by Dr. Amar Singh, MD Specializes in Urology

Erlanger Hospital is proud to announce its position as the first healthcare facility in Tennessee to utilize advanced ultrasound technology to treat patients with prostate cancer. We now offer Robotic Focal HIFU (high-intensity focused ultrasound), a groundbreaking method for focal prostate treatment.

Historically, the concept of a lumpectomy, as opposed to a radical mastectomy, for breast cancer was met with skepticism and resistance. However, it has since become the standard of care, significantly improving many women’s physical quality of life. Similarly, prostate cancer has been deemed unsuitable for focal therapy, or “lumpectomy,” due to the size and relative inaccessibility of the prostate, the multifocal nature of the disease, and concerns that focal therapy may limit treatment options in case of recurrence.

Today, thanks to Robotic Focal HIFU (high-intensity focused ultrasound), a prostate “lumpectomy” is indeed possible. Erlanger Health leads the way in Tennessee by offering HIFU, a specialized technology explicitly designed for focal treatment of the prostate.

During HIFU treatment, targeted sound waves heat and burn the affected prostate area while preserving healthy tissue. This approach can potentially reduce the risk of side effects such as incontinence or impotence. HIFU has already been successfully used worldwide in Europe, treating over 65,000 patients. Encouraging results have been observed regarding both survival rates and quality of life.

A significant advancement in HIFU treatment is integrating ultrasound images with MRIs and biopsy data, known as “fusion HIFU.” By viewing the combined 3D images on a monitor, physicians can precisely focus the ultrasound waves, improving treatment planning and allowing for smaller margins around the cancerous tissue. This precision minimizes damage to healthy tissue, resulting in fewer side effects for prostate cancer patients undergoing HIFU procedures.

While HIFU may not be suitable for all patients diagnosed with localized prostate cancer, it provides a viable option for those who find active surveillance stressful or wish to avoid radical treatment such as surgery or radiation. HIFU serves as a middle ground between these two approaches, enabling patients to maintain their quality of life.

HIFU is a minimally invasive, radiation-free procedure that directs high-frequency sound waves through a probe inserted into the rectum. By selectively heating and destroying cancerous tissue while sparing healthy areas, HIFU holds promise in reducing the risk of impotence or incontinence. Internationally, HIFU has demonstrated positive outcomes, such as preserving continence for 97% of patients and erectile function for over 78% of men in a multicenter study conducted by the French Association of Urology (AFU).

The fusion of HIFU images with MRIs and biopsy data represents a significant leap forward in prostate cancer treatment. This fusion capability allows for enhanced targeting of diseased tissue during treatment planning, resulting in smaller margins around the contours of the tissue. By minimizing damage to healthy tissue, HIFU reduces side effects.

Most women at some point get to have the experience of a urinary tract infection. This type of infection is commonly referred to as a UTI. According to statistics, approximately 10 million healthcare visits each year are attributed to this common problem. As much as UTIs may seem like just another annoying problem, there can be more to them than meets the eye.

Urinary tract infections are only beat by the common cold in terms of statistics. Being a highly common infection, the UTI is something every woman should be familiar with. Not in the way of having to endure the burning sensation and frequent need to urinate, but in the way of knowing more about how this infection may develop, how to decrease risk, and what to do in the event of a UTI.

Thoughts about UTIs to Forget

There are a few ideas about urinary tract infections that may lead to unnecessary suffering. These include:

• A UTI will go away on its own. This is not a given. Sometimes, the infection in the urinary tract may resolve spontaneously. However, one cannot “wait it out.” This infection is caused by the E. coli bacteria, one that has become more resistant over time. Prompt treatment is necessary to avoid infection affecting the kidneys.
• Sex causes UTIs. A urinary tract infection is not an STD. However, some women do notice that their UTIs tend to occur within 24 hours of having sexual intercourse. The reason this is so is that the close contact and friction between bodies may facilitate the movement of E. coli from the rectal area to the vaginal area.
• A UTI is associated with poor hygiene. A woman’s vaginal area does have a certain amount of bacteria, just like the rest of her body. The idea that poor hygiene can lead to a UTI is a myth. In fact, over-cleaning or using harsh chemicals or soaps in the genital area can destroy the good bacteria that are present to fight infection.

What Might Trigger a UTI?

There are several triggers to urinary tract infections. These include:

• coli bacteria (the most common cause of UTI) that live in the rectal area.
• Allergic reaction to feminine products.
• Certain birth control methods, such as spermicide or diaphragm use.
• Certain additives and chemicals in foods (caffeine, sugar, and fructose) can trigger symptoms that mimic a UTI.

How to Prevent and Treat UTIs

If you are prone to urinary tract infections, it pays to investigate your triggers. Cleaning the genital area before and after sex helps some women reduce instances of infection. Urinating after sex can also help. And, yes, there is truth to the fact that cranberry juice can help. It isn’t the juice, though, it’s a chemical in cranberry juice called D-Mannose that inhibits E. coli bacteria from adhering to the walls of the urethra and bladder.

If you develop a urinary tract infection and do not get quick relief from a supplement like D-Mannose and increased water intake, schedule a visit with your doctor. Proper antibiotics can promptly destroy the bacteria causing symptoms.

For a consultation with one of our friendly urologists, call (423)-778-5910.

Every man has an innate knowing that his testicles are a delicate area of his body. Even the topic of testicular pain is a sensitive one to discuss. The testicles are front and center, so to speak, which makes them vulnerable on a physical level.  Emotionally, the testicles are known to support male sexual development and virility throughout adulthood. Injury or pain in the testicles, then, can understandably present a fair amount of concern. Here, we discuss what testicular pain may mean.

Does testicular pain suggest cancer?

This is the big question, so we’ll tackle it first. Urologists may see one or more patients every week who are concerned about testicular pain. While pain itself is clearly a common issue, the correlation between pain and testicular cancer is very weak. Testicular cancer is actually quite rare, accounting for only one percent of all cancers that affect men. Furthermore, it is more likely that testicular cancer will present as swelling or a painless lump in one of the testicles. Men can and are encouraged to learn how to perform self-checks to spot testicular cancer or other changes to their anatomy.

Potential Causes of Testicular Pain

• Testicular torsion is a type of pain that may more commonly affect young men (aged 10- to 20-years). This condition can be serious due to its restriction of blood flow to the testes. Torsion typically occurs quickly and causes intense pain. If comfort does not improve within a few minutes, prompt medical attention should be sought.
• Epididymitis is a painful problem that involves inflammation in the tube at the back of the testicle. This condition is typically caused by infection. Often associated with STIs like chlamydia, it is also possible for a basic urinary tract infection to cause epididymitis. A course of antibiotics may be prescribed to resolve the infection.
• Orchitis is also related to infection. This inflammation occurs in the testicles themselves and may improve with antibiotics.
• Hydroceles can cause dull pain that also creates a sense of nausea. This condition involves fluid accumulation near or within the epididymis.
• Spermatocele is an uncomfortable problem related to fluid accumulation in the testicles.
• Varicoceles are a type of varicose vein, or swollen vein, in the testicle.

Most cases of testicular pain can be easily treated with nonsurgical or microsurgical techniques. Don’t let pain bench your quality of life. Call our Chattanooga office at (423) 778-5910 to schedule a consultation.

Dr. Amar Singh featured in the article, “After rough ride, Jim Trubey is back in his Santa suit.” Read the full article here or watch a video about Santa Jim to learn more about Dr. Singh’s kidney stone treatment.

When we think about overactive bladder (OAB) treatments, many of us inevitably focus on the many medications that we can use to treat the symptoms of urinary urgency, frequency or urgency incontinence. Or perhaps we might even think of more advanced therapies such as botulinum toxin, sacral neuromodulation or percutaneous tibial neuromodulation. However, patients and health providers should be careful not to dismiss everyday changes that can be made without ever going to the pharmacy or visiting the doctor’s office. In fact, because behavioral changes can be so important, the current American Urological Association guidelines on OAB urge providers to offer these as first-line therapies. Even better, behavioral treatments are as effective as medications with few if any side effects. For those people who may eventually require medications or more advanced therapy, multiple studies confirm that these treatments are made more effective if combined with behavioral treatments.

Behavioral treatments for OAB include fluid reduction, diet changes, weight loss, and pelvic floor exercises. Bladder training (BT) is another means of behavior therapy for OAB that can be effective in a properly motivated or dedicated person. BT begins with education about overactive bladder often accomplished with brochures, websites or videos. Completing a record for several days of how often one voids (and whether there is an urgency to void) helps to identify a time interval of typical urination. The goal becomes to gradually increase that interval, usually by 30 minutes every 1-2 weeks. There are numerous distraction techniques (pelvic contractions, relaxation techniques) that can be used to ignore any urinary urgency that comes in between the interval.

How effective is bladder training? Trials comparing BT to the most common medications used to treat OAB show that it is as effective as medications with fewer side effects. Perhaps more encouraging, other therapies including medications, are more effective if you add bladder training. So, not only can behavioral therapies be used to treat OAB on their own, but they should be continued even if you move on to other therapies.

It should be remembered that bladder training can be difficult. It requires time and attention that some people are not able to devote. The number of patients remaining adherent to bladder training tends to be low in many of these studies. We certainly could use better tools to make this therapy more successful. Yet, for the determined patient who wants a successful therapy without the cost or side effects of medication, BT can be a wonderful therapy.

Colin M. Goudelocke, M.D.

Voiding difficulty in women may include difficulty starting or maintaining the urine stream or the need to push or strain to empty the bladder. Often this voiding dysfunction results in incomplete emptying of the bladder. While it can result from more easily identified causes such as a previous incontinence surgery or advanced bladder prolapse, quite often the reason for the voiding dysfunction is not clearly known. Often, patients are treated for this voiding difficulty by undergoing a procedure to stretch the urethra (the urine tube that exits the bladder). This is called urethral dilation. And though this may be a commonly performed therapy, this review by Basu and Ducket accurately points out that there is little evidence to support the continued use of routine urethral dilation in the treatment of voiding dysfunction.

The authors detail the history of urethral dilation beginning in a time when very little was known about normal voiding.  Dilation of the urethra emerged as a treatment for numerous problems including urinary tract infections and bladder pain. The assumption was that these issues resulted from a urine tube that was too narrow to permit proper emptying of the bladder. However, it is now known that spontaneous narrowing of the urethra (urethral stenosis) is uncommon and probably represents only 1-2% of patients with voiding dysfunction. This is much less common than the frequency of urethral dilation would suggest. One concern is that repeated urethral dilation can even be the cause of narrowing of the urethra due to fibrotic healing.

Perhaps the popularity of urethral dilation is because it can produce a short-term effect, making voiding easier and relieving some symptoms such as incomplete bladder emptying. This is likely due to the temporary malfunction of the urethra and surrounding muscles caused by the stretching. This temporary benefit disappears in over 80% of patients by 6 months. And this may cause new urine leakage in nearly 20% of patients. Even patients with improvement are likely to be subjected to repeated urethral dilation to maintain this temporary effect.

There are treatments for voiding dysfunction that is either more effective or at least do not carry the risk of new urinary incontinence or development of urethral stricture. Patients may benefit from pelvic floor physical therapy using biofeedback, which may help to train patients to relax the muscles that constrict the urethra when voiding. Medications may help to relax these muscles as well. Finally, in patients who do not improve with biofeedback or medications, neuromodulation or botulinum toxin may be useful. These treatments rely on a better understanding of the complex interaction between the bladder and urethra that produces normal urination.

Outside of a small percentage of patients with urethral stricture (who often need a more extensive surgery rather than urethral dilation), urethral dilation provides, at best, a short-term fix that may carry significant risks. With little evidence to support its use, urethral dilation should become a rare treatment, not a common one.

Colin M. Goudelocke, M.D.

Ricky Crowe didn’t realize how big the tumor on his kidney was until he was in the recovery room.

His surgeon, Dr. Chris Keel, walked in with a three-dimensional, full-size model and Crowe saw for the first time the growth winding around his kidney.

“I’d seen the pictures, but I just didn’t understand it until he showed me that,” Crowe said. “It helped a lot.”

More patients at Erlanger hospital will have Crowe’s experience as a result of a contract the hospital signed Wednesday with 3D Ops, a local tech startup that hopes to launch a nationwide network of 3-D printing centers to give surgeons and patients a real-life look at damaged organs before starting surgery.

What’s key is that the model Keel used was not a normal kidney, but rather, a model of his patient’s actual kidney — with all of its abnormalities.

“It is Ricky’s kidney,” said Keith Campbell, president of 3D Ops. “You see the real thing.”

That can be a big help for a surgeon. Keel wanted the arteries to be printed in blue and the kidney in clear plastic, so he could see how to avoid slicing into the arteries when he cut out the tumor.

“There are some benefits in being able to see it in three dimensions and having a game plan when you get in there,” he said.

While he said he could have performed Crowe’s surgery without the aid of the model, it made it easier for him to remove the tumor without taking out the kidney as well.

Campbell said the idea for the process came three years ago, when he was talking with Dr. David Seaberg, dean of the University of Tennessee College of Medicine Chattanooga.

“We were looking at what you could do with 3-D printing and he said, ‘You know, we have all sorts of models of what is right. But we don’t have models of what is wrong,'” Campbell said.

The Erlanger contract is a major step forward in building what Campbell hopes will be a network of several dozen 3-D printing centers, serving hundreds of hospitals. 3D Ops’ goal is to turn around the models in 24 hours or less. The company has patents, Campbell said, on the software that converts images from CT scans or MRIs — the expensive machines hospitals use to capture an image of the insides of the body — into a format that can be used for 3-D printing.

The Erlanger deal also gives 3D Ops the opportunity to work with the hospital imaging staff to figure out the proper settings, or protocols, to use for each machine and each type of operation.

And it will give the company a chance to work with other surgeons to figure out more ways to use the models.

Keel believes the modeling would be particularly helpful for reconstructive surgery, where a doctor may need to bend pieces of metal around bones in order to reshape a face. If the metal could be shaped in advance using the physical model, he said, it could dramatically shorten the length of the operation. Campbell is also optimistic about future improvements in 3-D printing.

The technology has been around since the 1980s, but has made significant improvements in the past few years in terms of the materials that can be used, the level of detail that can be printed, printing speed and cost. The process works much like a traditional printer, with a print head moving across a space and spraying a layer of liquefied material. But instead of ink, metals such as copper or titanium can be used or various forms of plastic or even food products. Each pass of the printing head adds a new layer and over time those layers add up to form the 3-D model.

Many large teaching hospitals, where surgeons are trained, may be able to afford their own 3-D printing equipment, Campbell said.

But that still leaves more than 5,000 hospitals across the U.S. which are unlikely to buy their own equipment, given its complexity and how fast the technology is changing.

Campbell is not shy about his goals. In five years, 3D Ops hopes to have more than 300 hospitals in its network, printing an average of 11 models per hospital each month, at an average cost of $400 per model, plus a monthly subscription fee for each hospital.

“By the fifth year, we’re a $49 million company in revenue, $20 million in profit,” Campbell said.

Keel, a urologist who has been performing advanced kidney surgery for several years now, even foresees a time when a surgeon would use a detailed 3-D printed model of a damaged organ to work out exactly how to perform a surgery. Then the surgeon could upload those instructions to a robotic surgeon to perform the surgery on a patient located hundreds or thousand of miles away.

Read the original article here.