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Artificial Urinary Sphincter (AUS):
Sometimes complicated cases of incontinence require implantation of a device known as an artificial urinary sphincter. People who might benefit from this treatment include those who are incontinent after surgery for prostate cancer or stress incontinence, trauma victims and people with congenital defects in the urinary system. The artificial sphincter has three components: a pump, a balloon reservoir, and a cuff that encircles the urethra and prevents urine from leaking out. The cuff is connected to the pump, which is surgically implanted in the scrotum (in men) or labia (in women). The pump can be activated (usually by squeezing or pressing a button) to deflate the cuff and permit the bladder to empty. After a brief interval, the cuff refills itself and the urethra is again closed. Because the artificial sphincter is an implant, it is subject to the risks common to implants, such as infection, erosion (breaking down of tissue) and mechanical malfunction. Yet with appropriate pre-surgical evaluation, operative techniques and postoperative follow-up, many problems can be avoided and incontinent patients can experience an improved quality of life with this device.
A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.
A debilitating condition of fear, which interferes with normal life functions.
Derived from the same individual.
Different methods to help “retrain” the bladder and get rid of the urgency to urinate. (See biofeedback, bladder training, electrical stimulation, habit training, pelvic muscle exercises, prompted voiding).
Benign Prostatic Hyperplasia:
A condition in which the prostate becomes enlarged as part of the aging process.
A tumor that is not cancerous.
A term describing a condition that affects either sides of the body or two paired organs, such as kidneys.
A procedure that uses electrodes to help people gain awareness and control of their pelvic muscles.
A hollow muscular balloon shaped organ that stores urine until it is excreted from the body.
Bladder cancer is the fifth most common cancer in the United States. About 71,000 Americans are diagnosed with bladder cancer each year and 12-14,000 die annually of the disease. In recent decades there has been a steady increase in the incidence of bladder cancer.
What happens under normal conditions?
The bladder is a hollow balloon-shaped mostly muscular organ that stores urine until ready for release. The urine is produced in the kidneys. It flows through tubes called the ureters into the bladder and is discharged through the urethra during urination. The bladder muscle aids urination by contracting (tightening) to help force out the urine. A thin surface layer called the urothelium lines the inside of the bladder.
What is the most common type of bladder cancer?
Most (90%) patients diagnosed with bladder cancer have transitional cell cancer, also referred to as urothelial carcinoma which starts in the urothelium or lining the bladder. The majority of those bladder tumors are confined to the urothelium and have not invaded the bladder muscle.
Other types of bladder cancer include squamous cell carcinoma, adenocarcinoma, or small cell cancer.
A behavioral technique that teaches the patient to resist or inhibit the urge to urinate, and to urinate according to a schedule rather than urinating at the urge.
Benign Prostatic Hyperplasia (BPH):
A common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH.
Involves the placement of tiny radioactive pellets into the Prostate gland. By utilizing ultrasound to place the seed pellets, damage to surrounding tissues is minimized. Approximately 13,500-16,000 rads of radiation energy is delivered directly to the Prostate. This procedure is performed on an outpatient basis. It is a one time procedure with very effective results. The 10-year follow-up outcome data parallels that of Radical Prostatectomy.
A tube passed through the body for draining fluids or injecting them into body cavities. It may be made of elastic, elastic web, rubber, glass, metal, or plastic.
Insertion of a slender tube through the urethra or through the anterior abdominal wall into the bladder, urinary reservoir, or urinary conduit to allow urine drainage.
A hard, syphilitic primary ulcer, the first sign of syphilis, appearing approx. 2 to 3 weeks after infection. The ulcer begins as a painless lesion or papule that ulcerates. Occurs generally singly, but sometimes may be multiple.
The large intestine.
Two chambers in the penis which run the length of the organ and are filled with spongy tissue. Blood flows in and fills the open spaces in the spongy tissue to create an erection.
A waste product that is filtered from the blood by the kidneys and expelled in urine.
During an operation probes are placed in the prostate. The probes are then frozen which kills the prostatic cells.
A herniation of bladder into vagina.
A lump filled with either fluid or soft material, occurring in any organ or tissue; may occur for a number of reasons but is usually harmless unless its presence disrupts organ or tissue function.
Surgical removal of the bladder.
A flexible scope is inserted into the urethra and then into the bladder to determine abnormalities in the bladder and lower urinary tract.
A common form of diabetes in which the body cannot properly store or use glucose (sugar), the body’s main source of energy.
A drug that increases the amount of water in the urine, removing excess water from the body; used in treating high blood pressure and fluid retention.
Detrusor-External Sphincter Dyssynergia (DESD):
Damage to the nervous system can create a lack of coordination between the bladder and the external sphincter muscle, which is the muscle that controls the emptying of the bladder. As a result the bladder cannot empty completely which creates a buildup of urinary pressure. DESD is a combination of these two factors and can lead to severe urinary tract damage and life-threatening consequences.
Ejection of semen during male orgasm.
The discharge of semen into the bladder rather than through the urethra and out of the body.
Electrohydraulic Lithotripsy (EHL):
This technique uses a special probe to break up small stones with shock waves generated by electricity. Through a flexible ureteroscope, the physician positions the tip of the probe 1 mm from the stone. Then, by means of a foot switch, the physician projects electrically generated hydraulic shock waves through an irrigating fluid at the stone until it is broken into small fragments. These can be passed by the patient or removed through the previously described extraction methods. EHL has some limitations: It requires general anesthesia, and is generally not used in close proximity to the kidney itself, as the shock waves can cause tissue damage. Fragments produced by the hydraulic shock also tend to scatter widely, making retrieval or extraction more difficult.
Herniation of small bowel into vagina.
Erectile Dysfunction (ED):
The inability of a man to attain and/or maintain an erection sufficient for sexual activity. The process leading to an erection is a complex interaction between physical and psychological factors. There have been great advances over the past twenty or so years in the diagnosis and treatment of erectile dysfunction.
Hormones responsible for the development of female sex characteristics; produced by the ovary.
External Beam Radiation Therapy:
A 25-28 treatment protocol that utilizes External Beam Radiation. Approximately 6,800-7,400 rads of radiation energy is delivered to the Prostate. There can be some radiation effect on surrounding tissues.
Extracorporeal Shock Wave Lithotripsy (ESWL):
Extracorporeal shock wave lithotripsy uses highly focused impulses projected from outside the body to pulverize kidney stones.
A behavioral technique that calls for scheduled toileting at regular intervals on a planned basis. Unlike bladder training, there is no systematic effort to motivate the patient to delay voiding and resist urge.
Involves the use of anti-androgens. An androgen is a male hormone needed for the production of testosterone. By depriving the cancer cells of the testosterone they need for growth, tumors regress in size and cellular activity. Side effects include gynecomastia, the enlargement of breast tissue, hot flashes, and loss of libido (desire to have sex). Some long term hormonal therapy is associated with the loss of muscle mass, osteoporosis, and malaise (loss of energy).
A painless swelling of the scrotum, caused by a collection of fluid around the testicle; commonly occurs in middle-aged men.
A condition characterized in which the pelvic floor muscles can no longer provide the necessary support to the urethra and bladder neck. As a result, the bladder neck drops when any downward pressure is applied and causing involuntary leakage. This condition is the most common cause of stress urinary incontinence.
Excessive growth of normal cells of an organ.
The placement of semen into a woman’s uterus, cervix, or vagina.
A laser probe is placed within prostatic tissue. Laser energy is then used to destroy prostatic tissue which makes urination easier.
Intrinsic Sphincter Deficiency (ISD):
Weakening of the urethra sphincter muscles. As a result of this weakening the sphincter does not function normally regardless of the position of the bladder neck or urethra. This condition is a common cause of stress urinary incontinence.
Involuntary contractions of muscles in the bladder, which can cause lack of control of urination.
Exercises to strengthen the muscles of the pelvic floor, which lead to more control and prevention of leakage.
One of a pair of organs located at the back of the abdominal cavity. Kidneys make urine through blood filtration.
Approximately 58,000 people were diagnosed with kidney cancer in 2009 and for unclear reasons; its incidence has been increasing. It is important to realize that with timely diagnosis and treatment, kidney cancer can be cured. Survival rate for patients with kidney cancer ranges from 79 to 100 percent, if caught early. More than 100,000 survivors of kidney cancer are alive in the United States today.
What is a kidney tumor?
A kidney tumor is an abnormal growth within the kidney. The terms “mass,” “lesion” and “tumor” are often used interchangeably. Tumors may be benign (non-cancerous) or malignant (cancerous). The most common kidney lesion is a fluid-filled area called a cyst. Simple cysts are benign and have a typical appearance on imaging studies. They do not progress to cancer and usually require no follow-up or treatment. Solid kidney tumors can be benign, but are cancerous more than 90 percent of the time.
What are some facts about kidney cancer?
In the United States, 2 percent of all cancers arise from the kidney. Each year, kidney cancer is diagnosed in approximately 38,000 Americans. Kidney cancer is slightly more common in males and is usually diagnosed between the ages of 50 and 70 years. The most common kidney cancer is called renal cell carcinoma which accounts for 85 percent of kidney tumors. It is important to know that with early diagnosis and treatment, this cancer usually responds well.
Kidney stones are made of salts and minerals in the urine that stick together to form small “pebbles.” They can be as small as grains of sand or as large as golf balls. They may stay in your kidneys or they may make their way out of your body through the urinary tract.
What causes kidney stones?
Kidney stones form when a change occurs in the normal balance of water, salts, minerals, and other things found in urine. The urine becomes concentrated meaning you have too much of certain minerals, acid or salts.
Surgery using a laparoscope to visualize internal organs through a small incision. It is generally less invasive than traditional surgeries and requires a shorter recovery period.
Laparoscopic Lymph Node Dissection:
If a perineal prostatectomy is contemplated then prior to the operation the pelvic lymph nodes are sampled via three small incisions made in the abdomen, much like the procedure used to remove gallbladders.
A procedure done to break up stones in the urinary tract using ultrasonic shock waves, so that the fragments can be easily passed from the body.
Infertility is a common yet emotionally difficult and complex problem affecting approximately 15 percent of couples attempting to conceive a baby. In up to 50 percent of couples having difficulty getting pregnant, the problem is at least in part related to male reproductive issues. In 30 percent of couples of those, the problem is solely male. It is essential that men be assessed to pinpoint the treatable causes of this heartbreaking health issue.
Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sexual intercourse.
Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again.
What Is Male Infertility?
Male infertility is any condition in which the man adversely affects the chances of initiating a pregnancy with his female partner. Most commonly, those problems arise when the man is unable to produce or deliver fully-functioning sperm.
The period that marks the permanent cessation of menstrual activity, usually occurring between the ages of 40 and 58.
The spreading of a cancerous tumor to another part of the body.
A catheter is placed within the bladder and positioned within the prostate, and then the antenna emits microwaves. This procedure increases the passageway allowing for easier urination.
Minimally Invasive and Robotic Surgery:
Minimally invasive or laparoscopic surgery, performed through small incisions has provided more options. Robotic technology has revolutionized these surgeries. Patients recover quicker, have shorter hospital stays and return to normal activities sooner than after traditional open surgery.
Minimally invasive procedure is a specialized surgical technique in which the surgeon makes very small incisions and there is less operative damage to the body. As a result, recovery time is usually quicker, blood loss and surgical complications are less.
What is Robotic Surgery?
Robotic surgery is technically robotic-assisted surgery, as the robot cannot be programmed to perform surgical maneuvers independently.
Robotic-assisted surgery is a laparoscopic procedure with an added layer of technology.
Robotic surgical technology, originally developed by the military as an attempt to perform remote surgery on injured soldiers in the battlefield, ultimately produced what is known today as the da Vinci Surgical System. The da Vinci Surgical System is a computer-enhanced, robotic surgical system, which introduces a computer between the hands of the surgeon and the tips of micro instruments. The platform technology is designed to enable complex procedures of all types to be performed through tiny ports. It replicates the surgeon’s movements in real time, but cannot be programmed to perform surgical maneuvers independently.
As with laparoscopic procedures, a small incision is made for the insertion of a telescope and the abdomen is expanded with gas. Typically 4 to 5 additional small incisions are made to allow for the interchangeable instruments. The robotic device is placed next to the patient and the robotic arms are attached to the telescope and instruments. The surgeon sits the control console a few feet away and is able to view a highly magnified, 3 dimensional images of the patient interior structures. All movements of the camera and robotic instruments are precisely performed in real time with ergonomic finger controls which can potentially make any movement the surgeon desires.
This innovative option to traditional open and standard laparoscopic surgery allows urologists to perform the most delicate and complex procedures with unparalleled precision through very small incisions.
Having both stress and urge incontinence.
Removal of an entire kidney.
ON is the most invasive procedure for removing kidney stones. Because it is so traumatic, most kidneys can withstand no more than two such operations. Deep anesthesia is required, after which the surgeon makes a large (10-20 centimeter) incision in the patient’s back or abdomen, depending upon where the stone is located. Either the ureter or the kidney is opened and the stone extracted. Most patients require prolonged hospitalization afterward, and recovery may take up to two months.
The surgical removal of one or both of the testicles.
Inflammation of a testicle.
A condition characterized by involuntary bladder muscle contractions during the bladder filling phase which the patient cannot suppress.
Leakage of small amounts of urine from a bladder that is always full.
Percutaneous Nephrolithotomy (PNC):
Percutaneous means “through the skin.” In PCN, the surgeon or urologist makes a 1-centimeter incision under local anesthesia in the patient’s back, through which an instrument called a nephroscope is passed directly into the kidney and, if necessary, the ureter. Smaller stones may be manually extracted. Large ones may need to be broken up with ultrasonic, electrohydraulic or laser- tipped probes before they can be extracted. A tube may be inserted into the kidney for drainage.
Pelvic Muscle Exercises:
Pelvic muscle exercises are intended to improve your pelvic muscle tone and prevent leakage for sufferers of Stress Urinary Incontinence. Also called Kegel exercises. (see biofeedback)
Periurethral bulking injections:
A surgical procedure in which injected implants are used to “bulk up” the area around the neck of the bladder allowing it to resist increases in abdominal pressure which can push down on the bladder and cause leakage.
Post-void residual (PVR) volume:
A diagnostic test which measures how much urine remains in the bladder after urination. Specific measurement of PVR volume can be accomplished by catheterization, pelvic ultrasound, radiography, or radioisotope studies.
The prostate gland is a small, walnut-sized gland in men. It is located below the bladder and surrounds the upper portion of the urethra. The prostate gland lies in front of the rectum, and its posterior surface can be felt during a rectal examination. The function of the prostate is to secrete a fluid that makes up part of the semen. The prostate gland may be a source of many health problems in men, the most common being benign prostatic hyperplasia (BPH), prostatitis and cancer.
What Is Prostate Cancer?
Prostate cancer is a significant health-care problem in the United States due to its high incidence. It is the most common non-skin cancer in men affecting approximately 234,000 American men each year with approximately 27,000 of these men dying each year. Prostate cancer is different from most cancers in that an appreciable percentage of men, particularly older men with a shorter life expectancy, may have a silent form of this cancer—it will not cause symptoms or progress beyond the prostate gland during their lifetime. Sometimes this cancer can be small, slow growing and present limited risk to the patient. Clinically important prostate cancers can be defined as those that threaten the well-being or life span of a man.
Any of various oxygenated unsaturated cyclic fatty acids of animals that have a variety of hormonelike actions (as in controlling blood pressure or smooth muscle contraction).
A muscular, walnut-sized gland that surrounds part of the urethra. It secretes seminal fluid, a milky substance that combines with sperm (produced in the testicles) to form semen.
Surgical removal of the prostate.
A Perineal incision is utilized. The advantages are: less blood loss, easier visualization of the bladder/urethral anastomosis and decreased recovery time because the incision does not involve muscle or any other vital tissue.
Inserted through a cystoscope, it is a wire device that expands after placement thus pushing prostate tissue away from passageway allowing for easier urination.
Inflammation of the prostate.
A surgical procedure in which a man-made or cadaveric piece of material is placed under the bladder neck to support and immobilize. This technique improves sphincter function and decreases bladder neck movement, improving continence.
Inflammation of the kidney, usually due to a bacterial infection.
The presence of pus in the urine; usually an indication of kidney or urinary tract infection.
Radical Retropubic Prostatectomy:
Removal of prostate through an abdominal incision. The prostate is completely removed. The advantage is that the lymph nodes can be sampled at the time of the operation and the nerve-sparing procedure is easier to do via this operation.
A herniation of rectum into vagina.
This involves the removal of obstructing prostatic tissue through a supra-pubic incision (a cut below the belly button). The Prostate is not wholly removed. Suprapubic Prostatectomy requires incising the bladder to remove the obstructing tissue, while a Retropubic approach involves incising the Prostatic capsule to remove the obstructing tissue. Both approaches utilize an abdominal incision.
Sexually Transmitted Disease (STD):
Infections that are most commonly spread through sexual intercourse or genital contact.
Surgical methods for treating urinary incontinence involving the placement of a sling, made either of tissue obtained from the person undergoing the sling procedure or a synthetic material. The sling is anchored to retropubic and/or abdominal structures.
A ring of muscle fibers located around an opening in the body that regulates the passage of substances.
A diagnostic test that requires patients to lift something or perform an exercise to determines if there is urine loss when stress is placed on bladder muscles.
Stress Urinary Incontinence:
The involuntary loss of urine during period of increased abdominal pressure. Such events include laughing, sneezing, coughing or lifting heavy objects.
The sex hormone that stimulates development of male sex characteristics and bone and muscle growth; produced by the testicles and in small amounts by the ovaries.
Transient urinary incontinence:
Temporary episodes of urinary incontinence that are gone when the cause of the episode is identified and treated, such as a bladder infection.
TUMT (Transurethral Microwave Thermotherapy):
– TUNA (Transurethral Needle Ablation): The instrument is placed into prostate tissue through cystoscope the tissue between the needles is destroyed via thermal energy.
– TURP (Transurethral Resection of the Prostate): A surgical telescope is used to core out the inside of the prostate (urethra) creating a larger channel making the passage of urine easier. This is the gold standard for treatment of BPH.
Similar to ureteroscopy, ultrasonic lithotripsy uses an optical scope and electronic probe, inserted into the ureter under epidural (spinal) anesthesia, to locate the stone. High-frequency ultrasound waves then are directed at the stone to break it up gradually. The fragments can either be passed naturally by the patient or removed by grasping forceps, basket extraction or suction through the scope instrument. The instrument is not flexible; however, so ultrasonic lithotripsy typically can be employed only when a straight path directly from outside the body to the stone is possible.
A condition characterized by a bladder contraction of inadequate magnitude and/or duration to effect bladder emptying in a normal timespan. This condition can be caused by drugs, fecal impaction, and neurologic conditions such as Diabetic neuropathy or low spinal cord injury or as a result of radical pelvic surgery. It also can result from a weakening of the detrusor muscle from vitamin B12 deficiency or idiopathic causes. Bladder underactivity may cause overdistension of the bladder, resulting in overflow incontinence (see overflow incontinence).
A flexible, fiberoptic instrument resembling a long, thin telescope is inserted through the urethra and bladder up to the ureter to visualize the tube. Often used for retrieval of kidney stones.
The involuntary loss of urine associated with a sudden and strong urge to void (urgency).
A strong desire to void.
Urinary incontinence or the unwanted loss of urinary control affects 13 million of people of both sexes and all ages. It is often temporary, and it always results from an underlying medical condition. Four out of every 100 Americans have some symptoms of incontinence. Women and older adults are most at risk of developing some form of incontinence. Often, people are too embarrassed to seek help, think it is a normal part of aging or unaware that help is available.
The symptoms range from frequent and urgent urination to difficulty emptying the bladder and urinary leakage. Fear of accidents can prevent people from participating in activities and dramatically affect their quality of life.
A group of physical and chemical tests done on a sample of urine to check for various disorders, including those of the kidneys and urinary tract.
Involuntary loss of urine sufficient to be a problem. There are several types of UI, but all are characterized by an inability to restrain voiding.
Urinary Tract Infections (UTIs):
UTIs are caused by bacteria that invade the urinary system and multiply, leading to an infection.
Diagnostic tests to examine the bladder and urethral sphincter function.
An abnormal enlargement of the veins which drain the testicles. These blood vessels originate in the abdomen and course downward to the testis. Upward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilatation of the testicular veins near the testis, leading to the formation of a varicocele. Varicoceles are known as one of the main causes for male infertility and can be treated either by surgical or non-surgical means.
The cutting away of a varicocele.
An outpatient procedure in which the varicocele is closed off (occluded) by means of a balloon catheter (flexible tube with a tiny detachable balloon), steel coil, and/or sclerosing (vessel-hardening) solution.
When you have a vasectomy, the vas deferens (the two tubes in the scrotum which carry sperm from the testes to the prostate) are cut to prevent sperm from exiting during ejaculation. Sperm are still produced by the body but are entrapped within the ductal networks behind the vasectomy site; they die and are absorbed by the body after a vasectomy procedure.
The procedure usually takes usually takes about 15 to 30 minutes. Most men experience very little pain or discomfort and are able to return to nearly all activities typically within a week.
Please note that a vasectomy is over 99% effective and is intended to be permanent. However, vasectomies can be reversed in certain cases.
After a vasectomy, you will still produce seminal fluid so your ejaculate does not look or feel any different. A vasectomy does not affect your male hormone or testosterone levels, so your sex drive and ability to have an erection will remain the same.
The purpose of a vasectomy reversal procedure is to restore a man’s fertility and ultimate success is an unassisted pregnancy.
A Vasovasostomy (VV) or Vasectomy Reversal Procedure is a surgical procedure that is designed to bypass obstruction in the male genital tract. Vasectomy is the leading cause of obstruction of the vas deferens, but men may be born with or acquire obstruction later in life from trauma or infection.
During a vasectomy, the vasa deferentia, the tubes which carry sperm from the testicles to the seminal vesicles, are cut, tied, cauterized (burned or seared), or otherwise interrupted. A vasovasostomy creates an opening between the separated ends of each vas deferens so that the sperm may enter the semen before ejaculation.
A type of cautery electrode that vaporizes Prostatic tissue. This creates a larger prostatic channel which makes urination easier.