About.com Urology

Chronic Kidney Disease: At Thanksgiving, Discuss Your Family�s Risk

Tue, 24 Nov 2009 14:22:39 +0000

� Gino Santa Maria - Fotolia.com

Chronic kidney disease (CKD) is a devastating disease process that afflicts African Americans, American Indians, and Hispanic Americans disproportionally. It can lead to chronic kidney failure (CKF) and make you dependent on kidney dialysis.

The leading causes of chronic kidney disease are high blood pressure, diabetes, and heart disease.

Compared with white Americans:

African Americans are nearly 4 times as likely to develop chronic kidney failure
American Indians have a 3-fold increase in chronic kidney failure
Hispanic Americans have double the risk of chronic kidney failure

Years ago, many devoted African-American urologists went to churches on Sunday to educate African-Americans about their increased risk for prostate cancer, and elevated risk for more aggressive prostate cancer at earlier ages than white Americans. Bringing health messages to areas of worship or barber shops, or anywhere you can find high-risk groups available for listening is worthwhile. Thanksgiving weekend is a time when people are often ready to listen.

Kidney Sundays

The National Institute of Diabetes, Digestive Disorders, and Kidney Diseases (NIDDK), an institute of the National Institutes of Health has launched an initiative called "Kidney Sundays." You can download materials for free from their website on the program and use them to discuss risk factors for chronic diseases, and ways to help lower your risk. Admittedly, it is not the most joyful discussion to share over a Thanksgiving meal, but you might want to bring it up later over the weekend when all of you are together.

Related Materials

_{Chronic kidney disease. Downloaded Nov. 24, 2009 from familydoctor.org.}

_{Chronic kidney disease: a family affair. Downloaded Nov. 24, 2009 from the National Kidney and Urologic Diseases Clearinghouse.}

Chronic Kidney Disease: At Thanksgiving, Discuss Your Family�s Risk originally appeared on About.com Urology on Tuesday, November 24th, 2009 at 14:22:39.

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When Less is More In Urology: The Case of Kidney Cancer

Sat, 21 Nov 2009 01:14:46 +0000

The past few weeks have had me thinking: can Americans adapt to a message in medicine that "less is more," when science confirms it?

Back in April, at the American Urological Association (AUA) annual meeting, the AUA issued its first-ever guideline for the treatment of early-stage kidney cancer. It is actually good news for patients.

The guideline states that the kidney should be saved whenever possible. Complete removal of the kidney [in early-stage kidney cancer]"puts patients at risk for chronic kidney disease and cardiovascular disease," according to the AUA.

In recent years, the number of people diagnosed with early-stage kidney cancer who had their kidneys removed rose dramatically. Many were diagnosed when they had no symptoms and only had their cancers identified through an imaging study done for another reason. Many people thought that they were doing well because the kidney was totally removed, when the cancer was confined to a relatively small part of the kidney.

AUA's specific recommendations for early-stage kidney cancer state that any of the following are reasonable treatment options:

partial removal of the kidney
thermal ablation, which uses heat to remove cancerous tissue
active surveillance

According to the AUA, these treatments "minimize risks and are viable options for patients with early-stage kidney cancer."

Does the average patient with early-stage kidney cancer know of these new guidelines? Do urology oncologists treating kidney cancer follow these guidelines? It is probably much too soon to tell.

Taken in the context of the conflicts in the past few weeks over recommendations for less PSA screening, less breast cancer screening, and less cervical cancer screening, I commend the AUA and other physician organizations for reviewing the balance of benefits and harms in treating early-stage kidney cancer more aggressively.

I remember all too well the ruckus that ensued after a landmark clinical trial revealed that a lumpectomy resulted in no compromise in cancer control, yet spared the breast of women with early-stage breast cancer.

I think that it is going to take awhile for the American public to get used to thinking that less imaging, less screening, and less treatment in certain cases could possibly be better than more. Even though it has been a rocky start, we are taking some very positive steps.

Use Your Flexible Spending Account (FSA) $ Now

Wed, 18 Nov 2009 12:56:24 +0000

If you set up a flexible spending account with your employer in 2009, now is the time to review whether you have spent the money that you set aside. A flexible spending account (FSA) is an employer-sponsored benefit that you set up at the beginning of each year for spending on health care needs using pre-tax dollars.

Useful for some, flexible spending accounts may be moot for people who spent 2009 unemployed and for those who did not have extra dollars to divert to an FSA. FSAs are not available to those on Medicare.

FSAs allow you to purchase items that can be extremely costly when paid for out-of-pocket:

Continence and toileting supplies, including adult diapers
Fees for hospital services, long-term care services, accident and health, and qualified long-term care insurance premiums, nursing services, laboratory fees, prescription medicines, and insulin
Medical equipment (walkers, shower curtains, wheelchairs, etc.)
Gloves, first aid supplies, bandages, etc.

If you are still running short on spending your FSA allowance, consider adding these items:

Hand sanitizer. Because of the H1N1 (swine flu) virus, this is now an allowable expense.
Cold and flu medication
Contact lenses, eyeglasses, hearing aid batteries.
Sunscreen

Keep in mind that these benefits usually do not roll over. In some instances, an employer will allow you to carry your benefits forward, but you should check with your employer as soon as possible.

Have people found having that an FSA helps them manage their health care expenses?

Use Your Flexible Spending Account (FSA) $ Now originally appeared on About.com Urology on Wednesday, November 18th, 2009 at 12:56:24.

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Medicare Part D Enrollment Began Yesterday

Mon, 16 Nov 2009 22:32:50 +0000

Now is the time to actively review your options for Medicare Part D enrollment for 2010. You have until Dec. 31, 2009 to complete Medicare Part D enrollment, but health advocates suggest you review your plan options early and decide by Dec. 6th. Following the path of least resistance--rolling over into your current plan for next year, may not be cost effective and offer quality care. This is the once-a-year Medicare enrollment period.

To help you along, advocacy groups around the country are making themselves available to seniors:

Note to New York City Seniors: New York State Assemblymember Linda B. Rosenthal invites you to attend a Medicare Open Enrollment Information Session with the Medicare Rights Center tomorrow, Tuesday, Nov. 17, 2009, from 1PM to 2PM at JASA, 120 West 76 Street, between Columbus and Amsterdam Avenue. All are welcome. Light refreshments will be served.

Also check with State Health Insurance Assistance Program, a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities.

Picking the right plan is especially important for people who have significant health problems, whose health costs could spiral out of control, and those who hit the doughnut hole last year.

It will also be something you should review in the event of unexpected health problems in 2010.

How much risk are you comfortable taking on?

For the Medicare population with specific urology problems, take a hard look at how plans compare on drug and treatment coverage for urologic cancers, such as prostate, kidney, and bladder cancer, and an enlarged prostate or incontinence. I hope to provide you with more detailed suggestions on getting through this process as easily as possible.

Medicare Part D Enrollment Began Yesterday originally appeared on About.com Urology on Monday, November 16th, 2009 at 22:32:50.

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Trial Flags Overuse of Hormone Therapy in Prostate Cancer Patients Treated With Radiation

Tue, 10 Nov 2009 15:53:09 +0000

Low-risk cancer is the diagnosis for 7 of 10 men diagnosed with prostate cancer, and if all 10 men chose radiation therapy for prostate cancer treatment, only 3 men would need hormonal therapy before and during radiation therapy.

That's the take-home message from the National Cancer Institute's Radiation Therapy Oncology Group trial 94-08, the largest and longest trial of what is known as neoadjuvant hormonal therapy, hormonal therapy given to shrink the tumor prior to and during radiation therapy, Anthony L. Zietman, MD, president of the American Society of Therapeutic Radiation Oncology (ASTRO), told About.com's Urology Guide. Results from the trial were highlighted at the recent annual ASTRO meeting, the largest worldwide meeting of physicians involved in therapeutic radiation oncology.

Men who do not gain any benefit from hormonal therapy (the 7/10) are low-risk patients, which Dr. Zietman defined as men having PSAs between 4 and 5 and low-grade cancers, measured by a Gleason score 6 or lower. "Where it is clearly helpful is in men with intermediate- and high-risk cancers," he added.

If you have been diagnosed with prostate cancer, you should review these figures on your lab sheets and discuss this with your doctor.

Hormonal therapy was extremely popular, heavily promoted by industry, and lucrative for physicians during the 1990s. It caught on like wildfire across the United States, even though the evidence for using it was controversial.

What this really signals is another example of overuse of medical care that is not beneficial and may cause harm. It may sound discordant with how Americans view medical care.

However, Dr. Zietman explained: "Getting more from less fits with what patients really want and with contemporary economic reality." He added: "Recognizing areas of medicine in which we have been overtreating and changing our practice is what I call conscience-based medicine. It means doing what is right, whether it is ensuring that our patients get more when more is needed, or less when less is best, not operating with our wallets."

Trial Flags Overuse of Hormone Therapy in Prostate Cancer Patients Treated With Radiation originally appeared on About.com Urology on Tuesday, November 10th, 2009 at 15:53:09.

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FDA: Serious Complications of Transvaginal Mesh For Fallen Bladder, Stress Urinary Incontinence

Fri, 06 Nov 2009 17:55:09 +0000

If you are considering treatment options for a fallen bladder, uterus, or vagina, or bothersome stress incontinence, you should gather as much up-to-date information as possible. Transvaginal mesh is often used as a treatment to hold up a fallen bladder or stress urinary incontinence.

The Food and Drug Administration (FDA) issued a Medical Device Safety Alert about reports of complications associated with the placement of mesh through an incision made in the wall of the vagina. The FDA has received more than 1,000 reports from 9 manufacturers.

"The most frequent complications included erosion through the vagina, infection, pain, urinary problems and recurrence of the fallen bladder and/or incontinence.

Erosion and related vaginal scarring has sometimes led to discomfort and pain, including pain during sexual intercourse. Some patients needed additional surgery to remove the mesh. Injuries to adjacent organs, such as the bowel, bladder, and blood vessels was also reported to FDA.

The FDA urges women to discuss with their physician the pros and cons of using mesh for their particular stress incontinence problem. It lists 9 areas that patients should definitely discuss with their surgeon before agreeing to surgery:

Tell your surgeon whether you have previously had a reaction to mesh or polypropylene materials.
Ask what the pros and cons of using surgical mesh in your case in particular
If mesh is to be used, ask your surgeon what's been his or her experience with implanting this particular product--and what has been the experience of other patients that the surgeon has treated.
Ask how your surgeon deals with complications that might arise.
Ask what changes to expect after the surgery and how long to expect the results to last.
Ask about any specific side effects that you should tell your surgeon about after the surgery.
Find out what options you have, if for some reason, the mesh doesn't resolve your problem.
Find out what follow-up treatment would be done if you have complications related to the mesh--can the mesh be removed and what would the consequences be?
If a mesh is to be used, ask if for patient information that comes with the product

Reporting Complications to the FDA

Keep this on file:

You can report any problems to the FDA's MedWatch Adverse Event Reporting program either online, by mail, or fax:

Complete online MedWatch Voluntary Reporting Form 3500
Mail: MedWatch Forms to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
FAX: 1-800-FDA-0178
Phone: 1-800-FDA-1088

Related Resources

Video on Stress Urinary Incontinence.

FDA: Serious Complications of Transvaginal Mesh For Fallen Bladder, Stress Urinary Incontinence originally appeared on About.com Urology on Friday, November 6th, 2009 at 17:55:09.

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Urology Forum Takes Off

Tue, 03 Nov 2009 15:48:35 +0000

Good news: people are starting to chime in on the urology forum. I imagine that there are plenty of readers out there who might have urology concerns on their minds.

Right now, I have broken the forum up into three areas: for women, for men, and for kids. So try to post in the right category. Later there will be more.

We have some good discussions going on:

urinary incontinence in women
preventive antibiotics for kids with recurrent urinary tract infections
some cutting-edge research on the origins of prostate cancer

I'd like to point you to my new articles on an enlarged prostate , which are also in the spotlight now on my home page. I have heard of so many guys feeling frustrated by their symptoms of an enlarged prostate, wondering what treatments are for them, and if the treatments will end up worse than the bother they experience now.

The opportunities to discuss new topics is wide open, given that the messages are appropriate and informative.

You can sign up for my forum and newsletter at the links above. Hope to get to know you.

Urology Forum Takes Off originally appeared on About.com Urology on Tuesday, November 3rd, 2009 at 15:48:35.

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Chronic Kidney Failure Drug, Aranesp, At Center of Kick-Back Suit Against Amgen

Sat, 31 Oct 2009 09:15:50 +0000

Sales of Aranesp, the chronic kidney failure and anemia drug, were promoted through a kick-back scheme, alleges a suit against Amgen and AmeriSourceBergen Corporation, filed by 14 states and the District of Columbia. The kick-back scheme allegedly worked by providing free drug samples that were added to vials, The excess drug could then be used to treat patients and billed to Medicaid and other third-party insurers.

Physicians received sham consultant agreements and other services in exchange for promoting the drug to Medicaid and other third-party payers, according to a statement from N.Y.S. Attorney General Andrew Cuomo's office.

Amgen responded in a statement that the suit was "without merit" and is complying with lawmakers.

Once Amgen's product leader, Aranesp lost market share from $4.1 billion in sales in 2006 to $3.1 billion in 2008. The decline appears to be linked to questions about safety in kidney failure patients, particularly heart attacks and strokes. Its safety was questioned again this week in a clinical trial report in the New England Journal of Medicine, which revealed that kidney patients taking Aranesp had twice the rate of stroke as those on placebo.

Chronic Kidney Failure Drug, Aranesp, At Center of Kick-Back Suit Against Amgen originally appeared on About.com Urology on Saturday, October 31st, 2009 at 09:15:50.

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Testicular Cancer Survivors: Life Is Good

Thu, 29 Oct 2009 16:56:03 +0000

� Fotolia

Testicular cancer gets a lot of news coverage because of Lance Armstrong and other popular young athletes stricken with the disease. It upsets us when we hear about young men in the prime of their lives afflicted with it, but most of us have no idea how men with the disease do in the long term.

Now, there is good news that testicular cancer survivors report that their quality of life is good overall-- in fact the same as those for similar men without testicular cancer. Using standardized tests, a team of researchers studied all men treated at a Danish hospital between 1990 and 2000. They found testicular cancer survivors reported no statistically significant differences in a broad range of outcomes, including physical functioning, cognitive functioning, emotional functioning, depression, fatigue, motivation, and mental fatigue.

An examination of the impact of treatment strategy on outcome found that among patients treated with radiation therapy, a relatively high proportion reported GI symptoms. Patients who underwent chemotherapy reported higher levels of peripheral sensory neuropathy, hearing problems, and Raynauds syndrome. The authors state these problems are widely known to be irreversible.

If you or someone you know has testicular cancer, share this information with them. It may help them cope with dealing with getting effective treatment.

Sources

Women in Urology Increasing, But Better Numbers, More Leaders Needed

Tue, 27 Oct 2009 23:14:39 +0000

Women get kidney and bladder cancers, kidney stones, and need kidney transplants, just like men, Karen Boyle, MD, a female urologist from Baltimore, told me today. And we've got our special urologic concerns that merit the same attention as men's. However, the field has historically centered around that walnut-shaped gland, the prostate. That's an area that some fine women urology researchers have specialized in too, just as men have in female urology and ob/gyn.

It is no secret that I have been rooting for more women getting into urology since I first attended meetings of the American Urological Association in the 1990s. It is certainly impressive that the American Urological Association (AUA) now has 909 female members--although put into context--that is still only about 5.6% of the total membership.

I suspect that the figure of 909 members includes many women outside of the United States because the AUA is a global organization.

There has been a dearth of research on the status of women in urology, but a 2005 review revealed that as of 2003, women accounted for 1% of leaders in academic urology. Low figures mean that women may not find mentors to help them feel comfortable in the field or advance within it.

What do you think of these numbers and what can be done? Do you know of outstanding women urologists who are contributing to the field? I would very much like to see more up-to-date data and hear of initiatives to bring about change.

Sources

_{Lightner DJ, Terris MK, Tsao AK, Naughton CK, Lohse CM.Status of women in urology: based on a report to the Society of University Urologists. J Urol,/ 2005; 173(3): 560-3.}

About.com Urology

Chronic Kidney Disease: At Thanksgiving, Discuss Your Family�s Risk

Kidney Sundays

Related Materials

When Less is More In Urology: The Case of Kidney Cancer

Related Links

Use Your Flexible Spending Account (FSA) $ Now

Medicare Part D Enrollment Began Yesterday

Trial Flags Overuse of Hormone Therapy in Prostate Cancer Patients Treated With Radiation

FDA: Serious Complications of Transvaginal Mesh For Fallen Bladder, Stress Urinary Incontinence

Reporting Complications to the FDA

Related Resources

Urology Forum Takes Off

Chronic Kidney Failure Drug, Aranesp, At Center of Kick-Back Suit Against Amgen

Testicular Cancer Survivors: Life Is Good

Sources

Related Links

Women in Urology Increasing, But Better Numbers, More Leaders Needed

Sources

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