After menopause, there are many changes that happen to the genital and urinary systems due to the decrease in available estrogen. https://www.pacificnorthwesturology.com/post-menopausal-urologic-changes.html The vagina after menopause narrows and decreases in length. In addition, the labia thins and there is reduced blood flow to the vagina. The lack of estrogen weakens the bladder (which holds urine) and the urethra, the tube that carries urine out of the body, compromising their ability to control urinary functions. Reduced estrogen also alters the acidity of the vulva and the vagina, which can make the area more prone to infection by bacteria or yeast overgrowth. Symptoms related to the urinary system include: Stress incontinence, urge incontinence, increase urinary frequency, and nocturia (waking up at night to urinate). Symptoms related to vaginal atrophy include: vaginal dryness, itching, or burning; pain during intercourse; increased urinary tract infections, vaginal bleeding. Vaginal estrogen is a topical form of estrogen and there is minimal systemic absorption. It helps reverse many of the changes due to menopause.
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Ureteroscopy is a medical procedure that is performed by a urologist to evaluate the ureter. Dr. Daniel Reznicek from Pacific Northwest Urology Specialists (https://pacificnorthwesturology.com/ureteroscopy.html) explains what a ureteroscopy is and what to expect from the procedure. Ureteroscopy is performed with a small camera called a ureteroscope and is usually performed under general anesthesia as an outpatient procedure. Ureteroscopy is most often performed in the US to treat kidney stones using a holmium laser but it may also be performed to evaluate the ureter for other findings, such as hydronephrosis or to evaluate and treat urothelial cancer. There are some advantages and disadvantages of the procedure in comparison to extracorporeal shockwave lithotripsy (ESWL). Ureteroscopy is a minimally invasive procedure, however, ESWL is non-invasive. It has slightly higher risks. However, ESWL does not work well for very dense stones, those in the lower pole of the kidney, and sometimes may not be able to be performed if the stone is not visualized on X-ray or US. With a ureteroscope, the urologist is able to visualize the stone itself as well as the anatomy within the kidney. The stones may also be able to be grasped and removed with a basket completely, whereas after an ESWL the patient has to pass all the fragments that were broken. Many urologists combine a ureteroscopy with the placement of a ureteral stent. This is a small, temporary plastic tube that is placed from the kidney to the bladder. This allows the ureter to heal after surgery.
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Daniel Reznicek, MD explains the differences between a TURP (transurethral resection of the prostate, also known as a "roto-rooter") and a Urolift procedure. Both are treatments for men’s lower urinary tract symptoms due to benign prostatic hyperplasia, but are very different procedures and have different risks and benefits. The Urolift was FDA approved in 2013 and is a minimally invasive procedure to help open the urethra with the use of very tiny implants in the prostate. Rather than destroy tissue, it compresses the tissues and has a lower side effect profile than the TURP. In 2018, the Urolift was added as an option that should be considered for the treatment of BPH in the American Urological Association Guidelines. Trials have shown good efficacy and a low side effect profile. The treatment is not for everyone, it works well for some anatomies and not for others. See more at our website: https://pacificnorthwesturology.com/urolift.html
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Dr. Daniel Reznicek explains how extracorporeal shock wave lithotripsy works and what to expect from surgery. https://pacificnorthwesturology.com/eswl.html ESWL is an acronym for extracorporeal shockwave lithotripsy. ESWL is a non-invasive surgical procedure, that is performed under sedation or general anesthesia to treat kidney stones. Shockwaves are created outside the body and then focused onto a stone. The stone then fragments into smaller pieces for the patient to pass on their own. The procedure is an outpatient procedure and usually lasts less than an hour. ESWL cannot be performed on all stones and has some restrictions. It cannot be used during pregnancy, on people with blood thinners, or on patients with kidney tumors. It does not work well on very dense or very large stones. The stones also have to be visualized within the body to aim the shockwave and have to be tracked during the procedure with either fluoroscopy (x-ray), or with ultrasound. Some stones that are low in the urinary tract and in the pelvis may be difficult to treat because the shockwave has to be aimed around the bones. Stones not treated by ESWL are typically treated with other minimally invasive procedures such as a ureteroscopy (https://youtu.be/6rFViQjZr0c), or a percutaneous nephrolithotomy. Open or laparascopic surgeries for kidney stones are quite rare today.
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A ureteral stent is a temporary, small plastic tube that is placed in your ureter that helps drain urine from your kidney into your bladder by a urologist. A stent may be placed to help unblock your kidney if a stone or obstruction is present. A stent may also be placed during surgery to help allow the ureter to heal without forming a stricture or narrowing. Dr. Reznicek from Pacific Northwest Urology Specialists in Bellingham Washington explains the procedure and steps involved in a typical placement of a ureteral stent.
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Daniel Reznicek, MD from Pacific Northwest Urology Specialists explains the preoperative instructions for a Urolift procedure done under a local anesthetic with minimal sedation in an ambulatory surgery setting. Additionally, expectations for after the procedure are also explained
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TURP (transurethral resection of the prostate) and TUVP (transurethral vaporization of the prostate) are both procedures to treat BPH. There are subtle differences between the two, but overall, they are very similar procedures. A urologist may recommend one procedure versus another. This video goes over the differences and shows video of both procedures.
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What is a percutaneous nephrolithotomy or PCNL? Dr. Daniel Reznicek describes why a PCNL is performed and what to expect from the procedure. (https://www.pacificnorthwesturology.com/pcnl.html). A percutaneous nephrolithotomy is a procedure performed by a urologist to treat large or complex kidney stones. In the procedure, the urologist gains access to the kidney through the skin (percutaneously) and then uses instruments to crush and then remove the stones. Stones that are larger than 1.5cm or in difficult locations to reach by a ureteroscope are ideally suited for a PCNL. In the procedure, the urologist is able to use larger instruments and remove a much larger volume of stone compared to other surgical methods. It is important to see a urologist who is familiar with the procedure because it does come with higher risks than a ESWL or ureteroscopy and is a more complex procedure. In high volume centers, complication rates are quite low. Some urologists perform the procedure with the help of an interventional radiologist to help enter the kidney, often requiring a separate procedure and anesthetic. Preferably, this is performed by the urologist at the time of the procedure to minimize the need for multiple anesthetics. Access into the kidney is performed by a combination of fluoroscopy (X ray), and sometimes ultrasound guidance. The urologist closely examines prior CT imaging to make sure that the kidney is accessed sa
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Dr. Kelly Casperson describes the difference between prolapse and incontinence.
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Dr. Kelly Casperson describes what is a cystoscopy and what to expect from the procedure. A cystoscopy is an endoscopic procedure to evaluate the bladder. A small camera (cystoscope) is inserted in your urethra and then into the bladder. Cystoscopies are typically performed as a diagnostic procedure, to evaluate a problem such as difficulty urinating, blood in the urine (hematuria), or to remove a ureteral stent. The procedure is performed under a local anesthetic and generally takes less than 5 minutes total. The patient is able to watch during the procedure as well. Pacific Northwest Urology Specialists is located in Bellingham, WA. See our website at https://pacificnorthwesturology.com
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Dr. Kelly Casperson discusses medical expulsive therapy for a kidney stone: passing a stone with only the use of medications. https://pacificnorthwesturology.com/kidney-stones-disease.html Medical expulsive therapy (MET) can be a safe way of passing a kidney stone on your own. You should be seen by a urologist to determine if you are a good candidate for MET. Some stones are too large to be passed. Other times, the stone may be affecting your kidney function, or may be infected, both of which require urgent management. If you are a candidate for medical expulsive therapy, your urologist may prescribe a medication to help dilate your ureter and increase the chance of passing a stone. The medication that is typically used is an alpha blocker medication. Pain management may be with the use of non-steroidal anti-inflammatory medications or narcotics. If a stone does not pass within about 4-6 weeks you should be seen and treated with a ureteroscopy or extracorporeal shock wave lithotripsy because chronic obstruction may lead to permanent renal damage.
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Interstim is a long-lasting, treatment option for overactive bladder, urinary urgency incontinence, non-obstructive urinary retention, and fecal incontinence. https://pacificnorthwesturology.com/interstim.html Rather than treating with medications, Interstim acts with neuromodulation, providing an electrical stimulus to the nerves that helps decrease the sense of urinary urgency, as well as helps the bladder empty better in non-obstructive urinary retention. It is typically performed by a urologist and is often done under local anesthetic or sedation. Rather than just treat symptoms, the electrical pulses actually help the bladder function better. The procedure is generally covered by most insurance companies and is well tolerated. This video helps explain the procedure and what to expect after surgery. Pacific Northwest Urology Specialists are located in Bellingham, WA, and are the premier Bellingham urology practice. We are a high volume Interstim practice. Call us for an appointment: 360-733-7687.
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Dr. Casperson explains what is an overactive bladder (OAB) and treatment options. www.pacificnorthwesturology.com A strong, sudden urge to urinate, is the most common symptom of OAB. You may be worried that you won't make it to the bathroom in time. You may or may not leak urine after feeling this urge. It can also be associated with voiding very frequently. The first line of therapy is pelvic floor exercises to strengthen and tone the support muscles. We are experts in Intone to help you in the privacy of your home. Physical therapy is also a great option. The second line of therapy is medications, of which the most common are anticholinergics. They are a prescription and work by calming down the bladder muscle. Common side effects are dry mouth and constipation. Beta3 agonists, such as mirabegron, have fewer side effects. If medications aren't a good option for you, have you considered Botox? A 5 minute procedure in the office can give months of lasting treatment, and most insurances cover it well after the FDA approved it for OAB in 2013. InterStim is a therapy that modulates sacral nerves with electrical pulses to help the brain and nerves communicate to help relax the bladder. It is a solution for women with refractory OAB, not responsive to other treatments. It also works well for women who have trouble emptying their bladder all the way. It is placed under local anesthetic or sedation with no hospital stay required!
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Dr. Daniel Reznicek discusses why a prostate biopsy is performed and what to expect from the procedure. https://pacificnorthwesturology.com/prostate-biopsy.html A prostate biopsy may be recommended to you by a urologist to examine for prostate cancer as it is the only test that gives an accurate diagnosis. Other tests may indicate prostate cancer, but only a biopsy can confirm if it is present. The biopsy will be performed by a urologist in our surgery center and the entire procedure generally takes less than 10 minutes. An ultrasound probe is used to help identify the prostate and administer local anesthetic for pain control. This is inserted into the rectum. The urologist will then use a very small needle to take tissue samples of the prostate. These will then be analyzed by a pathologist to determine if there are any cancer cells.
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A penile prosthesis is a surgical treatment for erectile dysfunction. It offers a mechanical solution for any form of ED. Dr. Reznicek explains the procedure as well as common questions about the prosthesis and what to expect after surgery. https://www.pacificnorthwesturology.com/penile-prosthesis.html
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Renal Access for a percutaneous nephrostolithotomy (PCNL) is one of the more complicated portions of the procedure and great access makes the case much easier to perform. Endoscopically guided access with the use of the digital ureteroscope makes this case much easier and I think safer. I perform this in the prone position, with the use of the open Jackson table.
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Want to learn how to naturally increase your T levels using science? Dr. Reznicek explains how to do this without medications or supplements. References are included below. www.pacificnorthwesturology.com First, what is low testosterone? Testosterone is the primary male sex hormone and a key anabolic steroid. It helps promote secondary sexual characteristics such as increased muscle and bone mass and the growth of body hair. It is also important in mood and energy levels. Men with low testosterone often have low libido, erectile dysfunction, osteoporosis, sleeping problems, depressed mood, and decreased physical performance. Some men only have one or two of these symptoms. High Intensity Interval Training - This training uses resistance and weight lifting. In one recent study, the increase was 8% higher T levels after HIT versus 5% increases with low intensity. HIT has been shown to improve T levels in all age groups, another recent paper showed TT levels increased in 17% in sedentary 60-70 yo men after HIIT, they previously showed no benefit with simple cardiovascular exercise. https://www.ncbi.nlm.nih.gov/pubmed/28515052 http://www.hormones.gr/8540/article/relationship-between-salivary-and-serum-testosterone%E2%80%A6.html Lose the Pounds - Fat cells in the body convert testosterone to estrogen, which not only removes the male sex hormone but increases the female predominant hormone. Higher levels of body fat are strongly correlated to lower levels of testosterone. In a recent meta-analysis, diet associated weight loss of 9.8% body weight increased total testosterone levels by 84 ng/dL and surgical weight loss (bariatric surgery) increased total testosterone levels by 251 ng/dL on average. That is a huge gain. And that happens at smaller levels, even weight loss of 5% has been shown to increase T levels. https://www.ncbi.nlm.nih.gov/pubmed/23482592 Get Better Sleep: We are all told to get better sleep but it is hard to do in our modern society. Sleep fragmentation and lack of sleep lead to predictably lower testosterone levels. In older men, morning testosterone levels are partly predicted by total sleep time. https://www.ncbi.nlm.nih.gov/pubmed/15914523 https://www.ncbi.nlm.nih.gov/pubmed/18519168 https://www.ncbi.nlm.nih.gov/pubmed/17520786 Healthier Eating - Expanding on weight loss, Obese and overweight men who lose weight through low-fat, low-calorie diets seem to have improvements in their erectile function and testosterone levels. In addition, the Western Diet is associated with lower semen quality parameters. Switching to a more mediteranean, low-fat diet may be beneficial to all three parameters. https://www.ncbi.nlm.nih.gov/pubmed/14988451 Beware of Herbal Supplements - many companies will try and sell you pills or powders that will boost your testosterone. Many herbal companies will do the same. Oral supplements such as androstenedione, DHEA, and other pro hormones sell increased T levels. Most have no effect on T at all and only increase estrogen levels. Androstenedione has a short and modest impact on testosterone and after a short period of time return to normal but does increase estrogen. Many herbal supplements tout increased levels of testosterone. Some have been shown effective in animals, but no benefit in humans. Tribulus terrestrial, Tinospora cordifolia, and icariin are all commonly used ones that have not been shown to be beneficial. https://www.ncbi.nlm.nih.gov/pubmed/28359097 Stop the opioids - Narcotic medications suppress leutinizing hormone production which decreases your bodies ability to naturally produce testosterone. Narcotic use is rampant, and testosterone deficiency is high amongst those using pain relievers. Up to 86% of men using chronic pain medications had low testosterone. Regardless if it is pills, patches, or injections, narcotic use will decrease your testosterone. Think of it as another great reason to stop taking narcotic medications. https://www.ncbi.nlm.nih.gov/pubmed/14622741
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Erectile dysfunction is the inability to achieve or maintain an erection satisfactory for intercourse and is very common among adult men. Dr. Daniel Reznicek discusses the definition of erectile dysfunction, potential causes and risk factors, and what treatments are available for men: https://pacificnorthwesturology.com/erectile-dysfunction.html Erections require psychological or sexual stimulation which then through nerves, signals penile smooth muscles to relax and increase blood flow. The increased volume of blood then blocks blood draining from the veins. This should remain erect until after ejaculation. An interruption in any of these steps will lead to erectile dysfunction. Causes of erectile dysfunction include diabetes, high blood pressure, prostate cancer treatments, medications, nerve disorders or spinal cord injuries, among others. Treatment of erectile dysfunction is performed in a step-wise fashion. First line therapies include oral phosphodiesterase inhibitors (PDEi) such as sildenafil, tadalafil, vardenafil, and avanafil. These medications help increase blood flow to the penis by increasing a certain neurotransmitter. If oral medications do not work, or they are contraindicated, the next step includes options such as a vacuum erect device, intercavernosal injections, or intraurethral suppositories. A penile prosthesis is also an option if medications have failed. This procedure is a permanent ED treatment and has the highest satisfaction rate among all treatment options.
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Understanding the pelvis and a woman's symptoms can be difficult. Commonly it is confusing to discern the difference between incontinence (bladder leakage), overactive bladder symptoms and pelvic organ prolapse. What furthers this confusion is that treatment for prolapse may not always improve bladder leakage or bothersome symptoms, even though many times it does. This is a short narrative with the goal to educate. What is the difference between stress incontinence, urge incontinence (overactive bladder), and pelvic organ prolapse. Dr. Casperson also briefly discusses treatment options, both surgical and non-surgical. Leave us a message to let us know what other questions we can answer for you.
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https://www.pacificnorthwesturology.com/urolift.html Ed Keller recently had a Urolift procedure in our surgery center under nitrous oxide sedation. The procedure is 5-10 minutes and completely changed his urinary symptoms. Hear his story.
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