Urologic Health Highlights

One more reason to quit smoking

2011-01-11T22:30:43Z

By Abbey Forney, Communications Director

If quitting smoking is one of your New Year's resolutions, stick with it. You probably know that smoking damages the organs in your respiratory and circulatory systems, but did you know it is the number one risk factor for bladder cancer? Smokers get bladder cancer twice as often as people who don't smoke.

When you consider how the urinary system works, you can see the connection between smoking and the bladder. Your kidneys filter waste and toxins from your blood including the carcinogens found in tobacco. Then the kidneys send the concentrated waste to the bladder for storage until it is time to eliminate. Over time, the exposure to carcinogens can affect the bladder's lining and potentially lead to cancer.

Bladder cancer is one of the most unfortunate types of cancers. Its chief symptom, painless blood in the urine, can also signal many other less serious health problems so smokers might be tempted to dismiss the early warning signs. Bladder cancer has a very high recurrence rate. Fifty to 80 percent of people who are treated for the disease can expect it to come back. If someone is facing invasive bladder cancer that can't be managed with more conservative methods, the doctor may recommend a cystostomy or a procedure to remove the entire bladder. This operation is the most complex surgical procedure that urologists perform. A full recovery takes months, and learning to live without a normal bladder requires adjustments in every area of life. Cystectomy patients receive an internal or external bag that collects urine that they must empty several times a day.

Quitting smoking is the best things you can do to reduce your odds of developing bladder cancer. Once your kick the habit, stay alert for changes in your urinary patterns and follow up with a doctor, even if the symptoms seem to go away on their own.

We wish you health and happiness in 2011. Cheers!

Video: Young Prostate Cancer Survivor Shares His Story

2010-11-05T23:18:04Z

Sixty-five percent of all prostate cancers are found in men over age 65 so when Tim, a 44-year-old husband and father, learned he had the disease, he was shocked. In this video, Tim talks candidly about breaking the news to his family including his 6-year-old daughter. He explains how he arrived at his treatment decision (robotic surgery), the recovery process and his hope that this video will give encouragement to other men facing the disease, especially young men like him.

RunPee Alerts Moviegoers to Best Times to Answer Nature's Call

2010-09-14T20:37:40Z

By Abbey Forney, Communications Director

There's a smartphone app for everything - from the practical to the ridiculous. RunPee fits in the middle of this spectrum. It's a silly but handy tool that any moviegoer, especially a urology patient, can appreciate. The free app gives you a heads up about the best times slip out of the theater for a quick bathroom break. Who doesn't need that? Even if you don't have bladder troubles, an extra large soda is reason enough to download RunPee.

RunPee's tagline is, "Helping your bladder enjoy going to the movies as much as you do."

The premise is that every movie has slow points and scenes that aren't critical to the plot. The makers of RunPee preview current movies and alert you to the best times to answer nature's call. To avoid a spoiler, you have the option of seeing just the text describing your exit cue or a complete synopsis of what you'll miss.

The app includes movie trailers, an archive of less current films and a timer that you can start at the beginning of the show. The timer causes your phone to vibrate discretely when there's an opportunity to sneak away. Right now, the app is only available on the iPhone, iTouch and iPad, but the company behind RunPee is seeking testers for its Android version that is due out soon. If your phone doesn't support RunPee, you can still get the restroom cues at RunPee.com or at its mobile site, designed for times when you are on the run.

Over the weekend, I tested RunPee during The American, the assassin movie staring George Clooney. The first cue came 35 minutes into the film "as Jack is wandering around the mechanic's garage picking up random parts." I skipped this opportunity and waited for the second cue. At exactly 50 minutes from the start of the movie, my phone vibrated and the on-screen dialogue confirmed that the time was right. I had four minutes to slip away. RunPee told me I would miss a long sex scene. My husband, who stayed in his seat, concurred with the app's makers; the scene was not crucial. In fact, he wished he had skipped it too.

My iPhone is cluttered with apps, but this is one that I am going to keep and consult when I'm in the theater waiting for a movie to start.

If you try RunPee, leave a comment and let me know about your experience.

Kidney Stone Summer

2010-07-21T19:33:02Z

By Cameron Carr, Public Relations Intern

We've all heard horror stories about passing kidney stones. The summer months are the most common time for stones because people dehydrate more easily. The lack of water in the body cause minerals to build up in the kidneys and bladder. When you have too much of certain a mineral, acid or salt in your urine, you're prone to develop stones.

About 90 percent of kidney stones are small enough to pass through the body on their own without medical intervention. Drinking lots of water helps the stone move through the ureters and out the body. Passing a stone is uncomfortable and your doctor will probably prescribe medication to ease the pain. If your stones can't be passed naturally, your doctor may recommend a procedure to break down or remove the stone.

To keep from developing stones this season, keep a water bottle with you during the day and drink from it often, make a point to shed extra pounds since being overweight puts you at an increased risk for stones, and finally keep a pitcher of natural lemonade in the refrigerator. In addition to being a refreshing summer drink, the citrate in lemonade helps prevent stones from forming.

Free prostate screening offers peace of mind

2010-06-22T19:39:13Z

Men, please don't skip your prostate cancer screening because of cost. And don't let a few seconds of discomfort keep you from having the peace of mind that comes from being tested for a disease that's easy to detect and treat.

Come to our free prostate cancer screening this Thursday from 5:30-7:30 pm at the Nix Medical Center downtown. Go to www.urologysanantonio.com/screening for more details.

Here's a tip: most people arrive early, creating a bottleneck at the beginning of the event, but if you come at about 6:30 pm, and you'll be in and out in 15 minutes.

Need more reasons to be screened?

Prostate cancer is more common than breast cancer. It affects 1 man in 6. If you have the disease, you probably won't see any symptoms until the cancer is advanced and difficult to treat. But if it's detected early, your doctor can provide careful monitoring or highly effective treatment. For men with early-stage disease, the five-year survival rate is nearly 100 percent.

Update: Thanks to everyone who participated and supported this event. We screened 160 men. About 10% need further testing to confirm or rule out the disease.

Thinking about a vasectomy? Answer these questions.

2010-06-11T14:41:59Z

A vasectomy is classified as a permanent form of birth control. Technically it is possible to reverse a vasectomy, but the operation is expensive, rarely covered by insurance and there is no guarantee it will work. The best advice is for couples to make the decision about a vasectomy as if it were permanent.

If you're considering the snip, ask yourself these questions.

Do I want to have children in the future?
Am I in a committed long-term relationship?
Is my partner supportive of the idea?
If my relationship ended, would my feelings change?
If something happened to my children now, would my feelings change?
Am I considering a vasectomy for health reasons?

If you're confident in your answers, then a vasectomy is probably right for you. If you are unsure about some of your answers or there's a possibility that your attitudes or circumstances might change, opt for another form of birth control. You can always have the vasectomy in the future when there's no uncertainty about your decision.

Learn more about vasectomies at www.urologysanantonio.com/vasectomy

Finding solutions for erectile dysfunction - one man's story

2010-05-11T16:13:58Z

At a recent health education seminar, Bill a retired businessman spoke to a room of strangers about the emotions and experiences that he and his wife Cheryl faced when erectile dysfunction changed their intimate relationship.

Bill shares about the embarrassment of not being able to perform, his reluctance to talk to a doctor, the disappointment of trying several unsuccessful treatments and the eventual restoration he found.

Speaking publically about such a personal experience in is awkward, but Bill and Cheryl feel strongly that their story will help other couples struggling with similar issues.

Listen to their story. (Be patient; it takes a moment for the file to load.)

You can also hear Dr. LeRoy A. Jones explain the medial aspects of Peyronie's Disease, or read about the penile prosthesis, the treatment that helped Bill.

Urology San Antonio routinely hosts free educational seminars to provide to public with accurate medical information about urologic topics that may be difficult to discuss. As often as possible, a patient speaker provides his or her personal perspective on the topic. To find out about the next seminar or to sign up, go to urologysanantonio.com/events.

Infertility ad campaign uses lighthearted approach

2010-04-01T15:44:19Z

Infertility is a somber subject. Could some levity -- in the form a costumed bird and bee couple -- make the topic easier to discuss? That's the approach used by the ad agency that developed this creative, touching campaign.

At the heart of the campaign is the website increaseyourchances.org. There you can follow Karen and Neil through five carefully crafted video vignettes.

The contrast of the couple's ridiculous costumes and their deadpan portrayals makes you smile, but you also feel their pain.

The ads' takeaway message is simple. One couple in eight has trouble conceiving. Working with a fertility specialist can increase your chances.

For couples in Karen and Neil's situation, a natural first step is to talk with your regular OB-GYN. She can help you with the initial assessment, then, if needed, suggest a urologist (for male issues) and/or a fertility specialist.

If you are interested in learning more about the campaign, read this article in Brand Week. The ads are the work of mono, a Minneapolis agency, on behalf of their client, EMD Serono, makers of Gonal-f, a fertility drug.

Exercises target urinary and sexual health

2009-12-14T19:28:45Z

By Abbey Forney, Communications Director

Your pelvic floor muscles support your bladder, rectum, uterus and vagina. Although you can't see them, keeping these muscles toned with regular exercise will noticeably improve your urinary and sexual health.

Pelvic floor muscle exercises are sometimes called Kegel exercises, named after the doctor who developed them. The goal of these exercises is to increase strength and control. By strengthening your pelvic floor muscles, you ensure that they are capable of pinching tightly around the urethra (the urine tube) to prevent bladder leakage.

Normally your pelvic floor muscles do their job with little conscious thought on your part; however, when you practice flexing and relaxing these muscles, you can develop conscious control over them. Once you have control, you can flex the muscles to prevent urine loss, calm a "gotta go" urge, or even keep you from passing gas in an inopportune moment.

A fit pelvic floor can also enhance your sexual experience. Pelvic floor muscles are involved in orgasmic contractions. When the muscles are toned, they contract more powerfully than flabby muscles, which increases pleasure for both partners.

Another benefit of daily pelvic floor exercise is that it can help prevent pelvic prolapse -- a condition in which the pelvic organs, such as the bladder or uterus, move out of position because they are no longer adequately supported by the surrounding muscles and ligaments. A toned pelvic floor is more capable of holding these organs in their proper positions.

All women, regardless of whether they have symptoms of a weakened pelvic floor, can benefit from pelvic muscles exercises. Remember, like any muscle, the more you exercise the pelvic floor, the better it will function. Here's a sample pelvic floor workout provided by nurse practitioner Peggy Francis, the director of the Urology San Antonio Center for Urinary Control.

The Passing of a Statesman

2009-09-01T14:43:52Z

By Abbey Forney, Communications Director

Today, at a memorial service, friends and family will celebrate the life of Dr. John B. Case, the city's first board-certified urologist. Case was the first of three generations of urologists in his family. His son, Dr. George D. Case, and grandson, Dr. John R. Case, now practice with Urology San Antonio.

"He was a generous and gracious gentleman who always had a kind way about him and made me feel good about joining the urologic community," recalls Dr. Juan A. Reyna, CEO of Urology San Antonio. "He and [Dr.] Chuck Hulse were the face of urology many years ago when there were less than six urologists in the city. [Drs.] Case and Graham Koffman were the force in downtown urology. Those of us who came behind him owe him much for having kept the collegiality in our specialty. The Case family should certainly be proud of the legacy left by Dr. John Case."

Sign the online guest book.

Group opens Westover Hills clinic, adds new doctor

2009-08-17T18:50:47Z

At the beginning of August, Urology San Antonio opened a new clinic in the Westover Hills Baptist Medical Building. The office is staffed by the group's newest urologist, Dr. Samuel Hakim.

Dr. Hakim retired from a 24-year career in the U.S. Medical Corps in May. He cares for adults general urology issues and has special interests in robotic and minimally invasive surgery techniques, kidney stones, urologic cancers, and vasectomy reversals.

Get to know Dr. Hakim and tap into his knowledge of urology by participating in a Live Health Chat Thursday, August 20 from 12:30 - 1:30 p.m.

Live Health Chat-

2009-08-05T14:35:52Z

Dr. Samuel Hakim from Urology San Antonio is talking urology Aug. 20, at 12:30 p.m.- Submit your questions about prostate health, bladder and kidney issues, and sexual wellness now. Submit your questions.

According to Urology San Antonio general urology is a surgical specialty that deals with diseases of the urinary tract and sexual function concerns in men and women.

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Vasectomy reversal akin to suturing spaghetti

2009-07-28T13:51:33Z

By John Case, MD

Board-certified urologist

Fellowship trained in male reproductive medicine and surgery

In my previous post, I shared some statistics about the success rate of vasectomy reversals. In this post, I'll explain how the operation is performed.

A vasectomy reversal is like sewing together two ends of spaghetti. For the surgeon, it's a highly technical operation, but for the patient, it is a relatively simple outpatient procedure.

There are two types vasectomy reversal procedures. Each requires the surgeon to place tiny stitches, unseen to the naked eye. To accomplish this delicate feat, the doctor must use a special operating microscope that magnifies images 25 times their normal size.

The first and most common reversal procedure is a vasovasostomy. During this operation, the urologist sews together the two snipped ends of the vas deferens, a spaghetti-sized tube that carries sperm. The stitches are sewn in two layers: one around the inner passage of the vas deferens and the second around the outside of this tube. Imagine the words "In God We Trust" written on a penny. The diameter of the inner passage of the vas is the width of the letter "o" on the coin. That's small!

A newer modification of this operation is known as the "fibrin glue vasovasostomy." It involves connecting the vas with one layer of microsutuers, then coating the area with the medical equivalent of a sealant that dissolves after the body heals. The results for this modified procedure compare favorably to the conventional two-layer approach, but outside of the military, the fibrin glue procedure is not widely used.

Sometimes, if the sperms' flow is blocked and a vasovasostomy won't work, the doctor may need to perform a type of bypass operation in which he reroutes the vas deferens directly to the epididiymis, a coiled organ in the back of the testes. This more complex operation is called a vasoepididymostomy.

It's impossible to predict with absolute certainty which surgical technique will be needed. In general men whose vasectomies were eight or fewer years ago will not need the more complex procedure, but the surgeon will not know for sure until he can examine the vas deferens in the operating room. Since either technique may be required, men should choose a doctor who has a successful track record with both operations.

Regardless of the procedure or technique, recovery after a vasectomy reversal is swift. Most men return to non-strenuous within a week. They can resume sexual intercourse after their incisions have healed, usually two to three weeks.

When a vasectomy reversal is successful, sperm will appear in the semen after a few months, but it may take longer the sperm count and movement to return to normal. On average, couples are able to achieve a pregnancy one year after a successful vasectomy reversal.

Fatherhood and the vasectomy reversal

2009-06-19T18:24:28Z

By John Case, MD

Board-certified urologist

Fellowship-trained in male reproductive medicine and surgery

Today's post is in honor of Father's Day.

Half a million men have vasectomies each year in the U.S. But what happens if they change their minds and want to start a new family? A vasectomy reversal could be the answer.

As a male infertility specialist, I work with many couples seeking a vasectomy reversal. The most common reason for a reversal is remarriage and the new couple's desire to have children together. Another reason for a reversal is the death of a child.

The likelihood of a successful vasectomy reversal depends primarily on the length of time that has passed since the man's vasectomy. Most couples, and even doctors, are pleasantly surprised at the figures.

This chart shows vasectomy reversal success rates at different time intervals. The data comes from a national study that was published in the Journal of Urology in 1991.

Years Since Vasectomy	Chance of Return of Sperm to Ejaculate	Chance of Natural Pregnancy After Vasectomy Reversal
Less than 3 years	97%	76%
3 to 8 years	88%	53%
9 to 14 years	79%	44%
Greater than 15 years	71%	30%

Belker AM, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. Journal of Urology 1991; 145(3):505-11.

A vasectomy reversal is a delicate procedure that requires the surgeon to use a powerful microscope while suturing together the vas deferens, tiny tubes that are the width of a piece of spaghetti.

Like all extremely specialized and technical procedures, the best results are usually obtained by surgeons with extensive training in microsurgery and who perform many vasectomy reversals each year. Selecting a doctor who is fellowship-trained in microsurgery ensures that your surgeon meets the guidelines established by the American Society of Reproductive Medicine, the leading reproductive society in the U.S.

A vasectomy reversal costs between $4,500 and $9,000 and, the expense is rarely covered by insurance so men must think carefully before undergoing a vasectomy. But for those men who've had the snip find and themselves wanting to be a father again, it's encouraging to know a reversal is a possibility.

In my next post, I'll explain the reversal operation and the different surgical techniques.

Pfizer launches free med program for newly jobless

2009-06-10T20:27:00Z

By: Abbey Forney, Communications Director

Drug maker Pfizer announced that it will provide many of its popular prescription medications free to patients who have lost their jobs and health insurance. Two drugs that urologists commonly prescribe, Viagra for erectile dysfunction and Detrol LA for overactive bladder, are included in the program.

The initiative, which Pfizer has dubbed MAINTAIN (Medicines Assistance for Those who Are in Need) was announced yesterday, but it will not be fully operational until July 1, 2009.

To date, there is not a publically available list of the medications included in the MAINTAIN program, but the Pfizer representative who calls on our clinic informed me that the drug list is very similar to the one for Pfizer's existing Helpful Answers prescription assistance program.

To qualify for MAINTAIN, individuals must have lost their job and health insurance after December 31, 2008, and they or their dependants must have been taking a prescribed Pfizer drug for at least three months prior to the job loss. Applicants will need to sign a statement that they are suffering financial hardship and provide documentation of their job loss.

Beneficiaries of the program will receive their Pfizer prescriptions free for 12 months or until they are re-insured, whichever comes first.

MAINTAIN applications will be available on Pfizer's website beginning June 1, or you can get the application now by calling (866) 706-2400, but be prepared for a busy signal. Applications will be accepted through December 31.

Those who don't qualify for the MAINTAIN program but need help paying for Pfizer prescriptions can apply now for the company's Helpful Answers program.

For help paying for non-Pfizer drugs, visit the Partnership for Prescription Assistance, a clearinghouse for public and private patient assistance programs.

Do you qualify for the MAINTAIN program? Do you plan to take advantage of it? Leave your comments and let us know.