Urine Problems
Common Treatment for Chronic Prostatitis Fails to Reduce Symptoms
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Alfuzosin, a drug commonly prescribed for men with chronic prostatitis, a painful disorder of the prostate and surrounding pelvic area, failed to significantly reduce symptoms in recently diagnosed men who had not been previously treated with this drug, according to a clinical trial sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). The study is to be published in the New England Journal of Medicine.
“Although these results are disappointing, it is just as important to find out what doesn’t work as it is to know what does,” said NIDDK Director Griffin P. Rodgers, M.D. “We have conclusively shown that a drug commonly prescribed for men with chronic prostatitis did not significantly reduce symptoms compared to a placebo.”
Chronic prostatitis, which has no known cause and no uniformly effective therapy, is the most common type of prostatitis seen by physicians. Men with this condition experience pain in the genital and urinary tract areas, lower urinary tract symptoms such as pain in the bladder area and during urination, and sexual problems that can severely affect their quality of life. Population-based surveys estimate that 6 percent to 12 percent of men have prostatitis-like symptoms.
Men with Health Risk Behaviors Unaware of PSA Test
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New research of 7,297 men in California, published in The Journal of Urology ®, shows that self-reported prostate-specific antigen (PSA) test awareness was lower in current smokers, physically inactive men and obese men—a population with what researchers called, “health risk behaviors.” This study shows the need for more publicity to raise awareness of prostate cancer screenings. There is no better time than Prostate Health Month to raise awareness about prostate cancer screening.
The AUA and the AUA Foundation are trying to reach out to the public about prostate health. We are pleased to be co-sponsoring a number of events with different community partners to promote prostate health, education and awareness. Please see the attached calendar of events for more information on free Webinars, free prostate cancer screenings and 5K Runs/1 Mile Fun Walks around the nation that raise money to fund prostate cancer research.
The American Urological Association (AUA) and AUA Foundation want men to know that prostate cancer is curable, if found early through prostate cancer screenings. The AUA recommends that both a PSA test and a digital rectal examination (DRE) be offered annually, beginning at age 50 years, to men who have a life expectancy of at least 10 years. Men at high risk (those with a family history of prostate cancer or African American men) should consider beginning testing at an earlier age.
Health risk behaviors associated with lower prostate specific antigen awareness
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According to a study conducted at Columbia University Mailman School of Public Health, health risk behaviors such as smoking and obesity are associated with lower awareness of the Prostate Specific Antigen (PSA), which could lead to a lower likelihood of undergoing actual prostate cancer screening. Although previous studies have explored predictors of PSA test awareness, this is the first research to focus on health risk behaviors, such as smoking, physical inactivity, obesity, and excessive alcohol consumption. The study findings were reported in the August issue of The Journal of Urology.
Awareness of PSA testing is considered an important cognitive precursor of prostate cancer screening and it was found to contribute to differences in prostate cancer screening rates. Earlier studies have suggested that persons who seek out cancer information are more likely to acquire knowledge, demonstrate healthy behaviors, and undergo cancer screening. According to the Mailman School study, a quarter of the men older than 50 years without a history of prostate cancer who were among the population of 7,000 men studied, remain unaware of the PSA test.
“Our primary findings suggested that smoking, physical inactivity and obesity are inversely associated with awareness of the PSA test. These risk behaviors are linked with higher prostate cancer morbidity and mortality,” said Firas S. Ahmed, MD, MPH, Mailman School of Public Health, and first author. This finding may be due to a general lack of concern about health maintenance or less interactions with health care providers by smokers, according to Dr. Ahmed.
Male infertility fix works for men over 40
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A varicocele, an enlargement of veins in the scrotum, can impair a man’s fertility. Fortunately, surgery can correct the problem, and now a new study shows the procedure is just as effective for older men as it is for younger men.
“Older men (in the age range of 35-45) with varicocele do benefit from varicocele repair,” Dr. Armand Zini told Reuters Health, “particularly those men with secondary infertility”—i.e., infertility resulting from the varicocele.
Zini from McGill University in Montreal, Canada and his colleagues investigated the influence of age on pregnancy rates among partners of men who had undergone varicocele repair, comparing outcomes for men older and younger than 40 years.
Even modest weight gain raises kidney disease risk
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In healthy men of normal weight, relatively small increases in weight raise the risk of chronic kidney disease (CKD), according to a report by Korean researchers that will appear in the September issue of the Journal of the American Society of Nephrology.
The study, researchers say, suggests that CKD should be added to the list of conditions that are associated with weight gain, including diabetes and high blood pressure.
Obesity is a known risk factor for CKD, but the impact of weight gain in normal-weight individuals without high blood pressure or diabetes is unknown, Dr. Seungho Ryu, at Kangbuk Samsung Hospital in Seoul, and associates note in their report.
Tap water chemicals not linked to penis defect
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Though some research has linked chemicals in chlorinated tap water to the risk of birth defects, a new study finds no strong evidence that the chemicals contribute to a common birth defect of the penis.
The defect, known as hypospadias, occurs when the urinary outlet develops on the underside of the penis rather than at the tip. Genetics are thought to play a large role in hypospadias risk, but the other potential causes are not fully understood.
Some past studies have suggested that certain chemicals in tap water—byproducts of the chlorination process used to kill disease-causing pathogens—may contribute to the risk of birth defects and miscarriage. Other studies, though, have found no such links.
Weight Gain Within the Normal Range Increases Risk of Chronic Kidney Disease
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Healthy individuals who gain weight, even to a weight still considered normal, are at risk for developing chronic kidney disease (CKD), according to a study appearing in the September 2008 issue of the Journal of the American Society Nephrology (JASN). The study suggests that CKD should be added to the list of conditions that are associated with weight gain, including diabetes and hypertension.
Research has shown that obesity is linked to an increased risk of CKD, but no studies have looked at the effects of weight gain within the “normal” range of an individual’s body mass index. To investigate, Drs. Seungho Ryu and Yoosoo Chang of the Kangbuk Samsung Hospital in Seoul, Korea, and their colleagues conducted a prospective study of individuals who were of a healthy weight and had no known risk factors for chronic kidney disease.
In Korea, all workers participate in either annual or biennial health exams, as required by Korea’s Industrial Safety and Health Law. As a result, the investigators had access to clinical data from thousands of individuals. For this study, they included 8,792 healthy men who participated in the health exams in 2002.
Residual urine not tied to urinary infection
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Among nursing home residents, incomplete bladder emptying is not associated with the occurrence of a urinary tract infection, according to a report in the Journal of the American Geriatrics Society.
It is generally assumed that residual urine after voiding increases the risk for urinary tract infection, “in that it creates an environment favorable to bacterial growth,” Dr. Esther Kuhry from Namsos Hospital, Norway told Reuters Health.
However, she explained, “The few studies published so far show conflicting results with regards to the association of post-void residual and urinary tract infection in the elderly.”
Weight, lifestyle factors tied to urinary symptoms
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Adults who are obese or have less-than-ideal lifestyle habits may be more likely to have multiple, and more severe, urinary problems, new research suggests.
In a study of more than 5,500 men and women ages 30 to 79, researchers found that three-quarters of women and two-thirds of men reported at least one urinary tract symptoms—such as frequent trips to the bathroom overnight, difficulty emptying the bladder and urinary incontinence.
Obese adults were more likely than their normal-weight counterparts to have multiple, more severe symptoms. Smoking, lack of exercise and heavy drinking were also linked to more serious urinary problems.
Heart condition in those awaiting a kidney an ominous sign
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The presence of an often silent heart condition—systolic dysfunction, or decreased pumping action of the heart—nearly doubles the risk of death for patients on kidney transplant waiting lists, according to a study appearing in the Journal of the American Society of Nephrology for June.
“This study identifies a subset of chronic kidney disease population at significantly higher risk for death while awaiting transplantation, where the role of medical interventions and devices such as implantable cardiac defibrillators and pacemakers should be studied,” Dr. Angelo M. de Mattos, from the University of California in Sacramento, and colleagues write.
Widely available tests could be used to help identify those patients with chronic kidney disease who have systolic dysfunction, they add.
Legislation needed to provide coverage for ED treatment after prostatectomy
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Men who have developed erectile dysfunction (ED) following surgery for prostate cancer usually do not have insurance coverage for ED treatment even though their insurance policies cover surgery for prostate cancer, according to an analysis presented today at the 103rd Annual Scientific Meeting of the American Urological Association. In contrast, federal law requires that insurance companies which cover mastectomy for breast cancer treatment also cover breast reconstruction.
Erectile dysfunction (ED) is a common side effect of radical prostatectomy, though not always permanent, and almost all men experience some degree of ED following this surgery. The impact of ED on self-esteem and body image to prostate cancer patients can be as detrimental as the loss of a breast can be to a woman. However, the Women’s Health and Cancer Rights Act, passed by Congress in 1998, requires that third-party payers who cover mastectomy for breast cancer also cover the costs of breast reconstruction.
“There is compelling evidence that ED treatment leads to improved quality of life for the man and his partner,” said Ira D. Sharlip, M.D., a spokesman for the AUA. Therefore, as in the case of breast reconstruction for women, the cost of ED treatment should most certainly be covered for men.”
Poor kidney function tied to faster heart changes
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People with decreased kidney function have faster progression of clogged arteries in the neck and increased risk of heart attack, stroke and other cardiovascular events, research indicates.
Dr. Michel Chonchol, of the University of Colorado Health Sciences Center, Denver, and colleagues examined associations between different levels of kidney disease, the thickness of neck arteries—an indicator of atherosclerosis (hardening of the arteries)—and cardiovascular events in 3364 individuals.
At the outset, 551 subjects (16.4 percent) had chronic kidney disease and the average thickness of the neck arteries, determined with ultrasound, was 0.79 mm. The average change in neck artery thickness was 0.02 mm/year.
Bladder trouble tied to depression, anxiety
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Women who suffer from “dysfunctional voiding”—like having to urinate often and having difficulty voiding—experience a greater degree of depression and anxiety compared to women without these symptoms, research suggests.
“Dysfunctional voiding ... is more commonly seen in recent years,” Dr. Alex T. L. Lin, of Taipei Veterans General Hospital, Taiwan, told Reuters Health. “Although we suspect that depression and anxiety are reactions to the dysfunctional voiding, we could not preclude the possibility that psychological abnormalities might predispose one to the occurrence of lower urinary tract dysfunction,” he commented.
Lin noted that the stressful environment of modern society might be a contributing factor for the increased incidence of dysfunctional voiding.
Study Suggests Diet High in Saturated Fat Contributes to Prostate Cancer Treatment Failure
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In the online version of the International Journal of Cancer, Dr. Sara Strom and associates evaluate the association between saturated fat intake and biochemical failure among men who underwent radical prostatectomy (RP).
A cohort of 390 patients who underwent radical prostatectomy at MD Anderson Cancer Center had a semi-quantitative validated Block food frequency questionnaire modified to their regional diets and completed for the year prior to the diagnosis of prostate cancer. Body mass index (BMI) was also calculated. Clinical and pathological data were abstracted from medical records. Categorical and continual variables were analyzed.
Aging Men Can Reduce Health Risks Through Physical Activity
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Our results suggest that moderate to vigorous physical activity may reduce the risk of benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) by as much as 25% relative to a sedentary lifestyle. Although the strength of the association appears to be greater with higher levels of activity, there was a non-significant trend toward a protective effect with even light physical activity. Adjustment for multiple confounders in the studies included in this analysis underscores the independence of the protective effect of physical activity on the BPH/LUTS complex.
The notion that physical activity and other modifiable lifestyle factors may alter the risks and severity of BPH and LUTS challenges traditional etiological paradigms and intimates the need for the development of new pathogenic models for the BPH/LUTS disease complex. The assumption that BPH and LUTS are relatively immutable consequences of aging—driven by a combination of genetic predisposition, androgens, and estrogens—underpins prior models. While genotype and hormones are important components, the relationship of physical activity with BPH/LUTS demands consideration of additional modulators of these processes.
It is possible that physical activity influences prostate growth pathways through alterations in hormone levels. However, we believe a more likely explanation is that physical activity exerts beneficial effects through improved cardiovascular health.
