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August 5, 2009 > Prostate and Urinary Tract Seminar: What Men Need to Know

Prostate and Urinary Tract Seminar: What Men Need to Know

Many men are uncomfortable discussing health topics, especially when it has something to do with problems "down there." But ailments such as urinary tract infections, incontinence, erectile dysfunction and an enlarged prostate can greatly affect the quality of a man's life. An even more serious concern - prostate cancer - may actually be life-threatening in some cases.

To help men learn more about these serious health issues, Washington Hospital is sponsoring a special Health & Wellness seminar on Tuesday, August 18, from 1 to 2:30 p.m. Urologist Dr. Mark Saleh will outline the risk factors, symptoms, diagnosis and treatment options for these conditions. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium located at 2500 Mowry Ave., (Washington West) in Fremont.

Urinary Tract infections and Incontinence

"Urinary tract infections are more common in women than in men because of the structural differences in their anatomy," says Dr. Saleh. "Some of the causes of urinary tract infections in men would include having an enlarged prostate, incomplete emptying of the bladder, use of a urethral catheter or other problems in the urinary tract."

Some symptoms of a urinary tract infection might include:
* Pain, burning sensations or spasms while urinating.
* Frequent urination.
* The need to urinate seems very urgent.
* Urine that is cloudy or has an unusual odor.
* Fever or chills.
* Blood in the urine.

"Blood in the urine can be a serious symptom, not only of an infection, but also other problems," Dr. Saleh notes. "You should always be evaluated if you have blood in your urine - even if it occurs only once."

Urinary tract infections can be diagnosed easily with a simple urine test to see which, if any, bacteria are present. Then the lab can determine which antibiotics are best for the particular bacteria so the doctor can decide on the best one for that patient. It is important to treat urinary tract infections early, so they don't spread to the kidneys, where infections can cause serious complications.

Urinary incontinence - the accidental release of urine - can happen for a number of reasons. The two most common types of incontinence are:
* Urge incontinence - having an urge to urinate that is so strong you can't make it to the toilet in time, frequently caused by an overactive bladder.
* Stress incontinence - leakage that occurs when you sneeze, cough, laugh, lift objects or do something else that puts strain on the bladder.

"Most cases of urge incontinence can be treated with medications for overactive bladder," Dr. Saleh says. "Stress incontinence is due to weak muscles and support of the bladder, so it moves around during coughs or sneezes. For mild cases of stress incontinence, doing Kegel exercises may help strengthen the muscles supporting the bladder. For more serious cases, we can perform a minimally invasive outpatient procedure to insert a 'sling' under the bladder to support it."

Erectile Dysfunction

Erectile dysfunction (ED) is a condition that prevents a man from achieving or maintaining an erection long enough to have sexual intercourse. Causes of ED might include:
* Conditions that impede the flow of blood to the penis, such as hardening of the arteries, high blood pressure or high cholesterol.
* Problems with the nervous system, such as multiple sclerosis or Alzheimer's disease.
* Psychological or social problems, such as depression or stress.
* Endocrine and hormone imbalances, such as diabetes, a high or low level of thyroid hormones, or a low level of testosterone.
* Lifestyle habits that impede blood flow, including smoking, alcohol abuse, or illegal drug use.

"Men who have had surgery or other treatments for prostate cancer also may experience erectile dysfunction," Dr. Saleh explains. "For mild to moderate cases of ED, various oral medications such as Viagra, Levitra and Cialis have proven very effective. Treatment options for more serious cases of ED could include vacuum pumps, a medical urethral suppository inserted into the opening of the penis, or injections of a medication called Caverject into the penis. The injections can be self-administered after proper instruction by a physician.

"If all else fails, penile implants are a very good option," he adds. "A malleable implant that is a rod with flexible joints that the man can manipulate is one type. A more 'natural' option is an inflatable implant."

Prostate Enlargement and Cancer

"Benign prostate enlargement occurs in most men to varying degrees, especially after age 50," Dr. Saleh says. "Hereditary factors can play a role in determining the extent of the prostate enlargement. For the majority of men, the enlargement is not sizable enough to cause any symptoms, but if a man has symptoms that are bothersome, it's important to seek medical advice, since some of those symptoms also might indicate advanced prostate cancer."

Symptoms of benign prostate enlargement may include:
* Weak urine stream.
* Frequent need to urinate.
* Urgent need to urinate.
* Increased frequency of urination at night.
* Difficulty starting or stopping urination.
* Inability to completely empty the bladder.
* Blood in the urine.

Most men with benign prostate enlargement don't develop any complications, but in serious cases, treatment options might include medications, non-invasive therapies such as ultrasound and laser therapy, or - in the most severe cases - surgery.

Because early prostate cancer generally causes no symptoms, regular prostate screenings are important. Most early prostate cancer can be detected by a digital rectal exam (DRE) and a blood test to measure the level of prostate specific antigen (PSA), a protein made by prostate cells. With the DRE, the physician can feel whether there is any swelling, nodules or lumps. The higher the level of PSA, the more likely it is that there is cancer present.

The American Urological Association now recommends getting a baseline PSA screening along with a DRE at age 40, with follow-up screenings at intervals determined by the patient and his physician. Some risk factors that should be considered in determining how frequently a man should have screenings include age and family history of prostate cancer. Also, African American men are much more likely to develop prostate cancer than Caucasians or Asian Americans.

"If the patient's PSA is high and remains elevated, or the DRE indicates there might be a problem, a biopsy would be needed to determine if cancer is present," explains Dr. Saleh. "If the biopsy samples come back positive for cancer, we would have to determine how aggressive the cancer is, as well as whether or not it has spread outside the prostate."

Treatment options for prostate cancer generally depend on how aggressive the tumor is and the patient's personal preference. Age is also a factor, since prostate cancer in men under age 65 tends to be more aggressive than tumors in older men.

"For older men and for younger men who have low-grade, early stage tumors, the most likely recommendation would be 'watchful waiting,' which entails more frequent regular screenings and repeating the biopsy as indicated. Hormone therapy to stop the production of testosterone, which promotes cancer growth, might also be considered. Hormone therapy does not cure the cancer, but it can put the cancer in temporary remission and relieve symptoms. Hormone therapy also can be used in combination with radiation therapy to improve outcomes."

Radiation therapy for more aggressive prostate cancers could be in the form of external beam radiation therapy or brachytherapy - the implantation of radioactive "seeds" into the prostate. For many patients, surgery to remove the prostate is the most effective treatment.

"Surgery for prostate cancer could be a traditional open prostatectomy," Dr. Saleh notes. "Today at Washington Hospital, though, we have a less-invasive option, using the da Vinci robotic surgical system that allows us to perform the operation laparoscopically with three or four tiny incisions. The robotic system also magnifies the surgical site, giving the surgeon better visualization.

"The results of robotic surgery are as good as open surgery, and the patient experiences less post-operative pain," he continues. "Robotic surgery cuts the recovery time by about half. Some studies indicate that the robotic surgery also may be better than open surgery in terms of preserving the nerves necessary for erectile function and maintaining urinary continence."

Learn More

To register for the upcoming prostate seminar at Washington Hospital, please call (800) 963-7070. To see a list of upcoming seminars, visit and click on "The Community" and choose "Community Seminars and Health Classes" from the drop down menu.

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