Smith Blog

Kidney stones are crystals that separate out from components in the urine. They often form in the kidney, and if they are small enough, begin transiting from the kidney, down into the ureter on its way to the bladder.

A passing kidney stone is possibly one of the most painful diseases, often compared to the severity of labor pains of childbirth.  The pain comes on suddenly when the stone is stuck in the ureter and blocks the flow of urine.  Most kidney stones, if small enough will pass without any surgical intervention.

The time it takes for a stone to pass varies from person to person.  As shown in the graph below, a 2mm stone takes on average 5-10 days to pass; a 3mm stone can take an average of up to two weeks to pass. Larger stones between 4-6mm can take on average a month, and sometimes longer to pass.

Also, the size of the stone dictates the probability of the stone passing. Small stones of about 2mm have a 70-80% chance of passing. As the stones become larger, the chances of the stone passing become less. A 4-6mm stone has about a 50-60% chance of passing.

Increasing the amount of liquids you drink can certainly help the stone pass. Certain medications can be prescribed by your doctor to increase the chances of the stone passing.

Ultimately, some stones, regardless of size will not pass despite your best efforts. These stones will need to be removed. In these cases, minimally invasive surgical options are available for removing the stones.

References

1. Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol. 162(3 Pt 1):688-90. 1999.

An update on the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial with two additional years of follow-up continues to indicate a 21 percent reduction in prostate cancer specific mortality for patients undergoing screening for prostate cancer.  When accounting for non-compliance, risk reduction increased to 29 percent.  Based upon their analysis, the number of prostate cancers detected that are needed to prevent one death was now 37 (decreased from the previously reported 48) and in years 10 and 11, the mortality reduction in the screened cohort was 38 percent.

However, an update from the prostate arm of the Prostate, Lung, Colorectal and Ovarian cancer screening trial, did not find significant changes from their original report, finding no difference in prostate cancer specific mortality in the intervention group.  As a result, we are left with conflicting recommendations from the two largest trials of prostate cancer screening. 

There will continue to be debate regarding the overall benefit of screenings but several conclusions can be made from the trials.  First, it appears the potential benefit from PSA testing can be realized by biennial rather than annual screening.  Second, the potential benefits of screening do not become evident until at least 10 years of follow up.  Therefore, older men with significant co-morbidities are unlikely to benefit from screening and in fact, may experience significant harm from the morbidity of prostate biopsy and overtreatment of prostate cancer.

Still, given that the overwhelming majority of patients believe that screening for cancer is an important component of good health practice, the use of PSA testing is unlikely to diminish.  Therefore, more effort should be made to decrease the burden of overtreatment by increasing the use of active surveillance in men with low risk prostate cancer.  More research is needed to develop serum biomarker/genetic testing to identify high risk patients to be able to refine screening to targeted populations. 

Prostate cancer screening has recently been in the spotlight due to controversial recommendations made by the United States Preventative Services Task Force (USPSTF).  According to these recommendations, screening for prostate cancer is no longer advocated by the USPSTF.  Of course, many patients and families affected by prostate cancer are concerned with these recommendations, as are many physicians who care for prostate cancer patients on a daily basis.  A large majority of urologists are, in fact, in disagreement with the recommendations of the USPSTF. On March 1^st, 2012, Michael Schwartz, MD will be giving a free lecture on prostate cancer screening to the general public.  Dr. Schwartz is an expert in prostate cancer screening and the management and treatment of prostate cancer.  The recent controversies regarding prostate cancer screening will be discussed, and questions welcomed.  The lecture will be held at 7PM at 1350 Northern Boulevard, Manhasset, NY 11030. 

March is also National Kidney Awareness Month.  On March 14^th, there will be a combined lecture given by Michael Schwartz, MD and Scott Fields, MD on kidney cancer.  The term “kidney cancer” actually refers to a spectrum of different malignancies that can appear in the renal cortex (the solid portion of the kidney that filters blood and produces urine).   Dr. Fields is a medical oncologist focusing on genitourinary malignancies and with expertise in the treatment of advanced kidney cancer.  Dr. Schwartz is a urologist specializing in minimally invasive surgical treatment of localized kidney cancers.   The lecture will provide an overview of kidney cancer with the general public as its target audience. The location of the lecture will be at North Shore University Hospital’s Kaufman Board Room, 300 Community Drive, Manhasset, NY 11030.  Registration will begin at 6PM with the lecture to run from 6:30-7:30PM.

A well attended interstitial cystitis support group meeting was held on Wednesday, November 9th which was followup from another successful support group meeting on October 5th.  The most recent meeting was purely devoted to patients interacting with patients, sharing tips on topics such as control of constipation, varied food sensitivities and their management, and other self care strategies. Light refreshments were served. The meeting was supervised by Marina Ruzimovsky, NP and due to the enthusiasm of the group, the meetings will be held on a regular basis and will likely start up again at the beginning of 2012.

Attendees need not be patients at the Smith Institute for Urology to attend these meetings!

If you would like to attend future meetings, please contact Marina or Donna.

Farzeen Firoozi, MD
Director, The Center for Pelvic Health and Reconstructive Surgery
The Arthur Smith Institute for Urology
Hosftra North Shore-LIJ School of Medicine
North Shore-LIJ Health System

Urethral diverticula occur in 0.6-5% of women in the United States. Although uncommon, diverticula are often misdiagnosed and attributed to other lower urinary tract conditions. The majority of the studies evaluating outcomes of urethral diverticulectomy (UD) have been retrospective in nature, with small numbers and short-term follow ups. No studies have looked at patient-perceived outcomes after UD in order to gain perspective on patient’s perception of surgical outcome. The concept of patient-perceived outcomes in the field of urology, specifically female urology, has become quite popular. Many studies have correlated outcomes after incontinence and vaginal prolapse surgery to subjective measures, such as validated questionnaires. The general consensus form these studies is that patient reported outcomes measures (PROMs) correlates strongly with overall satisfaction with intervention. In addition, despite the fact that dyspareunia (pain with intercourse) is one of the 3Ds of the symptom complex associated with urethral diverticula, no study has evaluated the impact of UD on sexual function, specifically dyspareunia.

One hundred and twenty-two female patients underwent UD at the author’s institution during the study period. The participant’s self-reported improvement of symptoms on Patient Global Impression of Improvement, or PGI-I was 75% “better”, 13% “no change”, and 12% “worse”. The participant’s impression of symptom severity after surgery on Patient Global Impression of Severity, or PGI-S was 53% “normal”, 22% “mild”, 13% “moderate”, and 12% “severe”. Of the participants, 60% reported being sexually active. Of these sexually active patients, 43% reported having dyspareunia after UD.

To our knowledge, this is the first study evaluating patient-perceived outcomes and sexual function after UD. Based on PGI-I, the majority of patient responders who underwent UD reported improvement in symptoms after surgery. Based on PGI-S, most patient responders rated their symptom severity after surgery as “normal or mild”. These results are encouraging in terms of demonstrating high subjective improvement rates with UD. As a result, we have been able to utilize PROMs as new outcomes tool in evaluating patients after lower urinary tract reconstruction, something no other study in the current literature has demonstrated. Moving forward, we plan on using PROMs to prospectively evaluate patients undergoing lower urinary tract reconstruction at our institution.

Our findings regarding sexual function in this population are very surprising. Of the responders, 60% reported to be sexually active after surgery, with 43% of these patients complaining of dyspareunia. The dyspareunia rate is certainly higher than rates commonly published in smaller retrospective studies and reviews, which are approximately 15%. We believe this could be due to a several factors. First, there may be a negative impact on pelvic floor function in patients with symptomatic urethral diverticula over time. This pelvic floor dysfunction may not resolve with surgical repair of the anatomic defect. Second, there is a possibility that some of our patients may have persistent urethral diverticula that may be causing dysparuenia. Third, the repair itself, which at times requires a Martius labial fat pad interposition, may predispose some patients to dyspareunia. Finally, we did not take into account estrogen status causing lubrication issues in our population, which we concede could impact sexual function.

The novel approach to assessing outcomes using a PROMs sets this large study aside from what is currently available in the literature. In addition, the post-operative sexual function data is unique and sheds some light on this disease and its impact on sexual function in women. Dr. Firoozi’s study was awarded Best Poser at this year’s annual meeting of the American Urological Association in San Francisco, California. The full article is available in the December issue of AUA News.

Farzeen Firoozi, MD
Z. Chad Baxter, MD
The Center for Pelvic Health and Reconstructive Surgery
The Arthur Smith Institute for Urology
North Shore-LIJ Health System

The real time intraoperative adaptive approach to brachytherapy offers a great improvement over preplanned treatment. Fewer seeds are needed to produce the same total; this offers a smaller radiation dose with fewer side effects. We document our experience on Long Island with 1449 cases over a 12 year period, with respect to biochemical freedom from progression and overall survival rates. Treatment of men under 60 and potency outcomes are also discussed

Midurethral synthetic slings have increasingly become one of the most popular surgical procedures among urologists and gynecologists throughout the world for the treatment of stress urinary incontinence. Cure rates for stress urinary incontinence have been as high as 90.2%, with minimal morbidity. While severe perioperative complications are rare, one of the minor complications includes urinary tract infections, or UTIs. Rates of UTI vary widely and are reported in the literature to range from 4% to 43%.

The American Urological Association (AUA) recently developed a Best Practice Statement for antimicrobial prophylaxis for patients before undergoing sling surgery. These guidelines suggest that in women with minimal comorbidity, a single dose of a first- or second generation cephalosporin is recommended before vaginal procedures, and that duration of therapy should be < 24 hours. Alternatives, such as fluoroquinolones, or an aminoglycoside and clindamycin, are acceptable in cases of allergy or unavailability.

Despite the recent recommendations, many urologists around the country continue to prescribe several days of antibiotics after uncomplicated sling surgery. In a recent survey given to 7433 board-certified members of the AUA, nearly 1000 urologists responded that they perform sling surgery. Interestingly, among those who responded to the survey, more than half (54.5%) routinely prescribed more than 5 days of postoperative antibiotic therapy. This extended length of antibiotic use may lead to adverse events including yeast infection, bowel-related complications, and development of antimicrobial resistance.

The authors participated in a trial testing these guidelines in the first published study on this subject in a prospective fashion. They looked at 101 patients who underwent sling surgery with only a single pre-operative dose of antibiotics. The low percentage of women who developed a UTI (5.9%) was acceptable and additional antibiotics in the postoperative period were deemed unnecessary. The study demonstrated findings that support the AUA Best Practices Statement for antibiotic prophylaxis after sling surgery that suggest that prescribing <24 hours of antibiotics is sufficient.

Farzeen Firoozi, MD is the Director of the Center for Pelvic Health and Reconstructive Surgery at the Smith Institute for Urology, at the North Shore University Hospital and Long Island Jewish Hospital. His clinical interests include urinary incontinence, pelvic organ prolapse, complex reconstruction of the lower urinary tract, and management of complications of vaginal and lower urinary tract surgery. After completing his urology residency at Albany Medical Center, Dr. Firoozi completed his fellowship at the prestigious Cleveland Clinic, with specialization in male and female voiding dysfunction, pelvic organ prolapse, urinary incontinence, and overactive bladder– one of few fellowships formally recognized by both the American Board of Urology and American Board of Obstetrics and Gynecology. Dr. Firoozi was part of the team led by Dr. Michael Ingber that published this first prospectively designed study to answer the question of what is the appropriate antibiotic regimen for patients undergoing sling surgery. The article can be found in this month’s Urology journal.

Watch Dr. Lee Richstone give a presentation on Multiparametic 3T MRI of the Prostate.

Will MR imaging provide the answers for prostate cancer dilemmas?

Lee Richstone, MD* and Eran Ben-Levi, MD**
The Smith Institute for Urology*
Diagnostic Imaging Center at the Center for Advanced Medicine**
The North Shore-Long Island Jewish Health System

Urologists and patients are faced with dilemmas at nearly every phase of prostate cancer management.  From prostate cancer detection, staging to treatment, many fundamental questions remain.  It is in this context that advances in prostate imaging could have a major impact in clinical practice with the potential to revolutionize the way we localize and stage prostate cancer, individualize treatment, and manage patients after treatment failure.  Multiparametric magnetic resonance imaging (MP-MRI), which integrates MR spectroscopic imaging (MRSI), diffusion weighted imaging (DWI), and/or dynamic contrast enhanced MRI (DCE) with traditional T2 weighted MRI, may be such an imaging breakthrough.

T2 MRI Scanning: Endorectal vs. Pelvic Phased Array, and 1.5 vs 3.0T Scanning
Standard T2-weighted MRI with 1.5 Tesla (T) scanners has been employed to detect and localize prostate cancer, which is characterized by decreased signal intensity compared to the normal peripheral zone.  The use of an endorectal coil in addition to external coils (pelvic phased array) allows for superior imaging.1,2  The use of 3.0T scanners offers increased spatial resolution, speed, and improved localization and staging.3  Clinically, endorectal MRI can incrementally improve upon preoperative nomograms in predicting seminal vesicle invasion (SVI) and extracapsular extension (ECE).4,5  Endorectal MRI has demonstrated clinical utility, altering the pre-surgical plan for neurovascular bundle preservation vs. resection in 39% of patients and 78% of high risk patients.6  Prostatic venous anatomy and membranous urethral length as evaluated with endorectal MRI have been correlated with estimated blood loss and postoperative continence, respectively, and some argue that MR based surgical planning has improved patient selection and pathological outcomes.7 However, significant limitations of T2 endorectal MRI exist, including limited sensitivity and specificity for detection of low stage, low grade disease, limitations in detecting prostate cancer in regions other than the peripheral zone, difficulty distinguishing prostate cancer from post-biopsy hemorrhage or prostatitis, and lack of inter-observer reliability.1,8-11   As a result, the value of T2 endorectal MRI as a single modality has been debated.11,12

Functional MRI Techniques: MRSI, DWI, and DCE
MRSI differentiates normal from cancerous prostate tissue by detecting differences in the concentration of various metabolites within the cytoplasm and extracellular space.10  Compared with normal tissue, prostate cancer is characterized by reduced or absent citrate and polyamines and elevated choline and creatine.13,14 Enthusiasm accompanied the early use of MRSI, which can be used to assess tumor location, volume, stage and may correlate with Gleason grade.2,15  Although some data has suggested that MRSI may be superior to T2 MRI alone, a multi-institutional study failed to demonstrate such advantages.14,16,17 Diffusion weighted imaging of prostate cancer is predicated on differences in the motion of water within normal vs. malignant tissue. Prostate cancer demonstrates reduced average water diffusivity compared with benign tissue, perhaps due to increased cell density within cancerous tissue.18 DWI detects prostate cancer with high spatial resolution and may be superior to T2 MRI alone in sensitivity and specificity of cancer detection and prediction of tumor aggressiveness.11,19  Dynamic contrast enhanced MRI takes advantage of tumor angiogenesis and increased microvascularity of malignant vs. benign tissue.  Malignant tissue differs from benign tissue with respect to microvessel density, blood flow, vascular morphology and permeability, and flow dynamics.12 Following gadolinium-DTPA contrast administration, prostate cancer typically demonstrates not only a greater peak enhancement, but also differs with respect to time to peak and washout.20 Interpretation of DCE can involve qualitative, semi-quantitative, or quantitative analysis.12 A growing body of literature suggests that DCE may significantly improve cancer detection, localization, and staging.11,16,21,22 Continuing research is aimed at determining the ideal DCE protocol and data analysis methodology in order to standardize the technique and allow for wider application.

Multiparametric MRI: Comprehensive Imaging with Clinical Applications
Multiparametric MRI integrates T2-weighted imaging with one or more functional technique (MRSI, DWI, and/or DCE) in a single study, with the potential to compensate for the shortcomings of each technique applied individually.  Combining modalities aims to increase the accuracy of MR-based imaging in a convenient single 60-minute study.  Moreover, scanning at 3.0T may improve the performance of individual and combined MRI techniques, and may even obviate the need for an endorectal coil, reducing the invasiveness of the study.11

Clinical applications of MP-MRI begin with prostate cancer diagnosis. For example, the management of patients with negative biopsies, yet persistently abnormal PSA values, is a common clinical dilemma.  Repeat standard biopsy has low yield of cancer detection and saturation biopsies may lead to increased morbidity and the detection of insignificant cancers.23  In a recent prospective, randomized trial of 180 patients with elevated PSA and negative prior biopsies, MP-MRI imaging (DCE/MRSI) led to increased detection of prostate cancer, with 62% being Gleason grade >7.23  A combination of T2, MRSI and DCE imaging had a PPV and NPV of 89% and 93%, respectively.  In this context, MP-MRI may aid urologists in the detection of significant cancers, and avoiding repeated biopsies in patients at lower risk.

Once prostate cancer is diagnosed, it is imperative to improve our ability to distinguish indolent from clinically significant tumors to reduce the extent of overtreatment.  The integration of MRI/MRSI with clinical parameters has been demonstrated to significantly improve the performance of nomograms in predicting insignificant prostate cancer.24  In the future, the further incorporation of DCE, and/or DWI at 3.0T into a single study could further improve our ability to select patients for active surveillance.  Moreover, one could imagine the use of an optimized MP-MRI protocol to avoid biopsy altogether in patients with an elevated PSA but low risk for clinically significant disease.  Such a non-invasive adjunct to screening could revolutionize our approach to prostate cancer detection, limit the diagnosis of indolent disease, and reduce the number of unnecessary biopsies and associated morbidity.

Multiparametric MRI at 3T allows for greater accuracy in detecting prostate cancer.25   With the potential to improve tumor localization, MP-MRI may help in the selection of patients for focal therapy, aid in treatment planning, and demonstrate the efficacy of ablation following minimally invasive or focally-based treatments.26  MP-MRI may be helpful in selecting those intermediate and high-risk patients who are appropriate for surgery and in tailoring the surgical approach.  Similarly, MP-MRI can aid in IMRT and brachytherapy dose-painting for improved treatment planning.7   Post-treatment, MP-MRI  may aid urologists with the common diagnostic challenge of determining whether treatment failure represents local or systemic disease. Various techniques, including DWI, DCE and MRSI have been used to aid in the detection and localization of recurrence after brachytherapy, external radiation treatment, and surgery, which may help in salvage treatment selection, and perhaps allow for focal or focally intensified salvage treatment in the future.7.12,27,28,29

Conclusions:
Multiparametric MRI has significant promise to aid clinicians with common prostate cancer dilemmas.  Currently, MP-MRI can be employed to help detect prostate cancer in the setting of multiple negative biopsies, evaluate cancer stage and guide treatment selection particularly in high risk patients, among other indications.  In the future, MP-MRI may have a major role in selecting patients for active surveillance and/or focal therapies. Future study is necessary to determine the optimal combination of functional techniques, and to develop standardized protocols for data acquisition and analysis.

REFERENCES

1.    Hricak H, White S, Vigneron D, et al.  Carcinoma of the prostate gland: MR imaging with pelvic phased-array coils verus integrated endorectal-ppelvic phased-array coils. Radiology 1994;193:703-709.
2.    Kurhanewicz J, Vigneron D, Carroll P et al.  Multiparametric magnetic resonance imaging in prostate cancer: present and future. Curr Opin Urol. 2008;18(1):71-77.
3.    Heijmink SW, Futterer JJ, Hambrock T, et al: Prostate cancer: body-array versus endorectal coil MR imaging at 3T-comparison of image quality, localization, and staging performance. Radiology 2007;244:184-195.
4.    Wang L, Mullerad M, Chen HN, et al. Prostate Cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension. Radiology 2004;232:133-139.
5.    Wang L, Hricak H, Kattan MW, et al. Prediction of Seminal Vesicle Invasion in Prostate Cancer: Incremental Value of Adding Endorectal MR Imaging to the Kattan Nomogram. Radiology 2007; 242:182-188.
6.    Hricak H, Wang L, Wei DC, et al. The Role of Preoperative Endorectal Magnetic Resonance Imaging in the Decision Regarding Whether to Preserve or Resect Neurovascular Bundles during Radical Retropubic Prostatectomy. Cancer 2004;100:2655-63.
7.    Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT. Imaging prostate cancer:  a multidisciplinary perspective. Radiology 2007;243(1):28-53.
8.    Yu KK, Hricak H. Imaging prostate cancer. Radiol Clin North Am 2000;38:59-85.
9.    May F, Treumann T, Dettmar P, et al. Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer. BJU 2001;87:66-69.
10.    Kurhanewicz J, Swanson MG, Nelson SJ, et al. Combined magnetic resonance imaging and spectroscopic imaging approach to molecular imaging of prostate cancer. J Magn Reson Imaging 2002;16:451-463.
11.    Macura 2008 Macura KJ. Semin Roentgenol. 2008 Oct;43(4):303-13
12.    McMahon et al, Magn Reson Imaging Clin N Am 2009;17:363–383.
13.    Wefer AE, Hricak H, Vigneron DB et al. Sextant localization of prostate cancer: comparison of sextant  biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. J Urol 2000;164:400-404.
14.    Scheidler J, Hricak H, Vigneron DB, et al. Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging: clinicopathologic study. Radiology 1999;213:473-480.
15.    Zakian KL, Sircar K, Hricak H, et al. Corretlation of proton MR spectroscopic imaging with Gleason score based on step-section patholoigic analysis afgter radical prostatectomy. Radiology 2005;234:804-814).
16.    Futterer JJ, Heijmink SW, Scheenen TW, et al. Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 2006;241:449-458.
17.    Weinreb JC, Blume JD, Coakley FV, et al. Prostate cancer: sextant localization at MR imaging and MR spectroscopic imaging before prostatectomy–results of ACRIN prospective multi-institutional clinicopathologic study. Radiology. 2009 Apr;251(1):122-33.
18.    Desouza NM, Reinsberg SA, Scurr ED, et al: Magnetic resonance imaging in prostate cancer: the value of apparent diffusion coefficients for identifying malignant nodules. Br J Radiol 2007;80:90-95.
19.    Miao H, Fukatsu H, Ishigaki T. Prostate cancer detection with 3-T MRI: comparison of diffusion-weighted and T2-weighted imaging. Eur J Radiol 2007;61:297-302.
20.    Bonekamp D, Macura KJ. Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Prostate. Top Magn Reson Imaging 2008;19(6);273-284.
21.    Ocak I, Bernardo M, Metzger G, et al. Dynamic contrast-enhanced MRI of prostate cancer at 3 T:a study of pharmacokinetic parameters. AJR Am J Roentgenol 2007;189(4):849.
22.    Kim JK, Hong SS, Choi YJ, et al. Wash-in rate on the basis of dynamic contrast-enhanced MRI: usefulness for prostate cancer detection and localization. J Magn Reson Imaging 2005;22(5):639–46.
23.    Sciarra et al. Clin Cancer Res 2010;16(6):1875-1883).  Sciarra A, Panebianco V, Ciccariello M, Salciccia S, Cattarino S, Lisi D, Gentilucci A, Alfarone A, Bernardo S, Passariello R, and Gentile V.  Value of Magnetic Resonance Spectroscopy Imaging and Dynamic Contrast-Enhanced Imaging for Detecting Prostate Cancer Foci in Men With Prior Negative Biopsy. Clin Cancer Res 2010;16(6):1875-1883.
24.    Shukla-Dave A, Hricak H, Kattan MW, Pucar D, Kuroiwa K, Chen H, Spector J, Koutcher JA, Zakian KL and Scardino PT. The utility of magnetic resonance imaging and spectroscopy for predicting insignificant prostate cancer: an initial analysis. BJUI 2007;99:786-793.
25.    Turkbey B, Pinto PA, Mani H, et al. Prostate Cancer: Value of Multiparametric MR Imaging at 3 T for Detection–Histopathologifc Correlation. Radiology 2010;255(1):89-99.
26.    Larson et al, Urology 2003;62: 900–904.
27.    Haider MA, Chung P, Sweet J, Toi A, Jhaveri K, Me´ Nard C, Warde P, Trachtenberg J, Lockwood G, Math.M, and Milosevic M. Dynamic contrast-enhanced magnetic resonance imaging for localization of recurrent prostate cancer after external beam radiotherapy. Int. J. Radiation Oncology Biol Phys 2008;70(2): 425–430.
28.    Westphalen AC, McKenna DA, Kurhanewicz J, Coakley F. Role of magnetic resonance imaging and magnetic resonance spectroscopic imaging before and after radiotherapy for prostate cancer.J Endourol 2008; 22:789–794 87
29.    Sella T, Schwartz LH, Swindle PW, et al. Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 2004;231:379-385.

Marina Ruzimovsky led a superb Pelvic Pain Support Group on February 28th.

Topics discussed included…

*The male chronic prostatitis/chronic patient: current management strategies

*New concepts of patient evaluation: Examination of the multiple facets of patient presentation (co-morbid conditions) rather than just the bladder or prostate.

*Novel and evolving approaches to the treatment of pelvic pain
The role of…
Cannabanoids
Liposomes
Nerve Growth Factor Immunoglobulin (Tanezumab)
Physical Therapy
Posterior tibial nerve stimulation
Trigger point injections
Botulinum toxin injections
New bladder instillations
Medications that can be administered through the vagina or rectum
Neuromodulation
Interferential transcutaneous nerve stimulation (iTENS)
Diet changes

* Two new studies for Interstitial Cystitis patients were discussed

-Caffeine study. Interstitial cystitis patients who feel that they are “coffee sensitive” are encouraged to participate. The project is designed to determine whether caffeine is actually the cause of IC related symptoms. If interested in participating, please contact Dr. Sadek (516) 734-8565.

-Nerve growth factor Immunoglobulin study (Tanezumab) for Interstitial Cystitis.  This is a study which will likely start in May 2010. For more information, please contact Monica Johnson, RN, our new clinical research coordinator, (516) 734-8515.