Thursday, July 19, 2012

Check out the Men's Health Checklist by the AUA

The American Urological Association recently released a "Men's Health Checklist" as a pamphlet and as mobile apps for Apple and Android.

Here is a link to the pamphlet. 

Here is a link to the app for Android.

Here is a link to the app for Apple.

The checklist breakdowns the health concerns by age: (18-39, 40-49, 50-69, 70+) as well as "Urology Specific" vs. "Related Health".

I think it's a great reference for men and healthcare providers alike. So, check them out and share them with the men in your lives!

Monday, July 9, 2012

What is a urethral or "Foley" catheter?

A urethral or "Foley" catheter is used to provide continuous bladder drainage. The catheter is named after a Boston urologist, Dr. Frederic Foley, who was instrumental in creating the catheter in the 1930's.

Here are some reasons why a patient would have one:
  • monitor urine output
  • alleviate urinary retention or severely dysfunctional voiding
  • realign the urethra and bladder after urologic surgery or trauma
  • help stop lower urinary tract bleeding
They are sized on the  French scale.  The diameter of the catheter x 3 = French size.  Here is a good link on Wikipedia on this scale. The most common sizes for routine use are 16F and 18F.
Urethral catheter
 Source: Wikimedia Commons/Olek Remesz
Creative Commons Attribution-Share Alike 3.0 Unported License

The catheter is placed inside the urethra and allows the bladder to continuously drain via a closed drainage system.  One the left side of the diagram there is a balloon port and a urine drainage port. The balloon port is where a syringe is placed to fill the balloon with fluid at the right side of the diagram.  The balloon is needed to keep the catheter in the bladder.  Without the balloon, the catheter would simply slip out.

The urine drainage port is connected to a drainage bag.  There are two types of drainage bags:

Leg Bag- a small bag with elastic straps that can be placed on the leg.  This allows the patient to discretely wear the bag under pants and move about.

Overnight Bag - this bag is larger and is usually used at night because of its capacity.  This is placed at the side of the bed, attached to an IV pole, or carried by a patient.

There are many other catheters out there that urologists primarily use.  One noteworthy example is a 3-way catheter that is used to treat urinary tract bleeding.  This catheter has an additional inflow port that is used to irrigate the bladder.  This fluid then goes out the drainage port with the urinary output.  


Monday, July 2, 2012

Radiation oncologists against new USPSTF prostate cancer guideline

The United States Preventative Services Task Force issued a new guideline in May recommending against PSA screening for prostate cancer altogether.  This government based panel has been getting the deserved pushback from the American Medical Association (AMA) as well as from the American Urological Association (AUA).  

Here's a prior blog post with my thoughts on this as well as the AUA response with current PSA screening guidelines from the AUA as well the American Cancer Society.

I wanted to share in this post a statement from the American Society for Radiation Oncology (ASTRO).  These doctors are on the front lines with us (urologists) in fighting prostate cancer.  ASTRO also has lined up against the new USPSTF guidelines.  

ASTRO statement

My analysis:

I agree with Dr. Gunderson's quote on this issue.  There certainly is an over diagnosis issue with prostate cancer.  However, as active surveillance is becoming a viable method to keep track of the disease, advocating for a wholesale cessation of PSA based screening is like throwing out the baby with the bathwater.

Dr. Sandler also makes a great point in the release. The prostate cancer screening issue is not a problem that a cookie cutter approach can solve.  With multiple factors such as age, expected longevity, race, symptoms, and family history, each situation is unique and each man should have the opportunity to make an individual informed decision on the matter with his physician.