Dr. Phil’s Pearls of Wisdom

Updates on Urologic Topics of Interest in the Press -  Helping  you become a better informed health care consumer!

Incontinence
Possible link between Obesity and Incontinence is suggested in this article from the International Urogynecology Journal (August 2008) by Richter, et al. extracted and reviewed from Urology Select (Oakstone Publishing, Birmingham, Alabama, 2008)

This was data derived from a larger national study, “Program to Reduce Incontinence by Diet and Exercise” (PRIDE) clinical trial. In this substudy they explored the relationship between abdominal circumference (waist size), body mass index (BMI), and Urodynamic studies which serve to characterize incontinence as urge related (urge incontinence), related to physical forces (stress incontinence), or both forms (mixed incontinence) The average age was 55yrs and the average weight was 96kgs or 211.2 lbs. 85% were white and 13% were African American. The researchers discovered that there was a direct correlation between Abdominal Circumference, BMI, and incontinence due to the increase in pressures transmitted to the pelvis and pelvic floor. This suggests that obesity increases mechanical forces within the abdomen and pelvis which are responsible in part, for the increased incidence of incontinence in obese women.

In a article reviewed and extracted from Urology Select, (Oakstone Publishing, Birmingham, Alabama, 2008),  the reviewer Karl J. Kreder, MD looked at the role of Behavioral Therapy in women suffering from urge related incontinence, when it was added to first line medications known as anticholinergics and antispasmodic medications, Annals of Internal Medicine August 2008. 

“The trial demonstrated that while either mode of treatment (medication or Behavioral therapy) are effective  initial treatments for reducing the urgency and resultant urge incontinence, the combination of the two did not result in a sustainable reduction in incontinence episodes. Patients did however benefit in terms of their quality of life measures, such as satisfaction, perceived improvement in symptoms, etc….

The authors (Burgio KL, Kraus SR, et al) concluded that behavioral modification when added to a first line medication regimen was successful in helping reduce incontinence during the active phase of treatment  in women who either failed the medical regimen or obtained less than satisfactory outcomes on medication alone. The biggest deterrent to immediate combination therapy rather than stepwise treatment was the associated costs.”

Dr. Phil’s additional comment: The key to successful behavioral modification is a lifetime commitment to the exercise program. Too often patients will stop doing the very exercises that improved their bladder and bowel control issues, and helped reduce their pelvic pain.

Cancer
The Role of Vitamin C in Cancer:
In a article reviewed and extracted from Urology Select, (Oakstone Publishing, Birmingham, Alabama, 2008), IV Vitamin C given in large doses appears to be safe and free of toxic effects, including kidney stones, but it provides NO DIRECT TREATMENT IMPACT ON CANCERS BY ITSELF (Hoffer LJ, Levine M, et al. Ann Oncol 2008)

Prostate Cancer: Is More Vitamin D Better?
In a article reviewed and extracted from Urology Select, (Oakstone Publishing, Birmingham, Alabama, 2008), the study by Ahn J, Peters U, et al. in the J Natl Cancer Inst 2008;100 (April): 796-804, the authors conclude that “there is no association between Vitamin D levels and overall prostate cancer risk. Nonetheless, they point out that there may be an association between higher Vitamin D levels and a higher risk of aggressive prostate cancer.”

Dr. Phil’s take home message: Get a Vitamin D blood test drawn at your next Doctor’s visit, and with respect to taking Vitamin D-DON”T OVERDO IT!

Prostate Cancer: Robotic or Traditional Open Surgery?
In a article reviewed and extracted from Urology Select, (Oakstone Publishing, Birmingham, Alabama, 2008), and reviewed by Jay T. Bishoff, MD and published in European Urology 2008; (June 23) epub ahead of print, the authors (Schroeck FR, Krupski TL, et al.) retrospectively reviewed 219 cases of traditional radical open removal of the prostate and 181 cases of robotic prostatectomy between the years 2000 and 2007. A series of questionnaires were filled out by the patients that dealt with socio-demographic material, perioperative complications, type of procedure, length of followup, and questions about satisfaction and regret.

“Of the 400 patients responding (response rate of 61%),:

• 84% were satisfied (4 out of 5 men)
• 19% regretted their treatment choice (1 in 5 men)
• Patients who underwent Robotic Prostatectomy were in this study, more likely to express regret and dissatisfaction compared to those opting for the traditional open prostatectomy.”

Dr. Bishoff opines and Dr. Phil agrees that: “the expectations for robotic prostatectomy may exceed the reality of the results actually delivered by this new and costly technology.

Dr. Phil’s thought for the day:
It is only when you take the time to communicate with your doctors and they with you,
are expectations kept realistic, information shared,
misunderstandings avoided, and reasonable outcomes achieved.