absorbent products: Pads and garments, disposable or reusable, worn to absorb leaked urine. Absorbent products include shields, undergarment pads, combination pad-pant systems, diaperlike garments, and bed pads.
artificial urinary sphincter (AUS): Sometimes complicated cases of incontinence require implantation of a device known as an artificial urinary sphincter. People who might benefit from this treatment include those who are incontinent after surgery for prostate cancer or stress incontinence, trauma victims and people with congenital defects in the urinary system. The artificial sphincter has three components, including a pump, balloon reservoir, and a cuff that encircles the urethra and prevents urine from leaking out. The cuff is connected to the pump, which is surgically implanted in the scrotum (in men) or labia (in women). The pump can be activated (usually by squeezing or pressing a button) to deflate the cuff and permit the bladder to empty. After a brief interval, the cuff refills itself and the urethra is again closed. Because the artificial sphincter is an implant, it is subject to the risks common to implants, such as infection, erosion (breaking down of tissue) and mechanical malfunction. Yet with appropriate pre-surgical evaluation, operative techniques and postoperative follow-up, many problems can be avoided and incontinent patients can experience an improved quality of life with this device.
assisted reproductive technologies (ART) : The new forms of fertility treatment incorporate many methods of sperm retrieval and preparation. Once the sperm have been processed to ensure optimal fertilizing potential, they are used in a variety of procedures that aid the process of conception. These procedures include artificial insemination (AI), in vitro fertilization (IVF), and sperm microinjection techniques.
behavioral techniques: Different methods to help “retrain” the bladder and get rid of the urgency to urinate. (see biofeedback, bladder training, electrical stimulation, habit training, pelvic muscle exercises, prompted voiding).
brachytherapy: Involves the placement of tiny radioactive pellets into the Prostate gland. By utilizing ultrasound to place the seed pellets, damage to surrounding tissues is minimized. Approximately 13,500-16,000 rads of radiation energy is delivered directly to the Prostate. This procedure is performed on an outpatient basis. It is a one time procedure with very effective results. The 10-year follow-up outcome data parallels that of Radical Prostatectomy.
chancre: A hard, syphilitic primary ulcer, the first sign of syphilis, appearing approx. 2 to 3 weeks after infection. The ulcer begins as a painless lesion or papule that ulcerates. Occurs generally singly, but sometimes may be multiple.
chemolysis : Certain types of kidney stones can be dissolved with the application chemicals. Uric acid stones, for example, can be dissolved with a solution of sodium bicarbonate in saline. Cystine stones may be treated successfully with a combination of acetylcysteine and sodium bicarbonate in saline. Struvite and carbon apatite stones can be treated with an acidic solution of hemiacidrin. The procedure involves infusing the chemical solution into the affected area by means of a ureteral catheter in a series of treatments over time until the stone is dissolved. The patient’s urine must be cultured regularly throughout the course of treatment to guard against urinary infection and prevent the buildup of excessive chemical levels, particularly magnesium, which can cause other health problems.
cyst: A lump filled with either fluid or soft material, occurring in any organ or tissue; may occur for a number of reasons but is usually harmless unless its presence disrupts organ or tissue function.
detrusor-external sphincter dyssynergia (DESD): Damage to the nervous system can create a lack of coordination between the bladder and the external sphincter muscle, which is the muscle that controls the emptying of the bladder. As a result the bladder cannot empty completely which creates a buildup of urinary pressure. DESD is a combination of thses two factors and can lead to severe urinary tract damage and life-threatening consequences.
electrohydraulic lithotripsy (EHL) :This technique uses a special probe to break up small stones with shock waves generated by electricity. Through a flexible ureteroscope, the physician positions the tip of the probe 1 mm from the stone. Then, by means of a foot switch, the physician projects electrically generated hydraulic shock waves through an irrigating fluid at the stone until it is broken into small fragments. These can be passed by the patient or removed through the previously described extraction methods. EHL has some limitations: It requires general anesthesia, and is generally not used in close proximity to the kidney itself, as the shock waves can cause tissue damage. Fragments produced by the hydraulic shock also tend to scatter widely, making retrieval or extraction more difficult.
external beam radiation therapy: A 25-28 treatment protocol that utilizes External Beam Radiation. Approximately 6800-7400 rads of radiation energy is delivered to the Prostate. There can be some radiation effect on surrounding tissues.
habit training: A behavioral technique that calls for scheduled toileting at regular intervals on a planned basis. Unlike bladder training, there is no systematic effort to motivate the patient to delay voiding and resist urge.
hormonal therapy: Involves the use of anti-androgens. An androgen is a male hormone needed for the production of testosterone. By depriving the cancer cells of the testosterone they need for growth, tumors regress in size and cellular activity. Side effects include gynecomastia, the enlargement of breast tissue, hot flashes, and loss of libido ( desire to have sex ). Some long term hormonal therapy is associated with the loss of muscle mass, osteoporosis, and malaise ( loss of energy ).
hypermobility: A condition characterized in which the pelvic floor muscles can no longer provide the necessary support to the urethra and bladder neck. As a result, the bladder neck drops when any downward pressure is applied and causing involuntary leakage. This condition is the most common cause of stress urinary incontinence.
InterStim continence control therapy: A therapy used in treating urge incontinence. A device, about the size of a pacemaker, that is implanted into the sacral nerves of the lower spine, where it delivers electrical impulses that help regulate bladder function.
intrinsic sphincter deficiency (ISD): Weakening of the urethra sphincter muscles. As a result of this weakening the sphincter does not function normally regardless of the position of the bladder neck or urethra. This condition is a common cause of stress urinary intinence.
laparoscopic lymph node dissection: If a perineal prostatectomy is contemplated then prior to the operation the pelvic lymph nodes are sampled via three small incisions made in the abdomen, much like the procedure used to remove gallbladders.
microwave (targis): A catheter is placed within the bladder and positioned within the prostate, then the antenna emits microwaves. This procedure increases the passageway allowing for easier urination.
open nephrolithotomy: is the most invasive procedure for removing kidney stones. Because it is so traumatic, most kidneys can withstand no more than two such operations. Deep anesthesia is required, after which the surgeon makes a large (10-20 centimeter) incision in the patient’s back or abdomen, depending upon where the stone is located. Either the ureter or the kidney isopened and the stone extracted. Most patients require prolonged hospitalization afterward, and recovery may take up to two months.
percutaneous nephrolithotomy (PCN): Percutaneous means “though the skin.” In PCN, the surgeon or urologist makes a 1-centimeter incision under local anesthesia in the patient’s back, through which an instrument called a nephroscope is passed directly into the kidney and, if necessary, the ureter. Smaller stones may be manually extracted. Large ones may need to be broken up with ultrasonic, electrohydraulic or laser- tipped probes before they can be extracted. A tube may be inserted into the kidney for drainage.
pelvic muscle exercises: Pelvic muscle exercises are intended to improve your pelvic muscle tone and prevent leakage for sufferers of Stress Urinary Incontinence. Also called Kegel exercises. (see biofeedback)
periurethral bulking injections: A surgical procedure in which injected implants are used to “bulk up” the area around the neck of the bladder allowing it to resist increases in abdominal pressure which can push down on the bladder and cause leakage.
post-void residual (PVR) volume: A diagnostic test which measures how much urine remains in the bladder after urination. Specific measurement of PVR volume can be accomplished by catheterization, pelvic ultrasound, radiography, or radioisotope studies.
- suprapubic / retropubic prostatectomy: This involves the removal of obstructing prostatic tissue through a supra-pubic incision ( a cut below the belly button ). The Prostate is not wholly removed. Suprapubic Prostatectomy requires incising the bladder to remove the obstructing tissue while a Retropubic approach involves incising the Prostatic capsule to remove the obstructing tissue. Both approaches utilize an abdominal incision.
- radical retropubic prostatectomy: Removal of prostate through an abdominal incision. The prostate is completely removed. The advantage is that the lymph nodes can be sampled at the time of the operation and the nerve-sparing procedure is easier to do via this operation.
- perineal prostatectomy: A Perineal incision is utilized. The advantages are: less blood loss, easier visualization of the bladder / urethral anastomosis and decreased recovery time because the incision does not involve muscle or any other vital tissue
prostatron: Also called TUMT or Transurethral Microwave Thermotherapy. A catheter is placed within the bladder and positioned within the prostate, then the antenna emits microwaves. This procedure increases the passageway allowing for easier urination.
pubovaginal sling: A surgical procedure in which a man-made or cadaveric piece of material is placed under the bladder neck to support and immobilize. This technique improves sphincter function and decreases bladder neck movement, improving continence.
sling procedures: Surgical methods for treating urinary incontinence involving the placement of a sling, made either of tissue obtained from the person undergoing the sling procedure or a synthetic material. The sling is anchored to retropubic and/or abdominal structures.
stress urinary incontinence: Urinary Incontinence: The involuntary loss of urine during period of increased abdominal pressure. Such events include laughing, sneezing, coughing or lifting heavy objects.
TUMT (transurethral microwave thermotherapy): See Prostatron.
TURP (transurethral resection of the prostate): A surgical telescope is used to core out the inside of the prostate (urethra) creating a larger channel making the passage of urine easier. This is the gold standard for treatment of BPH.
ultrasonic lithotripsy : Similar to ureteroscopy, ultrasonic lithotripsy uses an optical scope and electronic probe, inserted into the ureter under epidural (spinal) anesthesia, to locate the stone. High-frequency ultrasound waves then are directed at the stone to break it up gradually. The fragments can either be passed naturally by the patient or removed by grasping forceps, basket extraction or suction through the scope instrument. The instrument is not flexible, however, so ultrasonic lithotripsy typically can be employed only when a straight path directly from outside the body to the stone is possible.
underactive bladder: A condition characterized by a bladder contraction of inadequate magnitude and/or duration to effect bladder emptying in a normal timespan. This condition can be caused by drugs, fecal impaction, and neurologic conditions such as Diabetic neuropathy or low spinal cord injury or as a result of radical pelvic surgery. It also can result from a weakening of the detrusor muscle from vitamin B12 deficiency or idiopathic causes. Bladder underactivity may cause overdistension of the bladder, resulting in overflow incontinence (see overflow incontinence).
ureteroscopy: A flexible, fiberoptic instrument resembling a long, thin telescope is inserted through the urethra and bladder up to the ureter to visualize the tube. Often used for retrieval of kidney stones.
vesica sling procedure: is a surgical sling procedure used to stabilize the bladder neck and provide support for the urethra using autologous or synthetic sling material. This procedure treats both hypermobility and ISD.
varicocele embolization: An outpatient procedure in which the varicocele is closed off (occluded) by means of a balloon catheter (flexible tube with a tiny detachable balloon), steel coil, and/or sclerosing (vessel-hardening) solution.
vasoepididymostomy A microsurgical procedure that uses a microscopic camera and very small operative tools to correct obstructions in the genital tract. The procedure requires removal of the blockage in the epididymis (the coiled tube that extends the length of each testis and connects with a larger duct – the vas deferens) and re-attachment of the epididymis to the vas deferens.