nterStim® Continence Control Therapy is a reversible treatment alternative for people with urinary urge incontinence who have found behavioral and pharmacological treatments ineffective or not well tolerated. InterStim® Continence Control Therapy uses a small stimulation system, about the size of a pacemaker that is surgically placed under the skin in the lower abdomen and lower back. The therapy uses mild electric pulses to stimulate a sacral nerve in the lower spine. This nerve influences the bladder and surrounding muscles that control urinary function. Clinical studies have shown that nearly half of all urge incontinent patients using the therapy are completely dry and many others have had their symptoms reduced significantly. The exceptional success rate of InterStim® Therapy is linked to the test stimulation procedure. This unique feature allows patients and their physicians determine the effect of InterStim® Therapy prior to consideration of a surgical implant procedure. During the test stimulation procedure patients are asked to keep a voiding diary to record voiding patterns with the stimulation. The voiding diary is then compared to diaries from before the test stimulation procedure and after the test stimulation procedure to determine the effect of the treatment on their symptoms. The test stimulation allows the clinician to evaluate the therapy as an option for the patient without significant cost or delay. It also provides patients with realistic expectations about the results of InterStim Therapy. Usually within three to five days both the patient and clinician can determine if InterStim® Therapy is a viable treatment option. After successful evaluation of the test stimulation, the InterStim® System may be implanted for long-term therapy. The procedure is performed under general anesthesia, and the InterStim® System can generally be activated on the first day after surgery. Potential side effects of the InterStim® Continence Control Therapy include: pain at the implant sites, lead migration, infection, change in bowel function, and undesirable stimulation or sensations.
The term scrotal mass means that a distinct mass can be felt within the scrotum, as opposed to a general swelling of the scrotum.
A lack of gonadotropin-releasing hormone (GnRH) - or deficiencies in pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) - can produce a variety of conditions defined as secondary hypogonadism or hypogonadotropic hypogonadism (delayed sexual maturity due to sex hormone deficiency). These disorders are usually inherited and are linked with abnormalities of the nervous system, genitals, and other body parts. One notable abnormality is anosmia - lack of sense of smell. Unlike the untreatable infertility caused by primary hypogonadism, infertility caused by secondary hypogonadism often is manageable by appropriate hormone therapy.
Segmental Cystectomy (partial removal of the bladder)—a bladder-preserving or "salvage" form of surgery—is appropriate only in a limited selection of male or female patients (for example, patients with squamous cell carcinomas or adenocarcinomas that arise high in the bladder dome). When segmental cystectomy is performed, it may be preceded by radiation therapy.
Semen analysis is the most informative test for male infertility. It is not, however, a conclusive indicator of fertility versus infertility, since there is still some confusion about what is required for adequate and healthy ejaculate (expelled semen). And, more importantly, semen characteristics are not absolute predictors of sperm function. In spite of these limitations, guidelines - such as those of the World Health Organization (WHO) - have been established to determine semen quality limits below which the chance of achieving pregnancy becomes increasingly less likely (see Table 1). Thus, a semen sample with a sperm count of 50 million sperm per milliliter of ejaculate, 65% motility, and 60% oval morphology (shape) would be classified as "normal"; a semen sample with a low sperm count (less than 10 million/ml), poor forward motility, and 30% oval morphology would be less capable of producing a pregnancy. A semen analysis should be repeated at least once and it may be a good idea to repeat semen analysis periodically as these levels can change over time.
Problem with sexual performance is an important risk factor for infertility, and sexual dysfunction is often correctable. Unfortunately, though, sexual dysfunction is a factor that may not be recognized or emphasized by patients who present infertility problems to their physicians. Sexual dysfunction includes such disorders as impotence (erectile dysfunction), low libido (sexual desire), poor timing of sexual intercourse, failure to complete intercourse, and ejaculation abnormalities.
Infections that are most commonly spread through sexual intercourse or genital contact.
An inherited blood disorder caused by an abnormal form of hemoglobin - the oxygen-carrying molecule of the red blood cells. Men with sickle cell anemia often show evidence of hypogonadism (delayed sexual maturity), as well as slowed skeletal growth, small testes and low sperm density. Hypogonadism usually is related to testicular malfunction as well as hormonal imbalances (e.g., pituitary hormone and hypothalamic hormone irregularities). Blood testosterone generally is low in men with sickle cell disease, although luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels are variable and may be normal, low or even increased.
Patients with severe stress incontinence and Intrinsic Sphincer Deficiency (Type III SUI or weakening of the urethra muscle) may not be helped by simple suspension procedures. Yet such individuals are good candidates for a sling procedure, which can create the urethral compression necessary to achieve bladder control.
Many IC patients feel that smoking worsens their symptoms. (Because smoking is the major known cause of bladder cancer, one of the best things a smoker can do for the bladder is to quit smoking.)
Sperm retrieval is not limited to ejaculated semen. With today's technology, sperm can be obtained from men with azoospermia (lack of sperm) that is caused by an obstructive lesion, failed vasectomy reversal, inherited absence of the vas deferens, or other uncorrectable blockage. For example, applying microsurgical methods in a process known as micro epididymal sperm aspiration (MESA), sperm can be gathered close to the blocked portion of the epididymis, the elongated, coiled duct that provides for the maturation, storage, and passage of sperm from each testis. Similarly, percutaneous epididymal sperm aspiration (PESA) uses a small needle to penetrate the testicular skin and draw sperm from the area near the epididymal obstruction. Testicular sperm extraction (TESE), the removal of a small amount of testicular tissue under local anesthesia, also can be a source of sperm (see also Testis Biopsy). Sperm retrieval methods usually are scheduled to coincide with the female partner's time of ovulation, so that they may be used for in vitro fertilization (IVF) of a retrieved egg. Sperm that is retrieved by MESA, PESA or TESE then can be processed for use in procedures such as intracytoplasmic sperm injection (ICSI) (see also Intracytoplasmic Sperm Injection). While excess sperm from MESA or PESA usually can be frozen for future use, most TESE-derived sperm are not of sufficient quality or quantity for frozen storage (cryopreservation). Multiple MESA or PESA procedures are not recommended, since repeated surgery can lead to scarring around the site of incision. Most patients are advised to wear scrotal supports for 1 week following MESA, PESA or TESE. Side effects are rare, although postoperative pain and swelling may persist for up to 2 weeks.
perm washing is a procedure that is used extensively for the treatment of semen with low sperm counts, abnormal sperm forms, antibodies, and other fertility-impairing features (see also Other Tests of Sperm Function). The "washing" is accomplished by adding culture medium (a fluid containing nutrients and buffers) to the semen and spinning the entire sample in a centrifuge (a machine that uses centrifugal force to separate heavier and lighter elements in a solution). The heavy sperm "pellet" is then rewashed in culture medium. If the physician needs a "rise" or "swim-up" fraction of the most active sperm, the concentrated sperm sample is incubated (kept warm) for about 1 hour, and the swimming sperm are extracted from the top of the test tube. If the physician wants to enhance the fertile potential of the sperm, TEST-yolk buffer (a special solution containing buffers, chicken egg yolk, glucose and antibiotics) may be used during the washing and pellet dilution procedures. The sperm that are gathered from such washing methods are subsequently used for artificial insemination and in vitro fertilization procedures.
A ring of muscle fibers located around an opening in the body that regulates the passage of substances.
Grading and the identification of cancer cell types can be helpful in determining a patient's prognosis, most doctors believe that establishing the cancer's stage gives a better indication of a patient's survivability. Staging allows a physician to gauge the size and location of tumors by using information gathered from such imaging studies as CT scans and MRIs, and information from pathology tests and physical examinations. Once a stage has been established, the physician can attempt to determine how a patient may do over time and decide what type of treatment offers the best potential for success.
Transurethral resection of the prostate (TURP) has been the standard choice for the past 50 years of treatment for urinary symptoms attributed to a large prostate condition commonly known as BPH that causes obstruction of the bladder outlet and voiding symptoms such as urinary frequency, voiding at night and a slow urinary stream. About 400,000 TURPs are performed each year in the United States. TURP is a safe procedure with 80% of patients experiencing resolution of their voiding symptoms and improvement of urinary flow measurements. A TURP involves the removal of the obstructing portions of the prostate with a telescopic hot wire loop that cuts like an electric knife. The TURP requires an anesthetic and takes about 30-60 minutes to perform. A tube or catheter is inserted into the bladder and is left in place for 2 to 3 days. The hospitalization lasts from 2-5 days and requires two weeks of severe activity restrictions and another two weeks of modest restrictions. The long term effectiveness of TURP in alleviating obstruction and symptoms caused by BPH has made the TURP the gold standard to which new procedures are compared. However, the TURP is a surgical procedure with potential risks and complications such as bleeding, impotence and incontinence. To decrease hospitalization costs and recuperation time from work, alternative therapies are being developed and introduced by the urologic community. These include medical treatments and alternative surgical treatments that have the potential to decrease complications and be as effective as the gold standard TURP.
A diagnostic test that requires patients to lift something or perform an exercise to determines if there is urine loss when stress is placed on bladder muscles.
Urinary Incontinence: The involuntary loss of urine during period of increased abdominal pressure. Such events include laughing, sneezing, coughing or lifting heavy objects.
Also known as "infection stones," struvite stones account for up to 20% of all kidney stones. They are made up of crystallized magnesium and ammonia, common byproducts of excessive acidity in the urine caused by the bacterial breakdown of urea. This often occurs in persons who experience infections of the urinary system. For this reason they are most common in women, who suffer more urinary tract infections than men. Struvite stones typically develop in a jagged or branch-shaped structure called a "staghorn."
The most prevalent theory -- super saturation crystallization -- holds that dehydration causes an imbalance in the liquids and dissolved solids in the urine. The kidneys must maintain a proper amount of water in the body as they remove harmful waste materials. If dehydration occurs, the urine may become overloaded (supersaturated) with substances that will not dissolve in water. These chemicals and trace elements combine to form crystals which slowly build up, layer upon layer until a stone is formed. Studies suggest that drinking plenty of water may prevent kidney stones.
This involves the removal of obstructing prostatic tissue through a supra-pubic incision ( a cut below the belly button ). The Prostate is not wholly removed. Suprapubic Prostatectomy requires incising the bladder to remove the obstructing tissue while a Retropubic approach involves incising the Prostatic capsule to remove the obstructing tissue. Both approaches utilize an abdominal incision.
This option is considered only if an IC patient has failed all available treatments and the pain is severe. Most doctors are reluctant to operate because the outcome is unpredictable in individual patients-some people have Surgery and still have symptoms. Anyone considering surgery should discuss the potential risks and benefits, side effects, and long- and short-term complications with a surgeon and family, as well as with people who already have had the procedure. Surgery requires anesthesia, hospitalization, and weeks or months of recovery, and as the complexity of the procedure increases, so do the chances for complications and failure. To locate a surgeon experienced in performing specific procedures, check with your doctor.
Many individuals with late-stage bladder tumor(s) and/or metastases have a poor prognosis. Therefore, researchers have begun a number of clinical trials to test the effectiveness of Systemic Chemotherapy with multiple drugs. In particular, combinations of agents such as cisplatin, methotrexate, and vinblastine, with or without doxorubicin (CMV or M-VAC), have produced some encouraging responses in late-stage patients. In addition, the combination of cisplatin, cyclophosphamide, and doxorubicin (CISCA) has shown some activity, although the responses have not been as great as those reported for CMV or M-VAC treatments. In metastatic bladder cancer, other chemotherapeutic agents that have produced some benefits are: paclitaxel, ifosfamide, gallium nitrate, and gemcitabine. Whenever possible, individuals should be encouraged to participate in such trials. Multi-agent chemotherapeutic trials for metastatic bladder cancer have produced response rates of up to 70%, and survival times may be increased. In persons with inoperable bladder cancer, the focus of care is palliation (relief) of symptoms. Large, late-stage tumors may cause frequent, painful, and bloody urination during the night and day. Decaying tissue within the tumor also may be a constant source of infection. Therefore, urinary tract diversion in such individuals may spare them the suffering and sleeplessness of persistent, agonizing urination.
Not much is known about the overall effects of illness on testicular function. Specific questions remain about how diseases, metabolism and therapeutic drugs may affect reproductive function. Yet fever alone has been shown to damage sperm. In humans, high temperatures may kill or injure sperm cells after only a few hours. The resultant decrease in sperm count often appears within 3 weeks after an episode of high fever and can last for as long as 1 months. In addition, the characteristics of the sperm itself may be changed, showing more abnormal shapes and immature cells.