your prostate cancer…consider a second opinion. It may not be the best option for you but it should be mentioned for your consideration.

THE "NEW" PROSTATE CANCER INFOLINK

According to a newly published paper in European Urology, a simple, hour-long lecture and training session can improve the ability of physicians to counsel patients systematically about active sureveillance and, at one major center, improved patient acceptance of active surveillance by as much as 17 percent.

This new paper by Ehdaie et al. discusses the development and implementation of a systematic method by which physicians can and potentially should counsel patients with very low- and low-risk prostate cancer to increase acceptance of active surveillance. The approach is based on the use of “framing techniques” that underlie principles of communication studies by negotiation scholars. The goal was to find ways to overcome perceived difficulties experienced by physicians in convincing newly diagnosed, low-risk prostate cancer patients about the merits of active surveillance and thus to avoid the tendency of many patients to unnecessarily elect immediate radical treatment for low-risk forms of prostate…

View original post 363 more words

How long to pregnancy after vasectomy reversal?

The time from having a microscopic vasectomy reversal and achieving pregnancy varies. Here’s an article from vasectomy.com.

Georgia Vasectomy Reversal-John McHugh M.D.

From Vasectomy.com

a-reversal-success-twins

Although vasectomies should be viewed as a permanent form of birth control, there may be certain circumstances in which a man desires to have his vasectomy reversed. If this is the case, questions might arise about how long it takes for a vasectomy reversal to result in pregnancy.

There are no definitive answers. Research indicates that, if a reversal is successful, it can take anywhere from three months to several years for couples to get pregnant. Up to 75 percent of all vasectomy reversals ultimately lead to natural pregnancies, with over half occurring in the first two years.

However, there are several factors that impact whether conception will occur and how quickly:

  • Type of vasectomy reversal procedure: The type of vasectomy reversal procedure a man has will impact reversal success and pregnancy outcomes. Men who have a vasovasostomy — the shorter and simpler of the two types…

View original post 380 more words

Tomatoes and prostates? A tomato a day will keep the urologist away.

The apple ain’t got nothing on the tomato!

download-2-toma

 

Article Reviewed: Lycopene Inhibits Disease Progression in Patients With Benign Prostate Hyperplasia. Schwarz S, Obermuller-Jevic UC, et al: J Nutr; 2008; 138 (January): 49-53.

Lycopene Inhibits Disease Progression in Patients With Benign Prostate Hyperplasia.

Schwarz S, Obermuller-Jevic UC, et al:
J Nutr; 2008; 138 (January): 49-53

Background: Lycopene is a carotenoid found in a variety of healthy foods such as tomatoes, watermelon, and pink grapefruit. It has garnered interest in the area of prostate cancer prevention, but has yet to receive adequate attention in the area of benign prostate hyperplasia (BPH). Objective: To determine the serologic, tissue, and clinical impact of higher plasma lycopene levels in patients with histologically proven BPH. Design/Methods: This was a randomized trial of 40 patients who received 15 mg per day of lycopene from a dietary supplement or a placebo for 6 consecutive months. Patients completed 4 visits at the medical practice during the 6-month period at baseline, after 1 month, after 3 months, and after 6 months. The primary end point was the reduction of increased PSA levels. Results: The mean patient age was 67 years and body mass index was 26 (slightly overweight). PSA levels decreased significantly in the lycopene group after 6 months from 6.6 mcg/L to 5.8 mcg/L, and there was no PSA change in the placebo group. Progression of prostate enlargement did not occur in the lycopene group compared to placebo as assessed by transrectal ultrasonography (TRUS) and digital rectal examination (DRE). Disease symptoms according to the International Prostate Symptom Score questionnaire significantly improved in both groups, but to a greater degree with lycopene. However, the placebo group experienced significantly greater reductions in LDL cholesterol compared to the lycopene group.

Conclusions: Lycopene at a dose of 15 mg/day may inhibit the progression of BPH.

Reviewer’s Comments: Lycopene from diet and supplements has not experienced impressive data as of late in the area of prostate cancer research. Perhaps the earlier use of lycopene in healthy patients with BPH was a more ideal opportunity to test the impact of this supplement. The most impressive finding was not the reduction of PSA by lycopene, but that both groups reduced their intake of overall calories to a large degree during the trial. In the Prostate Cancer Prevention Trial (PCPT), men in the placebo arm that reduced their caloric intake also reduced their PSA velocity. In other words, is the lycopene supplement responsible for the favorable impact in this study, or the fact that men reduced caloric intake, which may have also caused the LDL and PSA reductions? (Reviewer–Mark A. Moyad, MD, MPH).

Prostate problems? Visit Georgia GreenLight Laser for more information re: the laser treatment of prostate enlargement.

Or if you prefer enter your number below and we’ll contact you with an appointment.