1	A Public Awareness Presentation Common Urological Problems Content Contributions by Society of Urologic Nurses (SUNA) National Association for Continence (NAFC) Simon Foundation for Continence Medtronic, National Cancer Institute and…
2	Common Urological Problems This presentation will review 3 of the most common urinary system conditions and diseases encountered in our practice of urology at TerKeurst Urology Clinic: Urinary Control - or Incontinence BPH - or Enlarged Prostate Prostate Cancer
3	The urinary system Components of the urinary system are the same in males and females… Kidneys produce urine – which then moves through 2 ureters to the… Bladder, containing detrusor muscles to initiate urination through the… Urethra, carries urine out of the body. Pelvic floor muscles help keep urine in the bladder
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5	Urinary Incontinence Definitions: Any uncontrolled loss of urine – in any amount Types: Stress – sneezing, laughing, lifting, etc. Urge – leakage, as occurs on the way to the bathroom Mixed – combination of stress & urge Overflow – bladder can’t fully empty (straining)
6	Risk factors for incontinence Pregnancy Menopause Enlarged prostate Obesity Medications (diuretics, sedatives) Smoking Diet Child bearing Surgery Constipation Limited mobility Disease (Parkinson’s, MS, diabetes, spinal injuries) Urethral strictures Congenital defects
7	Who has incontinence? Over 33 million people in the U.S. alone Both men and women People of any age – not just a normal part of aging
8	Treatments Diet modification Pelvic floor muscle exercises Biofeedback Medications Catheterization Interstim® therapy Surgical procedures
9	Meds don’t work for everyone Voiding requires coordinated activity between nerves and muscles Medications address the muscles; Interstim therapy addresses the nerves If medications fail you, Interstim therapy may provide relief.
10	Interstim Therapy Small stimulation system is implanted under skin – usually in upper buttock Device provides electrical stimulation to sacral nerves to help restore normal voiding function Test determines how you will respond to the implanted device. Reversible any time Therapy widely covered by insurance companies and Medicare
11	Interstim Therapy Test & Implant Testing Lead placed under skin just above tailbone Lead connected to external device worn on belt 3-7 days Response to test determines if device will be implanted Implant O-R; local or general anesthesia (1-1½ hr.) Stimulator implanted (upper buttock); lead stimulates sacral nerve Programmer controls system – on/off/levels
12	"BPH – Benign Prostatic Hyperplasia..." BPH – Benign Prostatic Hyperplasia Definition: Non-cancerous enlargement of the prostate gland Obstructs the flow of urine through urethra May also cause impotence, retrograde ejaculation
13	Who has BPH? 8.4 million men over age 50 50% of men over age 50 60% of men over age 60 70% of men over age 70 80% of men over age 80
14	Anatomy of the prostate A walnut-sized gland, approx. 3-4 cm Weighs approx. 15-20 grams in adult Wedged between the pubic bone and rectum at the base of the urethra
15	Symptoms of BPH More frequent urination, especially at night Sudden need to urinate Must strain to begin urination Slow, weak, variable, or dribbling stream Pain or burning with urination Incomplete emptying of bladder
16	Diagnostic tools used by doctor BPH Index (AUA) Urine flow study Cystoscopy Ultrasound Digital rectal exam
17	BPH affects bladder, urination Enlarging prostate presses against urethra like a clamp Bladder wall thickens Bladder contracts more frequently Contractions cause bladder to weaken
18	BPH treatment options Medications In-office procedure such as Prostiva™ RF Therapy Surgery
19	Prostiva RF Therapy Before – Expect 60-90 minutes in office Dr. TerKeurst reviews procedure, expectations for prognosis and recovery and gives you comfort control medications During – Dr. TerKeurst will pass the instrument through urethra directly into the prostate and deliver RF energy to prostate, destroying tissue restricting urine flow. After – Return home, take it easy, and use OTC pain medications as prescribed. You may need a catheter for 1-2 days.
20	Recovery/symptom improvement Most patients resume normal activities in a few days Most patients notice improvement in 2-6 weeks Full improvement may continue 2-3 months Follow medical instructions re: BPH medications Side effects may be experienced – blood in urine, discomfort, minor burning on urination for 1-2 weeks, etc.
21	Are you being treated with BPH medications? Tell Dr. TerKeurst: How your medications are working Side effects from your medications If you don’t want to take a pill every day If you would like him to determine if Prostiva RF therapy is right for you
22	Prostiva RF benefits Procedure takes less than an hour in Dr. TerKeurst’s office Local anesthesia (generally) Return to normal activities in 24-48 hours Few side effects – compared to traditional surgery Catheterization 0-2 days Few reports of incontinence (0–3.1%) or sexual side effects (<1-<2%) Improvement within 2-6 weeks Proven 5-year durability Covered by Medicare and many private insurance companies
23	Prostate Cancer Definition: A disease in which malignant cells form in the prostate. Second of the 3 leading causes of cancer deaths in men, along with lung (1st) and colorectal (3rd) Death rate from all three were declining in the latest National Cancer Institute Annual Report to the Nation (Nov. 2007) Found mainly in older men
24	Possible signs of prostate cancer Weak or interrupted flow of urine Frequent urination Trouble urinating Pain or burning during urination Blood in the urine or semen Pain in the back, hips, or pelvis that does not go away Painful ejaculation
25	Tests to diagnose prostate cancer Biopsy (Gleason score) Transperineal Biopsy
26	Stages of prostate cancer Stage I – cancer in prostate only, usually found accidentally during surgery for other reasons (cannot be felt, not visible by imaging) Stage II – cancer remains in prostate only, but is more advanced Stage III – cancer has spread to tissues nearby Stage IV – cancer has spread to lymph nodes near or far from prostate, bladder, rectum, bones, liver, or lungs
27	Stage I – Stage IV
28	Treatment options Treatment options depend upon the stage of the cancer and the age of patient. Majority of men diagnosed with prostate cancer do not die of it. Standard options: watchful waiting, surgery, radiation therapy, hormone therapy New treatments being tested in clinical trials: cryosurgery, chemotherapy, biologic therapy, high-intensity focused ultrasound
29	Prostate cancer prevention Risk factors for prostate cancer include: age, race, family history, also, may include diet and lifestyle Risk increases as a man gets older Risk dramatically higher for blacks, intermediate for whites, and lowest among native Japanese Chemoprevention: further studies needed for use of natural or man-made drugs, vitamins or agents to reverse, suppress, or prevent cancer growth Diet & lifestyle: further studies needed on low-fat diet as preventive of prostate cancer
30	We will accelerate the discovery, development, and delivery of cancer prevention interventions by focusing on risk assessment, systems biology, behavior modifications, environmental and policy influences, medical and nutritional approaches, and training and education for research and health professionals. --The Nation’s Investment in Cancer Research A Plan and Budget Proposal for Fiscal Year 2008
31	"1" 1. PROSTIVA RF Therapy System User Guide. Safety information from System User Guide is available at www.prostiva.com 2. Hytrin, Flomax, Avodart, Proscar, Uroxatral prescribing information 3. Proscar Peak Flow rate from “The impact of medical therapy on bother due to symptoms, quality of life and global outcome, and factors predicting response” – Lepor H et al, J Urol 1998 4.van Kerrebroeck P, Jardin A, van Cangh P, Laval K.U. Long-term safety and efficacy of a once-daily formulation of alfuzosin 10 mg in patients with symptomatic benign prostatic hyperplasia: open-label extension study. Euro Urol 2002; 41:54-61 5. Issa M, Marshall F. Contemporary Diagnosis and Management of Diseases of the Prostate. 3rd ed. Newtown, PA:Handbooks in Healthcare Co; 2005. 6. American Urological Association Education and Research, Inc. Guideline on the Management of Benign Prostatic Hyperplasia (BPH) 7. United States Census Bureau. Available at: http://factfinder.census.gov/servlet/QTTable?_bm=y&-geo_id=D&-qr_name=DEC_2000_SF1_U_QTP1&-ds_name=D&-_lang=en&-redoLog=false 8. Naslund. Transurethral Needle Ablation of the Prostate, Urology 1997; 50:167-172 9. Hill, B, Belville W, Bruskewitz R, Issa M, Perez-Marrero R, Roehrborn C, Terris M, Naslund, M. Transurethral needle ablation versus transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia: 5-year results of a prospective, randomized, multi-center clinical trial. J Urol 2004 Jun; 171 (6 pt 1); 2336-2340. 10. Roehrborn, Issa. Bruskewitz et al. Transurethral Needle Ablation for BPH: 12-Month Results of a prospective Multicenter US Study, Urology 1998; 51:415-421 11. In November 2005, the Food and Drug Administration granted 510K clearance for PROSTIVA RF Therapy stating that it is substantially equivalent to TUNA (r) Therapy. This document refers to data gathered using any one of several previous models of Medtronic's RF therapy equipment.
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