[Music] good evening and welcome to Dr on call I'm Dr Peter nen professor and head of the Department of Family Medicine and biobehavioral health and Associate Dean for Rural medicine at the University of Minesota medical school duth campus I your host for our program tonight on Men's Health prostate bladder and kidney problems the success of this program is very dependent on you the viewer so please call in your questions or email them to ask pbsn north.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Benjamin Marsh a urologist with a Cena health and Dr John Wood a family medicine physician with asentia health and faculty member at the duth Family Medicine Residency program our medical students answering the phones tonight are Riley Berg from beiji Minnesota Micah Christensen of Alexandria Minnesota and Alex host from Brainard Minnesota and now on to tonight's program on men's health prostate bladder and kidney problems and Dr Marsh the first question this evening is uh would you briefly explain the difference between bloody urine and microscopic hemera sure Peter so um bloody urine I guess we would be calling that gross hematuria in the medical word and that just means that you can see the blood in the urine when you with your naked eye microscopic hemia means to you it looks pure yellow but under the microscope they might see a few red blood cells and so those aren't supposed to be there that's abnormal we call it microscopic thank you Dr Wood um please name or explain a reason for needing to get up at night to urinate well that's a big question that's a broad topic the the technical medical term for that would be nocturia and noctua can be a sign of uh basically your a storage problem with your bladder meaning you're not able to store enough urine so you can't make it through the night so um often you'll have to go to the bathroom multiple times during the evening it could also be a sign of an infection so noctua could be a sign of maybe your prostate is enlarged you think of a term called BPH which is actually a fairly common thing as men get older but not all men develop symptoms of noctu but most men have an enlarged prostate so that's not an unusual thing in and of itself but nocturia could be a sign of kind of a chronic problem perhaps you're you've got an enlarged prostate you're not able to store urine you're you're that's there's a lot going on when you have BPH and Luts or low urinary tract symptoms there's a lot of pathology there but often the symptom would be your get up at night to pee another sign could be that you might have an infection and you need some more acute management perhaps you need an antibiotic another sign could be perhaps your medications need to be adjusted you're on medications if you're on a diuretic forance and heart failure you're going to have to get up to to urinate perhaps you could talk to your physician or provider because there's a way to dose those where you might not have to urinate at night another sign could be that you could have a chronic medical problem that's manifesting it self is not there's lots of things that that could cause too Parkinson's disease for example or whatever some some problems can D can come present in all different kinds of ways so I hope I cover that yeah you sure did Dr Marsh what is chronic inflammation of the bladder and how is it diagnosed so I think what you're referring to would be that the term we might use would be Interstitial cystitis another name for it is chronic bladder pain syndrome um and this is a condition that's not extremely well known how or why it develops but um it basically manifests as pain specifically with a full bladder and also associated with frequent and Urgent urination um you asked how it was diagnosed um typically it's just it can be a diagnosis of exclusion so making sure there's no other possible explanation for that and then often we'll also what's called a cystoscopy which basically just means taking a small camera and looking inside the bladder um to look for signs of inflammation and uh following up on that looking inside the bladder could you just tell us a little about what procedures are available for visualizing the bladder yeah so the probably the best procedure is a cystoscopy so basically this is a procedure that's commonly done in the clinic with patients awake uh and usually when I say that people people's eyes R all back in their head but it's usually not as bad as you might think um we put some numbing jelly in the urethra and take a small camera take a look inside takes about 45 to 60 seconds it's pretty quick that's definitely the best way to get a look inside um sometimes we'll use some Imaging tests like a CAT scan um but generally the best thing would be direct visualization thank you and uh Dr Wood we've heard of stones but what are bladder stones well bladder stones are stones that would be formed in the bladder and typically that's from I think basically a manifestation of a urine that's concentrated meaning you're probably not getting the urine flow through the bladder and so stones are going to form inside the bladder just kind of a low low Flow State I think for lack of a better word and often you know but sometimes and bladder stones usually manifest because of some other problem in the Pro in the bladder let's say you have a lot of diverticular ridges in the bladder maybe you have a mass in the bladder things that are might impede the flow or actually cause if you think of the bladder as kind of a relatively smooth or you know but if there's rough edges you can maybe get some parti precipitation of stones forming and that's when we I should mention that often when we're suspecting this we'll be preferring these patients to our Urology colleagues because they'll be the ones that would actually diagnose and probably really work up the cost for that stone because you need to get the stone to figure out what's what kind of stone it is thank you Dr Marsh what does it mean to treat a kidney stone with a basket yeah so there's a number of different ways you can treat a kidney stone um probably the most common way I do it is taking a small camera and driving up to the urer or the kidney where the stones tend to be stuck and using a small laser to break the stone up into little pieces um sometimes you can uh turn it into basically dust or fine sand that will just pass out on its own but sometimes you have bigger fragments left behind and so we'll use a small basket that goes through our camera so we can grab the stone and pull it out of the body sometimes you can get the stone out in one piece without having to break it up but usually we use a laser to break it up first thank you that's so interesting Dr Wood uh what is the term UTI uh urinary tract infection which why is that well it's typically there's different kinds of organisms in the body you could think but typically it's formed by Gram negative bacteria which are often found in the colon and they can find their way into the bladder by a variety of different mechanisms and when where bacteria shouldn't be they tend to grow and when they tend to grow they tend to proliferate and cause symptoms and the symptoms could be you could get very sick you can have something called Euros sepsis where you get actually an infection in your bloodstream that's from the bladder or the kidney and often kidney stones can precipitate a bladder infection prostate infections can sometimes lead to bladder infections infections in the um testes can sometimes be manifested as bladder infections but UTI and there's common it's relatively simple to diagnose and often relatively straightforward to treat sometimes it can be more complex but it's often relatively straightforward to treat with antibiotics Dr Marsh what are the top three oral antibiotics used to treat or that you use to treat bladder infections sure the the ones that I use most commonly would be um cyprol foxysen um Baum uh is another one and then Macrobid are the three most common ones I use um we'll leave it at that I guess okay I was going to say the same thing same so that's good good TR all right uh Dr Wood other than clear or yellow what might be different colors of urine and what might cause it well Dr Marsh already discussed bloody urine or you know grossly bloody urine which of course would get everyone's attention um I'd say urine that's kind of dark brown sometimes can be a sign of a glul thritis or inflammation of the kidney that's more diagnosed with a urinalysis and then probably refer to nephology to kind of look for the causes of that so a urine that's more kind of on the Tanner or dark brownish color would be something that would be very concerning um sometimes that can just mean that you're not drinking enough water but often it can be a sign of something more nefarious um I could imagine you could probably have urine that would be you could have discharge you know maybe pus for example that might show and and of course that could be a sign of an infection or a sexually transmitted illness which of course you might not notice but you might see some discharge and then it might discolor your your as well but typically urine is going to be clear and if you see sludge in the urine like Dr Marsh talked about it could be a sign that you pass the stone or something else that you and if you this is just a plug for making sure that if you are concerned about something you might have passed in urine or if you're got a kidney stone it's nice to be able to potentially bring that in so that can be examined in the lab sometimes helps with diagnosis thank you Dr Marsh why might some doctors be reluctant to do PSA testing this is from a uh viewer in Esa yeah this can be kind of a controversial topic um there was some studies not too long ago that showed that or suggested that screening for prostate cancer with PSA testing was not doing much help and was actually harming some people and so there was a recommendation I think it was back in 2012 yeah the ussf guidelines that actually recommended to stop checking uh PSA testing um that has subsequently reversed and so the recommendation currently is that you should do shared decision making about the um PSA screening um but I think that was kind of the the start of of some Primary Care Providers being reluctant to order PSA testing I can get into that a little bit more too if we have time but maybe we could do other questions first okay uh Dr Wood a uh caller wants to know are there any particular dietary practices that can reduce the risk of prostate cancer the caller has heard that perhaps Tomatoes can be beneficial I wish it was that I don't want to use the word simple because that implies that's trivial but it it no I'd say the best maybe things you could do for overall prostate Health would be like things you could do for overall health to begin with and gener generally we think of Trying to minimize cancer risk and anything is not smoking exercise you know watching your weight kind of trying to decrease any of these inflammatory conditions that they going to put oxidative stress on your organs so I would say maybe look at it not so much from a dietary point of view but also more from a health more Global Health style approach if that helps thank you uh Dr Mark a patient caller from duth wants to know what is the overall care for medular sponge kidney and you know do you see it and how common might it be yeah uh we see it from time to time I think this is some uh a condition that urologists and nephrologists kind of overlap we both treat this condition uh a urologist might see this because these patients tend to develop nephrocalcin osis so they get all these tiny little stones that fill up the kidney um and sometimes those can cause obstruction or pain and and require treatment um I think that was is that what they were asking just I think so yes let's look um yeah what's the overall care and how common might it be sure I'm not sure about how common it is but we see it from time to time and again from my perspective it's it's managing risks of kidney stone and trying to decrease the risk of kidney stone formation for those patients which can be challenging thank you um I think we covered this about What treatments might be for kidney stones that are stuck in place anything else to say about that Dr well it often depends on the size of the stone uh and how comfortable the patient is but generally our first line is trying to let the patient pass it on their own um if the stone is less than 10 mm in size and they're not in severe pain or throwing up that's we'll often let them try to pass it for a few weeks um if the stone is too large or their pain is not well controlled or there's concerned for infection then we'd be considering a a ureteroscopic treatment so using a camera and a laser like we were talking about before thank you Dr wood if the two kidneys are usually side by side or right and left where else might one of the kidneys be otherwise are they always well you can have a horseshoe kidney which is kind of one big kidney sort of wrapped around you know those are the really the ways that I or you can have an atrophic or absent kidney on one side and just have one kidney that's not super uncom I mean it's uncommon but it's not unheard of but I would say typically the body's amazing they sit retr paral they sit wpe kidneys are incredibly well protected one on each side and if you have a horseshoe kidney you might have one kidney which is what was formed and that can be in a variety of places and not sometimes one side of the kidney would be a little larger than the other or you could have an atropic kidney one kidney being smaller than the other or only have one kidney I I don't know if I answered that question but that's how I the other place that we might see it a kidney would be a pelvic kidney so in in when they're forming they typically migrate from down in the pelvis up to the back like you were saying sometimes for whatever reason one might not make it all the way up there and stay down in the pelvis that the other place we see it sometimes Dr Marsh could you tell us about the uh educational training after college that leads to being a urologist sure so uh the pathway is after college you go to medical school like every doctor and then um and then residency that's specific to Urology um most programs are an additional 5 years after medical school for UR ology residency um and then there are some additional training programs you can do with fellowships that are one or two years after that um that's the general pathway thank you Dr Wood an 82-year-old male on saletto Sal Palmetto pardon me and uh milk thistle and been struggling with three to four episodes of noctua at night are there other recommendations for this CER there are there are medication he this person is taking salt pomal and milk thistle and salt paletto has was really popular back in the day so to speak but it's sort of lost some of its Studies have shown that it's not quite as effective as maybe I think everyone would hope there's three different classes of medications you can take there's alpha blockers which can work really pretty fast that can help lower your blood pressure the problem with those they cause low blood pressure there's something called floppy Iris syndrome that you can get if you're taking them and then you go get cataracts fixed and then you know you could have a problem getting your cataract prepared then there's five Alpha five alpha blockers that block the conversion of testosterone or dihydro dihydrotestosterone in the in the testes that can help shrink the size of the prostate and then the thing with those is that those those can take months to work but the first one's going to work a lot quicker and then you can have the phosphodiesterase Inhibitors like um um Calis as it's popular known that you can also take for individuals that have BPH can can take that medication as well and if those things aren't effective then there's obviously surgical interventions that can be done because I assuming we're talking with a gentleman with nocturia it sounds like it's been longstanding that would be referral to Urology either sooner or later to discuss more interoperative or procedural repair is to fix these symptoms because they can be really troubling I assuming this gentleman isn't on diuretics and all these other things we talked about so Dr pardon me yes thank you Dr Wood Dr Marsh um circling back to the PSA are there prospects for a better blood test than the PSA uh maybe um people have been trying so we mentioned earlier that um some controversy with it and part of that is related because the the PSA is not a great test uh there's a lot of different reasons why it might be elevated that are not necessarily cancer related such as just having an enlarged prostate having an infection not emptying your bladder wall all these things can cause your PSA to go up that aren't related to prostate cancer but it's as of today it Still Remains the best thing we've got um there are a few new urine tests that people are studying to look for uh to try to replace PSA but um they have not managed to Dethrone it yet um I would say the biggest advance in this setting that we've made over the last 5 to 10 years has been um using prostate MRIs so it used to be that anyone that came in with an elevated PSA often ended up just getting a prostate biopsy um and this there can be some side effects and problems associated with prostate biopsies and so nowadays we'll often get an MRI first uh as the next step after getting an elevated PSA um to see if there are any suspicious lesions in the prostate that could be biopsied and and if it comes back totally normal we might be able to avoid a biopsy altogether so I would say that's the kind of the biggest advancement we've had in that setting thank you uh Dr Wood a caller uh from clay has uh started on elquist for six months with dark brown pungent urine switched to zalto for four years improved to light brown is the blood thinner what's causing this I hard to answer has hopefully this individual's had a urine test to look for mic we'd be looking for microscopic hematuria and if that's the case then I would suggest that if there is blood in the urine without knowing more details probably would need to talk to Urology because usually you're on eloquest there's Z Alto for a reason that's hard to stop those blood thinners but if you're losing blood in your urine because of potentially because of the blood thinner that should be evaluated so it could be contributing but not the whole situation is what yeah but it's hard to say what's really going on without getting a urine analysis and making sure there is blood in there okay if that helps thank you for that um Dr Marsh what might be the role role of catheterization as an option for dealing with frequent urination at night uh I would say that's a pretty underutilized treatment method um mostly because people don't want to put a catheter in themselves um but also because uh there can be an increased risk of infection if you have an indwelling catheter in every night going in and out of the bladder um so typically I would say our goal is to try to figure out the cause of the frequent urination and fix it rather than putting a bandaid on it like putting a catheter in every night thank you um another question for you Dr Marsh uh CER was diagnosed with hydral two years ago continues to have no change in size and is painfree is surgery a must so a Hydra seal is basically a fluid collection uh around the testicle so basically presents as a swollen scrotum um generally does not cause pain but can be uncomfortable just from the size of it um and often times will not go away like this caller is describing um and yeah generally the best treatment option would be surgery um but uh the decision to go forward with that is really based on how bothersome it is so if it's if it's not to a large enough size that it's causing significant discomfort definitely do not have to do surgery thank you and Dr would uh this caller wants to know what lifestyle modifications like exercise or Diet are beneficial for overall genital urinary health and ereal dysfunction well well there are two kind of diff so erectile dysfunction is often a manifestation of a chronic medical problem let's say diabetes heart disease high cholesterol smoking um if someone's on opioids all these things can cause erectile dysfunction so for those kinds of issues I think what you really need to do is address whatever chronic medical problems you may have to overall looking at your your health that way meaning avoiding excessive alcohol not smoking exercising regularly watching your diet if you have a high cholesterol making sure you address that because the changes that are causing erectile dysfunction or kind of microvascular but a reflection of sort of bigger pictures does that make sense and then in terms of overall genit to urinary health I think it's very important to drink a lot of water and get a lot of exercise and some you know there's been there's anecdotal speaking you know if you bicycle a lot maybe that's hard on your prostate I've heard that and but there's ways to adjust B bcle seats and things like that in order to make sure that that's not a challenge so I guess in general that's kind of how I would look at that question or answer that question very good and uh Dr Marsh we might have time for this question can you just basically compare and contrast an internal or external approach to a prostate biopsy um I don't know if there's a there's only one well okay so the most common approach is using an ultrasound probe up the rectum and biopsy the prostate through there um there's been a push to try and do a different approach uh trans perally through the skin um to decrease the risk of infection associated with that biopsy but um that's been a little bit slow has kind of a high learning curve so um that will probably be the way of the future uh five 10 years from now but um right now most of them are still done internally thank you well it uh looks as though we've covered most of our questions I want to thank our panelist Dr Benjamin Marsh and Dr John Wood and our medical student volunteers Riley Berg Micah Christensen and Alex host please join me again next week for a program on lower extremity knee foot and hip problems when my panelists will be Dr Billy hog Dr Christy halman and Dr Luke wistrom thank you for watching good [Music] [Music] [Music] night [Music] [Music]