Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. The most common symptoms include blood in the urine and pain with urination.
[Risk factors for bladder cancer include smoking, prior radiation therapy, frequent bladder infections, and exposure to certain chemicals (paints, aniline dyes). The most common type is transitional (urothelial) cell carcinoma. Other much less common types include squamous cell carcinoma and adenocarcinoma.]
Diagnosis is typically by cystoscopy with tissue biopsies. Staging (how far the tumor has spread) of the cancer is typically determined by medical imaging such as abdominal/pelvic CT scan or MRI.
Treatment depends on the stage of the cancer. The basic staging of the disease is either invasive or non-invasive. If the latter, limited endoscopic surgical removal (transurethral resection) may be all that is required. If the tumor is high grade or multifocal (multiple areas) within the bladder then some form of intravesical therapy (medication instilled directly into the bladder) may reduce the frequency and severity of any recurrence as bladder tumors have a high propensity to return. If the tumor is invasive (i.e. into the bladder wall) treatment may include some combination of surgery, radiation therapy, chemotherapy, Surgical options may include additional transurethral resection, partial or complete removal of the bladder, with/without urinary diversion. Typical five-year survival rates in the United States are 77% for all grades/types of bladder cancer but less than 50% for those patients whose disease has penetrated (muscle invasive) into the bladder wall.
World-wide Bladder cancer, as of 2015, affects about 3.4 million people with 430,000 new cases a year. Age of onset is most often between 65 and 85 years of age. Males are more often affects than females. In 2015, bladder cancer resulted in 188,000 deaths.
In the past decade, considerable progress in patient survival has been made with the use of chemotherapy prior to bladder removal for those with invasive disease. Progress has also been made with the various forms of urinary diversion.
DEFINING ERECTILE DYSFUNCTION
Erectile dysfunction (ED) is defined as the inability to have an erection satisfactory for penetration. It is a very common complaint in men and fortunately, one that can be restored in most situations.
The causes are often psychogenic (anxiety, fear of not satisfying one’s partner, depression, etc.) or physical (trauma to the external genitalia , radiation injury, pelvic surgery, etc.). Rarely, the cause may be hormonal, i.e., secondary to a low serum testosterone (male sex hormone) level. Regardless of the cause, treatment is often effective in a single office session.
Erectile dysfunction can occur transiently as a result of the above causes which can be treated by reducing the psychogenic cause or if physical, have the ED treated by medical, injectable or surgical therapy. For example, erectile dysfunction (ED) in men who are anxious or who are afraid of “under-performing” can often be discerned on history and treated by reassurance and by reducing one’s fear of failure. If this approach is not successful, a small dose of medication used to increase blood flow to the penis is often enough to convince the patient that he does not have an ailment which can’t be corrected.
Medical therapy to improve penile blood flow has been the major advance in men’s health over the past several decades. There are a host of Food and Drug Administration approved medications around which can be utilized but the dosage and timing of these medications must be coordinated by a physician so that the incidence of negative side effects is kept to a minimum.
Hormonal therapy (testosterone supplementation) can often restore potency in men who have “low” serum testosterone levels. Testosterone is not absorbed orally so there is no testosterone medication a man can take by mouth. Testosterone therapy is provided in the form of a gel, drug patches or by deep tissue (muscle) injection. For those patients that do not respond to oral medical therapy, a vacuum pump device will often be satisfactory. The pump is a bit cumbersome but many couples find it to be acceptable.
Direct injection into the penile tissue of medications used to increase penile flow is another approach particularly in men who find the oral medications ineffective and/or who do not wish to use a vacuum pump. Men have to be taught by a physician how and where to inject the medication which one does prior to each sexual encounter. The erection provide by this technique is often very firm and can last for several hours. The downside to injection therapy is that it does cause a small amount of pain (particularly following the first few injections) and may stimulate the formation of some penile scar tissue. For those patients who do not respond to any of the above treatments, implantation of a surgical prosthesis (silicone rods) is the remaining option. This is a surgical procedure which is performed under an anesthetic in a hospital or ambulatory surgical care setting. The advantages are that no medication is involved and “one is always ready”. The downside is that this is a surgical procedure and there is a slight risk of infection since the rods are foreign bodies. If this does occur, the prosthesis may have to be removed.
Most cases of ED can be treated successfully. Usually one or a few physician visits can remedy the situation to everyone’s satisfaction.
Prostate cancer is the most common non-skin-related cancer in men in the United States. It is also the second leading cause of cancer death in men. One in seven men will be diagnosed with prostate cancer. African-American men face a one-in-three chance of being diagnosed. Over 29,000 men die each year from prostate cancer, but early detection may save lives.
Recent reports about PSA (prostate-specific antigen) testing may confuse patients about the value of prostate cancer screening. The PSA test is not perfect. However, when used correctly, this blood test gives important information. The PSA test can help diagnose, assess the risk of, and monitor prostate disease such as cancer. Men should talk to their urologist about whether to get screened or not. Talk with your urologist about the benefits and risks of testing. You should also talk about factors that can increase your risk for prostate cancer, including:
– your family history of prostate cancer (Did your
father, brother or other relative have prostate
– if you are African-American;
– a high BMI (a measure of your body fat)
– your age; and
– your previous health history
A number of things can change PSA levels and should be kept in mind when reading the results. High PSA levels can be caused by more than just prostate cancer. Other causes of higher PSA levels include:
– prostatitis (inflammation of the prostate) and other
types of urinary tract infections (UTIs);
– benign prostatic hyperplasia (BPH – enlargement of
– injury; or
– treatments such as prostate biopsies (tissue samples)
or cystoscopy (a test to look inside the urethra and
Men choosing the PSA test should know their results could be influenced by some important factors, such as:
– Blood PSA levels tend to rise with age.
– Larger prostates make more PSA.
– Change in PSA levels over time (known as PSA
velocity) can be markers of both cancer risk and how
quickly a cancer may be growing.
A prostate biopsy (tissue sample) is the only way to know for sure if you have prostate cancer. The decision to go ahead with a prostate biopsy should be based mostly on PSA and findings on a digital rectal exam (physical exam of your prostate). Other factors to take into account include your family history of prostate cancer, your race, results of any prior biopsies and other major health issues you may have.
The choice to use PSA for early detection of prostate cancer is a personal choice. While PSA screening has been shown to have benefits, it also carries risks.
Possible benefits of having a PSA test:
– A normal PSA test may put your mind at ease.
– A PSA test may find prostate cancer early before it
– Early treatment of prostate cancer may help some
men slow the spread of the disease.
– Early treatment of prostate cancer may help some
men live longer.
Possible risks of having a PSA test:
– The PSA test is not perfect. A normal PSA result
may miss some prostate cancers (a “false negative”).
– Sometimes the test results suggest something is
wrong when it isn’t (a “false positive”). This can
cause unneeded stress and worry.
– A “false positive” PSA result may lead to an
unneeded prostate biopsy (tissue sample).
– A positive PSA test may find a prostate cancer that
is slow-growing and never would have caused you
– Treatment of prostate cancer can cause side effects.
Short- or long-term problems that can occur are
issues with getting erections (“ED”), leaking urine,
or bowel function.
Before you decide to have a PSA test, talk with your urologist about the benefits and risks of testing. Also talk about your individual risk of prostate cancer, including your personal and family health history.
This blog is in response to the following article:
LinkedIn.com Article – click here to read
In this article the writer goes over the the hurdles our healthcare providers go through to get paid for their day to day claims. Some of these hurdles are affecting our patient care adversely. In many cases even treatment plans are affected because insurance do not cover certain medications or procedures. This leaves our patient community in a healthcare limbo since the plan doesn’t “want” to pay for a service and the patient also does not want to be responsible. As the article goes on to indicate, many providers who were polled would like a single payer system. While we don’t necessarily agree with this assessment for our practice, we do believe our current healthcare hodgepodge helps only the health insurance community and not the patients or the doctors who render their services in good faith and in the best interest of our patients.
Our practice which has a large young and middle age patient population is plagued with the current HIGH DEDUCTIBLE issue. This means that our patients are responsible for the first $2000 to $5000 worth of medical services. In most instances patients don’t satisfy their deductibles before seeing one of our doctors. Many of them do not need that many services in a year. This causes a payment lag for the doctors services which in turn hurts the medical practice as a whole. Many patients are finding it hard to pay for medical services immediately once the claims have been processed.
Another issue discussed is related to the time and effort spent on trying to get the insurance plan to approve and pay for services and medications. This alone consumes several hours a week of the doctors’ and their staff. This time could be better spent caring for our patients. Add to that constant records requests and all sorts of questioning and second guessing the doctor’s judgement and yes, they go mad!
We’re interested in our patients and would like to see some progress in the healthcare machine that will put the patient’s health and the doctors’ efforts first. Our patients need care, our doctors need to be compensated for the care they provide. Web searches, deferred treatment and ER visits do not cut it. But thats the way things are going because of our current circumstances. Things need to improve.
Thousands of patients annually are plagued by urinary leakage, yet many feel reluctant to raise this sensitive issue with their doctor. Many patients have been led to believe this is a “normal part of the aging process” or “an unavoidable consequence of childbirth”. Although age and child bearing can impact the bladder, this is an area where there are a growing number of treatment options which can improve the quality of life.
It’s critical to understand there are two types of urinary leakage. And it’s important to differentiate between the two as the treatment options depend on the type.
Stress Urinary Incontinence is the involuntary passage of small amounts of urine that occurs when one laughs, coughs/sneezes or exercises. This is often experienced after pregnancy/childbirth but can also be seen with significant weight gain and conditions associated with chronic pushing/coughing such as chronic constipation or asthma. It may also be more noticeable after the onset of menopause.
Stress urinary incontinence is treated with physical exercises. When this fails, there are surgical options. Surgery for stress urinary incontinence is an outpatient procedure with excellent outcomes.
Conversely, Urgency and Urge Incontinence is the involuntary passage of urine that is accompanied by the desire to urinate. Individuals feel they are unable to “make it to the toilet in time”. Patients often describe specific triggers, such as “putting a key in their apartment door” or “opening the bathroom stall”. This condition is often more noticeable with age, and is often worsened by bladder irritants. The most common bladder “triggers” are caffeine, tobacco, alcohol and artificial sweetener.
For urgency and urge incontinence, counseling and behavioral modifications are sometimes all that is required to improve bladder symptoms. For some, bladder medications provide relief. There are many medications from which to choose, including a newer medication with fewer side effects. When these options fail to bring relief, patients may choose to have a Botox bladder injection which will relax the bladder and thus prevent the spasms which are responsible for the leakage. Or, they may choose to try a sacral neuromodulator which is a tiny device that sends an electrical impulse to the bladder to prevent involuntary bladder contractions and therefore improve leakage.
In 2017 we are fortunate to have many tools in our armamentarium to offer to those suffering with urinary leakage. Please give us a call or request an appointment online to see how we can help.
We’ve received great feedback with our online appointment requests. Many of our existing patients have enjoyed the convenience. If you want to avoid the phone, or being on hold and don’t have an urgent appointment, request it online.
If you are a NEW PATIENT, take advantage of our ONLINE PATIENT REGISTRATION FORM. We need all your information in order to create your account and make your appointment. If you register online, after requesting your appointment, we’ll be able to check your insurance for participation, have your information in our system and even make your appointment and just send you a confirmatory email. It will also save you some time at the office, all you will need to do is review and sign the forms, no more filling them out.
This also benefits new patients whom want to update their information.
Save time, register online!
Kidney Stones in 1986
Having experienced kidney stones twice in the past 30 years (see A Kidney Stone, a patient’s perspective) has given me some good insights, which I share with our patients at the New York offices from time to time. There are many aspects involved with diagnosis and treatment of kidney stones. Fortunately, our diagnostic and treatment options have improved significantly. Over time the art and science in treating kidney stones has improved vastly. I say art since not all stones are treated in the same way.
When I suffered my first kidney stone attack in 1984 diagnostic and treatment options were limited. During that episode the pain was unforgettable. It was like nothing I had ever experienced. At the time the mainstay of pain management consisted of narcotics which carry significant side effects. Patients where prescribed Percocet and/or morphine which did dull the pain caused by kidney stones but carried side effects of nausea, dizziness and constipation. The diagnostic options at the time of my first attack consisted of plain x-ray and intravenous pyelography (IVP). IVPs are rarely done today. This type of x ray was time consuming and and required an injection of dye into the bloodstream to locate the stone. X-rays do however deliver significant radiation exposure.
In 1984, I was unable to pass my stone (3-4mm) which was located in my left ureter (tube which transports urine from the kidney to the bladder) and caused intense and constant pain. There was no form of medical therapy at that time. My treatment consisted of a surgical procedure called ureteroscopy and stone extraction. At that time the instruments were large and cumbersome. During this procedure, the doctor inserts the ureteroscope through the urethra, into the bladder and then into the affected ureter. There he uses the instrument to visualize and grasp the stone to remove it. In some cases, the doctor has to break the stone into smaller fragments and remove them one at a time. The smallest pieces are to pass normally during urination. I underwent this procedure which lasted 2-3 hours and I was kept in the hospital for 3 days. The pain from the procedure was severe. After the procedure an ureteral stent was inserted to keep the ureter open and allow urine to flow from the kidney into the bladder. The ureteral stent was kept in place for one week. It left me with significant sympthoms. After it was removed, I slowly returned to my normal day to day activities.
In hindsight, the progress we have made over the last 30 years in treating kidney stones is amazing . Im glad we at New York Urological in Manhattan have access to much advanced methods for treatment today. I’ll be discussing my most recent experience in my next post for comparison of all aspects; from diagnosis through treatment. We know how it feels and understand that prompt and efficient treatment are the key to a better experience.
Dear CIGNA OPEN ACCESS PATIENTS:
Recently, several Cigna imaging claims were reprocessed. CIGNA reviews imaging claims through their third party contractor MSI. The affected claims were assigned patient responsibilities which were not due. Some of you who paid, co-pay, coinsurance and deductible may have received or will receive a refund if your claim was one of the affected. Please note this only relates to claims where imaging services were billed.
You’re welcome to call our office if you have any questions, or email us to askbilling @ nyurological.com.