Postprostatectomy Incontinence Reduced by Behavioral Therapy Program

For men with incontinence for at least one year following radical prostatectomy, participation in a behavioral training program can result in a significant reduction in the number of incontinence episodes, according to a study in the January 12 issue of The Journal of the American Medical Association.
Components of the behavioral training included pelvic floor muscle training, bladder control strategies such as keeping a diary, and fluid management.
Men in the United States have a 1 in 6 lifetime prevalence of prostate cancer. Incontinence is a known risk of prostate removal surgery, and as many as 65% of men will still have some degree of incontinence up to five years after the surgery. Loss of bladder control can be a physical, emotional, psychosocial, and economic burden for men who experience it.
Postprostatectomy incontinence has been attributed to intrinsic sphincter deficiency and/or detrusor dysfunction, leading to stress and/or urgency incontinence, respectively. Surgical interventions for incontinence are quite effective but are usually reserved for moderate to severe incontinence, and many prostate cancer survivors are reluctant to undergo another surgery.
Previous studies have shown the value of behavioral therapy in postoperative recovery of continence, there none have looked at the issue for postprostatectomy incontinence persisting more than 1 year.
Patricia S. Goode, M.S.N., M.D., of the University of Alabama at Birmingham, and colleagues conducted a study to evaluate the effectiveness of behavioral therapy for reducing persistent postprostatectomy incontinence and to determine whether the technologies of biofeedback and electrical stimulation enhance its effectiveness.
The researchers conducted a prospective randomized controlled trial involving 208 community-dwelling men aged 51 through 84 years with incontinence persisting 1 to 17 years after radical prostatectomy at a university and 2 Veterans Affairs continence clinics (2003-2008) and included a 1-year follow-up after active treatment. Of the participants, 24% were African American; 75%, white.
After stratification by type and frequency of incontinence, participants were randomized to 1 of 3 groups: 8 weeks of behavioral therapy (pelvic floor muscle training and bladder control strategies); behavioral therapy plus in-office, dual-channel electromyograph biofeedback and daily home pelvic floor electrical stimulation (behavior plus); or delayed treatment, which served as the control group. Participants completed 7-day bladder diaries.
The researchers found that at 8 weeks, those in the behavioral therapy group had more than double the average reduction of incontinence episodes compared to the control group [55% (from 28 to 13 episodes per week) and 24% (25 to 21 episodes per week) respectively].
Those in the behavior-plus group experienced an average reduction of 51% (from 26 to 12 episodes per week), indicating that the addition of biofeedback and electrical stimulation did not improve 8-week results compared with behavioral therapy alone.
The improvements were noted to be durable to 12 months in the active treatment groups: 50% reduction (13.5 episodes per week) in the behavioral group and 59% reduction (9.1 episodes per week) in the behavior plus group.
At the end of the 8-week treatment period, 15.7% of men in the behavior therapy group, 17.1% in the behavior-plus group, and 5.9% in the control group achieved complete continence, reporting no incontinence episodes in their 7-day bladder diaries.
Behavioral therapy also improved the effects of incontinence on daily activities and condition-specific quality of life.
In an accompanying editorial, David F. Penson, M.D., M.P.H., of Vanderbilt University and VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nash­ville, Tenn., writes that questions remain regarding the optimal way to address postprostatectomy uri­nary incontinence.
"Is it behavioral therapy, which likely re­quires considerable patient and clinician time and effort to implement and is associated with limited benefit? Is it sur­gical implantation of an artificial urinary sphincter [a structure, or a circular muscle, that relaxes or tightens to open or close a passage or opening in the body] that works, but requires another surgical procedure? Or is it applica­tion of new technologies at the time of prostatectomy that purport to result in better patient-reported outcomes but still appear to be associated with a significant incidence of postprostatectomy urinary incontinence? Perhaps none of these is ideal. A better strategy would be primary preven­tion: increased utilization of active surveillance among pa­tients with lower-risk disease and selective application of aggressive interventions in patients with worse prognostic variables."

Screening men over 65 for abdominal aortic aneurysms could save lives

Between 5% and 10% of men aged 65 to 79 have abdominal aortic aneurysms, but don't know it. If their weakened arteries burst they stand a very high risk of dying. Ultrasound screening of men in this age group can significantly reduce the numbers of men who die from this condition. The overall benefits of screening are complex, however, because many men may be subjected to unnecessary anxiety and/or to the complications of surgery.
An aneurysm is a localised widening of an artery. It occurs because the artery wall is weakened and without treatment it could easily burst. If the aneurysm is in the aorta, the main artery that carries blood through the abdomen, the result often can be fatal. Doctors believe that any abdominal aortic aneurysm that is greater than 5cm is at a high risk of bursting.
To see whether a program of ultrasound screening could detect these aneurysms before they burst, and save lives as a result, Cochrane Researchers performed a systematic review of screening trials. They identified four controlled trials that were conducted in the UK, Denmark and Australia, and involved a total of 127,891 men and 9,342 women.
The results showed that men aged 65-79 could benefit from screening, but there were insufficient data on women (whose risk of death from ruptured aortic aneurysm is much lower than the risk in men) to ascertain effectiveness in women.
Understanding the nature of this benefit is complex. Screening detects aneurysms before they burst, and the opportunity to repair them early significantly reduced deaths from aortic aneurysms. However, not everyone with an aneurysm will die as a result, even if it is not repaired, and so some people whose aneurysm would not have otherwise burst are subjected to major surgery with its attendant complications or to anxiety about their unoperated aneurysm through screening. Screening had no significant effect on overall mortality, which is to be expected given that aortic aneurysm is relatively infrequent as a cause of death.
"The overall population benefit from screening appears to be established, in that fewer people died from their aortic aneurysm as a result of screening. However, there will still be some deaths and ill health resulting in a small number of people dying or suffering ill health as a result of elective aneurysm repair, who otherwise consider themselves healthy, and whose aneurysms detected by screening may not have ruptured in the future. Patients may therefore be asked to undergo risky surgery for a procedure that may not have killed them, others may discover small aneurysms and worry about them unnecessarily," says lead author Dr Paul Cosford, Director of Public Health at the East of England Strategic Health Authority.
"Resource analysis indicates that screening may be cost effective in relatively developed countries, but that this needs further expert analysis particularly given the lack of information on life expectancy, complications of surgery or quality of life," says Cosford. The researchers say there is a need to see whether surveying a larger population of women would demonstrate that they could benefit from screening as well.

Prostate Cancer Treatment Options

Prostate cancer, a very prevalent condition, is diagnosed in more than 220,000 men each year in this country, but fewer than 40,000 of those men die of the disease. That’s because prostate cancer often is a slow-growing cancer that does not cause symptoms. Many men can live out their entire lives with prostate cancer without every experiencing disease or discomfort.
For those patients whose localized prostate cancer is felt to justify treatment, options include surgery, radiation therapy, hormone therapy, cryoablation (freezing), and high frequency ultrasound or HiFu (heat energy). Active surveillance, also known as “watchful waiting” is an alternative to immediate treatment. It involves closely monitoring the cancer’s status through regular blood tests, rectal examination, and periodic biopsy. Patients are encouraged to engage in healthy lifestyle behaviors – eating a nutritious diet, exercising regularly, reducing stress. Then instead of trying to destroy the cancer, with the potentially detrimental effects of treatment, your physician watches it closely. If any sign of progression develops, treatment can be given with no discernable detriment to the patient for having waited.
Age is the most common risk factor, with nearly 65 percent of prostate cancer cases occurring in men age 65 and older. Other risk factors for prostate cancer include family history, race and possibly diet. There is some evidence that a diet higher in fat, especially animal fat, may increase the risk of prostate cancer.
As men age, however, their statistical risk for harboring a prostate cancer increases to the point that if we were to perform biopsies on 80–year-old men, we’d find prostate cancer in virtually every one of them to some extent. The question is how many of these men could live the rest of their life healthy without having any symptoms or problems from that cancer?
There is compelling evidence that prostate cancer is over treated. Our ability to diagnose prostate cancer is well established. Using the PSA blood test, more men are diagnosed at an earlier stage of disease. However, it has been estimated that between 30-50% of men, whose prostate cancer was diagnosed solely by an abnormal PSA blood test, could have lived out their entire life never knowing they had prostate cancer.
Active surveillance could be the right choice for many. It spares patients from unnecessary treatments that can cause life-altering side effects, such as loss of sexual function, urinary incontinence, and rectal issues.
When a man is diagnosed with prostate cancer, the first question answered should be “What would happen if I do nothing?” Your urologist should be able to answer this question based upon your age and medical condition, as well as the grade, stage and various parameters used to measure the aggressiveness of your prostate’s cancer. Once this question has been addressed, the patient is now empowered to make clear decisions regarding his body and his health.

Male Fertility Improves After minimally Invasive Treatment

A minimally invasive treatment for a common cause of male infertility can significantly improve a couple's chances for pregnancy, according to a new study published in the August issue of Radiology. The study, conducted at the University of Bonn in Germany, also found that the level of sperm motility prior to treatment is a key predictor of success.
"Venous embolization, a simple treatment using a catheter through the groin, can help to improve sperm function in infertile men," said lead author Sebastian Flacke, M.D., Ph.D., now an associate professor of radiology at the Tufts University School of Medicine, director of noninvasive cardiovascular imaging and vice chair for research and development in the department of radiology at the Lahey Clinic in Burlington, Mass. "With the patients' improved sperm function, more than one-quarter of their healthy partners were able to become pregnant."
Normally, blood flows to the testicles and returns to the heart via a network of tiny veins that have a series of one-way valves to prevent the blood from flowing backward to the testicles. If the valves that regulate the blood flow from these veins become defective, blood does not properly circulate out of the testicles, causing swelling and a network of tangled blood vessels in the scrotum called a varicocele, or varicose vein.
Varicoceles are relatively common, affecting approximately 10 percent to 15 percent of the adult male population in the U.S. According to the National Institutes of Health, most cases occur in young men between the ages of 15 and 25. Many varicoceles cause no symptoms and are harmless. But sometimes a varicocele can cause pain, shrinkage or fertility problems.
The traditional treatment for problematic varicoceles has been open surgery, but recently varicocele embolization has emerged as a minimally invasive outpatient alternative. In the procedure, an interventional radiologist inserts a small catheter through a nick in the skin at the groin and uses x-ray guidance to steer it into the varicocele. A tiny platinum coil and a few milliliters of an agent to ensure the occlusion of the gonadic vein are then inserted through the catheter. Recovery time is minimal, and patients typically can return to work the next day.
Dr. Flacke and colleagues set out to identify predictors of pregnancy after embolization of varicoceles in infertile men. The study included 223 infertile men, ages 18-50, with at least one varicocele. All of the men had healthy partners with whom they were trying to achieve a pregnancy.
In the study, 226 of the patients' 228 varicoceles were successfully treated with embolization. A semen analysis performed on 173 patients three months after the procedure showed that, on average, sperm motility and sperm count had significantly improved. Six months later, 45 couples, or 26 percent, reported a pregnancy. A high level of sperm motility before the procedure was identified as the only significant pre-treatment factor associated with increasing the odds of successful post-treatment pregnancy.
"Embolization of varicoceles in infertile men may be considered a useful adjunct to in-vitro fertilization," Dr. Flacke said.

New York City Needs Safer Sex

New Yorkers are not practicing safe sex, which affects the disease and sexual health situation in the city. Reports shows that they need to have a fewer partners and more condomns. We say no sex outside of marriage.
Fewer Partners and More Condoms Would Decrease Risk of Infections, including HIV. More than One Third of Men Who Have Sex with Men and Who Have Multiple Sex Partners Did Not Use Condoms Consistently.
New Yorkers with multiple sex partners, and low rates of condom use, are putting themselves at risk of sexually transmitted infections, including HIV, or unplanned pregnancy. According to a new Health Department report – Are New Yorkers Having Safe Sex? – rates of unsafe sexual behavior, particularly among men who have sex with men, continue at a high rate. In 2006 alone, more than half of all New York City pregnancies were unplanned and more than 60,000 new sexually transmitted infections (STIs) were reported – including 3,745 new HIV diagnoses.
Overall, 11% of New Yorkers, some 610,000 adults, report having more than one partner in the past year, according to the new report. Men are three times more likely than women to report multiple partners (17% vs. 6%), and young adults are four times more likely than older adults to report multiple partners. New Yorkers with same-sex partners are three times as likely as those with opposite-sex partners to report more than one partner in the past year. And 5% of New Yorkers who are married or in steady relationships say they’ve had two or more partners in the past year.
“Tens of thousands of New Yorkers put themselves at risk by having unsafe sex,” said Dr. Thomas R. Frieden, Health Commissioner for New York City. “Reducing your number of sexual partners, and using condoms correctly and consistently, makes it less likely you’ll get a sexually transmitted infection such as HIV.” Dr Frieden continued: “Of most concern, among men who have sex with men who had 5 or more partners in the past year, 36% did not use condoms consistently. This is a core group which is at high risk for getting – and spreading – HIV.”
Condom Use Not Consistent
Only 60% of New Yorkers with multiple partners reported using a condom the last time they had sex. The proportion is even lower – just 43% – among New Yorkers who are in committed relationships but have had other partners during the past year. “Unless you’re in a long-term, mutually monogamous relationship with an uninfected partner,” said Dr. Frieden, “use a condom every time.”
Only half of men with both male and female partners (55%) reported consistent condom use. Among men who have sex exclusively with other men, 75% said they always use condoms.
Free NYC condoms are available at locations throughout the city. Call 311 or visit www.nyc.gov/condoms for more information. The Health Department has distributed more than 48 million NYC Condoms since 2007 and continues to give away more than 3 million every month at clinics, health clubs, bars, barbershops and other venues.
Double Up to Prevent Pregnancy
The best way to prevent a pregnancy is to use condoms correctly and consistently and use another effective form of birth control, such as the pill, patch, or ring. More than one third of New York City women ages 18-44 (39%) did not use any form of contraception the last time they had sex, yet most of these women (83%) say they were not planning a pregnancy. Another third (34%) said they used only condoms. Only 7% of women employed two forms of contraception, the report showed.
Plan B (also known as emergency contraception) is a safe and effective way for women to prevent pregnancy after unprotected sex. The Health Department offers free Plan B at its STD clinics in the five boroughs to all women.
Getting tested – Express visits are available
Getting tested will help identify STIs early when they are most treatable. Many STIs don’t cause symptoms, especially in women, but without treatment, STIs can have serious consequences, including infertility, poor birth outcomes and some cancers.
Free and confidential screening is available on a walk-in basis at Health Department STD clinics. To make testing easier, New York City now offers an express visit option at each of the 10 clinics. Express visits are a quick, easy testing option for people who have no symptoms or aren’t sure if they were exposed to an STI. Complete medical exams are still available for people with symptoms, or for exposure to a partner who is known to have an STI. Call 311 for clinic locations and hours of operation. Services are available to people 12 and older without parental notification and without regard for immigration or insurance status.
Tell your partners if you put them at risk
If you have exposed any partners to an STI, it is important to tell them so they can be tested and treated if necessary. Ideally, patients would notify their partners themselves, but for some people, this is too difficult. In these cases, New Yorkers can call 311 and ask for “Partner Notification Assistance” and the Health Department will notify partners without ever revealing who you are. New Yorkers can also notify partners electronically through a web service called inSPOT, at www.inspot.org. InSPOT allows New Yorkers to send e-cards to partners, either anonymously or by name. This service operates in several U.S. cities and was introduced in New York City last summer.
About the Data
The Health Department’s Vital Signs report is based on the Community Health Survey, a telephone survey of approximately 10,000 New York City adults (18 years or older).

Dangerous Problems with Counterfeit Viagra

The world, including the US, is being flooded with counterfeit Viagra and other erectile dysfunction medications. A report in the Feb 12, 2009 issue of the New England Journal of Medicine highlights the dangerous problems.
The article reports on a total of 150 non-diabetic patients with severe hypoglycemia (low blood glucose) were admitted to the five public hospitals in Singapore. The admissions were between January 1 and May 26, 2008. All the patients were men except one, ages ranged from 19 to 97 years (median, 51). Seven patients remained comatose as a result of prolonged decrease glucose to the brain,and four subsequently died.
Several patients (45/150 or 30%) admitted to ingesting illegal sexual-enhancement drugs before the onset of hypoglycemia. Samples of the drugs obtained from these patients and from drugs seized in police raids were analyzed by means of high-performance liquid chromatography. It was found that many of the preparations were contaminated with Glyburide (a powerful medication used to treat diabetes).
So people thought they were taking Cialis or Viagra. What they were often taking were herbal preparations (e.g. Santi Bovine Penis ErectingCapsule) that contained small amounts of the active ingredient (Cialis or Viagra), but which also contained glyburide.
Since none of the men were diabetic, they experienced a severe drop in blood sugar (hypoglycemia). Seven men sustained serious brain damage due to low blood sugar, of which four ultimately died.
Harmful ingredients found in counterfeit medicines include boric acid, leaded road paint, floor polish, shoe polish to get the sheen on the tablet, talcum powder, cement powder, chalk and brick dust, nickel and arsenic. Any active drug ingredient is usually minimal or simply wrong – one supply batch of fake Viagra was in fact amphetamine and not Viagra (sildenafil).
Here are some signs (from eDrugStore) to help you identify illegal "generic Viagra" [Cialis or Levitra:
· The site sells "generic VIAGRA" or "generic sildenafil citrate" [Viagra does not have a generic form available.]
· The site claims to sell a cheaper form of VIAGRA
· The price is cheaper than VIAGRA, by as much as 70%
· The site claims the drug is made to World Health Organization (WHO) standards, which may be a lie. The WHO does not review or approve any medication
· The drug is sold as a pill, but looks different from VIAGRA's normal color, shape and imprinting
· Delivery times may be extended (4 -21 days) due to product being shipped into the United States from a foreign country
· Shipping is initiated using a foreign country postal service to minimize chances of detection and seizure when entering United States