A

absorbent products : Pads and garments, disposable or reusable, worn to absorb leaked urine. Absorbent products include shields, undergarment pads, combination pad-pant systems, diaper like garments, and bed pads.

Alpha Adrenergic Agonists - Alpha adrenergic agonists are drugs which stimulate sites in the nervous system that respond to the chemical norepinephrine. Therefore, patients suffering from forms of incontinence requiring increased muscle tone and urethral resistance -- for example, stress incontinence -- may benefit from the use of alpha-adrenergic agonists.

Alpha-1 Adrenergic Blocking Agents (Alpha Blockers) - Benign prostatic hyperplasia -- noncancerous enlargement of the prostate -- can encroach upon the urinary tract, leading to overflow or urge incontinence. Alpha-1 adrenergic receptor blocking agents --known as alpha-1 blockers or alpha blockers -- are used to treat BPH, because they reduce the tone of striated and smooth muscle, thereby decreasing urethral resistance and relieving symptoms of obstruction. Alpha blockers should not be used in people who are hypersensitive (have an exaggerated reaction) to such medication or who experience postural hypotension (extremely low blood pressure when standing up or standing still).

Alternative Treatment Devices - In addition to standard methods such as biofeedback, drug therapy and surgery, a number of treatment devices are available to help patients achieve bladder control.

Interstim is a new therapy which may be effective in treating urge incontinence in some patients. It consists of a device, about the size of a pacemaker, that is implanted into the sacral nerves of the lower spine, where it delivers electrical impulses that help regulate bladder function.

In this way, Interstim reduces the likelihood and severity of accidental urination or leakage. The surgery required for implantation is minimal, and the device can be adjusted to meet the bladder control needs of each patient.

Prosthetic occluding devices can be used to block the flow of urine by squeezing the urethra shut. For men, such mechanical devices include penile clamps (for example, the Cunningham clamp) and compression rings. The penile clamp is a V-shaped casing with a foam cushion that fits over and under the penis. When closed, the penile clamp should stop the flow of urine without causing discomfort. Compression devices are adjustable rings that surround the penis and, when inflated with air, pinch off the urine flow. Occluding devices usually are reserved for temporary use by individuals with stress incontinence. These devices must be removed at regular 2- to 3-hour intervals to empty the bladder. Therefore, they should be used only by mentally competent individuals who are able to adjust them by hand and who are able to remember the bladder-emptying schedule. Improper use of penile clamps and compression devices can result in penile and urethral erosion, penile edema (swelling), pain and obstruction.

Vaginal pessaries -- ring, cube or doughnut-shaped devices made of rubber or silicone -- are inserted into the vagina to support the bladder neck in female patients with stress incontinence. Vaginal pessaries are available in different sizes, and they are generally put in place by a gynecologist. The major side effects of pessary use are wearing away of the vaginal skin and vaginal infection. Therefore, people who use pessaries need frequent examinations to ensure vaginal health. Erosion problems usually can be managed by removal of the pessary until the skin heals, and vaginal infections are treatable by douching and/or antibiotic therapy. Pessaries may be an alternative form of treatment for frail elderly women who cannot undergo other forms of incontinence therapy.

Introl is a pessary-like vaginal prosthesis that also works to support the bladder neck. A woman can insert and remove the device, which should not be worn continuously for more than 24hours without proper cleaning. The manufacturer recommends removing the prosthesis at night before going to bed.

A number of additional treatment devices recently have become available for women. The first device--the Reliance urinary control insert--also is known as a urethral plug. The Reliance insert is a single-use, balloon-tipped tube that is about one-fifth the size of a tampon. The insert can be placed in the urethra by means of a special applicator. When in place, the small balloon (which extends into the bladder) can be inflated with air to prevent leakage. If the wearer wishes to urinate, she just pulls a string to deflate the balloon and then removes the insert. Unfortunately, fairly high infection rates are seen with this device, because it is placed directly into the urethra. The manufacturer reports that urinary tract infections are most common during the first month of use and decrease as women become more familiar with its proper use.

Amitriptyline (Elavil) and doxepin (Sinequan) act as antidepressants when given in large doses. In smaller doses, they can help IC symptoms by blocking pain, calming bladder spasms, and decreasing inflammation.

Some cases of IC may be caused by too much histamine in the bladder. Antihistamine drugs such as hydroxyzine (Vistaril and Atarax) and cimetidine (Tagamet) relieve symptoms in some IC patients. If taken at bedtime, hydroxyzine may also help patients sleep.

Androgen receptor Deficiency - Like 5-alpha-reductase deficiency, androgen receptor deficiency is a genetically-linked expression of abnormal androgen (male sex hormone) activity. And, like 5-alpha-reductase deficiency, androgen receptor deficiency can produce a syndrome of pseudohermaphroditism (see also 5-alpha-reductase deficiency). The clinical features of androgen receptor deficiency, also known as Reifenstein syndrome, may range from infertility alone to pseudohermaphroditism (incomplete masculinization of the external male genitalia in men with bilateral testes). Cryptorchidism may be present, along with vas deferens defects and incomplete sperm production.

Patients often show high blood levels of testosterone, coupled with increased levels of luteinizing hormone (LH) and increased secretion of estradiol (natural estrogen) by the testes. The enhanced estradiol output leads to feminization (development of female sex characteristics), androgen resistance and changeable degrees of masculinization. Irreversible fertility often results from the severe deficiency or lack of sperm caused by this disorder.

anemia : A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.

Angiomyolipoma - Also known as renal hamartoma, angiomyolipomas are rare benign tumors usually caused an inherited genetic mutation. They can occur on an isolated, individual basis, but most often are associated with the rare genetic disease called tuberous sclerosis, an affliction characterized by small tumors of the blood vessels, resulting in numerous bumps on the skin, mental retardation, seizures, cysts in the kidneys, liver and pancreas, and, in some cases, RCC. About 80% of persons diagnosed with tuberous sclerosis also have hamartoma.

In patients without tuberous sclerosis, hamartoma most often occurs in middle-aged women. Most cases are discovered when the patient undergoes a CT scan for an unrelated abdominal problem, complains of gastrointestinal discomfort, or suffers a sudden hemorrhage caused by the rupture of a large tumor.

Management of the condition depends on the size of the tumors and the severity of the symptoms they produce. Asymptomatic patients and those with small tumors usually are not treated; instead, they are observed periodically with an eye toward surgery if the tumors grow or produce symptoms. Because of the potential for spontaneous rupture and life-threatening hemorrhage, patients with large tumors usually are considered candidates for some form of surgical treatment, ranging from partial nephrectomy to arterial embolization.

Antibiotics - Antibiotics frequently are prescribed to eliminate infections that could impair fertility, such as infections of the urinary tract and prostate. The physician will be especially inclined to prescribe an antibiotic if leukocytes (white blood cells) are detected in the man's semen sample. Strong antibiotic medications - like double- strength trimethoprim plus sulfamethoxazole (Bactrim DS) and doxycycline hyclate (Vibramycin) - often are the drugs of choice. They usually are administered for intervals of 1 to 3 months. Nitrofuran antibiotics are avoided, since they may impair sperm maturation. STDs, such as gonorrhea or ureaplasma, commonly are treated with ceftriaxone sodium or doxycycline.

anxiety: A debilitating condition of fear, which interferes with normal life functions.

Arterial Embolization - This procedure usually is reserved for patients whose overall health does not permit surgery, such as those with heart or lung problems. In arterial embolization, a very small tube called a catheter is inserted through a blood vessel in the groin and passed up to the kidney. There it is used to inject a small piece of gelatin sponge into the artery that supplies blood to the cancerous kidney. This cuts off the flow of blood to the kidney and the cancerous tumor, which die. The kidney usually is surgically removed at a later date, if and when the patient's overall condition permits.

Artificial Insemination - Artificial insemination (AI) is a process in which a relatively large number of healthy sperm are deposited in a woman by artificial means. The sperm are placed either at the entrance to the cervix or directly into the uterus (womb) near the fallopian tubes (intrauterine insemination or IUI). Artificial insemination is particularly useful when the male partner's sperm count is low or when sperm quality is below average (e.g., in cases of spinal cord injury, ejaculation disorder or impotence). The sperm can be prepared by washing, concentration, or other methods to ensure the best chance of conception (see also Sperm Retrieval). Artificial insemination also is commonly performed using sperm from a donor.

Artificial Sphincter - Sometimes complicated cases of incontinence require implantation of a device known as an artificial urinary sphincter. People who might benefit from this treatment include those who are incontinent after surgery for prostate cancer or stress incontinence, trauma victims and people with congenital (present at birth) defects in the urinary system.

The artificial sphincter has three components, including a pump, balloon reservoir, and a cuff that encircles the urethra and prevents urine from leaking out. The cuff is connected to the pump, which is surgically implanted in the scrotum (in men) or labia (in women). The pump can be activated (usually by squeezing or pressing a button) to deflate the cuff and permit the bladder to empty. After a brief interval, the cuff refills itself and the urethra is again pressed closed.

Because the artificial sphincter is an implant, it is subject to the risks common to implants, such as infection, erosion (breaking down of tissue) and mechanical malfunction. Yet with appropriate presurgical evaluation, operative techniques and postoperative follow-up, many problems can be avoided and incontinent patients can experience an improved quality of life with this device.

assisted reproductive technologies (ART) : The new forms of fertility treatment incorporate many methods of sperm retrieval and preparation. Once the sperm have been processed to ensure optimal fertilizing potential, they are used in a variety of procedures that aid the process of conception. These procedures include artificial insemination (AI), in vitro fertilization (IVF), and sperm microinjection techniques.

AUA (American Urological Association) Score - The AUA Score or Symptom Index is a self-administered questionnaire used to establish how severe a patient's BPH symptoms may be. It asks seven questions related to common symptoms of BPH and asks the patient to rate the degree of frequency or severity for each on a scale of 1 to 5. A total AUA Score of 0 to 7 is considered mild; 8 to 19 is rated moderate, and 20 to 35, severe.

Augmentation makes the bladder larger, most often by adding a section of the patient's small intestine, a tube-like structure that absorbs and transports nutrients from food for use by the body. With this treatment, scarred, ulcerated and inflamed sections of the patient's bladder are removed, leaving only healthy tissue and the base of the bladder. A piece of the patient's small intestine is removed, reshaped, and attached to what remains of the bladder. After the incisions heal, the patient may be able to void normally.

Even in carefully selected patients-those with small, contracted bladders-the pain, frequency, and urgency may remain or return after surgery and the patient may have additional problems with infections in the new bladder and difficulty absorbing nutrients from the shortened intestine. Some patients are incontinent while others cannot void at all and must insert a catheter into the urethra to empty urine from the bladder.

autologous : Derived from the same individual.

B

BALLOON DILATION - Balloon dilation has been used clinically as an alternative to prostatectomy. It is very similar to the angioplasties done for coronary artery disease. Basically, a balloon is placed into the prostatic channel, either by finger guidance or telescopic guidance, and the balloon is then inflated to stretch the prostate channel. This has the apparent end result of tearing the prostate gland and creating a wider opening in the urinary channel. No prostate tissue is removed and the procedure does not work well for very large prostates. Recent numerous studies have demonstrated that most of the patients after balloon dilation have recurrence of their symptoms relatively soon and require repeat treatments within two years. With today's wider and more efficaceous variety of BPH treatments, balloons are less accepted as a viable alternative treatment.

behavioral techniques : Different methods to help "retrain" the bladder and get rid of the urgency to urinate. (see biofeedback, bladder training, electrical stimulation, habit training, pelvic muscle exercises, prompted voiding).

benign tumor: A tumor that is not cancerous

bilateral : A term describing a condition that affects both sides of the body or two paired organs, such as kidneys.

Biofeedback/Electrical Stimulation - Biofeedback is practiced to help people gain awareness and control of their urinary tract muscles. The principle of biofeedback is simple: a variety of instruments are used to record small electrical signals that are given off when specific muscles are squeezed during contraction. These contraction-related signals are instantly converted into audio and/or visual signs that patients can recognize and learn from, in order to control muscular activity. With biofeeback, weak muscles can be better activated on demand, overly tense muscles can be relaxed, and overall muscle activity can be coordinated.

Biofeedback usually is performed in conjunction with Kegel exercises, since it helps to reinforce correct Kegel techniques. Biofeedback lets patients visualize and identify the pelvic floor and/or abdominal muscles that are appropriate for their exercise programs.

Neuromuscular electrical stimulation (NMES) also is employed to "reeducate" and strengthen weak urinary muscles. In NMES, electrical stimulation of the pudendal nerve causes contraction of the pelvic floor and periurethral (urethra-encircling) muscles. A probe is inserted into either the vagina (female reproductive canal) or anus (outside opening of the large intestine), and NMES is applied at an intensity that is below the threshold of pain. Most NMES devices are biphasic: that is, they produce a current that stimulates contraction, followed by a rest period of 5 to 10 seconds.

Patients are instructed to join in with the NMES-stimulated contraction. Such assisted exercise eventually strengthens the pelvic floor muscles and improves bladder control. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence. NMES treatment programs usually last 20 to 30 minutes. NMES devices are available for both home and hospital use.

Bladder - A hollow muscular balloon shaped organ that stores urine until it is excreted from the body.

Bladder Augmentation - Individuals who suffer from a low-capacity bladder -- for example, a bladder that is small, hyperactive or nonresilient -- may benefit from surgery that increases the fluid-holding potential of the bladder. Surgery that increases bladder capacity, otherwise known as bladder augmentation or augmentation cystoplasty, is conducted using either the bladder itself (autoaugmentation) or bowel (intestine) segments. Such surgery is not recommended for patients who are unable to perform self-catheterization (self-placement of a urinary tube) or who have kidney disorders, bowel disease or urethral disease.

Autoaugmentation is a novel method of bladder augmentation. It increases the capacity of the bladder without using bowel or stomach segments, which may result in complications after other augmentation procedures. During autoaugmentation, the detrusor (the smooth muscle in the wall of the bladder that contracts and expels urine) is cut out of the dome of the bladder, leaving the mucosa (mucous membrane tissue) intact. This procedure creates a bladder with reduced muscle squeezing ability and improved function; however, long-term findings in some subjects suggest that contraction of the mucosa eventually can occur.

Bowel augmentation makes use of segments from the ileum (the last part of the small intestine), cecum (the first part of the large intestine) or ileocecum (junction between the small and large intestines) to increase the capacity of the bladder. In all bowel augmentation procedures, the bowel segments are changed in shape from a cylinder to a sphere to produce a flexible, low-pressure vessel. The bladder is opened at the dome and is cut at right angles on each side to create a clam-like shape. The open bowel segment then is joined to the "clammed" bladder with sutures.

Bowel augmentation is associated with post-operative complications, such as leakage of urine, continued incontinence, and kidney problems. Long-term risk factors include the development of bladder stones, increased risk of bladder cancer and increased risk of incontinence during and after pregnancy.

Bladder Distension - Because some patients have noted an improvement in symptoms after a bladder distension done to diagnose IC, the procedure is often thought of as one of the first treatment attempts.

Researchers are not sure why distension helps, but some believe that the procedure may increase bladder capacity and interfere with pain signals transmitted by nerves in the bladder. Symptoms may temporarily worsen 24 to 48 hours after distension, but should then return to predistension levels or improve after 2 to 4 weeks.

Bladder Instillation - This procedure may also be called a bladder wash or bath. During a bladder instillation, the bladder is filled with a solution that is held for varying periods of time, from a few seconds to 15 minutes, before being drained through a narrow tube called a catheter.

The only drug approved by the U.S. Food and Drug Administration (FDA) for bladder instillation is dimethyl sulfoxide (DMSO, RIMSO-50). With DMSO treatments a narrow tube (catheter) is guided up the urethra into the bladder. A measured amount of DMSO is passed through the catheter into the bladder, where it is retained for about 15 minutes before being expelled. Treatments are given every week or two for 6 to 8 weeks, and repeated as needed. Most people with IC who respond to DMSO notice improvement of symptoms 3 or 4 weeks after the first 6- to 8-week cycle of treatments. Highly motivated patients who are willing to catheterize themselves may, after consultation with their doctor, be able to have DMSO treatments at home. Self-administration of DMSO is less expensive and more convenient than going to the doctor's office.

Doctors think DMSO works in several ways. Because it passes into the bladder wall, DMSO may more effectively reach tissue to reduce inflammation and block pain. It may also prevent muscle contractions that may cause pain, frequency, and urgency.

A bothersome but relatively insignificant side effect of DMSO treatments is a garlic-like taste and odor from the breath and skin. This may last up to 72 hours after a treatment. Long-term DMSO treatments have caused cataracts in animal studies, but this side effect has not appeared in humans. Blood tests, including a complete blood count and kidney and liver function tests, should be done about every 6 months.

A variety of other drugs have been used experimentally for bladder washes, including silver nitrate, sodium oxychlorosene (Clorpactin WCS-90), heparin, and pentosanpolysulfate (Elmiron).

Silver nitrate and oxychlorosene sodium are thought to work by first attacking the bladder lining. This triggers the body's immune system to step in and start the healing process. Some patients have been successfully treated with these drugs, but the frequent, painful treatments usually must be done under general anesthesia. Neither drug can be used in people who have urinary reflux, a condition in which urine flows backward up the ureters into the kidneys.

Heparin and pentosanpolysulfate are thought to work by replacing or repairing the "leaky" bladder lining.

Bladder Removal (Cystectomy) - Different methods can be used to reroute urine once the bladder has been removed. In most cases, the ureters are attached to a piece of bowel that opens onto the skin of the abdomen, called a stoma. Urine empties through the stoma into a bag outside the body. This procedure is called a urostomy. Some urologists are using a technique that also requires a stoma but allows urine to be stored in a pouch inside the abdomen. At intervals throughout the day, the patient puts a catheter into the stoma and empties the pouch. Patients with either type of urostomy must use very clean, or sterile, steps to prevent infections in and around the stoma.

With a third method, a new bladder is made from a piece of the patient's bowel (large intestine) and attached to the urethra in place of the removed bladder. After a time of healing, the patient may be able to empty the bladder by voiding at scheduled times or may insert a catheter into the urethra. Few surgeons have the special training and expertise needed to perform this procedure.

Even after total bladder removal, some patients still experience variable symptoms of IC. Therefore, the decision to undergo a cystectomy should only be undertaken after serious deliberation on the potential outcome.

Bladder Training - People who have found some relief from pain may be able to reduce frequency using bladder training techniques. Methods vary, but basically the patient decides to void at designated times and use relaxation techniques and distractions to help keep to the schedule. Gradually, the patient tries to lengthen the time between the scheduled voids. A diary of voids is usually helpful in keeping track of progress.

Blood Tests - Another laboratory procedure typically used in the diagnosis of RCC involves microscopic and/or chemical examination of the patient's blood to detect conditions that indicate the presence of cancer. These tests screen for:

Bone Scan - This is another nuclear imaging procedure used to detect the spread of cancer to bones. It usually is prescribed in cases where aggressive tumors and metastasis are suspected. In a bone scan, a small amount of low-level radioactive material is injected into the body. This material discloses metastatic cancer, as well as some noncancerous diseases, in bones.

Brachytherapy - Technically, brachytherapy is more a form of therapy than a surgical procedure, but it does involves a surgical element - the implantation of tiny, radioactive implants into a cancerous prostate gland. Radiation emitted by the implants kills the malignant tumor. Men whose cancers are small and confined to the prostate (Stage 1 or 2) are candidates for brachytherapy.

The physician first uses an ultrasound device (TRUS) to create a three-dimensional grid map of the prostate. A computer then is used to calculate the volume of the gland, the number of radioactive implants (called "seeds") that will be needed and where they should be placed.

The procedure, performed on an outpatient basis, takes 45 to 60 minutes and is done under local (spinal) anesthesia. From 50 to 100 rice-sized seeds are then inserted by a special needle through the perineum and into the prostate in a preplanned pattern, guided by the TRUS and grid map. The seeds contain a radioactive isotope, usually Palladium 103 or Iodine 125, which emit radiation for about three months before decaying to an inert state.

Brachytherapy patients can be discharged the same day and usually resume normal activity within a day or two. A small proportion, generally those over 70, experience incontinence or impotence problems. But brachytherapy has been found to deliver a higher and better focused dose of radiation with fewer side effects and at substantially lower cost than external beam therapy. In a recent study of 111 brachytherapy patients, 100% were prostate cancer free after five years.

Bromocriptine - Bromocriptine is a drug that is classified as a dopamine agonist. This means that bromocriptine acts like dopamine, a catecholamine (sympathetic nervous system chemical) that stops the release of prolactin hormone from the pituitary gland. Bromocriptine therapy is useful for men in whom impaired sperm production is due to hyperprolactinemia (high blood level of prolactin) (see also Hyperprolactinemia).The customary daily dose of bromocriptine is 5-10 mg. The side effects of bromocriptine therapy include high blood pressure, headache, dizziness, nausea, and vomiting.

BTA test -The BTA® test was designed to detect proteins that are released by reproduction of bladder tumor cells, and its interpretation does not require a technician or specialist. The BTA® test significantly identifies superficial (surface) bladder tumors by changing color. The top of the BTA® test strip turns yellow when positive for bladder cancer, and it turns green when negative. The BTA stat test is an immunologic assay that can be used to identify recurrent bladder cancer. The FDP® test detects the breakdown products of blood-clotting proteins (fibrin, fibrinogen), which are increased in the urine in the presence of bladder cancer. Both the BTA stat and FDP® tests are superior to voided urine cytology, especially for low-stage and low-grade disease.

Burch procedure, also known as Burch colposuspension (vaginal suspension), often is performed when the abdomen is already open for another purpose, such as abdominal hysterectomy. During the suspension procedure, the sutures are placed laterally (sideways), which avoids urethral obstruction and allows the physician to repair any small cystoceles that may be present. The bladder neck and urethra are separated from the back surface of the pubic bone. The bladder neck then is elevated by means of lateral sutures that pass through the vagina and Cooper's (pubic) ligaments. The vaginal wall and ligaments are brought together without tension, and the sutures are tied.

C

Calcium Stones - About 70% to 80% of all kidney stones are composed of hard crystals of either calcium oxalate or insoluble phosphate salt, or a combination of both. Calcium stones are the most common type experienced by people of Anglo-Saxon descent. They occur in people who have hypercalciuria, a condition characterized by excessive calcium in the urine. Calcium is a normal part of a well-balanced diet, responsible for maintaining the health of teeth and bones. In most people, excess calcium is flushed out by the kidneys and excreted in the urine. People with hypercalciuria build up excess calcium in their kidneys, where it joins with other waste products to form a stone.

In about 40% of people who develop calcium stones, this buildup is caused by an inherited metabolic disorder whose cause is unknown. In rare cases, a tumor on the parathyroid gland may trigger an overproduction of parathyroid hormone, the chemical that regulates calcium metabolism. Certain drugs, such as the diuretic furosemide, antacids and steroids, can produce hypercalciuria. It also can be brought on by certain intestinal diseases, excessive amounts of vitamin A or D, or a diet too high in purine, typically associated with meat, fish and poultry consumption.

Calcium oxalate stones also are commonly associated with having too little vitamin B or too much vitamin C in one's diet.

catheter: A tube passed through the body for draining fluids or injecting them into body cavities. It may be made of elastic, elastic web, rubber, glass, metal, or plastic.

catheterization : Insertion of a slender tube through the urethra or through the anterior abdominal wall into the bladder, urinary reservoir, or urinary conduit to allow urine drainage.

chancre: A hard, syphilitic primary ulcer, the first sign of syphilis, appearing approx. 2 to 3 weeks after infection. The ulcer begins as a painless lesion or papule that ulcerates. Occurs generally singly, but sometimes may be multiple.

chemolysis : Certain types of kidney stones can be dissolved with the application chemicals. Uric acid stones, for example, can be dissolved with a solution of sodium bicarbonate in saline. Cystine stones may be treated successfully with a combination of acetylcysteine and sodium bicarbonate in saline. Struvite and carbon apatite stones can be treated with an acidic solution of hemiacidrin. The procedure involves infusing the chemical solution into the affected area by means of a ureteral catheter in a series of treatments over time until the stone is dissolved. The patient's urine must be cultured regularly throughout the course of treatment to guard against urinary infection and prevent the buildup of excessive chemical levels, particularly magnesium, which can cause other health problems.

Chest X-ray - If there is reason to believe RCC is present and sufficiently advanced to have metastasized, the doctor may order a standard chest X-ray to determine if it has spread to the lungs or bones in the chest area.

Clomiphene Citrat e - Clomiphene citrate, a synthetic steroid drug related to estrogen (female sex hormone), has both anti-estrogenic and estrogenic effects. In men with oligospermia (low sperm count), clomiphene has been used to increase gonadotropin secretion, which, in turn, may stimulate testosterone release and improve sperm output (see also Endocrine Disorders). Yet the male response to the drug is not as pronounced as that seen in women. Clomiphene usually is given in oral daily doses of 25-50 mg for a 3- to 6-month period. However, the results from clomiphene trials are extremely variable, with differing success rates for conception. Therefore, more clinical data are needed to confirm the effectiveness of this drug.

colon : The large intestine.

Combined Estrogen/Alpha-Adrenergic Agonist Therapy - Since estrogen therapy appears to heighten the response of nerve receptors in the urethra (that is, the alpha-adrenergic receptors, which increase the tone of striated and smooth muscle), it is believed that a combination of estrogen and alpha-adrenergic agonists (drugs specific for the alpha-adrenergic receptors) may be beneficial in women who have undergone menopause and who lose bladder control because of insufficiency (malfunction) of the urinary sphincter muscles.

A common estrogen/alpha-adrenergic agonist combination is phenylpropanolamine (PPA, 25-100 mg twice a day) plus intravaginal or oral conjugated estrogen (1.25 mg/day orally or 2 g/day vaginally). Phenylpropanolamine is found in many over-the-counter cough/cold preparations, such as Tavist-D, Comtrex, Dimetapp, Triaminic, and Robitussin-CF.

Computed Tomographic (CT) Scan - Also known as a computer-assisted tomography or "CAT" scan, the CT scan is a type of X-ray procedure that gives three-dimensional images of internal organs or glands. It can be used to detect pelvic lymph nodes enlarged by cancer, although some authorities suggest its results are insufficient for a clear diagnosis. CT scans typically are used only when tumors are large or associated with high PSA levels.

Congenital adrenal hyperplasia (CAH) -  An uncommon inherited disorder that may be associated with a lack of 21-hydroxylase - an enzyme found in the adrenals (glands above each kidney). Hyperplasia (overgrowth) of the adrenals leads to excessive production of adrenal testosterone that, in turn, inhibits the release of pituitary gonadotropin.

Early puberty and short stature (height) are hallmarks of CAH. However, congenital adrenal hyperplasia is difficult to diagnose, since affected men often appear "normal" and sexually mature, without excessive masculinization. Men with CAH often will show low/normal blood levels of adrenal steroid compounds, such as cortisol. In addition, they may have low/normal urinary levels of 17-hydroxycorticoid and high urinary levels of 17-ketosteroids and pregnanetriol (a byproduct of the pregnancy hormone progesterone). Testicular tumors sometimes are detected in men with CAH (see also Testicular Tumors).

Dexamethasone may be used to suppress adrenal secretion in men with CAH. In addition, glucocorticoid therapy may provide fertility benefits in men with CAH by increasing sperm output.

corpora cavernosa : Two chambers in the penis which run the length of the organ and are filled with spongy tissue. Blood flows in and fills the open spaces in the spongy tissue to create an erection.

creatinine: A waste product that is filtered from the blood by the kidneys and expelled in urine.

Cryosurgery - This treatment alternative uses a TRUS-guided probe to deliver freezing temperatures to the cancerous tumor. Intermittent freezing and thawing kills the cancer cells. Long-term results of cryosurgery are still unknown. Reported side effects include urinary incontinence, rectal injury and impotence.

Cryptorchidism - Cryptorchidism, also known as cryptorchism, is the failure of one or both testes to descend (move down) into the scrotum. The descent usually is complete at birth or by the end of the first year of life. However, if the testes do not drop and remain in an upper, abdominal location, spermatogenesis (sperm production) and, correspondingly, fertility, usually is impaired. Unilateral (one-sided) cryptorchidism is associated with oligospermia (low sperm count), whereas uncorrected, bilateral (two-sided) cryptorchidism usually is associated with azoospermia (no sperm in the semen). Researchers believe that the increased temperature within the abdomen harms the enzymes and proteins that are responsible for normal sperm production. Sperm quality may be especially poor in men who have bilateral undescended testes.

Culture of Prostate Secretions - In men, the doctor will obtain prostatic fluid from the patient. This fluid will be examined for signs of an infection, which can be treated with antibiotics.

cyst : A lump filled with either fluid or soft material, occurring in any organ or tissue; may occur for a number of reasons but is usually harmless unless its presence disrupts organ or tissue function.

cystectomy : Surgical removal of the bladder.

Cystic Fibrosis - Low ejaculate volume and azoospermia (lack of sperm in the semen) are common findings among men who carry a gene for cystic fibrosis. This is because male cystic fibrosis patients usually have an inherited, bilateral absence of the vas deferens and malformations or absence of seminal vesicles.

Cystine Stones - Cystine is one of the body's chemical building blocks, an amino acid that helps make up nerves, muscles and other body tissues. A rare genetic defect called cystinuria can cause excessive cystine buildup in the urine, leading to the development of cystine stones in the kidneys. Cystine stones are relatively rare, occurring in about 1% to 2% of persons who experience kidney stone disease. Because it is genetically inherited, the condition often runs in families.

cystocele: A herniation of bladder into vagina

Cystometrogram - The cystometrogram is the most important of the urodynamic tests. It is used to examine the different phases of bladder function, such as filling and voiding. During cystometry, the intra-abdominal pressure (pressure within the pelvic cavity) and the detrusor pressure (downward-pushing pressure of the bladder) are electronically recorded and subtracted.

In tests of filling cystometry, the bladder is filled to capacity, then tested for volume, sensation, involuntary instability (contraction, or muscle squeezing) and compliance (yielding to pressure). Any change in detrusor pressure may indicate an abnormality, especially if it mimics the patient's symptoms, such as urgency and increased frequency of urination. The patient is asked to cough and strain with a full bladder. Urine leakage without a change in detrusor pressure may indicate a diagnosis of stress incontinence. By contrast, patients with urge incontinence may experience detrusor contractions, with urine leak during filling and a related sensation of urgency.

Voiding cystometry tests usually are normal in patients with stress incontinence, urge incontinence, and mixed incontinence. However, patients with intrinsic sphincter deficiency may lose urine without any indication of detrusor contraction. In addition, patients with an acontractile (noncontracting, nonsqueezing) bladder -- for example, patients with diabetes, spinal cord injury or prior pelvic surgery -- will have a low detrusor pressure during voiding and a pattern of straining.

Cystoscopy - Cystoscopy, or cystourethroscopy, is a test that lets the physician see the inside of the bladder, bladder neck and urethra. A cystoscope (a thin, telescope-like tube with a tiny attached camera) is inserted into the bladder through the urethra. The physician then moves the cystoscope to detect any abnormalities in the urinary tract, such as trabeculation (strands of connective tissue), diverticula (sacs caused by abnormal holes in the organ), fistula (abnormal passages), an ectopic (displaced) ureter, ureterocele (ballooning of the lower end of the ureter), tumor, or changes in the lining of the urinary tract.

D

Denervation is a complicated procedure done by surgeons who have special training and expertise. Rarely used in the treatment of IC, it involves cutting some of the nerves to the bladder, interfering with pain signals. Many approaches and techniques are used, each of which has its own advantages and complications that should be discussed with the surgeon.

Depending on your diagnosis your physician may elect to use a sling made of either a biocompatible synthetic material or of your own tissue. This sling (like a hammock) is secured to the anchor placed in the bone and serves as additional support for the urethra, bladder neck and sphincter.

detrusor-external sphincter dyssynergia (DESD) : Damage to the nervous system can create a lack of coordination between the bladder and the external sphincter muscle, which is the muscle that controls the emptying of the bladder. As a result the bladder cannot empty completely which creates a buildup of urinary pressure. DESD is a combination of thses two factors and can lead to severe urinary tract damage and life-threatening consequences.

diabetes mellitus : A common form of diabetes in which the body cannot properly store or use glucose (sugar), the body's main source of energy.

Diet - There is no scientific evidence linking diet to IC, but some doctors and patients believe that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Some patients also notice a worsening of symptoms after eating or drinking products containing artificial sweeteners. Patients may try eliminating such products from their diet and reintroduce them one at a time to determine which, if any, affect symptoms. It is important, however, to maintain a well-balanced and varied diet.

Digital Rectal Exam (DRE) - In a DRE, the physician inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard, often asymmetrical or stony, like the bridge of the nose. The test is subjective, however, and relies on the physician's ability to interpret what he or she feels. Only larger tumors can be felt; as many as one-third of patients subsequently diagnosed with prostate cancer actually will still have a normal DRE.

Ditropan® XL - Extended-release tablets contain oxybutynin chloride. Ditropan® XL is a once-a-day medication for overactive bladder. One tablet releases medication into your system continuously for relief that lasts up to 24 hours with one dose. In many patients, once-a-day Ditropan® XL has been shown to help effectively treat urgency, frequency, and wetting accidents. Some patients use far fewer pads. Some patients experienced relief after taking Ditropan® XL after 1 week. In a clinical study with Ditropan® XL, patients experienced a 90% reduction (from 16 to 2) in the number of wetting accidents per week versus patients taking a sugar pill who experienced a 51% reduction (from 21 to 11). The typical dosage is 5-15 mg to be taken orally 1 time/day. In clinical studies, the most common side effect was dry mouth. However, only 1% of patients discontinued therapy for this reason. Other common side effects included constipation, drowsiness, diarrhea, blurred vision, dry eyes, dizziness, and runny nose. Only 7% of patients in clinical studies discontinued therapy due to side effects.

diuretic : A drug that increases the amount of water in the urine, removing excess water from the body; used in treating high blood pressure and fluid retention

Dormia basket is, as the name implies, a small basket made of thin metal wire. Especially smaller stones, that are located in the 'lower' ureter can be reached through urethra and bladder, picked up in the basket and pulled out. General anesthesia is necessary, because such a treatment can be quite painful. It is an easy an quick method, although sometimes the stones do not get 'grabbed' by the basket.

Doxazosin mesylate (Cardura) - Doxazosin mesylate is a drug that acts by blocking the alpha-1 adrenergic r receptor sites within the body. Doxazosin is prescribed for the treatment of urinary outflow obstruction in BPH and for hypertension. The typical dose is 1-8 mg, taken once daily.

Duct Obstruction - If a man is found to have normal levels of reproductive hormones and a normal testis biopsy, yet his semen does not contain sperm and it is fructose-negative, then the physician should consider the possibility of ejaculatory duct obstruction due to inherent or inflammatory causes. Repeated urinary tract infections (UTIs) - as experienced by men with spinal cord injuries - may lead to inflammation of the prostate or epididymis which, in turn, may lead to ductal obstruction. In addition, vasectomy - a contraceptive procedure in which the vas deferens is cut - is now the leading cause of infertility due to ductal obstruction in men who have undergone vasectomy reversal procedures.

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ejaculation, retrograde : The discharge of semen into the bladder rather than through the urethra and out of the body.

ejaculation : Ejection of semen during male orgasm.

Electrical Stimulation - Electrical stimulation of the sacral autonomic and somatic nerves has been used with varying degrees of success to treat stress and urge urinary incontinence as well as urgency and frequency syndromes. Most of the studies documenting use of the technology have been uncontrolled. Stimulation with electric current causes initial contraction of the bladder that is followed by a prolonged relaxation and gradual fatigue of the contractile response. In addition, stimulation results in reflex inhibition that may "calm" the detrusor and improve storage; however, the ultimate role of this treatment modality is not yet known.

ELECTROEJACULATION - Electroejaculation - ejaculation that is stimulated by an electrode - is a successful form of therapy for men who have normal testes but who cannot emit semen or ejaculate because of a fault in the sympathetic nervous system. Candidates for electroejaculation include men who have undergone orchiectomy (testis removal), retroperitoneal lymph node dissection (RPLND) or spinal cord injury (see also Neurogenic Causes).

The technique of electroejaculation involves the placement of a probe in the rectum (end of the large intestine). Electrical current from the probe then causes the emission of semen due to direct stimulation of nerve fibers within the male reproductive tract. Forceful ejaculation generally does not occur during this procedure, and semen may be released in an antegrade/retrograde manner - that is, semen may dribble out through the urethra, or it may be released backward into the bladder (see also Retrograde Ejaculation). Because semen may need to be retrieved from the urine, the urine will be made alkaline (nonacidic) by having the patient take sodium bicarbonate tablets (600 mg) during the day before the procedure.

electrohydraulic lithotripsy (EHL) :This technique uses a special probe to break up small stones with shock waves generated by electricity. Through a flexible ureteroscope, the physician positions the tip of the probe 1 mm from the stone. Then, by means of a foot switch, the physician projects electrically generated hydraulic shock waves through an irrigating fluid at the stone until it is broken into small fragments. These can be passed by the patient or removed through the previously described extraction methods. EHL has some limitations: It requires general anesthesia, and is generally not used in close proximity to the kidney itself, as the shock waves can cause tissue damage. Fragments produced by the hydraulic shock also tend to scatter widely, making retrieval or extraction more difficult.

Electromyography (EMG) - Electromyography, or EMG, is used to evaluate the electrical activity of urinary tract muscles in patients who are suspected of having nerve disorders (multiple sclerosis, spinal cord injuries, lesions, or disease) or functional incontinence. EMG also can be used for biofeedback and medicolegal (medical/legal) cases.

The patient is placed in a comfortable, supine (lying with the face upward) position, with extended legs. Needle electrodes are placed in test muscles (for example, the bulbocavernosus [urethra-tightening] muscle in men), surface electrodes are placed on the skin (for example, the vaginal lining in women), and catheter electrodes are mounted on a catheter that is placed in the urethra. These electrodes detect electrical activity in the urinary tract muscles when the patient is told to hold urine. Patients with neurologic (nervous system) disorders may show dyssynergia (incoordination) between the detrusor and sphincter muscles, involuntary muscle spasms, or detrusor instability (unstable bladder).

enterocele : Herniation of small bowel into vagina

estrogen : Hormones responsible for the development of female sex characteristics; produced by the ovary.

Exercise - Many IC patients feel that regular exercise helps relieve symptoms and, in some cases, hastens remission.

external beam radiation therapy : A 25-28 treatment protocol that utilizes External Beam Radiation. Approximately 6800-7400 rads of radiation energy is delivered to the Prostate. There can be some radiation effect on surrounding tissues.

External Radiation Treatment (XRT) - This, too, is more a form of therapy than surgery. It usually is prescribed for patients with localized cancer, that is, those whose tumors have spread outside the prostate capsule, but are still likely confined to the immediate surrounding tissues. Treatment involves projecting a high-energy beam of X-rays onto the prostate tissues from a machine outside the body. The radiation kills cancer cells and shrinks tumors. Radiation treatment usually is done on an outpatient basis over a period of 7 to 8 weeks. Common side effects include impotence, particularly in older men, discomfort with urination, urinary urgency and diarrhea, especially during the later stages of treatment.

extracorporeal shock wave lithotripsy (ESWL) : Extracorporeal shock wave lithotripsy uses highly focused impulses projected from outside the body to pulverize kidney stones.

Fibroma - Fibromas are tumors of the fibrous tissue on, in or surrounding the kidney. They are rare and most often found in women. Their cause is unknown. Usually they grow on the periphery of the kidney and can become large before becoming clinically obvious. Most are asymptomatic. While generally benign, these tumors have no special characteristics to differentiate them from other, malignant tumors of the kidney. Because of this uncertainty of diagnosis, most physicians treat them surgically. Partial or radical nephrectomy is the standard approach.

Fine Needle Aspiration - As noted, the tumors that characterize RCC are made up of malignant (cancerous) cells that grow together in a mass. If imaging or other procedures detect the presence of a tumor, a cell sample may be taken for microscopic examination.

In general, physicians avoid performing needle biopsies of suspected kidney tumors because of the risk of causing bleeding or other complications. However, in some cases the tumor may contain a fluid-filled cyst. By puncturing the cyst with a fine needle, a small amount of this fluid can be drawn out for examination by a pathologist, who will look for cancer cells. This can help determine the type of cancer a patient has, and aid the physician in recommending an appropriate form of treatment. While no longer common, a similar technique can be employed to collect a sample of solid tissue from a noncystic tumor.

Gamete Intrafallopian Transfer - Gamete intrafallopian transfer (GIFT) is an ART procedure in which the egg and sperm (gametes) are placed together within the fallopian tubes. Like IVF, GIFT requires prior, hormone-induced "super stimulation" of the woman's ovaries to produce mature eggs. The eggs then are retrieved from the woman by laparotomy, a surgical incision through the abdomen. After a number of mature eggs have been collected, they are combined with sperm which, as in IVF, has been treated to concentrate the most healthy and active cells. Finally, the gametes are transferred back into the fallopian tubes, where fertilization should take place. Any embryos that result from this procedure will naturally descend into the uterus for implantation.

Gittes procedure is a transvaginal technique that does not require an incision. Instead, a small puncture is made above the pubic fat pad. A suture is then transferred by a needle through the rectus (muscle of the pubic crest) and down toward the vaginal wall, where it is looped and drawn back and out through the puncture. A second pass is made through the same incision (1 or 2 cm beside the first pass) to create a strong support for the suspension. The process is repeated through another puncture hole, which is made 1.5 to 2.0 cm away from the first site. Both suspending sutures are tied down within their respective puncture sites.

Bone anchors are new additions to the techniques for needle suspension of the bladder neck. When needle suspension was first developed, surgeons questioned the amount of tension that was suitable for the suspension sutures. They wanted to avoid the complications of bladder outlet obstruction and suture breakdown that could because by too much tension or sutures pulling out of the anchoring tissue.

Gleason Score - Once the presence of a cancerous tumor has been confirmed by biopsy, the pathologist will evaluate its relative malignancy and potential for metastasizing (spreading). He or she will examine the biopsy sample(s) under a microscope while looking for cells or groups of cells that are markedly different from healthy tissue. The greater the disparity between the healthy cells and those that are malignant, the more likely the tumor is aggressive and will spread. The usual method for expressing the results of this analysis is the Gleason Grading System.

Under the Gleason System, the pathologist examines biopsy samples from two different parts of the tumor and assigns them a grade of 1 to 5 based on their degree of differentiation (the amount by which they differ from healthy tissue). The more abnormal the tissue, the higher the score. The results of these two samples are added together to produce a Gleason Score of from 2 to 10. Gleason Scores of 2 to 4 are considered well-differentiated, meaning the tissue is not too different from normal; 5 to 7 are moderately differentiated; 8 to 10 are poorly differentiated. Higher scores indicate aggressive tumors that are likely to require aggressive treatment.

Gonadotropins  - Gonadotropins are gonad-stimulating hormones. The gonadotropins human chorionic gonadotropin (HCG), human menopausal gonadotropin (HMG), and their combinations very successfully treat men with hypogonadotropic hypogonadism (delayed sexual maturity due to sex hormone deficiency) (see also Hypogonadotropic Hypogonadism). Both HCG and HMG stimulate testosterone synthesis, which, in turn, improves sperm production and pregnancy rates.

Gonadotropin therapy also has been tested in men with oligospermia (low sperm count) due to unknown causes. For these men, HCG and/or HMG therapy may or may not improve fertility. Given the expense of such therapy and potential difficulty of administration (HMG requires injection), most specialists do not recommend gonadotropin therapy for oligospermic patients.

Grading - Doctors often will assess an RCC by its grade. The grade of a cancer cell is a assessment of its appearance relative to that of a normal, healthy kidney cell. Grading is done on a scale of 1 to 4, with Grade 1 RCCs having cells that differ little from normal. Such cells typically spread slowly and have a good prognosis for treatment. At the opposite end of the scale, a Grade 4 RCC looks extremely different from a normal kidney cell and indicate an aggressive cancer with poor prognosis.

habit training: A behavioral technique that calls for scheduled toileting at regular intervals on a planned basis. Unlike bladder training, there is no systematic effort to motivate the patient to delay voiding and resist urge.

Hemochromatosis - A disorder of iron metabolism within the body that may lead to fertility problems. Roughly 80% of men with hemochromatosis experience testicular dysfunction. Such dysfunction may be caused by abnormal iron deposition within the testes, liver, pituitary gland and other organs.

Hormonal Replacement/Estrogen Therapy - Estrogen therapy helps to maintain and restore the health of urethral tissues in women who have undergone menopause (the end of monthly menstrual periods). In particular, estrogen appears to reduce stress incontinence and heighten bladder outlet resistance by increasing blood flow, tone and nerve response in the urethral muscle. Yet the exact mechanism of estrogen is still unknown.

Studies suggest that estrogen replacement therapy, by oral or vaginal administration, may benefit patients with stress incontinence or mixed incontinence . To prevent an abnormal build-up of the endometrium (lining of the uterus), estrogen replacement should be given with the pregnancy hormone progesterone (Premphase).

Medications such as Introl and Suctim pro should only be used if the patient's uterus is present--that is, only if the patient has not had a hysterectomy.

Various doses of estrogen and progester one are available. Oral conjugated estrogen usually is given at doses of 0.3-1.25mg per day, and vaginal estrogen is given at 0.5-2.0g per day.

In addition, estradiol--the most potent naturally-occurring estrogen in humans--is available as askin-patch (Alora, Climara, Fempatch, Vivelle, Estraderm) and as a vaginal ring (Estring). All of the sepreparations release estrogen slowly.

Estrogen therapy is not recommended for patients with diagnosed or suspected cancer of the breast, cervixoruterus, or for patients with undiagnosed vaginal bleeding or blood clotting disorders such as thrombophlebitis (inflammation and clotting of the veins) or thromboembolism (blood clot).

hydrocele: A painless swelling of the scrotum, caused by a collection of fluid around the testicle; commonly occurs in middle-aged men.

Hyoscyamine sulfate (Levbid; Cytospaz) - Hyoscyamine sulfate, like oxybutynin chloride, is an anticholinergic and antispasmotic drug. It is prescribed for the treatment of urge incontinence. Hyoscyamine sulfate is specifically contraindicated (improper) for patients with obstructive urinary tract disorders (for example, bladder neck obstruction due to an enlarged prostate) and for those with glaucoma or ulcerative colitis (severe inflammation of the large intestine). - The usual dosage of hyoscyamine sulfate is one to two 0.375 mg tablets every 12 hours.

hypermobility: A condition characterized in which the pelvic floor muscles can no longer provide the necessary support to the urethra and bladder neck. As a result, the bladder neck drops when any downward pressure is applied and causing involuntary leakage. This condition is the most common cause of stress urinary incontinence.

hyperplasia: Excessive growth of normal cells of an organ.

Hyperprolactinemia or Postpubertal Gonadotropin Deficiency - Gonadotropin shortage in a sexually mature man usually is the result of a pituitary tumor, which influences the secretion of the gonadotropins LH and FSH. A tumor, whether small (microadenoma; less than 10 mm) or large (macroadenoma; greater than 10 mm), may cause excess secretion of prolactin, a hormone produced by the front of the pituitary. Affected men may experience a loss of libido (sexual desire), reduced potency, gynecomastia (overdevelopment of the male breasts), galactorrhea (spontaneous milk flow), and altered sperm production. Also, they may produce particularly small amounts of ejaculate, due to abnormal function of the Leydig cells (testosterone-producing cells) within the testes. In addition, pituitary insufficiency can result from other, less common factors such as pituitary damage from surgery or radiation.

The signs of postpubertal gonadotropin deficiency may arise years before any other symptoms of pituitary tumor (i.e., headache, changes in the visual field, or low levels of thyroid and adrenal hormones) . If the pituitary tumor is long-standing (5 to 10 years), the patient eventually may begin to lose secondary sex characteristics, and the testes may become small, soft and atrophied (shrunken). Blood testosterone level will be below normal, gonadotropin levels will be low/low-normal, and testis biopsy will show a lack of mature Leydig cells. In addition, men with postpubertal gonadotropism may have below-normal blood levels of corticosteroids, thyroid-stimulating hormone (TSH), and growth hormone.

Men with suspected tumors should undergo scanning by CT (computerized tomography) or MRI (magnetic resonance imaging), and they should undergo functional laboratory testing of the anterior pituitary, thyroid and kidney. Since prolactin release is governed by the catecholamine dopamine, the dopamine-like medication bromocriptine will reduce prolactin levels and restore normal gonadal function in men with prolactin-secreting tumors (see also Drug Therapy). The customary therapeutic dose is 5-10 mg daily.

Ileal Conduit - The ileal conduit is a small urine reservoir that is surgically created from a small piece of the patient's bowel. During this procedure, the ureters are attached to one end of the bowel piece; the other end is brought out onto the surface of the body to make a stoma. The patient then attaches an external, urine-collecting bag to the stoma. This bag needs to be worn at all times. Complications of the ileal conduit procedure include bowel obstruction, urinary tract infection (UTI), blood clots, pneumonia, upper urinary tract damage, and skin breakdown around the stoma.

Imaging - The preliminary workup usually is followed by one or more imaging procedures to obtain a visual picture of the kidney(s) and any abnormalities that may be causing the patient's symptoms. A variety of modern, accurate, imaging procedures is available to assist the physician in this process. Most of these procedures are essentially painless, although a few require the injection of a special "tracer" material (dye or low-level radioactive isotope) into the patient's bloodstream.

In Vitro Fertilization - In vitro fertilization (IVF) is, by definition, the fertilization of an egg in the laboratory. Using a variety of hormonal drugs, the woman's ovaries are "super stimulated" to produce eggs. Then, many mature eggs are gathered from the ovaries, and they are fertilized in the laboratory using the man's sperm. Two methods used to collect the eggs. Transvaginal aspiration is an ultrasound-guided technique in which the eggs are aspirated (drawn out) via the vagina; this procedure also is known as TV collection. Laparoscopy involves an incision through the abdomen to extract the eggs.

Once the eggs have been collected, they are placed in a special fluid and are incubated (kept warm) with a prepared sample of the man's semen. The semen sample will have been processed to separate out the most active, healthy sperm. After the eggs are fertilized (roughly 48 hours after collection), they are replaced inside the woman's uterus.

Incontinence Questionnaire - Your physician may ask you to complete a questionnaire about your medical history (medications used, surgeries, illnesses, allergies, etc.) as well as a questionnaire about your bladder-related symptoms and quality of life. Such questionnaires may be sent to you before your office visit, or they may be given to you when you arrive for your appointment. In either case, your physician will use the information that you provide to help evaluate your condition.

Inhibitors - Normally, urine contains chemicals that prevent or inhibit the formation of crystals. Substances known to act as inhibitors include pyrophosphate, citrate, magnesium, zinc and macromolecules. Another prevalent theory holds that some persons do not possess these inhibitors in sufficient quantity to prevent crystallization, or that their inhibitors somehow fail to produce the necessary chemical reactions that prevent the formation of crystals. The formation of such crystals is the first stage in the development of a kidney stone.

Injectables - Other alternatives to invasive, stress incontinence surgery include injectable agents that increase the bulk around the urethra. These agents compress the urethra near the bladder outlet and can greatly improve the function of the urethral sphincter muscle. Injectable materials include collagen (a naturally occurring protein found in skin, bone and connective tissues), polytetrafluoro-ethylene (PTFE, a synthetic compound known as Teflon, Polyte for Urethrin) and fat.

In women, injectable agents are a good choice if the patient is older, is not a good candidate for surgery, and has persistent intrinsic sphincter deficiency without urethral hypermobility (distinguished by leak point pressures less than 90 cm of water). In men, injectable agents may be beneficial for patients with intrinsic sphincter deficiency that has lasted longer than one year.

The Contigen Bard implant is a new collagen-based form of injection therapy for leakage caused by stress incontinence. Contigen uses a highly purified form of collagen made from cowhide; therefore, all potential Contigen recipients should receive a skin test 28 days before scheduled injection to determine whether or not they are allergic to bovine collagen.

The Contigen implant is injected around the top of the urethra using prefilled syringes. The procedure generally is conducted on an outpatient basis with a local anesthetic (painkiller). Most patients need one to three Contigen treatments (up to 28 cc) to achieve bladder control.

Polytetrafluoroethylene (PTFE, a synthetic compound known as Teflon, Polytef or Urethrin), in the form of a micro polymer paste, can be injected into the upper urethra. The PTFE particles spur the growth off ibroblasts (fiber-making cells), which help to fix the PTFE in the urethral tissue and assist in urethral closure. PTFE is not approved in the United States for treatment of incontinence, because questions remain regarding the potential for PTFE particles to migrate to other regions of the body, such as the lungs, brain and lymph nodes.

Fat injections also have been used to treat intrinsic sphincter deficiency. Autologous fat (fat from the patient's own body) is gathered by liposuction from the abdominal wall and is then injected around the urethra. Like collagen and PTFE injection, fat injection is a simple technique that can take place under local anesthesia. The results of this procedure appear favorable and cost-effective, although long-term findings are lacking.

insemination: The placement of semen into a woman's uterus, cervix, or vagina.

Intermittent Catheterization - Intermittent Catheterization involves inserting a catheter thru the urethra into to bladder to empty it of urine. Once the bladder is empty the catheter is removed. Intermittent catheterization should be performed every 3 to 8 hours or as recommended by your physician.

For instructions on the proper technique for intermittent catheterization click here.

Internal Collection Devices - An internal collection device, such as a catheter (a hollow plastic tube), may be recommended for certain individuals to ensure that the bladder is emptied on a regular schedule and does not overfill. Intermittent catheterization -- the periodic insertion of a catheter into the urethra, past the sphincter muscle and into the bladder -- is performed at regular intervals each day (usually every 3 to 6 hours).

These devices are usually used in managing cases of neurogenic and overflow incontinence.

Catheters used for intermittent catheterization range in size. Catheters usually are attached to a drainage tube and/or bag. Since intermittent catheterization completely empties the bladder, wetting accidents can be avoided.

Intermittent catheterization poses a risk of infection because the catheter must pass from the external environment to the internal environment of the body. Therefore, hand washing is required before touching the catheter or drainage bag. In addition, the catheter should be cleaned after each use.

InterStim continence control therapy: A therapy used in treating urge incontinence. A device, about the size of a pacemaker, that is implanted into the sacral nerves of the lower spine, where it delivers electrical impulses that help regulate bladder function. Click here a to see picture.

Interstitial Laser Coagulation - This new procedure uses a device called a cystoscope in the urethra to introduce a special fiberoptic probe directly into the prostate. The probe focuses a beam of low-power laser energy to vaporize a controlled amount of obstructing prostate tissue, resulting in prostate shrinkage and improvement of BPH symptoms. The process is repeated as needed, and takes about 30 to 60 minutes to perform on an out-patient basis.

INTERSTITIAL LASER COAGULATION OF THE PROSTATE (ILC) - Similar to transurethral needle ablation of the prostate, a thin laser fiber is inserted into the prostatic adenoma via a tranurethral or transrectal route under ultrasound guidance. Laser energy is then utilize to induce tissue destruction by local tissue heating with the laser light energy. Preliminary data on small series of patients suggest it has potential as a viable minimally invasive surgical alternative for the treatment of BPH. This device is currently not FDA approved.