 Texas Urology Provides Current Urological Updates for Primary Care Physicians
Our goal is to provide the most advanced urological care to our patients and be a resource to our
referring provider partners. As always if you have any questions, feedback or topics you would like
 to see discussed, don't hesitate to contact us. If you have a patient
you would like to refer to Texas Urology, please call 972-420-8500.
Use of MRI in Diagnosing and Managing Men with Prostate Cancer
Multiparametric MRI (mp-MRI) imaging has recently been employed to determine the location and volume of prostate cancer in men with elevated PSA, as well as recurrent prostate cancer. Studies of magnetic resonance (MR) spectroscopic imaging (1H-MRSI) have been done in conjunction with dynamic contrast-enhanced MR (DCEMR). In combination, these studies have shown a significant improvement in the detection of men with higher grade prostate cancer, extension of prostate cancer outside the prostate, and recurrence of men previously treated. This is with a sensitivity of 86% and a specificity of 100%.
Please click here to read more.
What is a MRI?
When placed in the strong magnetic field of an MRI scanner, the protons of hydrogen atoms in the prostate tissue align with the magnetic field. Radio frequency pulses applied to that field produce images that the radiologist can review when the protons are displaced by this alignment.
Please click here to learn more.
Is hematuria really hematuria?
A perplexing urologic problem that I frequently hear Primary Care Physicians ask about is microscopic hematuria. I have decided to devote a PCP Update to this topic acknowledging that the vast majority of the following information was taken right from the American Urologic Association Guidelines for the diagnosis, evaluation, and follow-up of asymptomatic microscopic hematuria in adults.
A separate article will discuss gross (visible) hematuria which does require urologic evaluation unless secondary to a documented urinary tract infection by culture.
The definition of asymptomatic microscopic hematuria is defined as three or more red blood cells (RBC) per high-powered field on a properly collected urine specimen. A negative repeat microscopic urinalysis following a positive test does not preclude the need for evaluation as outlined below. A positive dipstick urinalysis does not define asymptomatic microscopic hematuria (AMH).
Please click here to read more.
Choosing Wisely
Dr. Goldberg, a Dallas / Fort Worth Urologist, recently have become aware of an organization with a campaign called "Choosing Wisely" whose goal is to improve quality and reduce waste by getting physicians and patients talking about medical tests and procedures which may be unnecessary and possibly harmful.
So far, more than 60 national medical societies have joined the initiative www.choosingwisely.org to identify and create lists of the top five tests and procedures that they say are over-used or inappropriate.
Please click here to read more.
Not all Urinary Bacteria are Bad!
Asymptomatic Urinary Tract Infections
Bacteria are present in, on, and around the entire human body. There is a normal bacterial flora present on the skin, in the mouth, in the GI tract, and in the vaginal canal as well. This normal flora keeps virulent bacteria under control and co-exists well with bodily and organ functions.
It should not be surprising then that articles have now demonstrated that there is normal bacterial flora present in the lower urinary tract. Click here to read more.
New Treatment for Peyronie's Disease, XIAFLEX
Peyronie's Disease is a local connective tissue disorder characterized by a change (scar formation) in the collagen composition of the tunica albuginea of the penis.
The two corpora cavernosa and corpus spongiosum of the penis are composed of an elastic covering within the tunica on top of the erectile-spongy tissue inside. During an erection, blood is trapped in all three corporal bodies leading to dissension of the corpora and an erection occurs. Peyronie's plaque, which is composed predominately of collagen, although calcium deposits may occur, replaces the normal elastic tissue. This results in penile deformity, primarily a curvature (I have seen up to 120 degree bends!); along with penile narrowing, indentation and shortening of the penis. Click here to read more.
Texas Urology Response to Testosterone Replacement Therapy Recent News
Probably, like you, I have received numerous calls and questions from men on testosterone therapy
who have seen advertisements by attorneys regarding lawsuits related to deaths, heart attacks, and
strokes from testosterone replacement therapy.
Click here to read a revision of the Texas Urology response originally distributed on
November 10, 2013, discussing the article in JAMA
(JAMA.2013;310(17):1829-1836.doi:10.1001/jama.2013.280386) that set off all the controversy.
What does Post-Traumatic Stress (PTS) have to do with Urology?
Essentially, very little. What does PTS have to do with me? A lot.
My younger son, Josh, went to work for an organization called "Save a
Warrior" (www.SaveAWarrior.org), as their Head of Awareness and
Contributions. (NOTE: This article is not intended in any manner, shape or
form to request any donations from you) Save a Warrior works with returning
veterans (called Warriors) who have significant PTS, are highly suicidal, and
have exhausted all other means of resolution of their problems. Josh and the
creator/executive director invited me to embed as a civilian (called a
"witness") for a cohort of 12 Warriors with significant PTS recently at the 5˝
day program in southern California. Ten of the 12 men have admitted to
having had a gun in their mouth in the last month, and one admitted on
camera to CNN's Soledad O'Brien, who filmed the entire week for a special
to air this summer, that if this program didn't work, he was going to kill himself.
Click here to read the complete article by Dr. Kenneth Goldberg.
The Use of Testosterone in Men With Prostate Cancer
Doctors, trained between 1960 and 1995, were of the opinion that using testosterone in men with prostate cancer was like "adding gasoline to a fire". This was the admonition and categorical contraindication to the use of androgens in men with prostate cancer because androgen replacement therapy was thought to hasten the recurrence of the disease. There were even physicians who were fearful of using androgens in clinically hypogonadal men because they were concerned about increasing the risk of prostate cancer by using exogenous androgens. Using evidenced based medicine, it is now considered safe to use testosterone in some men who are symptomatic for hypoandrogenism, who have documented decrease in their serum testosterone level, and who have been treated for localized prostate cancer.
It has also been proven that supplemental androgens in men without prostate cancer is safe and does not lead to prostate cancer. HOWEVER, IT SHOULD BE NOTED, ACCORDING TO THE FDA, THE USE OF TESTOSTERONE THERAPY IN MEN WITH A HISTORY OF PROSTATE CANCER IS CONTRAINDICATED.
Click here to read the full article.
Stendra: Is It Faster? Is It Better?
Recently, a new PDE5 inhibitor, Stendra, (Avanafil) was approved by the FDA and you will be
hearing about it very shortly. Based on the information that I have, in the majority of ways, it is
simply a ME-TOO drug.
The main difference relates to onset of action. Stendra's
main claim to fame will be onset of action as early as 15
minutes. Its T max, however, is 30 to 45 minutes in the
fasting state. Although the package insert states it can
be taken with or without food, a high fat meal reduces
the rate of absorption and delays the T max to an hour
and fifteen minutes. Duration of Stendra is the same as
Viagra and Levitra at 4-6 hours. Viagra and Levitra
report onset at 30 minutes to 1 hour. Cialis is about the
same or a little longer, but duration is 24-36 hours.
Click here to read the full article.
Omega-3, What is the True Story?
Recently, a study was published in the Journal of the National Cancer Institute suggesting a link between omega-3 fish oil and an increased risk of prostate cancer. Texas Urology has fielded numerous questions as a result of this media coverage and many questions have been answered regarding whether men should discontinue the use of omega-3 supplements. This reminds me of a time in the mid 1990's when an article appeared implicating vasectomies in an epidemiologic study linking this common procedure to prostate cancer. Previously, there had been isolated studies suggesting that vasectomy could cause testicular cancer and atherosclerosis. Needless to say, further studies as well as review of prior studies showed these results to be false and, indeed, vasectomy is not associated with prostate cancer, testicular cancer or atherosclerotic heart disease.
Click here to read the full article.
About Low T
Many men as they age, face symptoms of low testosterone (low T), such as low energy and low sex drive. There has been a lot of discussion and research on menopause in women, however, not until recently has there been a spotlight on low testosterone (low T) in men. Some have called this “Andropause”. Low testosterone affects about 40% of men over the age of 45. As men age, their levels of testosterone may decrease. Increasingly people are mentally, physically and sexually active much later in life than their parents or grandparents were. This awareness of low testosterone is only magnified by the numerous “Low T Centers” that are popping up in advertising in newspapers, radio and TV.
Click here to read the Texas Urology Opinion on the recent JAMA study linking Testosterone and Heart Disease.
Alpha-Blocker Therapy in the Management
of Urological Disorders
Activation of Alpha adrenergic receptors for smooth
muscles causes the smooth muscle to contract. Alpha
blockers, therefore, produce smooth muscle relaxation
by inhibiting contraction of this type of muscle. There
are multiple types of alpha receptors resulting in
different levels of selectivity of the alpha blockers.
Click here to read the full article.
Two approaches to Overactive Bladder (OAB)
OAB (over-active bladder) is found in both men and
women and is associated with the symptoms of
urgency, frequency, nocturia and urge incontinence.
Regulation of bladder storage and voiding involves both
sympathetic and parasympathetic control. Bladder
voiding is primarily regulated by the parasympathetic
nervous system via the neurotransmitter acetylcholine.
Muscarinic receptors (M1-M3-M5) are mediated by
acetylcholine in controlling the contraction of the bladder muscle and relaxation of the internal
sphincter to facilitate voiding. M2 and M3 are predominate muscarinic
receptors found in the bladder. The anti-muscarinic (Ditropan, Ditropan XL,
Vesicare, Sanctura, Gelnique, Toviaz and Enablex) all work by blocking the
receptor, leading to a reduction in bladder contractions. Because they block
the acetylcholine receptor systemically, they can be associated with
constipation and dry mouth.
Click here to read the full article. "Tis the Season"
Stones are seasonal. Stones increase with warm
weather in addition to being more prevalent in warmer
parts of the country. With the warm weather coming,
you can expect to see an increase in the number of
your patients complaining with renal colic. While there
is no good explanation for this fact, one theory is
dehydration, which leads to dislodging of the stones
from the lining of the uroepithelium.
Click here to read the full article.
What Do Men Have Over Women?
Clean Catch Urine Specimens!
For men - simply unzip, uncover, if needed, point and aim. For a woman, it is much more difficult. The proper urine collection requires: 1. Opening the wipes and taking off the top of the specimen container and placing them close to the toilet. The woman, if wearing slacks, needs to pull them down to the ankles followed by panties. Then, with her legs wide apart, using one hand to hold the vagina open, take the wipe and wipe from front downward toward the back. And continuing to hold the vagina open, place the cup and begin collecting the urine specimen. Click here to read the full article.
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