Frequently Asked Questions
PSA are the initials of prostatic specific antigen. This is a substance that is only produced in the male prostate gland and thus the measurement of which can tell us a lot about what is going on in the prostate. The PSA can be normal or can be elevated. Normal is usually 4.0 but it is age related. In other words, a 35-year-old with a PSA of 2 might be dramatically abnormal whereas a 75-year-old with a PSA of 4.5 might be perfectly normal. The PSA can become elevated by anything that inflames the prostate such as infection, bicycle riding, constant irritation possibly from prostate stones, cancer or benign enlargement of the prostate. All of these conditions can be evaluated by a urologist and usually an explanation for an elevated PSA can be found.
There are certainly several different types of urinary leakage. We call urinary leakage, urinary incontinence. When a person has the sudden urge to urinate and leaks before finding toilet facilities, we call this urge incontinence, and it is usually treated with medicine. When a patient leaks urine when they stress, cough, sneeze, step off of a curb, etc., this is called stress incontinence. Mixed urine incontinence is a combination of the two above. These two are usually treated with surgery or biofeedback (pelvic exercise). When patients have had surgery and their urinary sphincter has gotten damaged we call this instrinsic sphincter dysfunction (or Type III urinary incontinence). Occasionally, patients will have a foreign body in the bladder such as a catheter, and this provokes bladder spasms around the catheter, which may stop up or occlude the hole in the end of the catheter. Urine is then forced around the catheter and leakage is experienced. In other words, the type of incontinence determines the treatment - surgery, medicine or bulking agents.
This is a variable question. If the patient has no complication from the vasectomy and follows the instructions to the T by taking a few days off and not stressing or straining for a week, most are back at their jobs 72 hours after a vasectomy and to full activity within one week. Any complication along the way might make the recovery a little bit longer. If one develops an infection or bleeding following the vasectomy, recovery could be as long as a month, but this is extremely rare (less than 5%).
If a patient is still symptomatic three days after starting a medication for a urinary tract infection, several things could be wrong. Either the infection could have been misdiagnosed, the patient might have been placed on the wrong antimicrobial, inflammation might have been present without infection, a viral infection might have been present, or another ailment such as interstitial cystitis or trigonitis (inflammation of the base of the bladder) might be occurring. If a patient is still symptomatic after having been placed on an antimicrobial for 72 hours then I would recommend seeking the attention of a urologist.
Dr. Lugg finished his residency in 1996 and received his Boards in Urology in 1998. He was in practice for four years in North Carolina before deciding to move back to the West. He moved to Cheyenne in May 2000.
Dr. Bryant finished his residency in 1978 and became Board Certified in 1986. He was in practice for 17 years in Chattanooga, Tennessee before moving to Cheyenne in May of 2002.
Dr. Harris finished his urological residency in 1984, and he has over 20 years exprience.
Trigonitis is an interesting disease that has been studied since before 1920. We used to think that it was an inflammation of the trigone (the base of the bladder), but others think that it may have something to do with hormone levels in the area of the base of the bladder. This area of the bladder has the same embryologic origin as the top of the vagina in a female and thus sometimes responds to hormone therapy, as do problems with the vagina. Treatments over the years have been offered to stretch the urethra (urethral dilatation), fulgurating or electrocoagulating the trigone, lasering the trigone to try to destroy the nerve endings, in addition to using antispasmodic medications and medicines that prevent burning urination. More recently a neurological origin has been proposed for trigonitis and some people think that the disease should be lumped into the category of "pelvic pain syndrome." Stimulating some of the nerves that come out of the sacral spine has been tried with some success and studies are ongoing in this area.
The treatments are determined by the cause of the erectile dysfunction. Sometimes medications can cause the problem and merely changing the medicine for hypertension, for example, can solve the problem. If a man has a low male hormone level (testosterone), supplemental testosterone by patch or injection might solve the problem. Other causes of erectile dysfunction may be treated by a vacuum erection device (VED) to help pull blood into the penis or by medication such as Viagra. Urethral suppositories of a dilating substance can be tried alone or occasionally in combination with one of the above. Our office is usually doing research on these types of medicines and sometimes patients can qualify for a protocol to try an investigational drug for the erectile dysfunction. Other therapies include injection of the penis with substances that cause dilation of the blood vessels, giving an erection that can last anywhere from ten minutes to four hours. The last alternative, but one that has met with over 90% acceptance and success rate around the country, is the implantation of an inflatable prosthesis. Pressing a bulb in the scrotum can inflate the penis long enough for intercourse and then it can be deflated at will. This is a surgical procedure usually requiring one night in the hospital.
The treatment for prostate cancer is varied according to the Stage and Grade of the cancer as well as the patient's age. Younger men who develop prostate cancer, if it is confined within the prostate and has not spread to other organs, usually opt for prostate removal (radical retropubic prostectomy). Other options are external radiation and implantation of radioactive seeds. A newer option available for more advanced disease or the older population is cryotherapy (freezing the prostate). This therapy has been available at Cheyenne Regional Medical Center West since 2001 and has met with excellent success across the country. When prostate cancer has spread beyond the confines of the prostate, other options are available including various experimental protocols for chemotherapy as well as manipulation of male hormones to try to deprive the prostate cancer growth. These protocols are available here in Cheyenne through our relationship with medical oncologists and radiation oncologists, and here at Cheyenne Urological, P.C.
The treatment of bladder cancer depends on what type of cancer exists and in what stage it exists. Superficial bladder cancer can be treated by lasering in the office, resection in an outpatient facility or intra-bladder chemotherapy with a variety of three or four different substances. When the bladder cancer has invaded the muscular wall of the bladder, however, more drastic steps must be taken consisting of removing the bladder and diverting the urinary stream by a piece of intestine, or occasionally a patient has too many severe medical conditions to consider major surgery, and then a combination of radiation therapy to the bladder and chemotherapy can be employed. This actually has a pretty good success rate in the population that is not amenable to surgery.
Dr. Bryant has 18 years of experience in pediatric urology and surgery
Dr. Harris, sees pediatric patients and has over 20 years experience