This is a video of a patient who is s/p  a prostatectomy and has developed a bladder neck contracture. He presented with diminution of his urinary stream. If a  patient is voiding well after the prostate is removed and then the stream slowly decreases the likelihood is that he has developed a bladder neck contracture. The most common cause it is felt is that the mucosa of the bladder was not joined to the mucosa of the urethra and this in turn encouraged the formation of scar tissue or stricture. Strictures of the urinary tract are bad actors as they are perpetually are striving to heal in a closing concentric fashion which in turn narrows the urinary passage way and slows the stream at time to a dribble.

In this video  I am  using a cold knife urethrotome to incise the bladder neck contracture at 5 and 7 o’clock. In…

Bud Abbott was diagnosed with prostate cancer shortly after breaking his hip in 1972. Because he died of the disease two years later the fracture may have been a pathologic fracture i.e. weakened bone because the prostate cancer had spread there. He was 79.

North Georgia is known for being in the foothills of the Blue Ridge Mountains and for the small streams associated with that. The state fisheries department “stocks” the streams with Rainbow trout that they raise at various hatcheries. The state then takes them by truck and empties the fish into the small streams at bridge crossings. The “locals” know when the trucks are coming or they keep a look out for them and when they see them go by they follow them to see when and where they are stocking. They call their friends and get their rods and corn and go and catch the stocked fish often times depleting the trout before the unsuspecting or “un enlightened” can get there. I have fished out West many many years and out there the streams have native trout and lots of room for your fly line to flip about to put a fly…

Review of “Salvage” options if prostate cancer comes back after radiation.

One of the most common reasons I am given by patients choosing to have their prostate removed is the argument that one can do radiation after surgery but you can’t (easily) do surgery after radiation. It is a valid argument and I think something to consider in the decision-making process.  The concept is, however, not that cut and dried. Here are some caveats.

• If you have your prostate removed and at some point your PSA goes up then that means there is residual disease. In most cases the disease is microscopic and local (near the bed from which the prostate was removed). In this case where there may be a very small amount of disease then external beam radiation can “clean up” the residual disease for a curative intent. An example would be may be a very small…

The below is helpful but not a stand alone type statistic or characteristic of your PSA.

• I have a friend whose free PSA was very high indicating a low probability of prostate cancer and ….all of his twelve cores showed cancer, however all the cores were Gleason’s 6.
• The free PSA (being very low) was what prompted me to “get off the fence” and do a biopsy..so in that regard it sometimes is that extra shove in the reluctant patient.
• I have  had patients with a low free PSA and no cancer.

In general the chart below indicates that you have a higher chance of having prostate cancer on a biopsy if your free PSA is low, and vice versa if it is high, but again this is not fool-proof and should only be “one of the arrows in your prostate decision-making quiver.”

PSA Scale/ Partin table

Rush Limbaugh weighs in on the Breast vs. Prostate debate

the prostate and prostate cancer….the rodney dangerfield of cancers and organs

June 26, 2010 by John McHugh M.D. | Edit

 

budding urologist with incontinence-author circa 1959

 

 

Five reasons the prostate is the “Rodney Dangerfield” of organs…it gets no respect.

“I’m not a sexy guy. I went to a hooker. I dropped my pants. She dropped her price.”- R.D.

The reason why the prostate doesn’t get any respect has a little to do with the very nature of the organ and its disease and a little to do with the mindset of the male.  The perfect storm which is a gland that the male can’t see or feel and a cancer that doesn’t cause symptoms until it is too late is the reason for the tragedy of over 25,000 deaths a year in the United States a year…