Prostate Cancer Screening↑
KNOW YOUR PROSTATE CANCER STATS
• More than 230,000 men will be told they have prostate cancer this year. It is the 2nd most common cancer in men in the US.
• About 1 in 7 men will be diagnosed in his lifetime.
• Prostate cancer is the 2nd leading cause of cancer death in men.
• Almost 2 out of every 3 prostate cancers are found in men age 65 or older.
WHAT IS PROSTATE CANCER?
Only men have a prostate. This walnut-shaped gland sits below the bladder. The prostate surrounds the urethra, the tube that carries urine out of your body. Prostate cancer occurs when abnormal cells from your prostate grow out of control.
AM I AT HIGHER RISK FOR PROSTATE CANCER?• If you are African-American, you are more likely to develop prostate cancer. African-American men are also twice as likely to be diagnosed with more deadly forms of the disease.
• If your father, brother or other close relative was diagnosed with prostate cancer, you have a higher chance of being diagnosed. This is especially true if two or more close relatives have been diagnosed, or if they were diagnosed before age 55.
If you are at higher risk for prostate cancer, talk to your doctor about screening.
SHOULD I BE SCREENED FOR PROSTATE CANCER?
The choice to be screened for prostate cancer is a personal one. Before you decide to be tested, talk to your doctor about your risk for prostate cancer, including your personal and family history. Then talk about the benefits and risks of testing.
If you are age 55 to 69, talk to your doctor about prostate cancer screening.
Some men are at higher risk for prostate cancer. Talk to your doctor about prostate cancer screening if you are age 40 to 54 and:
• are African-American or
• have a father, brother or son who has had prostate cancer.
DOES A HIGH PSA MEAN I HAVE PROSTATE CANCER?
Not necessarily. Less than one-third of high PSA results are caused by prostate cancer. A prostate biopsy (tissue sample) is the only way to know for sure if you have prostate cancer. However, your doctor may want to repeat your PSA or do other testing.
I’VE BEEN HAVING PROBLEMS WHEN URINATING. SHOULD I BE WORRIED?
If you are having problems when urinating, your health care provider may use the PSA test to check your prostate health. Remember, urinary symptoms like these are usually caused by prostate health issues other than cancer.
• You urinate often during the day and/or night.
• It is hard to wait when you have to urinate.
• Your urine flow is weak or slow.
• You have to push or strain to start urinating.
• You stop and start several times when you urinate.
• You have pain with ejaculation.
If you have symptoms, talk to your doctor about your prostate health.
WHAT ARE BENEFITS AND RISKS OF TESTING?
Before you decide to have a PSA test, talk with your doctor about your risk for prostate cancer, including your personal and family history. Then talk about the benefits and risks of testing.
Possible benefits of a PSA test
• A normal PSA test may put your mind at ease.
• A PSA test may find prostate cancer early before it has spread.
• Early treatment of prostate cancer may help some men slow the spread of the disease.
• Early treatment of prostate cancer may help some men live longer.
Possible risks of a PSA test:
• A normal PSA result may miss some prostate cancer (a “false negative” result).
• Sometimes the test results suggest something is wrong when it isn’t (a “false positive”). This can cause unneeded stress and worry.
• A “false positive” PSA result may lead to an unneeded prostate biopsy (tissue sample).
• A positive PSA test may find a prostate cancer that is slow-growing and never would have caused you problems.
Possible risks of a biopsy and treatment:
Biopsies can cause side effects of bleeding and infection. Treatment of prostate cancer can also cause side effects. Erection problems, urine leakage, or bowel problems can occur.
If certain symptoms or the results of early detection tests – a PSA blood test and/or DRE – suggest that you might have prostate cancer, your doctor will do a prostate biopsy to find out.
A biopsy is a procedure in which a sample of body tissue is removed and then looked at under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. It is usually done by a urologist, a surgeon who treats cancers of the genital and urinary tract, which includes the prostate gland.
Using transrectal ultrasound to “see” the prostate gland, the doctor quickly inserts a thin, hollow needle through the wall of the rectum into the prostate. When the needle is pulled out it removes a small cylinder (core) of prostate tissue. This is repeated from 8 to18 times, but most urologists will take about 12 samples.
Though the procedure sounds painful, each biopsy usually causes only a brief uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needle in a fraction of a second. Most doctors who do the biopsy will numb the area first by injecting a local anesthetic alongside the prostate. You might want to ask your doctor if he or she plans to do this.
The biopsy itself takes about 10 minutes and is usually done in the doctor’s office. You will likely be given antibiotics to take before the biopsy and possibly for a day or 2 after to reduce the risk of infection.
For a few days after the procedure, you may feel some soreness in the area and will probably notice blood in your urine. You may also have some light bleeding from your rectum, especially if you have hemorrhoids. Many men also see some blood in their semen or have rust colored semen, which can last for several weeks after the biopsy, depending on how frequently you ejaculate.
Your biopsy samples will be sent to a lab, where a pathologist (a doctor who specializes in diagnosing disease in tissue samples) will look at them under a microscope to see if they contain cancer cells. If cancer is present, the pathologist will also assign it a grade (see the next section). Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer.
Even when taking many samples, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer (because your PSA level is very high, for example) a repeat biopsy might be needed to help be sure.
WHAT IS ADVANCED PROSTATE CANCER?
Prostate cancer is divided into 4 stages.
• Stages I & II: The tumor hasn’t spread beyond the prostate. This is often called “early stage” or “localized” prostate cancer.
• Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called “locally advanced prostate cancer.”
• Stage IV: Cancer has spread outside the prostate to other tissues and often the lymph nodes, bones, liver or lungs. Often called “advanced cancer.”
This fact sheet is for men with advanced disease. If you have localized or “locally advanced” prostate cancer, see our Prostate Cancer Patient Guide.
When an early stage prostate cancer is found, it may be treated and cured, or left alone. If prostate cancer spreads beyond the prostate or returns after treatment, it’s often called advanced prostate cancer.
Stage IV prostate cancer is not “curable,” but there are several new ways to treat it. And more treatments are being studied. Treatment can control advanced prostate cancer and help you feel better, longer. It helps to talk about your treatment options with an experienced health care provider.
ADVANCED PROSTATE CANCER CAN BE:
• Metastatic: Cancer cells have spread beyond the prostate.
• Biochemical recurrence: PSA (prostate specific antigen) level has risen after the first treatment(s) with no other sign of cancer.
• Castrate-resistant prostate cancer (CRPC): PSA has risen, even after surgery to remove the testicles or drugs to block testosterone. (Prostate cancer cells can change and learn how to adapt. They can find ways to grow, even when the testosterone level is very low.)
• Metastatic castrate-resistant prostate cancer (mCRPC): PSA has risen after hormone treatment, AND cancer has spread to other parts of the body. Many of the newest treatments are for men with mCRPC.
SIGNS OF ADVANCED PROSTATE CANCER
Men with advanced prostate cancer may or may not have
symptoms. Symptoms depend on the size of new growth
and where the cancer has spread.
With advanced disease, you may have problems urinating or see blood in your urine. Some men may feel tired, weak or lose weight. When prostate cancer spreads to the pelvic bones, for example, you may feel lower back or hip pain. Please tell your doctor and nurse about any pain or other symptoms you feel. There are treatments that can help.
Sexuality of men ↑
Erectile Dysfunction (impotence)
What should I do if I have problems with impotence?
If you are unable to obtain or maintain an erection sufficient for penetration and for the satisfaction of both sexual partners, you should contact your urologist for further advice.
Your urologist will normally wish to review both you & your partner together and several visits may be needed before a full picture of the problem can be obtained.
Following initial discussions, it is not unusual for some couples to decide not to pursue any further investigations or treatment for impotence (erectile dysfunction).
What are the facts about impotence?
- Impotence becomes commoner with increasing age and is seen in 50-55% of men between 40 and 70 years old
- It is often associated with the so-called "deadly quartet" of obesity, high blood pressure, high cholesterol & diabetes which are all significant risks to health
- Investigation is only indicated if both partners wish to pursue treatment
- Most treatable causes can be identified by a clinical history, physical examination and routine blood tests
- If there is no treatable cause, treatment with tablets is the first option for most men
- Other methods of treatment are only indicated if tablets prove ineffective, cause side-effects or cannot be used because of specific medical conditions
What could have caused my impotence?
90% of men with impotence (erectile dysfunction) have at least one underlying physical cause for their problem.
Although a psychological component, often called "performance anxiety", is common in men with impotence, a purely psychological problem is seen in only 10%.
Of the 90% of men who have an underlying physical cause, the main abnormalities found are:
- Vascular disease in 40%
- Diabetes in 33%
- Hormone problems (e.g. high prolactin or low testosterone levels) & drugs (e.g. antihypertensives, antipsychotics, antidepressants, antihistamines, heroin, cocaine, methadone) in 11%
- Neurological disorders in 10%
- Pelvic surgery or trauma in 3-5%%
- Anatomical abnormalities in 1-3% (e.g. tight foreskin, short penile frenulum, Peyronie's disease, inflammation, penile curvature)
What treatments are available for this problem?
Treatment is only indicated if both partners are troubled by the impotence and they have realistic expectations of what can be achieved by any treatment.
Initial treatment will usually involve:
If these fail to help, your urologist will issue a prescription for Viagra®, Cialis® or Levitra®. These drugs require sexual stimulation to be effective and will not produce an erection without it; they will have no effect whatsoeveron your sex drive. There is no evidence that these drugs are dangerous if you have underlying heart disease. However, they should not be taken if you are taking nitrates (e.g. GTN, isosorbide) for angina.
You should only take Viagra, Cialis or Levitra by getting a prescription from your urologist and you should have a detailed discussion about the risks & benefits before starting treatment.
Your GP will arrange a reassessment after an initial period of drug usage. If drugs prove ineffective, if there are significant side-effects (seen in 15%) or if they cannot be used, other measures may need to be considered. This will entail referral to your local Erectile Dysfunction clinic where the available treatments include:
- Penile injections to produce erections Self-administered injections of prostaglandin E1 (Caverject® , Viridal® ) provide a simple means of obtaining a natural erection. You will be taught how to administer the injections (pictured) and told what to do in the event of problems such as an erection which will not go down.
- Medicated urethral system for erection (MUSE) Insertion of a prostaglandin pellet in the urethra (water pipe) is no longer widely used because of its poor success rates and troublesome side-effects
- Vacuum erection assistance devices (VEDs) VEDs provide a simple way of obtaining an erection for 30-45 minutes by sucking blood into the penis and holding it in place with a constriction (pictured). Ejaculation may be restricted by the ring but this technique is simple, safe and has no known side-effects. Unfortunately, most patients have to purchase VEDs themselves.
- Vascular surgery/angioplasty If you have blockage of the large blood vessels to the legs and the pelvis, it may be possible to undergo reconstruction of the arteries or angioplasty to re-establish erections. Re-vascularisation for small artery blockage is rarely successful.
- Penile prostheses Insertion of artificial penile implants (pictured) is highly effective. It is reserved as a last resort when all other forms of treatment have failed. It involves major surgery with a significant risk of complications. You will need to undergo long-term follow-up in a specialist andrology unit for many years after the surgery.
Vasectomy is a simple, safe surgical procedure for permanent male fertility control. The tube (called a “vas”) which leads from the testicle is cut and sealed in order to stop sperm from leaving.
The procedure usually takes about 10 to 20 minutes.
Since the procedure simply interrupts the delivery of sperm it does not change hormonal function – leaving sexual drive and potency unaffected.
The No-Scalpel vasectomy is a technique used to do the vasectomy through one single puncture. The puncture is made in the scrotum and requires no suturing or stitches.
This procedure is done with the aid of a local anesthetic called ‘Xylocaine 2%.
Risks and Other Important Information of Vasectomy As with any surgical procedure, the primary risks of vasectomy are infection and bleeding. These risks are generally low for this procedure.
It is also important that each patient understand that vasectomy is approached as an irreversible procedure. While vasectomy can be reversed surgically at times, its successful reversal cannot be guaranteed.
Also important is the fact that the vas deferens can grow back together on its own. This is called recanalization and occurs only rarely – less than 1/2 percent of the time.
If your ejaculation is earlier than desired (before or soon after penetration) with minimal stimulation and you have little control over it, you should consider seeking further advice from your GP
What are the facts about premature ejaculation?
- Premature ejaculation is usually lifelong (i.e. it usually dates back to the first sexual experience)
- Rarely, premature ejaculation may develop in later life when it is often progressive
- We do not know accurately how common it is but between (20-30%) are thought to have premature ejaculation
- Less than a quarter of men with premature ejaculation actually seek medical advice for their condition
- Premature ejaculation is often associated with erectile dysfunction (impotence) and with rapid loss of erection after ejaculation
What could have caused my premature ejaculation?
The cause of premature ejaculation is unknown; it appears unrelated to performance anxiety, hypersensitivity of the penis or nerve receptor sensitivity.
Premature ejaculation may, however, have a genetic tendency and is also associated with prostate inflammation (prostatitis), thyroid disorders, emotional disorders and previous traumatic sexual experiences.
What treatments are available?
Psychosexual counselling may help men with less troublesome premature ejaculation but, in most men, the mainstay of long-term treatment is with drugs.
Selective serotonin uptake inhibitors (SSRIs) are powerful antidepressants but they also have a beneficial effect on premature ejaculation. They are used as first-line treatment for this condition and their effectiveness is often maintained for several years.
Dapoxetine (Priligy®, pictured) is the only SSRI licensed for use in premature ejaculation. It is normally available on the NHS but local prescribing rules may restrict its use: you should, therefore, check with your urologist whether it is available in your area. Other SSRIs (e.g. paroxetine, fluoxetine, fluvoxamine, sertraline, clomipramine) can be used if necessary, but dapoxetine is the only drug which can be taken "on demand" (i.e. when needed).
Common side-effects of SSRIs include fatigue, drowsiness, nausea, dry mouth, diarrhoea & excessive perspiration. These are often mild and usually settle after 2-3 weeks.
SSRIs are powerful drugs. You should only take them by getting a prescription from your GP & you should have a detailed discussion about the risks & benefits before starting treatment.
Other drugs which delay ejaculation (e.g. tramodol, terazosin, alfuzosin) have been used but their role is unclear and, at the moment, they are not recommended for clinical use in premature ejaculation.
Viagra®, Cialis® or Levitra® and self-administered penile injections have also been used to help premature ejaculation but their exact role is uncertain. They do, however, improve sexual confidence and reduce performance anxiety by producing better erections (if this is a problem).
Local anaesthetic cream (lignocaine + prilocaine or SS-cream), applied 20 - 60 minutes before intercourse, can be useful but may numb the vagina unless used with a condom. It can occasionally cause irritation of the penile skin.
"Long love" condoms, containing the local anaesthetic benzocaine, are also available commercially and have proved useful in some patients.
Stress Urinary Incontinence↑
What is Stress Urinary Incontinence?
Stress Urinary Incontinence (SUI) is a common medical condition that involves the involuntary loss of urine that occurs when pressure on the bladder is increased during physical movement of the body.
How do I know if I have SUI?
When you leak urine involuntarily, whether loss of only drops to tablespoons or more, this is SUI. If it is mild incontinence, you will have light leakage during rigorous activity such as playing sports or exercising, or when you sneeze, laugh, cough, or lift something. If it is moderate or more severe incontinence, you will leak urine even with low impact movement such as standing up, walking, or bending over. How is SUI different from Urge Incontinence, or Overactive Bladder (OAB)? SUI is different from Overactive Bladder (OAB, also known as Urge Incontinence), which is the strong, sudden urge to urinate at unexpected times, such as during sleep, while SUI is leakage. (This fact sheet does not pertain to OAB.)
How common is SUI?
Estimates of the number of women experiencing SUI vary widely because there is no one definition of the condition. However, urinary leakage is a common medical condition occurring in about one out of every three women at some time in their lives. Among these women, about six in ten have both SUI and OAB. Of this group, about one in three have SUI. Approximately one-third of women age 30 to age 60, and one-third of women under the age of 30, experience urinary incontinence.
How did I get SUI?
SUI is more common among older women, but is not caused simply by aging. It occurs in younger, active, healthy women as well. Caucasian or Hispanic race, being obese, smoking, and chronic cough (which places frequent strain on the pelvic floor muscles that can, in turn, cause bladder leakage) are risk factors for development of SUI. Pregnancy and childbirth increase the chances of SUI because they may stretch, weaken, or damage the pelvic floor muscles, resulting in bladder leakage. Nerve injuries to the lower back and pelvic surgery are also potential causes of SUI because they weaken the pelvic floor muscles.
Why does it matter if I have SUI?
SUI can interfere with your life and day-to-day decisions about your social activities. You may be embarrassed by your body and feel you can’t talk about urinary leakage to your friends and loved ones. SUI can affect the relationship with your partner, especially because you may be embarrassed about having sex. This can lead to feeling isolated and even hopeless. To know if SUI is a problem for you, ask yourself: Is SUI limiting my daily activities? Have I stopped playing sports? Have I stopped other recreational activities or changed my lifestyle in any way because I’m afraid of urine leakage? Have I become uncomfortable with myself and my body? Am I avoiding sex because I am worried that I may leak urine and be embarrassed? If any of your answers are yes, you need to know that there is hope and there are options to help you better manage and treat SUI.
Is it a problem that I use pads?
Treatments for SUI are not perfect. If a woman’s SUI cannot be resolved with conservative approaches such as pelvic floor muscle training and daily practice, lifestyle changes, urinary control devices, or surgery, it is recognized that she may need to rely on sanitary or incontinence pads from time to time. Pads may also be an appropriate strategy for women who are not bothered by their urinary leakage or who do not consider it to be a major problem in their life.
What should I do if I think I have SUI?
You can make an appointment with your primary health care provider, who may do a basic evaluation
or refer you to a specialist.
u You can talk with friends, or learn more about SUI online – go to UrologyHealth.org/SUI for more information.
Where can I find professional help?
Not all health care providers address SUI, so it sometimes goes undiagnosed and untreated. If your
health care provider is experienced with SUI they may be able to perform basic tests and suggest
lifestyle changes to help reduce urinary leakage or refer you to an incontinence specialist who will
perform more specialized tests in order to confirm the diagnosis.
I feel uncomfortable talking about my urine leakage even with my doctor. What should I do? See the Urology Care Foundation publication, “Talking to Your Doctor About SUI,” for helpful tips.
Should I think about surgery to cure my SUI?
Surgery is an option when behavioral or nonsurgical treatments fail or if you don’t want them. Before going ahead, you should have a clear diagnosis of SUI from an incontinence specialist during a physical examination. Additionally, you should only consider surgery if the SUI significantly bothers you or affects your daily activities. Surgery is also not easily reversible, and depending on the type of surgery, is not always a long-lasting solution.
Are there any risks with surgery?
All surgery carries some level of risk. SUI surgery is not easily reversible, and depending on the type of surgery, is not always a long-lasting solution. It is important to have a full exchange of information and discussion with your provider before making the final decision to go ahead. It’s not convenient for me to have surgery right now. Can I wait? SUI surgeries are voluntary procedures that you can have at any time, without risk that waiting will cause you harm. Unlike some other medical conditions, there is no evidence that delaying surgery for SUI makes the outcome worse.
I don’t want surgery. What else can I do?
• You can keep your weight in a healthy range, stay in good overall health, and do not smoke.
Weight loss is especially important for obese women and can reduce or eliminate SUI.
• Pelvic Floor Muscle Exercises. Your provider can help you locate the pelvic floor
muscles and teach you exercises to strengthen them each day in order to help prevent
stress urine loss.
• Urinary control devices are good for women who are not physically fit or interested in other treatments. They are a way of reducing pressure inside the pelvis or supporting the bladder, neck and urethra, which can then reduce stress urine leakage. Your provider can explain these and help you decide which if any are appropriate for you.
Are there any drugs I can take for SUI?
There are currently no approved drugs in the United States to treat SUI.
Common myths about SUI:
“It’s a normal part of being a woman.”
“My mother had SUI, so I have it – it’s hereditary.”
“SUI is a normal, inevitable part of aging – it only happens to older, not younger women.”
“Urine leakage happens because of a dropped bladder.”
“I could have prevented it with pelvic exercises.”
“SUI can’t be treated.”
“Surgery is the only way to treat SUI.”
“If you get treatment early, you’ll prevent it from getting worse.”
“SUI surgery is not permanent and will only last a few years.”
1 in 3 women will experience SUI in their lifetime. Talk to your doctor and get the help you need.
Stress Urinary Incontinence↑
What is Overactive Bladder (OAB)?
Overactive Bladder (OAB) isn’t a disease. It’s the name of a group of urinary symptoms. The most common symptom of OAB is a sudden urge to urinate that you can’t control. Some people will leak urine when they feel this urge. Having to urinate many times during the day and night is another symptom of OAB.
How common is OAB?
OAB is common. It affects millions of Americans. As many as 30 percent of men and 40 percent of women in the United States live with OAB symptoms.
Who is at risk for OAB?
As you grow older, you’re at higher risk for OAB. But no matter what your age, there are treatments that can help.Both men and women are at risk for OAB. Women who have gone through menopause (“change of life”) have a higher than normal risk. Men who have had prostate problems also seem to have an increased risk for OAB. People with diseases that affect the brain or nervous system, such as stroke and multiple sclerosis (MS), are at high risk for OAB. Food and drinks that can bother your bladder (like caffeine, alcohol and very spicy foods) may make OAB symptoms worse.
What is the major symptom of OAB?
The major symptom of OAB is a sudden, strong urge to urinate that you can’t control. This “gotta go” feeling makes you fear you will leak urine if you don’t get to a bathroom right away. This urge may or may not cause your bladder to leak urine.If you live with OAB, you may also:
Leak urine (incontinence): Sometimes people with OAB also have “urgency incontinence.” This means that urine leaks when you feel the sudden urge to go. This isn’t the same as “stress urinary incontinence” or “SUI.” People with SUI leak urine while sneezing, laughing or doing other physical activities.
Urinate frequently: You may also need to go to the bathroom many times during the day. The number of times someone urinates varies from person to person. But many experts agree that going to the bathroom more than eight times in 24 hours is “frequent urination.”
Wake up at night to urinate: Waking from sleep to go to the bathroom more than once a night is another symptom of OAB.
What causes OAB?
OAB can happen when nerve signals between your bladder and brain tell your bladder to empty even when it isn’t full. OAB can also happen when the muscles in your bladder are too active. Either way, your bladder muscles “contract” to pass urine before they should. These contractions cause the sudden, strong urge to urinate.
How can OAB affect my health and my life?
OAB symptoms may make it hard to get through your day without many trips to the bathroom. You may even cancel activities because you’re afraid of being too far from a restroom.
OAB can get in the way of your work, social life, exercise and sleep. Your symptoms may make you feel embarrassed and afraid of being wet in public. You may be tired from waking at night or feel lonely from limiting social activities. If you are leaking urine it may cause skin problems or infections.
But you don’t have to let OAB symptoms control your life. There are treatments to help. If you think you have OAB, please see your healthcare professional.
How will my healthcare professional diagnose OAB?
During your visit, your healthcare professional may:
Gather facts about your past and current health problems, the symptoms you’re having and how long you have had them, what medicines you take, and how much liquid you drink during the day.
Do a physical exam to look for something that may be causing your symptoms, including examining your abdomen, as well as the organs in your pelvis and your rectum in women, or prostate and rectum in men.
Collect a sample of your urine to check for infection or blood.
Ask you to keep a “bladder diary” to learn more about your day-to-day symptoms.
Do other tests, such as a urine culture or ultrasound, when needed.
Are there treatments for OAB?
Yes. There are treatments that can help you manage OAB. Your healthcare professional may use one treatment alone or several at the same time. Treatment choices include:
Lifestyle changes: You can try changing what you eat and drink to see if less caffeine, alcohol, and spicy foods will reduce your symptoms; keeping a daily “bladder diary” of your trips to the bathroom; going to the bathroom at scheduled times during the day; and doing “quick flick” pelvic exercises to help you relax your bladder muscle when it contracts.
Prescription drugs: Your healthcare professional may prescribe drugs that relax the bladder muscle to stop it from contracting at the wrong times.
If these treatments don’t help, your healthcare professional should send you to a specialist, such as a urologist who may specialize in incontinence, for other tests and treatments.
What should I do if I think I have OAB?
Talk with your healthcare professional. Sometimes OAB symptoms can be the result of a urinary tract infection (UTI), an illness, damage to nerves, or a side effect of a medication. So it’s important to go to a healthcare professional to find out if you have any of these problems.
If you do have OAB, there are treatments to help. Together, you and your healthcare professional can choose what’s best for you.
Where can I find help?
To get more facts on OAB, please visit ItsTimeToTalkAboutOAB.org. This site has printed materials you can order and a “Think You Have OAB?” quiz you can take. There, you will find a “bladder diary” that you can print out and use to track your symptoms. You can also use the Find-a-Urologist tool to find a specialist near you.
WHAT ARE THE KIDNEYS AND WHAT DO THEY DO?
Healthy kidneys work around the clock to clean our blood.
Our kidneys are needed for life. These two bean-shaped
organs are found near the middle of the back below the
Male and Female Urinary System Copyright © 2015 Nucleus Medical Media, All rights reserved. Our kidneys are our body’s main filter. They clean about 150 quarts of blood daily. Every day, they remove about 1-2 quarts of water and waste from the blood in the form of urine. As a filter, the kidneys:
• Detoxify (clean) blood
• Balance fluids
• Maintain electrolyte levels (e.g., sodium, potassium, calcium, magnesium, acid)
• Remove waste (as urine)
• Regulate blood pressure and red blood cell counts
WHAT IS KIDNEY CANCER?
When cells grow out of control in the kidney, it’s called
kidney cancer. Kidney cancer is fairly common. About 1 in
63 people will develop kidney cancer in their lifetime. Kidney
cancer is one of the top 10 most common cancers diagnosed
in the United States. There are different types of kidney
cancer, they are:
• Renal cell carcinoma is the most common kidney cancer in adults.
• Transitional cell carcinoma is the second most common kidney cancer in adults.
• Wilms Tumor is a type of kidney cancer found in children.
WHAT ARE THE SYMPTOMS OF KIDNEY CANCER?
Kidney cancer usually does not hurt or show any signs or
symptoms. Rarely, kidney cancer may show some of the
• Blood in the urine (Hematuria)
• Pain in the side, abdomen or back that doesn’t go away • A lump in the abdomen
• Loss of appetite and weight loss for no known reason
• Anemia and fatigue
If kidney cancer spreads (metastasizes) beyond the kidney, symptoms will depend upon where it spreads. Most kidney cancers are found during x-rays or blood tests that your doctor may have ordered for other reasons.
HOW IS KIDNEY CANCER TREATED?
There are many options to treat kidney cancer. The most
• Watch and Wait ( called “Active Surveillance”)
• Renal Tumor Ablation (destroys the tumor with heat “radiofrequency” or cold “cryoablation” energy and spare the remaining normal kidney)
• Surgery to remove the entire kidney (called “Radical Nephrectomy”)
• Surgery to remove only the tumor and spare the remaining normal kidney( called “Partial Nephrectomy”)
• Targeted therapy is a therapy that uses drugs that kill just kidney cancer cells
• Immunotherapy/Biologic Therapy that stimulates your body’s defense mechanism to specifically kill kidney cancer cells
• Radiationto relieve pain and symptoms
• A clinical trial to try a new treatment Your doctor will base your treatment options on:
• What type of tumor you have
• Overall health
• Whether the cancer is within the kidney, has spread to nearby lymph nodes or metastasized
• If the tumor will likely grow and spread
WHAT DO I DO NOW THAT I HAVE KIDNEY CANCER?
It is normal to be surprised and worried after you have been
diagnosed with kidney cancer. However, it is important to
develop a treatment plan right away. Learn as much as you
can about your disease and the different treatment options
available. Specialists who can help you are:
• A urologist: a surgeon who specializes in treating diseases
of the urinary and reproductive systems
• A radiation oncologist: a doctor who treats cancer with radiation therapy
• A medical oncologist: a doctor who treats cancer with medicines such as immunotherapy and chemotherapy
• Nephrologist: a doctor who specializes in kidney care and treating diseases of the kidneys
• Nurse Practitioners, Nurses and Physician Assistants: important partners in implementing the treatment plan
QUESTIONS TO ASK MY HEALTH CARE PROVIDER
• Do I have kidney cancer or something else?
• What is the stage and grade of my cancer and what does
• Has it spread anywhere else?
• Do I need other tests before we can decide on treatment?
• What are my treatment options? Which do you recommend and why?
• How long will I be hospitalized after surgery? How long before I can return to work and participate in vigorous activity after surgery?
• What are the chances that my cancer can be cured?
• What are the chances that my cancer will return after treatment?
• What risks or side effects should I expect from treatment? For how long?
• Will I need to see a nephrologist following surgery? Will I need to be on dialysis after surgery?
• Following surgery, will I need other treatments?
• What should I do to prepare for treatment? What will it be like?
• What will we do if the treatment doesn’t work?
• Can you recommend another urologist for a second opinion?
• How often will I need to have checkups after treatment?
WHAT ARE KIDNEY STONES?
Urine contains many dissolved minerals and salts. When the urine has high levels of minerals and salts, it can help to form stones.
WHAT ARE THE DIFFERENT TYPES OF KIDNEY STONES?
Kidney stones come in many different types and colors.
There are four main types of stones:
Calcium stones are the most common type of kidney stone. There are two types of calcium stones: calcium oxalate and calcium phosphate.
Uric acid stones
Having acidic urine increases your risk for uric acid stones. Acidic urine may come from being overweight, chronic diarrhea, type 2 diabetes, gout, and a diet that is high in animal protein and low in fruits and vegetables. This is not a common type of stone.
These stones are related to chronic urinary tract infections (UTIs). Struvite stones are not common.
Cystine is an amino acid that is in certain foods; it is one of the building blocks of protein. When high amounts of cystine are in the urine, it causes cystine stones to form. Cystine stones often start to form in childhood. These are a rare type of stone.
WHAT ARE THE SYMPTOMS OF KIDNEY STONES?
Stones in the kidney often do not cause any symptoms and
can go undiagnosed. However, if a stone blocks the flow
of urine out of the kidney, it can cause a lot of pain. Other
symptoms of stones include:
• A sharp, cramping pain in the back and side, often moving to the lower abdomen or groin.
• A feeling of intense need to urinate.
• Urinating more often or a burning feeling during urination.
• Urine that is dark or red due to blood.
• Nausea and vomiting.
• For men, you may feel pain at the tip of the penis.
HOW ARE KIDNEY STONES TREATED?
Treatment of your kidney stone depends on the type of
stone you have, how bad it is and the length of time you
have had symptoms. There are different treatments to
choose from. It is important to talk with your health care
provider about what is best for you.
Wait for the stone to pass by itself
Often you can simply wait for the stone to pass. Smaller stones are more likely than larger stones to pass on their own.
Certain medications have been shown to improve the chance that a stone will pass.
Surgery may be needed to remove a stone from the ureter or kidney if:
• The stone fails to pass.
• The pain is too great to wait for the stone to pass.
• The stone is affecting kidney function.
HOW CAN I PREVENT STONES?
Once your health care provider finds out why you are
forming stones, he or she will give you tips on how to
prevent them in the future. There is no “one-size-fits-all”
for preventing kidney stones. Everyone is different. You may
have to change your diet or take medications. Below are
some tips to help prevent stones.
• Drink enough fluids each day (about 3 liters or ten 10-ounces glasses).
• Reduce the amount of salt in your diet.
• Eat the recommended amount of calcium.
• Eat plenty of fruits and vegetables.
• Eat foods with low oxalate levels.
• Eat less meat.
To understand how these tips apply to you, talk to your healthcare provider.
Preventing Kidney Stones
DIET TIPS TO PREVENT STONES
Half of all people who get a stone will get another one. Based on the type of stone you have, your current health issues, age and nutrition needs, your health care provider may give you tips to prevent future stones. It is very unlikely you will need to follow every tip below. But it is important to talk with your health care provider and find out which tips will work best for you. Check which diet tips your health care provider recommends for you:
Drink enough fluids each day.
If you are not producing enough urine, your health care provider will recommend you drink at least 3 liters of liquid each day. This equals about 3 quarts (about ten 10-ounce glasses). This is a great way to lower your risk of forming new stones. Remember to drink more to replace fluids lost when you sweat from exercise or in hot weather. All fluids count toward your fluid intake. But it’s best to drink mostly no-calorie or low-calorie drinks. This may mean limiting sugar-sweetened or alcoholic drinks.
Reduce the amount of salt in your diet.
This tip is for people with high sodium intake and high urine calcium or cystine. Sodium can cause both urine calcium and cystine to be too high. Your health care provider may advise you to avoid foods that have a lot of salt. The Centers for Disease Control (CDC) and other health groups advise not eating more than 2,300 mg of salt per day.
Eat plenty of fruits and vegetables.
Eating at least five servings of fruits and vegetables daily is recommended for all people who form kidney stones. Eating fruits and vegetables give you potassium, fiber, magnesium, antioxidants, phytate and citrate, all of which may help keep stones from forming.
Eat foods with low oxalate levels.
This recommendation is for patients with high urine oxalate. Eating calcium-rich foods (see next page) with meals can often control your urinary oxalate level. Urinary oxalate is controlled because eating calcium lowers the oxalate level in your body. But if doing that does not control your urine oxalate, you may be asked to eat less of certain high-oxalate foods. Nearly all plant foods have oxalate, but a few foods contain a lot of it. These include spinach, rhubarb and almonds. It is usually not necessary to completely stop eating foods that contain oxalate. This needs to be determined individually and depends on why your oxalate levels are high in the first place.
Eat less meat.
If you make cystine or calcium oxalate stones and your urine uric acid is high, your health care provider may tell you to eat less animal protein. If your health care provider thinks your diet is increasing your risk for stones, he or she will tell you to eat less meat, fish, seafood, poultry, pork, lamb, mutton and game meat than you eat now. This might mean eating these foods once or twice rather than two or three times a day, fewer times during the week, or eating smaller portions when you do eat them. The amount to limit depends on how much you eat now and how much your diet is affecting your uric acid levels.
Eat the recommended amount of calcium.
If you take calcium supplements, make sure you aren’t getting too much calcium. On the other hand, make sure you aren’t getting too little calcium either. Talk with your health care provider or dietitian about whether you need supplements. Good sources of calcium to choose from often are those low in salt. Eating calcium-rich foods or beverages with meals every day is a good habit. There are many non-dairy sources of calcium, such as calcium-fortified non-dairy milks. There are good choices, especially if you avoid dairy.