Urology
Frequently Asked Questions (FAQ's)
I
invite all of my patients to freely ask questions. Here I have
listed the most commonly asked questions along with brief answers.
I invite you to visit me in the office so that we can discuss
your individual concerns.
Sincerely,
David
Cornell
Quick
Jump Links:
Impotency (Erectile Dysfunction)
Incontinence (Loss of Urine)
Kidney Stones
Nerve
Sparing Radical Prostatectomy
Prostate Cancer
Radiation Seed Implant Surgery
Prostate
Enlargement
Vasectomy
Information
Viagra® Information
Q:
For what reasons do you perform circumcisions?
A:
The most common reasons for which I perform circumcisions are:
·
Cosmetic appearance
·
Paraphimosis (inability to pull the retracted foreskin back over
the glans)
·
Balanitis and balanoposthitis (inflammation of glans
and foreskin)
·
Frenulum breve (short frenulum which tears with intercourse)
·
Diseases of the foreskin, including cancer
·
Phimosis (tightness of foreskin)
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Q:
What is available for impotency (erectile dysfunction)?
A:
Erectile dysfunction (ED) is a common disorder impacting up to
40% of 40 year old men. The physical causes of ED are cardiovascular
disease, diabetes, surgery on the prostate, colon, or bladder,
neurological diseases such as disc disease, stroke, or MS, or
hormonal (testosterone) deficiency. Psychological causes of ED
include excess alcohol consumption, depression, anxiety, fatigue,
or marital discord.
Evaluation of a man with ED is quite simple, consisting of history
and physical examination and a limited number of blood and urine
tests.
·Treatment
options for ED include:
·Testosterone
replacement (topical gel or injection)
·Oral
medication (Viagra, Cialis, or Levitra)
·Urethral
suppositories (MUSE)
·Penile
injections (Caverject)
·Vacuum
erection devices
·Inflatable
penile prosthesis implants
Most insurance companies, including Medicare, will cover the evaluation
and treatment of impotence.
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Q:
How do you treat women with incontinence (loss of urine)?
A: Urinary incontinence is a very fascinating and complex
problem which adversely impacts the lifestyles of many women.
The vast majority tolerate it without seeking medical advice.
This is unfortunate, since at least 80% of incontinent women may
be rendered dry with simple medications.
The cornerstone to successful treatment is a thorough basic evaluation.
This includes history and physical exam and then perhaps some
specialized testing. None of this evaluation should be painful,
nor time consuming. If testing suggests that there is any medically-treatable
component to the problem, I will begin by treating this with medication
as this often produces dramatic results which exceed expectation.
In the event that medical treatment does not produce dryness,
a number of non-invasive or minimally-invasive surgical techniques
may be used. These are all outpatient therapies and produce high
rates of success in properly selected patients. The key to successful
treatment of incontinence is to individualize therapy to the patient.
No single treatment, whether medical or surgical is successful
for all patients.
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Q:
How are kidney stones treated?
A:
My practice offers many advanced treatment options for kidney
stones, such as:
·Shock
wave lithotripsy
·Laser lithotripsy
·Percutaneous
nephrolithotomy
No one single treatment is appropriate for all stones. These are
all usually outpatient treatments. Prior to any treatment, X-rays
or a CT scan is used to locate the stone so that you may receive
accurate information about your treatment options. I also provide
patients with information regarding prevention of future stones.
Q:
How do kidney stones form?
A:
Kidney stones are the result of mineral precipitation in the urine.
The most common cause is dehydration which causes the urine to
become saturated with specific minerals that begin to precipitate
as crystals and subsequently stones.
Q:
What are kidney stones made of?
A:
About two-thirds to three-fourths of all kidney stones are of
calcium oxalate content.
Q:
Is it true that cranberry juice is a good preventative for kidney
stones?
A:
If a person forms calcium oxalate kidney stones, cranberry juice
is not recommended since it is very high in oxalate content. Cranberry
juice got its reputation for being helpful for kidney stone prevention
many years ago when a larger percentage of stones were the result
of infection. This is now a rare cause of stone formation.
Q:
How can kidney stones be prevented?
A:
The single best means of preventing kidney stones is drinking
enough water to cause production of two liters of urine daily.
Q:
What causes the pain of kidney stones?
A:
For the most part, a kidney stone does not cause pain while it
is located in the kidney where it was formed. When a kidney stone
becomes dislodged and falls into the ureter (the tube which drains
the urine from the kidney down to the bladder) the person feels
pain. The pain is due to the obstruction of urine flow caused
by the kidney stone blocking off the ureter. The pain is actually
due to back pressure of urine in the affected kidney.
Q:
How do you diagnose kidney stones?
A:
Pain in the back or flank area or blood in the urine may suggest
the presence of a kidney stone, but the diagnosis requires imaging.
The most accurate (and currently most popular) means of diagnosing
a kidney stone is a CAT Scan. The specific technique used is helical
kidney stone protocol.
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Q:
What treatments do you offer for prostate cancer?
·Surgical
removal of the prostate gland (radical prostetactomy)
·Radiation seed implants (brachytherapy)
·External radiation
·Hormone therapy (Lupron, Zolodex)
Q:
Do you perform nerve sparing radical prostatectomy?
Yes, nerve sparing radical prostatectomy was started
in the early 1980's. I have been performing this operation since
1984 with very rewarding results.
Q:
Who is a good candidate for nerve sparing radical prostatecomy?
Almost
any man with localized prostate cancer who chooses to have his
prostate gland removed is a candidate for the nerve sparing operation.
Q:
Do you perform radiation seed implant surgery for prostate cancer?
For whom do you recommend it?
Clinically
referred to as brachytherapy, I have been performing radiation
seed implant surgery for prostate cancer for almost 20 years.
The current technique with ultrasound guidance is much more accurate
than the technique of the 1970's and 1980's. Virtually any man
with localized prostate cancer is a candidate for this procedure.
Q:
What is prostate enlargement and how do you treat it?
A:
The prostate gland is part of the male genital tract responsible
for producing most of the semen men ejaculate. It surrounds the
urethra (voiding channel) and lies at the base of the urinary
bladder. Enlargement of the prostate is a normal part of aging
in all men and begins after the age 40. As the prostate enlarges,
it may obstruct the flow of urine through the urethra. This may
cause a poor urinary stream, hesitancy in starting the stream,
inability to completely empty the bladder, and difficulty with
frequency of urination and control of urine.
There are a number of medical treatments for prostate enlargement:
·Saw palmetto is an herbal product which reduces the size
of the prostate
·Finesteride (Proscar) is a pharmaceutical product designed
to shrink the prostate
·Flomax, Hytrin, Cardura are medications which improve
the urine stream
·Laser and heat therapies are surgical procedures done
with light anesthesia that reduces the patient's gland size
·TURP (Transurethrithral resection of the prostate) is
a surgical procedure in which the portion of the prostate causing
obstruction is trimmed out through the voiding channel (urethra).
This does not require an incision.
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Vasectomy
Information
An
informative resource for vasectomy and vasectomy reversal is vasectomymedical.com.
Our office performs "no scalpel" and VasClip vasectomies.
In
addition to vasectomy, there is a new alternative, called the
Vasclip implant procedure. Dr. Cornell now offers the Vasclip
implant procedure to his patients.
The
Vasclip implant procedure is relatively new and, therefore, your
insurance carrier may not cover the cost of the Vasclip device.
If you are interested in having the Vasclip implant procedure,
there will be an upfront charge of $500 to cover the cost of the
Vasclip implant device. If your insurance carrier does cover the
Vasclip implant device charge, you will be reimbursed the amount
of that coverage when it is paid.
For
more information on the Vasclip implant procedure, including a
video that desribes the similarities and differences between vasectomy
and the Vasclip implant procedure, please visit www.vasclip.com.
If
you have any questions regarding either procedure, please be sure
to bring them with you and ask Dr. Cornell during your consult.
Viagra®
Information
Sildenafil citrate, or Viagra®, is a medication produced
and marketed by Pfizer, Inc. that was approved by the FDA in April
1998 for the treatment of erectile dysfunction (ED). Since April
1998, over 15,000,000 patients have received prescriptions for
the medication worldwide.
Q: What are the side effects of Viagra®?
A: The side effects of Viagra® are generally very mild and
disappear within a few hours of taking the drug. The most common
side effects are: headache (15%), flushing (10%), upset stomach
(7%), and abnormal vision (3%).
Q: Is Viagra® addictive or habit-forming?
A: No. The medication has been well studied and there is also
no evidence that Viagra® becomes less effective the longer
it is used.
Q: At what age do men begin having erectile dysfunction?
A: At one time it was considered a normal part of aging, but this
is no longer considered to be true. Erectile dysfunction affects
nearly 40% of 40 year old men to some degree.
Q: How commonly is Viagra® prescribed?
A: As mentioned above, since becoming available in April 1998,
more than 15 million patients have received the drug worldwide.
Q: Can men taking medication for high blood pressure take Viagra®?
A: Yes. Viagra® has been well-tolerated by men on antihypertensive
medications in drug trials.
Q: Is it necessary to have severe erectile dysfunction to be a
candidate for Viagra®?
A: No. In fact, better results occur in men with mild or moderate
erectile dysfunction than in men with more severe dysfunction.
Q: Is Viagra® safe for all men?
A: No. The most common contradictions to Viagra® use are:
patients who use nitrates, patients with heart disease, and patients
with retinitis pigmentosa.
Q: Do you see patients for the sole purpose of prescribing Viagra®?
A: Yes. I am delighted to see men who want nothing more than a
prescription for the medication.
(Viagra® is a registered trademark of Pfizer, Inc.)
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