Q. What treatments are available for incontinence?
A. The one-half of all females who experience bladder control
problems can be encouraged to learn about several different
solutions. Some solutions include InterStim therapy, female
incontinence slings (surgical), and tension-free vaginal tape.
Q. I sometimes have an “accident” when
I cough, sneeze, laugh hard, or make other movements. What
can be done to help this?
A. Many treatments are available for the condition you describe,
known as “stress incontinence.” A treatment usually
performed during an outpatient procedure is placement of a
urethral support sling, a narrow strip of material, in a woman’s
body just below the bladder.
Q. What causes stress incontinence?
A. Weakened or damaged pelvic muscles and ligaments can cause
stress urinary incontinence, also known as “fallen
bladder.”
Q. What are the causes of a “fallen
bladder?”
A. The pelvic muscles and ligaments can be weakened by pregnancy,
childbirth, obesity, trauma, radiation, prior surgery, muscle
damage or hormonal changes. Any of these causes may make
the bladder and urethra relax from their normal positions.
The sudden, added pressure from coughing, sneezing, laughing,
or simple lifting can cause accidental loss of urine.
Q. If I choose to have surgery to receive an incontinence
sling, what does this treatment involve?
A. Placement of a narrow strip of material to support the urethra
is performed during an outpatient procedure in less than an
hour under local, regional, or general anesthesia, depending
on what the patient and the doctor choose. Two tiny skin incisions
are made near the inner thigh. The hammock or sling is inserted
through a small incision in the vagina and placed under the
urethra and secured under the skin.
Q. How long is the recovery?
A. Most women will see results as soon as the catheter from
surgery is removed, usually within a day or two after the
procedure. Full recovery and return to all normal activities
can be expected in approximately four to six weeks.
Q. Where can I take my child for treatment
of urinary problems?
A. A physician whose specialty is urology
is able to treat the common urinary problems of children. Typical
problems treated are urinary tract infections and bed-wetting.
Q. What is recommended as the best treatment for an enlarged
prostate gland?
A. Urologists approach the treatment of men with BPH (usually
over age 50) on an individual basis. There is no cure for BPH,
and once prostrate growth starts, it often continues, unless
medical therapy is started. One possibility is microwave therapy
(TUMT). Another is called TUNA.
Q. What is TUNA® Therapy?
A. The letters stand for transurethral needle ablation. It
is a proven, minimally invasive, office based procedure that
destroys excess prostate tissue, which may improve urination.
It uses radio frequency energy delivered directly to the
prostate.
Q. How effective is TUNA Therapy?
A. It has been on the market for more than 10 years. The recovery
is quick and the side effects are few. Key benefits are relief
from BPH (enlarged prostate) symptoms, a short procedure
time, and procedure done in an outpatient setting. Patients
observe improvements in symptoms in two to six weeks after
the procedure and may continue to improve over two or three
months.
Q. What will happen during the TUNA procedure or the Prostiva™ RF
Therapy procedure?
A. You will be given a mild sedative orally. Local anesthesia
will be delivered to the urethra and your physician will insert
the TUNA or Prostiva RF device through the urethra to deliver
low-level radio frequency energy directly into the prostate.
After the procedure, your doctor may insert a catheter to ensure
your comfort.
Q. How long does the procedure take?
A. Usually about 30 minutes. However, your entire visit will
take up to 90 minutes for preparation, procedure, and post-procedure
care. In the Prostiva RF Therapy, your doctor will use two
small probes to deliver RF energy to destroy the obstructive
prostate tissue which is restricting your urine flow. The
physician will treat four to eight sites within your prostate
until determining that enough sites have been treated to
relieve your symptoms.
Q. Is general anesthesia ever used?
A. Most doctors prescribe a mild anesthetic, however, others
may determine general anesthesia is more appropriate for
your comfort. In Prostiva RF Therapy, a prostate block, spinal,
or general anesthesia is sometimes used, if necessary.
Q. Is this a recommended treatment for BPH?
A. Yes. TUNA Therapy and Prostiva RF Therapy are among the
few recommended minimally invasive treatments in the American
Urological Association Guideline on Management of BPH.
Q. Is TUNA Therapy or Prostiva RF Therapy
effective long-term?
A. In a 2003 study of 188 patients, data suggested that TUNA
Therapy is effective and provides good long-term clinical
improvement at five-year follow-up. In a study published
in 2004, data showed Prostiva RF Therapy provided good, long-term
clinical improvement within a five-year span following the
RF therapy treatment.
Q. Will I have to spend the night in the hospital?
A. TUNA Therapy and Prostiva RF Therapy were designed for use
in an office or a hospital outpatient setting. Most men are
able to go home the same day.
Q. Is the procedure safe?
A. Yes. The instruments used in TUNA Therapy and Prostiva RF
Therapy contain several important safety features. The device
constantly measures temperature in the treatment area and
automatically shuts off if it detects that it is getting
too hot.
Q. What will happen after the procedure?
A. There is minimal discomfort after a Prostiva RF Therapy
treatment or TUNA Therapy treatment. This can be relieved
with over-the-counter pain medicines as needed.
Q. How long before I can return to normal activities?
A. Most patients are allowed to resume most activities within
a few days.
Q. When can I expect my BPH symptoms to go away?
A. From two to six weeks patients will notice improvement.
Full improvement may not occur for two to three months. Follow
your physician’s instructions as to when to stop taking
your BPH medication.
Q. What side effects are associated with Prostiva RF Therapy?
A. Possible side effects include obstruction, bleeding, blood
in urine, pain/discomfort, urgency to urinate, increased
frequency of urination, and urinary tract infections.
Q. Is there a risk of incontinence?
A. There were no reported cases of incontinence in the original
clinical study conducted by Medtronic for approval of the
therapy. In some other clinical studies, incontinence has
occurred in 3.1 percent of patients.
Q. What about sexual side effects?
A. During the original clinical study conducted by Medtronic
for the approval of the therapy, less than two percent of
RF therapy patients experienced impotence and less than one
percent experienced retrograde ejaculation.
Q. What is the procedure known as TURP?
A. This is the abbreviation for transurethral prostatectomy.
It is a surgical technique, performed under anesthesia using
a specialized instrument, to remove the prostatic tissue
bulging into the urethra and blocking the flow of urine.*
Q. What is PSA and what is a normal PSA range?
A. PSA stands for prostate specific antigen. When the prostate
is irritated, inflamed, or damaged, the PSA level in the
bloodstream rises. The normal range is usually 0 to 4. There
may be some variations of normal range based on age and race.*
Q. How common is prostate cancer?
A. In American men, prostate cancer is the most common cancer
(excluding skin cancer). More than 75% of the cases of prostate
cancer are diagnosed in men older than 65.*
Q. What is prostate cancer screening?
A. Prostate cancer screening is composed of
both a digital rectal examination and a serum
PSA. Prostate cancer screening should be performed on a yearly
basis, except for men with a very low initial PSA level who
may want to consider screening every other year.*
Q. Some of my good friends have prostate cancer and have undergone
various treatments with good results. Should I have what they
had?
A. Your friends may be able to help you develop
a list of questions and concerns to address with your doctor(s).
However, what may be appropriate for your friend may not be
for you.*
Q. What type of doctor does vasectomies?
A. A urologist can do the minor surgical procedure
called vasectomy, which cuts or blocks the vas deferens, a
tube that carries sperm from the testicle to be added to semen.
After a vasectomy, a man’s semen is sperm-free.
Q. After my prostate was removed, I developed incontinence.
I was afraid of accidents and wanted to stay home or very close
to home. Is there anything urologists can do to help?
A. There are two surgical options which we use for men with
varying severity of incontinence. A male sling system made
by American Medical Systems is for mild to moderate incontinence.
The AMS 800™ Urinary Control System is for those with
moderate to severe incontinence, and consists of a control
pump, a balloon, and cuff that surrounds the urethra. Both
surgeries are performed on an outpatient basis.
Q. Are these procedures new?
A. Not extremely new. The AMS 800 Urinary Control System has
helped more than 94,000 men throughout the world over the
past 30 years. The InVance™ Male Sling System has been
in use since 2000 in approximately 8,000 men.
Q. What if a man’s incontinence
is not very severe?
A. There are many options, including protective undergarments
and external clamps.
Q. Where can I find out more about the surgery for male incontinence?
A. Our office staff encourages patients to take home brochures
from our office, and to telephone us with questions or concerns
about your health.
Q. Who is a candidate for interstitial
seed therapy?
A. The goal of interstitial seed therapy
is to cure prostate cancer. With this in mind, the candidate
should have a life expectancy of more than 7 to 10 years
and no underlying illness that would interfere with the effectiveness
of this therapy.*
Q. When can I return to work after interstitial
seed therapy?
A. Because the procedure in minimally invasive
and requires no incisions, you can typically return to work
and full activity within 3 to 4 days after the procedure.*
Q. Where can I take my child for treatment
of urinary problems?
A. A physician whose specialty is urology
is able to treat the common urinary problems of children.
Typical problems treated are urinary tract infections and
bed-wetting.
Q. What is the new minimally invasive treatment for prostate
cancer?
A. The term you are seeking is cryotherapy for prostate cancer.
It is relatively new. Prostate cryotherapy is surgery, but it
is minimally invasive, using freeze and thaw cycles to destroy
the disease.
Q. What is cryotherapy/cryosurgery?
A. Cryotherapy is a technique used for prostate cancer treatment
that involves controlled freezing of the prostate gland.*
Q. Who gets cryotherapy?
A. Cryotherapy is an
option for prostate cancer patients who
want to avoid major surgery. Patients with smaller prostates
are better candidates for treatment. Those with larger prostates
can undergo therapy to decrease the prostate size prior to
cryotherapy.
Q. What are some other uses of this procedure?
A. Cryotherapy has been used to destroy skin tumors, precancerous
moles, skin tags, and unsightly freckles. It also has been
used to destroy a childhood cancer of the retina. In addition
to treating prostate cancer, physicians have begun to perform
this procedure in patients with kidney, liver, and cervical
cancer, especially if surgery is not an option.
Q. Will cryotherapy eventually be a treatment option for all
types of cancer?
A. Currently, research is being done to determine the effectiveness
of cryotherapy for tumors of the brain, kidney, bone, lung, and
spine. In addition, researchers are evaluating its usefulness
in freezing and shrinking benign breast lumps.
Q. Who is cryotherapy recommended for?
A. Presently, cryotherapy is recommended for patients who have
localized prostate cancer or have recurrence of prostate cancer
despite radiation.
Q. Is cryotherapy performed the same way in every patient?
A. Not exactly. Cryotherapy will vary from patient to patient
according to the tumor stage and grade.
Q. What does “tumor grade” mean?
A. A “tumor grade” is a labeling system telling how
quickly a cancer is growing.
Q. What is a prostatectomy?
A. This is where an attempt is made to surgically remove the
entire prostate.
Q. What happens to the prostate after cryotherapy?
A. Unlike a prostatectomy, cryosurgery attempts to destroy prostate
tumor tissue in place, without removing it.
Q. What happens to the tumor and tissue following the procedure?
A. At this point, the cancer tumor and its blood supply have
been destroyed; the dead tissue is reabsorbed or remains in
the body as scar tissue and poses no other health threat.
Q. What can one expect at home during the post-operative period?
A. Scrotal swelling occurs in approximately 25% of patients,
and patients are advised to apply ice packs to the scrotum for
the first five days after the procedure.
Q. How do you know if cryotherapy is the right treatment for
you?
A. The decision regarding treatment for prostate cancer is a
very personal one. It is a cancer that has multiple treatment
approaches with different complications and cure rates.
Q. What are the main treatment options for prostate cancer patients?
A. There are three main approaches to the treatment of prostate
cancer, including: surgery, radiation therapy and cryotherapy.
The decision of what therapy to choose is based on the extent
and type of the cancer, age of the patient, general health
of the patient and the preference of the patient.
*Information Television Network Healthy Body,
Healthy Mind “Prostate
Cryotherapy” April 2005
*Pamela Ellsworth, John A. Heaney, Oliver Gill,
100 Questions and Answers About Prostate Cancer
(Boston, Jones
and Bartlett, 2003) p.7, 12-14, 35-36, 81, 107, 110, 117, 225;
Take Control and Restore Your Lifestyle, End Urinary Incontinence, ©American
Medical Systems, Inc. 2005; TUNA® Therapy Enlarged Prostate?
What you should know. Prostiva™ RF Therapy for Symptomatic
Enlarged Prostate, ©Medtronic, Inc. 2005, 2006.
Female
Urology Male
Urology Cryosurgery Male &
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