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		Frequently Asked Questions

What is viagra?

Viagra is an oral medication for the treatment of male erectile dysfunction. It works selectively on the penis. It is not a hormone. It will not increase your sex drive. It is not an aphrodisiac. Viagra works by increaing the smooth muscle relaxation in the penis. For an erection to occur, the smooth muscles in the penis and its arteries must be relaxed. Studies suggest that it works in 40-70% of patients depending on the severity and the cause of the problem. If there is a serious lack of blood flow (artheroscierosis) or the patient has had a radical prostatectomy , the success rate is lower or it may not work at all. The dosages are available in 25 mg, 50 mg, and 100 mg. We recommend starting with the one 50 mg. pill 1-2 hours before anticipated sexual activity. You can increase the dose safely to 100 mg if needed. Studies show that more than 100 mg will not increase the effects of the medication. If you have othe questions, visit the Pfizer Web page at www.pfizer.com.

Q:	I would like to have my vasectomy reversed. What are the success rates?
A:	The success rate of this surgery depends somewhat on how long ago you had the vasectomy. For instance, the pregnancy rate of a successful reversal is about 50% if the vasectomy was done less than five years ago. The success rate falls to about 35% if the vasectomy was done more than 10 years ago.

Are vasectomy reversals covered by most insurance companies?

It is usually not covered by insurance companies. It is done on an outpatient basis so there is no overnight stay. It is usually done under general anesthesia at one of the surgery centers. Our fee is approximately $3300. The facility fee varies depending upon the surgery center that is used. Those fee range from $2100-$2400. There is also an additional charge for the anesthesia. We require that the surgeon's fee be paid in full before the surgery is performed.

I have been told I will be scheduled for surgery to remove my kidney stone. What is the process for being scheduled?

The Kidney Stone Center in Denver maintains responsibility for scheduling Kidney Stone Surgery (ESWL). The procedure is as follows:

Your doctor at Urological Associates will recommend the surgery. Your medical history, xrays and necessary forms will be forwarded to the Kidney Stone Center (KSC) in Denver. A copy of your insurance card will be faxed as well.

The KSC staff will contact your insurance company to obtain pre-authorization.

The surgery will be done at Penrose Hospital on an outpatient basis. The KSC will contact you to discuss when the surgery could be scheduled. This process takes approximately 5 days. Urological Associates does not schedule the surgery.If you have questions about your surgery date, please call the KSC at 303-839-6060.

After your surgery has been scheduled, KSC staff will advise you to contact Jeanne at Urological Associates. (719-634-1994 ext 15). Jeanne will ask you to come into the office to pick up a pre-surgical packet. The packet will include orders for laboratory tests and possibly an EKG. Please have these tests performed immediately. The packet will also contain laxatives that must be taken the day before the surgery. It will also contain paperwork that must be completed and taken to the hospital the day of the surgery.If you have any additional questions, please call the KSC at 303-839-6060.

I have been diagnosed with prostate cancer. I have heard that Dr. Patrick Faricy is performing a procedure that involves a radiation seed implant. What can you tell me about this procedure?

In order to kill the cancer, your physician places implants (radioactive seeds) into your prostate gland. These seeds give off low energy gamma rays. These seeds are about the size of a grain of rice. Depending on the size of your prostate gland, your phisician will place 70 to 150 of these seeds into your prostate gland. The entire prostate gland is treated because microscopic cancer cells may be in areas of the prostate that are not in the biopsy area.

PHASE ONE
Prior to the implant procedure,you will be scheduled for a prostate ultra scan (volume study). This procedure will be done at your urologist's office. The volume study will determine the number of seeds needed to treat the cancer.

PHASE TWO
The urologist's staff will give you specific instructions on preparations for your implant.Be sure to arrange for a ride home from this procedure as you will have been sedated.

PHASE THREE
As part of your followup, approximately three weeks after the implant, you will be scheduled to return the Radiation Oncology Department at the Cancer Center to have a partial CT scan to verify seed placement. The Radiation Oncology Department will call to schedule your procedure. .

Possible Side Effects Include:

Swelling and brusing between the legs.
Post-operative pain or discomfort.
Urinary obstruction and/or irritative symptoms associated with urination.

Rectal irritations, impotence and/or incontinence.
Temporary side effects usually subside as the implants lose their radioactivity.

What causes reccurrent urinary tract infections and how are they treated?

Recurrent urinarty tract infections are almost always caused by bacteria that reside in the vagina going up the very short urethra into the bladder. This is not caused by poor hygene. Women who have a tendency toward recurrent infections have particulary sticky cells in their bladder lining that allows the bacteria to stick and cause symtoms such as burning on urination, frequency and occasionally even blood in the urine. It is not understood why centain women have this condition.

Recurrent bladder infections do not, as a rule,ever cause kidney damage. Bladder infections are a bothersome problem but they are not a serious health problem. Here are a couple of suggestions regarding hygiene that are helpful:
Try to void and push fluids to mechanically flush your bladder following intercourse since bacteria that can cause a bladder infection reside in the vagina, and intercouse can start these bacteria up the urethra.
Wipe from front to back i.e.,away from the urethra after urinations.

We discourage the use of a vaginal diaphragm for birth control.

In addition to these suggestions, the long-term use of low-dose antibiotics that are specific for urinary tract infections can almost always prevent recurrent infections. If you have rapid recurrences(one infection every 2-3 months), we suggest a minimum of six months of nightly antibiotics. Sometimes we recommend an antibiotic following intercourse rather than a nightly dose. Stop the antibiotis at the end of six months, but keep a five day supply of the same antibotic on hand. If the typical symptoms of an infection returns, begin taking full strength for 5-7 days. It is not necessary to call us unless you have fever over 101, grossly bloody urine, true flank pain high up on one side of your back or you don't feel well after a week of treatment.

If you experience frequent recurrences after stopping a six month course of nightly medicine, go back on nightly medication for six additional months, again keeping a least a five day supply of medicine left over to treat the next bout of cysititis, whether that is three months from then or two years from then. Be sure to take extra medicine with you when you travel. You may repeat the above for years.

What is an IVP?

An IVP(Intravenous Pyelogram) is an x-ray of your kidneys and other parts of your urinary system. This includes your ureters(the tubes leading from the kidneys) and your bladder. An IV will be inserted into your arm. You will be given a special x-ray dye through the IV. This dye will outline the kidneys and the urinary system. This x-ray will enable the doctor to see how well the kidneys are functioning. Several images of your kidney will be taken. The test takes about an hour to complete.

Why is it important to chose a physician who is "Board Certified"?

The certification process evaluates a physician's clinical skills based on education, examination, review of actual surgical cases, peer review, and other criteria. Certification by an American Board of Medical Specialities does not guarentee compentence in practice, but does indicate that the physician has completed certain basic training requirements, and has demonstrated at the time of examination a knowledge and compentence in the care of patients. Board Certification is voluntary. It is not a requirement for practicing urology.

What are the Requirements for Board Certification?

1.EDUCATION

Must have graduated from an accrediated medical school.
Must have satisfactorily completed a minimum of five clinical years of postraduate clinical training in an ACGME-accrediated program. Twelve months of residency must be spent in general surgery, urology or other clinical rotation relevant to urology. The final three years of training must be spent in urology with the last year as a chief resident in urology.

2. REVIEW OF CREDENTIALS
Upon satisfactory completion of their graduate education, urologists may apply for Certification. Upon satisfying all of the Board's requirements, they are admissible to take the examination.

3.EXAMINATIONS
Applicants for Certification must first pass a day-long written examination which assesses the physician's knowledge of urology and related subjects.

Upon successful completion of the examination, 18 months of continious medical practice in the same community, positive peer review and letters of recommendation, and submission of a pracice log demonstrating clinical proficiency, the physician is admitted to the "Certifying Examination". This is an interactive oral process between the examiner(American Board of Urology)and the physician candidate. An assessment is made of the Candidate's ability to diagnose and manage ordinary/complex urologic problems. If the physician meets the standards, he/she becomes Board Certified.

I am having trouble emptying my bladder. What causes this and what can be done to treat my problem?

Most likely your problem is the result of an enlarged prostate. This condition is also known as BPH (begign prostatic hyperplasia). Approximately 50% of all men over the age of 50 have BPH. By age 80, this number has jumped to 80%. Common symptoms include:

Weak urine flow

Sudden urge to urinate

Difficulty/pain in starting urination

Multiple trips to the bathroom

Feeling of not emptying the bladder

Stopping and starting of urine flow

As a man ages, his prostate enlarges. The enlargement encroaches upon the urethra, causing partial and sometimes nearly complete obstruction of urine flow. While this condition is not life threating, it can be uncomfortable and affect the quality of life. There is no relationship between prostate cancer and BPH.

In order to determining whether you have BPH, your urologist will perform a number of diagnostic tests. He will have you fill out a questionaire, known as the AUA Symptom Score, to assist him in determine whether you have BPH. If you are diagnosed with BPH, your urologist will perform a complete physical exam as well as tests which measure urine flow rate and the amount of urine in the bladder after urination. These tests will allow your urologist to better understand your particular condition.

Several treatment options are available. Surgery is a proven and effective approach, but requires hospitallization and can involve many significant side effects. Drug therapy is chosen by many men, but requires a life long committment and sometimes presents undesireable side effects. In addition, many insurance plans do not cover these medications and drug therapy can be very costly. Another approach is called "watchful waiting". If your symptoms are bearable, you can , with the guidance of your urologist, simply wait and see. It does nothing to improve your condition and unlikely your symptoms will improve.

Urological Associates is offering an alternative to the options listed above. It is called microwave therapy or TUMT. The procedure is done in the office. Therefore, no hospitals, no costly prescriptions, just 90 minutes in the office. Clinical studies indicate that this procedure provides a safe and effective treatment for BPH. The application of thermotherapy(heat) to the prostate causes changes in the prostate tissue, thereby providing symptomatic relief to the patient.

This therapy is a simple,relatively painless way to treat BPH. It is not a surgical procedure, so an operating room is not required. No general or spinal anesthesia will be used. Instead, you will be given a mild conscious sedation. You will be able to leave the office as soon as your procedure is over, however, you must have a driver because of the mild sedative you will receive.

The therapy takes approximately 90 minutes. Your urologist will apply a local anesthetic and will pass a small flexible catheter through your urethra. The catheter contains a patented micro wave antenna that delivers heat to the prostate. The cathether is attached to Microwave Generator. Microwave heat will be applied to your prostate for about one hour. Your urologist will offer you mild pain medications prior to your treatment. You can listen to music or read during the procedure if you choose.

At the end of the procedure, your urologist will place a small catheter, which will drain urine from your bladder and will remain in place for a few days. During this time, you will need to take it easy. After your urologist determines that the catheter can be removed, you will be free to resume your normal day to day activities.

A period of six weeks to three months is requiured for complete healing of the prostate and noticeable improvement in your BPH symtoms. You are urged to discuss these improvements with your urologist at your follow-up visits.

Please contact our office if you think this is an option you would like to discuss.

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