WSUS

June Presidents Message

noemail@wsus.org — Wed, 11 Jun 2008 21:00:00 GMT

The Washington State Urology Society was well represented, once again, at the 2008 Joint Advocacy Meeting in Washington D.C. March 31- April 3. This was the third annual meeting jointly hosted by the AUA and AACU. It provided a forum in which we could meet with State and Federal legislators representing the interests of Washington Urologists voicing concerns about current legislation. In addition to concerns over the SGR and the Recovery Audit Contractor (RAC) Program, we discussed the importance of comprehensive office radiology access and the counterproductive effect of legislation limiting ownership of Ultrasound, CT, and MRI. Last week we finally saw the proposed fix of the Medicare Physicians Payment reductions that were scheduled to go into effect July 1st (10.6%) and January 1st, 2009 (15.6%). The proposal by Senator Baucus (D-Montana) provides for avoidance of the July cut and a 1.1% increase in 2009 scheduled reimbursements. The cost of the legislation is borne partly by...

HORMONE REPLACEMENT THERAPY - A Personalized Approach

noemail@wsus.org — Thu, 29 May 2008 18:00:00 GMT

HORMONE REPLACEMENT THERAPY - A Personalized Approach Amy Ochino, MD Spokane, WA Today, hormone replacement therapy (HRT) is often underutilized because of poor public image and perceptions. It isn’t for everyone, but it can help a great number of women transition into menopause. It is a personal decision to be made between a woman and her health care provider. The average age of menopause is 51 years. We define menopause as the absence of menses for a twelve month period of time. The years preceding menopause, called perimenopause, are usually a three to five year period in which menopausal symptoms can begin. This is the time of life that can be characterized by menstrual cycle changes, hot flushes, night sweats, mood changes and vaginal dryness. Options for HRT depend on a woman’s symptoms. Some women are lucky enough to go through their change of life with minimal concerns. These women may not need any transition relief with HRT. Many women, however, feel that...

Female Urinary Incontinence

noemail@wsus.org — Wed, 28 May 2008 18:00:00 GMT

Urinary Incontinence Jane Miller, MD Associate Professor of Urology, University of Washington (Seattle, WA) Elizabeth Miller, MD Bellevue Urology Associates (Bellevue, WA) Urinary incontinence (UI) is the involuntary loss of urine. UI is very common in women. Approximately 38% of women experience urinary incontinence at some time in their lives. Although UI can occur at any age, it does become more prevalent as women get older. UI has been shown to significantly affect patient’s quality of life, sexual function and in some cases their health. Women with osteoporosis (thinning bones) and urinary urge incontinence (UUI) have been shown to have greater rates of hip fracture due to falling as they hurry to the bathroom. Patients with UI have higher rates of anxiety and depression. There are two major types of urinary incontinence. The first and most common is stress urinary incontinence (SUI)—involuntary urine loss associated with activities such as coughing or...

OVARIAN CANCER

noemail@wsus.org — Fri, 29 Feb 2008 15:00:00 GMT

OVARIAN CANCER William A. Peters, III, M.D. Gynecologic Oncologist, Swedish Medical Center (Seattle, WA) Introduction: Approximately one in seventy women in the United States will develop ovarian cancer during their lifetime. The most common type of ovarian cancer is called epithelial ovarian cancer. The average age of a patient at the time of diagnosis is in their early sixties. There are rarer types of malignancies arising in the ovaries called germ-cell tumors and stromal tumors. These are very different in presentation and management and are more frequently seen in adolescent or young adults. A subcategory of epithelial ovarian tumors is called borderline tumors. Another term for these is tumors of low malignant potential. Tumors that fall within this category have a very good prognosis even when they have spread beyond the ovary and are usually managed with surgery alone. Risk Factors: It has long been recognized that epithelial ovarian cancers are more...

NON-PHARMACOLOGIC TREATMENT OF OVERACTIVE BLADDER

noemail@wsus.org — Fri, 29 Feb 2008 15:00:00 GMT

OVERACTIVE BLADDER Fred Govier, MD Virginia Mason Medical Center (Seattle, WA) Overactive bladder (OAB) is a prevalent problem affecting an estimated 33 million patients in the United States. It is defined as urinary urgency with or without urge incontinence, usually with frequency and nocturia, in the absence of pathologic factors. It occurs in both males and females and the incidence increases with advancing age. There are multiple etiologies for OAB but in most patients the symptoms are caused by an abnormal contraction of the bladder that the patient interprets as urgency. If the contraction is strong enough, the patient suffers urge incontinence. After taking a medical history and performing a physical examination, the clinician needs to rule out confounding factors such as urinary tract infections, incomplete bladder emptying, or hematuria that may indicate bladder pathology. When these studies are negative, the symptoms can often be managed by a combination of...

OSTEOPOROSIS DIAGNOSIS AND MANAGEMENT

noemail@wsus.org — Fri, 29 Feb 2008 15:00:00 GMT

OSTEOPOROSIS – DIAGNOSIS AND MANAGEMENT Hope Druckman, MD Overlake Medical Center (Bellevue, WA) Osteoporosis is a common and silent disease primarily affecting women, particularly in the postmenopausal years. This is a costly problem of enormous public health proportions. It is important to focus on screening and treatment of this condition, so that we can prevent serious fractures. Hip fractures in the elderly can be particularly debilitating, resulting in loss of independence, nursing home placement, and in some situations can lead to death because of complications such as blood clots to the lungs. Fortunately, accurate, cost effective, and safe testing is now available to diagnose osteoporosis. The definition of osteoporosis is based on measurements of bone density, or the strength of the skeleton. By using a machine called a DEXA scan, it is possible to look at an individual’s bone density and compare it to those who are of the same age and gender. This is called...

WHAT IS PELVIC PROLAPSE, WHAT ARE THE SYMPTOMS,

noemail@wsus.org — Fri, 29 Feb 2008 15:00:00 GMT

PELVIC PROLAPSE Kathleen Kobashi, MD Virginia Mason Medical Center (Seattle, WA) Pelvic prolapse (PP) is a general term referring to the falling down of the pelvic floor. Patients have a variety of complaints depending on which compartment of the pelvic floor or vagina is falling (see below). Prolapse often results from weakness of the supporting structures of the pelvic floor following vaginal childbirth, or due to some degree to hormone changes and aging. PP is a common problem amongst women with an estimated 11% of women undergoing surgery for PP by the age of 80 years1. The National Center for Health Statistics found that 16.3% of hysterectomies were performed for prolapse between 1988 and 19902. In 1996, 600,000 hysterectomies were performed in the United States3; therefore, by inference >90,000 hysterectomies were performed for PP that year. The vagina is located between the bladder and the rectum. At the top of the vagina are the uterus and cervix. Following a...

URINARY TRACT INFECTIONS IN WOMEN

noemail@wsus.org — Fri, 29 Feb 2008 15:00:00 GMT

URINARY TRACT INFECTIONS IN WOMEN Tanya M. Nazemi, MD Eastside Urology Associates (Kirkland, WA) Infections of the urinary tract are a common occurrence, accounting for an estimated 7.3 million physician office visits annually.[i] In addition, approximately 30% of women will have at least one symptomatic urinary tract infection (UTI) by the age of 24, and almost half of all women will have at least one UTI in their lifetime.1,[ii] Once a patient has had an infection of the urinary tract, they are also likely to develop another infection in the future. Most UTIs are caused by bacterial organisms that originate from the gastrointestinal tract and travel into the urinary tract via the urethra. Certain bacteria tend to have more virulent characteristics that allow them to adhere to host vaginal and urothelial cells, thereby increasing the host’s risk for infection. In addition, some women have receptors on the vaginal and urothelial cells that may cause them to be more...

MEDICAL MANAGEMENT OF URGE INCONTINENCE

noemail@wsus.org — Fri, 29 Feb 2008 15:00:00 GMT

MEDICAL MANAGEMENT OF URGE INCONTINENCE Karny Jacoby, MD Northwest Hospital (Seattle, WA) What is urge incontinence? Urge Incontinence as defined by the International Continence Society is the complaint of involuntary leakage (of urine) accompanied by or immediately proceeded by urgency. Other terms used to describe this condition are Overactive Bladder and LUTS or Lower Urinary Tract Symptoms. Some patients experience urgency without leakage and sometimes this is described as Overactive Bladder, Dry. When the sensation of urgency spills into the night we use the term Nocturia, the complaint that the individual has to wake at night one or more times to void. Nocturia can be accompanied with Urge Incontinence. Urge and Urge Incontinence are quite prevalent. Up to 16% of the population may be affected and it’s more common in women than men by about 3 to 1. Men tend to be affected later in life than women. We’re not sure what causes urge incontinence but it may have...

SKIN CARE

noemail@wsus.org — Fri, 29 Feb 2008 15:00:00 GMT

Skin Care Dan Downey, MD FACS Northwest Hospital (Seattle, WA) Everyone wants to look younger or remain young looking. Youth is synonymous with vitality and health. There are some lifestyle behaviors that are good for slowing skin aging: eating well, getting rest, not smoking, exercising and sweating(!), laughing and having fun, taking oral antioxidants (also found in abundance in red wine, dark chocolate, and green tea), and avoiding getting too much sun. Sun block with at least SPF 15 should be on your face every day. The next step in your skin health is to turn to a skin care professional. A licensed clinical aesthetician will evaluate your skin and treat it with topical nutrients and therapies. Deep cleansing and massage, vitamins, peels, and mineral based makeup are all part of your regular skin care. Skin Rejuvenation At the plastic surgeon’s office you may choose to receive Botox therapy, which inactivates muscle tissue, flattening creases where the Botox is...

Breast Cancer