People suffering from bladder, urinary tract, and other urologic conditions can find relief at UPMC in Pittsburgh, Pa. The Department of Urology at UPMC provides treatment strategies for diseases of the male and female urinary tract and the male reproductive organs. Urological Comprehensive Care Program Based at UPMC Shadyside, this patient-centered treatment approach streamlines continuity of care, from admission to surgery to discharge. Comprehensive Prostate and Urologic Cancer CenterUPMC CancerCenter's urologic surgeons have expertise in the surgical management of prostate and urologic cancers. UPMC Kidney Stone Center This multidisciplinary center provides long-term treatment for people who have previously had kidney stone surgery or spontaneously passed a stone. The Women’s Center for Bladder and Pelvic HealthLocated at Magee-Womens Hospital of UPMC, the center offers comprehensive services to help relieve a variety of bladder and pelvic conditions. At the Department of Urology, we aim to improve our patients' well-being and overall quality of life.
Our urologists and urologic surgeons have expertise in using specialized technologies and minimally invasive surgical techniques for treating urology conditions. Our multiple locations throughout Pittsburgh give adults and children convenient access to comprehensive urologic care.
Our research on urogenital cancers and urologic diseases allows us to discover and develop more effective treatments.
For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. When Viagra came out, all of a sudden there were ads on television with the presidential contender Bob Dole talking about it and introducing the term ED to the public, and everybody was fascinated. Since haematuria can arise from any part of the urinary tract, the standard initial investigation is an xray called Intravenous Urogram (IVU). Sometimes, the bladder tumour can also be seen on an ultrasound examination if it is > 1 cm [Fig 3].
This is easily done under local anaesthesia in the clinic using a flexible scope without causing much discomfort [Fig 4]. Once the diagnosis of a bladder lesion is confirmed, endoscopic surgery using a resectoscope instrument to cut away the tumour (called TURBT). After endoscopic tumour resection of superficial bladder tumours, periodic surveillance cystoscopies are needed to pick up recurrences. Treatment of patients with invasive bladder cancer has to be individualised according to the general status of health, extent of cancer and personal preferences. Although radiotherapy is a safer option and allows bladder conservation, the 5 year survival for bladder cancer with muscle invasion is only 20%-40%.
Laparoscopic prostatectomy entails removal of the entire prostate gland via a few small key-hole incisions. Laparoscopic (key-hole) surgery achieves similar results without the need of a long incision. Laparoscopic extraperitoneal retropubic prostatectomy, performed directly by the surgeon mimicks all the surgical principles of the well established open prostatectomy technique with the advantage of small incisions and better accuracy during dissection. Our centre has been performing laparoscopic extra peritoneal prostatectomy since 2003 and we have the largest experience in Singapore. Surgery for cure in early prostate cancer can be done by open surgery, laparoscopic prostatectomy or robotic assisted laparoscopic prostatectomy. Laparoscopic prostatectomy can be done directly by the surgeon or with the assistance of a surgical robot. There are several possible side effects after prostatectomy, and many of them will depend on a patient's individual characteristics. Incontinence (leakage of urine) of varying degrees will be initially experienced by most patients, but should improve over time. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Part of what happens is that almost anything that’s bad for blood vessels is bad for that part of the man’s anatomy.
We started seeing ads on television that talked about erections — even the four-hour erection that required medical attention. Men are affected 3 times more commonly than women and it occurs mostly in those above 50 years old.
It involves the injection of contrast material which is excreted by the kidneys to outline the urinary tract. The advantage is that even small tumours can be seen and biopsy taken to confirm if the bladder tumour is indeed cancerous as some 5% of bladder tumours may in fact be benign. Total removal of the bladder (radical cystectomy) for muscle-invasive cancer (Stage 2 and 3) provides the best chance of cure.


The limitation with radiotherapy is that it may not kill the cancer cells completely and there will be cumulative side-effects on the bladder and bowel, causing irritation and incontinence. The advantage of laparoscopy is that the incision is small and recovery from surgery and return to work is much quicker.
It achieves all the advantages of robotic prostatectomy without incurring huge expenses on capital cost (robot costs USD$1.2mil) and consumable items. Risk factors for impotence include age, pre-operative erectile dysfunction and sparing of the erectile function nerves during surgery. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. Morgentaler, an associate clinical professor of urology at Harvard Medical School, had never heard of such a thing. It is important to note that bladder cancers may look the same but may not behave the same. A typical treatment protocol would consist of weekly instillation for 6 weeks followed by a booster over 3 weeks. Partial cystectomy is seldom done as most bladder tumours are of the transitional cell type and may recur in the remaining bladder.
The magnification under laparoscopy allows more accurate dissection and preservation of vital structures like the external urinary sphincter and neurovascular bundle. Some patients will be potent within a few weeks after surgery, while others will take up to 2 years to recover potency. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. When a patient first came to me with that, which was probably five or six years ago, I confessed that I’d never heard any such thing and I was fascinated myself. It brought this whole issue to the forefront; we had words for it in public discourse that were acceptable, and of course it was in Pfizer’s interest to actually inform the public that this was a common condition that could be treated. Quite commonly, the diagnosis is delayed because the haematuria is intermittent or wrongly attributed to other causes esp.
After a radical cystectomy, the urine from the kidneys and ureters is diverted into a short segment of small bowel (called an ileal conduit) which opens as a stoma on the abdominal wall [Fig 6].
Otherwise, it is exactly the same as laparoscopic prostatectomy performed directly by the surgeon.
A bladder catheter (rubber tube) will be placed at the time of surgery to assist passage of urine and is generally removed one week later.
Now what’s happened as a result is that it’s changed expectations for men and their sexuality. BCG is considered to be superior for tumours that are likely to recur and those with CIS disease.
Robotic surgery has several inherent disadvantage as it does not allow dissection of the lymph nodes and usually necessitates entry into the peritoneum cavity.
But what really interested me about that story, after I got over the question of how did he do it, is the mind of men and why a man would do that.
Now men have the idea, which I’m not sure they had before, that they can be sexual even if they live to be 120. Every day, we see patients who request the pills or who already take them but who actually don’t have true ED.
If so, they have the real risk of becoming invasive in the future, especially if the pathological grade is of the aggressive type or if CIS is present. This type of diversion remains the most popular choice as it is relatively easy and quick to construct.
The techniques of laparoscopic is technically more demanding and usually performed by an experinced urologist, trained in the area of advanced laparoscopic surgery. In addition, it is significantly more costly to perform as the capital cost of the robot as well as robotic consumables are always factored into the total surgical bill.
It turns out the reasons men fake it are actually pretty similar to the reasons that women fake it. Then the question is, if the guy has adequate ability to have sex and he’s able to have a climax, then what does he gain by being a little bit firmer? Invasive tumours will eventually spread to the lymph nodes and distant organs, especially the lungs, bones and liver. For younger patients, and those who wish to remain continent or avoid a urostomy, a “new bladder” can be constructed using a long intestine segment. Prognosis for invasive disease is poor, hence it is important to treat bladder cancer at its early stage (stage 1) before it penetrates into the muscle layer.
Clearly, his sample is a bit skewed: These are men who have sought out sex-related medical help.
Most guys will say that they think they’re providing a better experience for their partner.
Although there is no need to wear an external bag, self intermittent catheterisation may still be needed as the neobladder may not empty well or become blocked with mucus produced by the intestine lining.


But Morgentaler says it’s important to know the range of experiences that are out there. In this particular case in the book, this guy had trouble having an orgasm during intercourse, but it had never bothered him before. Masculinity in the gay world is a different story, to some extent, than in relationships between men and women.
As a neobladder operation are more difficult and takes longer to perform, only motivated and fit, young patients are suitable candidates. Part of the struggle for straight men and women is that the traditional roles we grew up with are shifting.
But when he gets in the exam room, he’s totally torn apart talking about his girlfriend and how he can’t satisfy her because he has premature ejaculation.I have a case in the book of a 27-year-old paraplegic who can’t feel or move anything from the waist down. Once he got his feelings involved, he became concerned that she was feeling bad about her own feminine charms and skills, and so to solve that for her he started to fake it.How common is it really, though?There’s not a lot of work on it, but there was an online survey from a men’s website, which probably attracted mainly younger guys, where 31 percent of the guys said they had faked it at one point or another in their lives.
I would suggest to you that in the gay world those relationships have never been terribly well established.
There’s talk of tops and bottoms, but if you have two men, regardless of whether they’re a top or bottom, how much is their essence and idea of self attached to being a provider? And I can tell you anecdotally that when I got a first copy of my book, I went out to a restaurant to show it to a friend. I think it is a different story for them.This idea of defining masculinity while social roles and ideas are so rapidly changing is a challenge for everybody. We’re sitting at the bar, and there’s a group right next to us who saw the cover of the book, and a woman said, “Faking it? To me, one of the reasons I thought it was worthwhile to write this book now is that we have so little information regarding the truth about men.
It can’t be about faking orgasms because men can’t do that.” One of the men with her said, “Sure they can. So in essence, they still have the pleasure from sex, but [ED] is an insult to their masculine identity.
Would it be terrible of me if I left that as a tease for your reader to actually get into the book? And I think the void has been filled by mythology, by negative impressions created by the bad apples that show up in the scandal sheets, and by the loudest and most brazen. I think that there’s a tremendous need for men to enter into the conversation and for people to know, especially in the sexual realm, what’s real. What woman would want to be with a guy that can’t satisfy her?” The idea that a man might be rejected because he can’t be an adequate provider sexually turns everything upside down. Moving along, how have you noticed the rise of Viagra in your practice?It’s changed so much of how we think about men and sex. Matter of fact, we didn’t know how common it was until 1994, when there was a big study called the Massachusetts Male Aging Study, which blew the lid on this issue. What’s out there in news stories, and frankly even in some academic papers, is the idea that men are the product of their minute by minute, moment by moment variations in testosterone. It was only a little while before that that the Masters and Johnson idea was universally held, that if a man has a sexual problem it was all in his head. A week or two ago, a British newspaper reported that men aren’t designed to be monogamous and that if a woman wants to find a man who will be faithful, she should find a man with low testosterone. When I started my practice in the late 1980s, a lot of the guys who did come to see me for ED would start telling me about how they thought they had their problem because they slept in the bed with their mother until age four or they wet the bed until they were age eight.
It doesn’t work that way!It’s part of a picture we have where we accept complexity for women but we simplify the story for men.
There are a lot of men now who are in relationships or may enter into relationships where it’s the woman who has the better-paying job or more prestige.
The challenge for men is how to feel good about themselves as a man while still embracing the strength and capability of today’s woman.And how specifically does that dynamic affect men’s sex lives?Well, I think part of what’s happened is that the opportunity for men to be the provider, if you will, in most realms of life, like [they were] in the 1950s, has decreased.
For a lot of men, it’s in the bedroom that this role may still be there, and if anything, it becomes more important now than it was in the past.
That’s why one of the things that’s a cruel joke is that men are stuck with a very high rate of sexual dysfunction now. So as much as they want to feel great, to sexually feel like they’re the provider, if you will, we have slightly more than 50 percent of men between the ages of 40 and 70 who have some degree of erectile dysfunction.




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