Month: December 2022

Categories
Enlarged Prostate

Improving Prostate Treatment with Innovation

One of the turning points in the treatment of benign prostate hyperplasia was the invention of the irrigating cystoscope.

One of the turning points in the treatment of benign prostate hyperplasia was the invention of the irrigating cystoscope, and the many improvements made to it by Dr. Hampton Young, of Johns Hopkins University Hospital.

Following the development of the irrigated cystoscope and other critical tools, physicians continued to experiment with all sorts of other methods for treating an enlarged prostate. This included high-frequency currents to treat bladder tumors.

In roughly 1926, a physician by the name of Maximilian Stern introduced another innovative instrument to be used in prostatic procedures called the resectoscope.

A resectoscope is a tool that is inserted through the cystoscope sheath and has a tungsten wire loop on one end. Under direct vision by way of the cystoscope, Dr. Stern was able to cut slivers of prostate tissue with the loop, through which flowed an electrical cutting current.

Unlike cautery heat, these high-frequency currents did not penetrate and damage the surrounding tissue nearly as much. As a result, patients reported having fewer side effects and a lower risk of complications such as hemorrhage.

Though the electric current cut well, some physicians took issue with it not coagulating deep enough. Thus making it, in some cases, just as effective as using a knife.

This led to the invention of a modified resectoscope by a South Carolina urologist, with a background in electrical engineering, named Theodore Davis.

Not only did Davis use a larger instrument with a larger viewing window and a wider loop, but he also is credited with incorporating a current that cuts and coagulates. Davis even went so far as to invent a foot pedal, which allowed him to switch between the two during surgery.

Around the same time that Davis was improving the resectoscope, another doctor by the name of Joseph McCarthy was busy making further improvements.

Dr. McCarthy was able to successfully combine the improved resectoscope with the phonendoscope, which had a greatly improved viewing system.

By combining these two advancements, McCarthey created what would become known as the Stern-McCarthy resectoscope.

In our next article, we will take a look at the Stern-McCarthy resectoscope and its use in the treatment of an enlarged prostate, and also begin to look at the dominant treatment methods that emerged, some of which are still performed today.

 

Categories
Knee Osteoarthritis

Knee Pain, Even at Rest?

The pain of knee osteoarthritis can be felt not only during movement such as walking, but also during rest.

The pain of osteoarthritis in the knees can be felt when standing up, walking, or doing any other movement. Which makes sense.

However, did you know that many people with knee osteoarthritis experience pain even when they are at rest?

In order to decrease this pain, many turn to over-the-counter NSAIDs, prescription medications, knee injections, and physical therapy. Then if none of those work, the next step is usually knee replacement surgery, however, this is changing as more and more people are opting to treat their condition with Genicular Artery Embolization.

Genicular artery embolization is a procedure that can treat knee osteoarthritis by blocking the blood flow to the inflamed areas of the knee that are causing decreased mobility and pain.

The outpatient procedure is performed by way of a tiny catheter which is inserted into the blood vessels and then guided by a highly skilled interventional radiologist, to the artery that supplies blood to the areas of knee pain.

The interventional radiologist then releases microscopic spheres into the specific blood vessel (genicular artery) to block this flow.

As a result of this blockage, inflammation is greatly decreased and so is knee pain.

Unlike knee replacement surgery which requires recovery time in the hospital, patients who undergo GAE treatment can go home the same day.

In most cases, pain relief begins to occur within two weeks, as the inflammation in the knee joint is reduced, thereby relieving the knee pain associated with osteoarthritis.

In fact, according to a study published in The Journal of Vascular and Interventional Radiology, knee pain has been shown again and again to be significantly reduced as a result of genicular artery embolization- particularly for those dealing with moderate-to-severe knee pain.

This particular study found that its participants showed continued improvement in their knee osteoarthritis symptoms at one-month, three-months, and at their six-month checkups. Not only did their symptoms improve, but the MRI scans taken at this point of recovery, proved it.

The Journal of Vascular and Interventional Radiology also published the results of a study that followed ten patients through their GAE journey, pre and post-procedure.

At the one-year mark, the participants reported:

Median pain: 15.4% improvement
Knee/leg function: 21.3% improvement
Quality of life: 100% improvement

This study also conducted follow-up tests with the participants that included a six-minute walk and a 30-second chair sitting/standing test. As a result of the GAE procedure scores for these tests improved by 26% and 43% respectively.

Add to that, the fact that in both studies no adverse reactions were reported, and you have yourself an excellent option for treating knee osteoarthritis.

To learn more about GAE, and to see if this procedure could benefit you and relieve your osteoarthritis knee pain, please call and set up a consultation today.

Categories
Knee Osteoarthritis

Inflammation or Osteoarthritis?

Knee osteoarthritis can develop into a debilitating condition with a marked impact on a person’s overall health and quality of life.

When left untreated, knee osteoarthritis can develop into a debilitating condition with a marked impact on a person’s overall health and quality of life.

For many years the gold standard for treating knee osteoarthritis has been a total knee arthroplasty, also known as a knee replacement surgery.

Though this surgery has a well-established track record with a positive outcome, it is not without its complications.

First of all, a knee replacement, which is a major surgery that involves replacing either the damaged part of or the entire joint with a prosthesis— has a long long recovery period. And, it’s not necessarily a good fit for everyone.

According to an article published in the Journal of Arthroplasty called “Why are total knee arthroplasties failing today—has anything changed after 10 years,” a fair number of patients with knee osteoarthritis are not good candidates for knee replacement surgery.

The study found that certain comorbidities, such as diabetes, obesity, coronary artery disease, malnutrition, renal disease, cirrhosis, and immunosuppression, are associated with increased medical and surgical complications when a knee replacement surgery is performed.

Studies have also found that the patient’s age is another factor to consider, due to the possibility that a knee replacement surgery performed on a young person, could increase their risk of aseptic loosening, and lead to several revision surgeries in the future.

Studies have also found that elderly patients are not always the best candidates for knee surgery, given the occurrence of age-related co-morbidities, and their increased risk of fractures.

Though knee osteoarthritis used to be considered a normal “wear-and-tear” disease brought on by years of stress on the knee and meniscal degeneration that comes with age, recent data has suggested it’s not that simple.

In fact, according to recent data published in The Journal of Rheumatology, entitled “Osteoarthritis, angiogenesis, and inflammation,” it is now understood that inflammation plays a role in not only the pain from knee osteoarthritis but also the progression of the disease itself.

So if inflammation is not only causing pain but driving the progression of knee osteoarthritis, can anything be done to stop it?

Fortunately, yes.

There is a treatment that can help alleviate these symptoms and potentially prevent further structural progression. That treatment is called Genicular Artery Embolization.

Genicular Artery Embolization is a minimally invasive outpatient procedure, in which the arteries that supply blood to the synovial lining of the knee are selectively catheterized.

Once the arteries are reached, tiny particles are injected through the catheter into these arteries where they reduce the blood supply, and in turn, reduce inflammation. The procedure typically takes one to two hours, and the patient can return home the same day.

Many people are experiencing the benefits of Genicular Artery Embolization, which can result in both immediate and long-term pain relief for patients with osteoarthritis.

GAE is an excellent choice for people who are not good candidates for knee replacement surgery due to certain comorbidities. It’s also a great choice for people who would like to postpone surgery, or who are too young for a knee replacement operation.

To learn more about Genicular Artery Embolization, and to find out if the procedure can benefit you, please call us today to set up your initial consultation.

Categories
Enlarged Prostate

Inventions to Treat BPH

It is estimated that at some point in their lives, 8 out of 10 men will experience the uncomfortable symptoms caused by an enlarged prostate.

It is estimated that at some point in their lives, 8 out of 10 men will experience the uncomfortable symptoms caused by an enlarged prostate. However, this occurrence isn’t anything new.

Doctors have been working to find cures and develop treatments for this very common condition for centuries.

In fact, in our last few articles, we took a deeper look at the origin of the diagnosis of an enlarged prostate, and when it was first documented. And, we looked at some of the many attempts to treat or even cure the condition- Some of which actually made things worse.

Fortunately, as time went on, and medical advancements continued to be made, medical experts and physicians were able to find newer and better ways to treat men with this prostate condition.

A real turning point in the development of treatment procedures for an enlarged prostate, occurred in 1904 when Dr. Hampton Young perfected the surgical procedure known as a “radical perineal prostatectomy”.

By perfecting the perineal approach and developing specialized instruments for the procedure, Dr. Young was able to lower the mortality rate for those undergoing prostate surgery.

While open surgeries for treating an enlarged prostate continued to develop, another method was emerging called the transurethral method.

The transurethral method is a treatment based on the idea of increasing the lumen of the prostatic urethra by destroying or damaging the prostatic tissue so that it would contract.

Several instruments for transurethral removal of bladder neck obstruction by ‘valves’, were created, however, the procedure was done blindly, and though effective at times, it also came with the high risk of hemorrhage, and many patients were left with urinary incontinence.

Fortunately, physicians continued to develop better and better techniques for transurethral procedures, including using a wire loop cautery. As well as treatments that included a thermogalvanic destruction, which is when cautery is introduced through the urethra, requiring a cautery plate and a cautery knife.

However, one of the biggest issues with these methods was that,  just like with the previous procedures, all of them were done blindly. That is until various new instruments were invented and came into use, such as the irrigating cystoscope, which allowed for visual control during these procedures.

The irrigating cystoscope was a real game changer, even more so, as Dr. Young worked to modify it, making it better and bed.

Young is credited with adding illumination to the external end of the tube, by way of a small electric bulb. And then, just a few years later, Young replaced the cutting tube with an electrically heated cautery tube and made the outer tube double-walled so that water could circulate to cool it. Young’s basic design was the forerunner of a great variety of subsequent operations.

In our last article of this series on the history of diagnosing and treating an enlarged prostate, we will take a look at some of the procedures that emerged after Dr. Young’s irrigating cystoscope, and begin to explore the modifications and improvements that have been made to these techniques.

 

Categories
Fibroids

Excessive Cramping and Pelvic Discomfort

One of the most common symptoms associated with uterine fibroids is excessive cramping and pelvic discomfort.

One of the most common symptoms associated with uterine fibroids is excessive cramping and pelvic discomfort.

Unlike menstrual cramps, which are caused by the contracting uterus as it pushes out the endometrium during a monthly period, fibroid cramps can exist outside of the average 5-7 days that menstruation lasts.

In fact, for women with uterine fibroids, not only do these cramps occur outside of the menstruation period, but they can be rather severe. And, unfortunately, if the fibroids are left untreated, these symptoms are likely to get worse and include several others as well.

Fibroids can range in size and location. They also vary in terms of how many each woman has. Some women may have a single fibroid while others could have multiple fibroids.

When it comes to the symptoms directly related to uterine fibroids- the location, size, and number of fibroids can play a role in the specific symptoms experienced and their severity.

For example, women with large fibroids have reported that they feel a heaviness or pressure in their lower abdomen or pelvis. Not only is this uncomfortable, but it can also make it hard to lie down, bend over, or exercise.

Though all fibroids can contribute to pelvic pain and cramping, more often than not, these symptoms are experienced as a result of having intramural fibroids.

Intramural fibroids grow inside the muscular wall of the uterus. As intramural fibroids grow larger, they increase the likelihood of more severe symptoms that can have a direct impact on one’s quality of life.

The other types of fibroids can also cause cramping and pelvic discomfort. These types are called: submucosal, subserosal, and pedunculated fibroids.

Submucosal fibroids grow into the uterine cavity, while subserosal fibroids grow toward the outside of the uterus. Pedunculated fibroids are those that are not directly attached to the uterus and grow from a stem-like stalk.

Cramping and discomfort caused by submucosal fibroids are usually caused by the uterus trying to rid itself of them.

Unlike the contractions that happen every month in order to shed the endometrium, painful contractions caused by submucosal fibroids can happen at any time during a menstrual cycle.

No matter what type of fibroid is causing your uncomfortable symptoms- there is treatment available.

If you think you are experiencing moderate to severe cramping outside of your monthly period, or even if it’s severe during your period- it’s important to seek out treatment right away.

Though most causes of pelvic pain and cramping are treatable, if you do not address the issue it is likely that your symptoms and the underlying condition will get worse.

If the cause of the cramping is indeed fibroids, there are many treatment options available such as medication, surgery, or uterine fibroid embolization.

UFE is a non-invasive outpatient procedure that can relieve the painful cramping and other frustrating symptoms caused by uterine fibroids.

To learn more about UFE and to find out if it could benefit you, please call our office today.