We know that some medical terms are sometimes difficult to comprehend. This resource is meant to address some common conditions and treatment methodologies we use so that you are more informed about your condition, the techniques and equipment used to treat it and potential preventive measures.
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Conditions, Problems, Treatments
In Office Procedures and Studies:
With a cystoscope, the physician removes small tissue samples from the bladder to send for pathological analysis.
This is a non-invasive way to assess how effectively one voids
Comprehensive Erectile Dysfunction Evaluation
In men who have difficulties achieving and/or maintaining a full erection who have not had a good result with oral medications , we offer a Comprehensive ED evaluation. This battery of tests is performed in the office over a 3 hour period. These tests include measurement of the nerves in the penis (Biothesiometry) and measurement of the penile blood vessels and blood flow (Doppler studies) before and after stimulation of the penis. These tests allow us to identify the cause of the ED in many cases and to optimize therapy for the individual patient. These tests are especially well suited for men who have been treated for prostate cancer or who do not respond to treatment with oral medications.
The physician inserts a cystoscope (fiberoptic camera) into the urethra and then into the bladder to visually inspect for tumors, stones, etc. This is usually performed in the office under local anesthesia with or without an oral urinary analgesic taken beforehand. Patients are usually given one or two antibiotic pills following the procedure to lessen the possibility of infection. It is not uncommon to have some irritative urinary symptoms (urgency, frequency, hesitancy) for a few days following the procedure as well as some blood in the urine.
Extracorporeal ShockWave Lithotripsy
The patient lies prone in a vat of liquid while shock waves are directed at the kidneys to break up a calculus deposit.
Technique utilizing chromosomal analysis to detect bladder cancer in the urine.
This is a non-invasive test, which uses sound waves to look at the kidneys for growths, stones, etc. It is a good ‘screening’ tool but is not as sensitive as computerized tomography (CT).
Prostate Needle Biopsy
This is a procedure to rule out the presence of cancer. It is typically performed if the prostate is suspicious on digital rectal exam and/or the serum PSA test (see below) is abnormal. The test is performed through the rectum. A sonographic probe is inserted and the prostate is imaged and measured. Then, under local anesthesia, typically 12 cores from different locations are taken and sent for analysis. Patients need to be prepped before the procedure with an antibiotic (see instruction sheet) and a fleet enema. Patients will experience some blood in the urine, from the rectum and in the ejaculate for up to six weeks following the procedure.
Serum PSA Tests
This test is done to look at the level of Prostatic Specific Antigen (PSA) in the blood. The results of this test are used to help in the assessment of prostate health including BPH and prostate cancer. We also perform a ‘free’ PSA in many patients. PSA exists in two forms: one complex (bound to a protein often a malignant one) and the other free (circulating unbound). Prostate cancer is less likely in patients who have a high free PSA and a low total PSA.
Serum Testosterone Test
Testosterone(T) is the male sex hormone. Many men (some estimates are as high as 30% of the male population) have low T. Low T can affect many aspects of a man’s life. Serum Testosterone levels are also studied in conjunction with PSA tests to help in the early detection of prostate cancer
The physician introduces a cystourethroscope or a catheter or a sound to help open up the urethral tube and allow the bladder to empty.
Lab personnel and/or the physician will inspect the urine, with either a dipstick or under the microscope , for signs of blood, infection, sugar, protein, etc.
This measures the expression of prostate cells (prostate cancer is highly over expressed) in voided urine after a vigorous prostate massage. This test adds additional information particularly in men who have undergone a negative (benign) prostate biopsy.
This is a “pap” test and looks for malignant cells in the urine.
Urine samples are tested for bacterial growth within 48 hours. If an infection is present, cultures are also tested for their sensitivities to appropriate antibiotics.
This is an office test, which measures the strength and capacity of the urinary bladder and the various sphincters. It involves placement of several probes and a computer based analysis at various levels of bladder pressure and filling. It is quite helpful in ascertaining if the patient’s problem is one of obstruction or poor muscle (bladder) strength or both. The entire test takes about an hour.
The patient urinates into a special electronic instrument (funnel) that measures the strength of the stream, the volume, and length of time one takes to empty the bladder.
This is male sterilization where the vas deferens is surgically interrupted on each testicular side. This results in an ejaculate free of viable sperm and is an effective form (in >99%) of male contraception.
These are done in our office using modern fluorsocpic equipment.
- Abdominal (Kidney, Ureter, Bladder)– The physician takes and examines X-ray images from the front to the back of the abdomen.
- Voiding Cystourethrogram (VCUG) – The physician fills the bladder with a special dye to show more detail on an x-ray. Images of the bladder, during filling and emptying, are taken and interpreted.
- Intravenus Pyelogram (IVP) – The physician injects a dye into a vein and then several x-ray images follow to assess the functionality of the kidneys, and ascertain kidney size, location, etc. This imaging test helps identify urinary tract malformations, stones, growths or blockages.
- Retrograde Ureterogram -The physician introduces a special dye, via a cystoscopy (see above), into the kidneys and the tubes that carry urine from the kidneys to the bladder (ureters). The dye is inserted so that it enters the kidneys and ureters. The physician then takes and examines an X-ray image of these structures.