Shedding New Light on Bladder Cancer

Bert Vorstman MD, MS, FAAP, FRACS, FACS

For patients with localized high-risk bladder cancer, ta new blue light technology is available.

Using the new blue light technology, doctors are able to make cancer cells in the bladder light up and glow in a color different than the surrounding tissue. This process is similar to the way a blue light exposes blood or other bodily fluids at a crime scene. This technique can help doctors target treatment more effectively and successfully.

Once the blue light has highlighted the bladder cancer, the area is then treated.Furthermore, the light allows for the area to be checked after treatment to ensure that all of the cells have been destroyed, lessening the chance of recurrence.

For many patients, bladder cancer symptoms can, at times, mirror those of a urinary tract infection. For example,

> Visible blood in the urine

> Urgency to urinate

> Burning on urination

Patients experiencing these voiding symptoms should seek the help of a urologist to rule out bladder cancer.

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Testosterone Supplementation May Be a Risky Choice

Bert Vorstman MD, MS, FAAP, FRACS, FACS

When men start to struggle with a loss of libido, testosterone may be the culprit. Low testosterone levels can cause a range of symptoms, but loss of libido is often the first one men notice. Supplementing with testosterone is a common approach, but it may be too risky.

A recent study finds that using testosterone as a supplement raises a man’s risk of heart attack if he is over the age of 65 or already has heart disease. For many men this is not a risk worth taking.

Of course, there are potential benefits as well. Diabetic men who supplement with testosterone may find that they can better control their diabetic symptoms. The increased metabolism and body muscle caused by increased testosterone in the system can contribute to better control of diabetes.

Are there other ways to treat low testosterone? Absolutely. Increasing exercise, decreasing weight and lessening alcohol consumption all contribute to higher testosterone levels. The Endocrine Society has shown that obese men that lose around 17 pounds will have increased testosterone levels.

Statins to control cholesterol and antihypertensive medicines to control blood pressure are also notorious for compromising libido and erections. Check on the possible side effects of the medicines you have been prescribed and if you believe them to be affecting you adversely, have your doctor prescribe an alternative. Remember to monitor your own blood pressure periodically to ensure your pressure has been normalized.

If you are struggling with low testosterone levels, testosterone supplementation may not be your best line of defense.

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New Recommendations for Lipid Profiles in Kidney Disease Patients

Bert Vorstman MD, MS, FAAP, FRACS, FACS


A new recommendation for patients with chronic kidney disease asks physicians to perform a full lipid profile at first presentation of the condition. The new recommendations come from a work group working on behalf of the Kidney Disease: Improving Global Outcomes organization.


According to the guidelines, measuring lipid status at the discovery of chronic kidney disease will not improve clinical outcomes. It will, however, improve the health of people who suffer form dyslipidemia as part of their condition. The procedure is noninvasive and inexpensive, and the potential benefit is worth the small inconvenience or additional cost.


The work group that presented the recommendation believed that the low quality of supporting evidence was not a problem because of the low cost and low risk of the procedure. Follow up lipid measurement was not recommended, except in those cases where doctors believed a new treatment may be warranted or a new condition has developed.


The guidelines also made recommendations in statin treatment, which are different depending on the age of the patient. For those ages 50 and older with an estimated glomerular filtration rate below 60 mL/min/1.73m2, but who are not on dialysis or awaiting transplant, treatment with a statin alone is sufficient, or treatment with statins combined with ezetimibe.


For those ages 18 to 49, statin treatment is only recommended if other conditions, like diabetes mellitus, coronary disease or an ischemic stroke, are present. Adults on dialysis should not be treated with statins alone or statins with ezetimibe, due to inconclusive benefits of the treatment on patients undergoing dialysis. However, patients who begin dialysis and are already taking these medications should continue.


The new guideline was published online in Kidney International.

To learn more about kidney disease, other urological conditions and

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Patients Report Being Unaware of Over-diagnosis/Over-treatment Risk from Cancer Screenings

Bert Vorstman MD, MS, FAAP, FRACS, FACS


Overdiagnosis and overtreatment of prostate cancer is a very real risk, yet very few men are actually told of the potential for this risk. In fact, patients are not regularly informed of the risks of overdiagnosis and overtreatment for most types of cancers. In one online study of 317 men and women ages 50 to 69 years, less than 10 percent of patients surveyed indicated they had been told of these possibilities.


The survey asked the respondents how many had been informed of overdiagnosis and overtreatment when they were diagnosed, and how much overdiagnosis they were wiling to tolerate. Among men, PSA testing and colonoscopy/sigmoidoscopy testing were the two most common screenings reported. Only 9.5 percent of the survey participants indicated they had been told about the possibilities of prostate cancer overdiagnosis and overtreatment. The number of men who were informed was slightly higher than the number of women, with 10.6 percent and 8.4 percent respectively.


Interestingly, patients indicated that they, in theory, were not very tolerant of overtreatment. Half of the participants reported they would not start a screening that resulted in more than one overtreated person per live saved from death due to cancer. However, when the study became personal, 59 percent indicated they would continue the cancer screenings they were already receiving, even if they learned that the results led to overdiagnosis.


What can be concluded from this study? Currently, physicians are not providing adequate counseling about screening to meet the standards and expectations their patients have. This lack of patient education could point to a lack of physician understanding about the dangers of overscreening for certain types of cancers.


Prostate cancer is one of the cancers that is prone to overdiagnosis and overtreatment. Men who are undergoing routine screening for prostate cancer need to understand the risk of overdiagnosis and overtreatment and posed by ongoing screenings, and need to discuss their options with their doctors to avoid these risks.

To learn more about these risks and alternatives to conventional prostate cancer treatments, visit Dr. Bert Vorstman’s website,

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Non-Surgical Treatments for Pelvic Floor Issues Show Promise

Women suffering from pelvic floor dysfunction often suffer in silence, either because they are embarrassed by their symptoms or because they have sought help in the past and come up empty. New research points to some simple, yet effective solutions. For the one in three women who suffer from pelvic floor dysfunction (PFD), this is good news.

Surgery and Medication May Not Be Necessary

Researchers at the University of Missouri have demonstrated through a recent study that comprehensive, non-surgical treatment provides a solution that improves the symptoms of this uncomfortable condition. Pelvic floor rehabilitation, for example, can solve many pelvic problems without the need for medication or surgery. The goal of this treatment, according to Julie Starr, doctoral student and family nurse practitioner, is to strengthen muscles for bladder control problems or relax muscles for constipation and pelvic pain problems.

The study, which Starr participated in with other University of Missouri researcher looked at data from close to 800 women with PFD. Specifically, the women were treated for urinary, bowel or pelvic pain and sexual dysfunction symptoms. The results were interesting:

According to their findings, patients who underwent at least five comprehensive pelvic floor rehabilitation therapy sessions had the best result, with an 80 percent average improvement in defecatory dysfunction, pelvic pain and urinary incontinence.

Understanding Pelvic Floor Rehabilitation Therapy

What is this comprehensive pelvic floor rehabilitation therapy? According to Starr, it involves:

  • Vaginal electrogalvanic therapy
  • Biofeedback
  • Kegel exercises
  • Behavior modification

Of these, the electrogalvanic therapy (e-stim) proved to be very effective at relaxing muscles and lessening or eliminating pelvic pain during intercourse. Based on the results of the research, Starr states that she rarely offers medication to women with PFD, and does not advise surgery unless pelvic floor rehabilitation does not work.

In light of this study, women who have pelvic floor issues need to realize that less invasive treatment options do, in fact, exist. As men with prostate cancer often learn, the most aggressive treatment is not always the best, as it has the potential to cause unwanted risk and side effects. Whether treating a woman dealing with pelvic floor issues or a man with a recent prostate cancer diagnosis, Dr. Bert Vorstman recommends taking the least invasive approach.

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Multiple Procedures Show Promise to Treat Pelvic Organ Prolapse and Urinary Incontinence in Women

For women dealing with stress urinary incontinence due to pelvic organ prolapse, research from Taiwan points to a new treatment. Combining a midurethral sling with a trocar-guided transvaginal mesh surgery may help alleviate the symptoms more effectively than other treatment options.

The study followed a pool of 89 patients who had both procedures performed simultaneously for an average time of 35 months. In addition to the two aforementioned procedures, 17 of the patients had concurrent vaginal hysterectomies, 20 had vault suspension and 52 had uterine suspension.

Positive Results Seen Early

For these patients, all parameters of the Pelvic Organic Prolapse Quantification improves over the first six months of the study. At the six month mark, 69 patients had urodynamics testing, showing significantly higher maximum flow rate and mean flow rate combined with a much lower post-void residual urine volume and maximum urethral closure pressure. They also had a much better one-hour pad test result.

Some of the patients, 29 to be exact, had persistent overactive bladder symptoms. The researchers noted that these symptoms were treated using antimuscarinic treatment. Of the patients with preoperative voiding difficulty, 96.5% were successfully treated. A total of 20 of the patients had postoperative stress urinary incontinence.

The Results

The study was performed at the Chi Mei Foundation Hospital in Tainan under the leadership of Ming-Ping Wu. It was published in the Taiwanese Journal of Obstetrics & Gynecology, and the researchers concluded that the combined technique provides a good option for treating women with stress incontinence and pelvic organ prolapse, but they did not conclude that it was the only option. This type of intervention has a higher risk of technique-related problems, like internal bleeding and organ injury. Also, researcher warned that no treatment is a one-size-fits-all solution, no matter what the circumstances, so all patients need to discuss their treatment options with their doctors.


Women who are struggling with urinary incontinence or pelvic organ prolapse need to understand all of their options. Dr. Bert Vorstman offers a variety of treamtents for these conditions.

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Causes and Treatment of Hemospermia

Blood in the semen is a condition known as hemospermia, and while it is unsettling, it is rarely, if ever, serious.

Causes of Hemospermia

Blood in the semen is relatively common but virtually never important. The blood itself is believed to come either from congested seminal vesicles or from the prostate and possibly as a consequence of infrequent sex. The blood is commonly bright red and can occur more than once. Usually, no cause is identified.

Treatments of Hemospermia

Typically, the patient is without symptoms other than the hemospermia. Routinely the urinalysis, urine culture, prostate exam and PSA will be within normal limits and no other testing is required.

Hemospermia does not present any health risks and the condition resolves commonly without needing treatment.

The good news is that there is no obvious link between hemospermia and prostate cancer.

To learn more about treating hemospermia and prostate cancer effectively withoutbeing exposed to risk, and to learn about the dangers of radical prostate surgery/robotic prostatectomy, visit Dr. Bert Vorstman’s website,

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Causes and Treatment of Peyronie’s Disease

While rare, for the 1% of men it affects, usually between 40-60 years of age, Peyronie’s disease is often uncomfortable and a potentially embarrassing condition. This relatively rare disease is an inflammatory disease of unknown cause that affects the penis and can often seem to present over night. It can cause discomfort and modularity of the penis and a concern for cancer, which it is not.

However, for most men it’s the bending of the penis on erection which is the most problematic. Depending on plaque location, the bending can be in various directions.

Causes of Peyronie’s Disease

The causes of Peyronie’s disease have not yet been discovered. Because of this, treatment only starts after the condition has started. There are no known ways to prevent Peyronie’s disease.

Treatments of Peyronie’s Disease

Some men, about half of all cases, will find that the condition goes into remission on its own without any treatment.

For those who do not have remission, treatment options may include:

Oral treatments – Vitamin E and/or Potaba are sometimes used to treat this condition, although proof that they are effective is missing.

Topical treatments – Topical applications of verapamil or DMSO may help.

X-ray treatment – External beam and radiation implants may lessen the inflammation.

Ultrasound treatment – Ultrasound treatment has been effective for some men.

Injectables – Collagenase (Xiaflex) this is a relatively new agent  which isinjected about the plaque in the penis in order to dissolve the fibrotic area.

The patient is instructed on bending and stretching the penis at home after the injection. Several courses of injections may be needed over several months till reasonable straightening is achieved. This procedure can be useful in men where the bending on erection is 30 degrees or greater.

Anti-inflammatory medications – The nodules that can develop with this condition may respond to anti-inflammatory medications.

Surgery – If the bending progresses to the point that vaginal penetration becomes impossible, some men will seek surgical treatment. This can take the form of penile implants which are not usually recommended unless there are permanent and extenuating circumstances or, reconstructive procedures such as the dermal graft or Nesbit plication procedures.

Although NOT related to prostate cancer, patients need to understand the dangers of all potential treatments. To learn more about Peyronie’s disease and prostate cancer treatment dangers, visit Dr. Bert plication website,

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Causes and Treatment of Male Impotence

Bert Vorstman MD, MS, FAAP, FRACS, FACS


When a man suffers from impotence, or erectile dysfunction, his connection with his partner is interrupted. For many, this has a significant impact on quality of life, yet the condition may make them feel self conscious, and thus some fail to seek treatment. Understanding the underlying causes will help these patients understand that the condition is nothing to feel embarrassed about, and this will help them seek treatment.


Underlying Causes of Impotence


The process of creating an erection is an extremely complex one involving the nervous and cardiovascular systems. If a part of that process is interrupted, then a man will struggle with erectile dysfunction. Because of the complexity of this process, male impotence has several underlying causes, including:


  • Lifestyle factors – Smoking, alcohol abuse and obesity can all damage the nervous system or impact blood flow to the penis.
  • Hormonal imbalance – Hormones play a role in sexual arousal, so an imbalance can create a problem.
  • Neurological problems – Sexual arousal relies on the nervous system. If it is not functioning properly, neither will the arousal process.
  • Emotional or psychological problems – Problems with anxiety or emotional problems with the partner can make attaining an erection difficult.
  • Underlying physical problems – Hypertension, peripheral vascular disease, diabetes and priapism can all lead to erectile dysfunction.
  • Medications – Medications that affect blood flow or the nervous system can create the problem.
  • Surgery or pelvic trauma – Radical pelvic surgery or trauma to the pelvic area are also contributors to erectile dysfunction. For this reason, many men who seek radical prostate cancer treatment, like surgery, will suffer unnecessarily.


Treatment Options for Impotence


If you are struggling with impotence, it may not have to remain a struggle. There are numerous treatment options available that are highly effective at helping certain men with their condition. These include:


  • Oral treatments – Medications like Cialis, Levitra, Staxyn and Viagra, in addition to testosterone treatments and certain herbal treatments can help some men overcome ED.
  • Testosterone treatment – If the problem is hormonal, testosterone treatment can help.
  • Injectable treatments – Certain medications (prostaglandin) can be injected directly into the shaft of the penis to elicit an erection during intimacy.
  • Prostaglandin pellet (Muse)– This pellet is inserted directly into the penis to create an erection.
  • Vacuum device – An external vacuum devise forces blood flow into the penis, then a tension ring is placed at the base to maintain the erection.
  • Surgery (artificial penis)– When more conservative treatments do not work, surgery to treat problems with the arteries or to place a penile prosthesis into the penis can provide a solution.


Unfortunately, an increasing number of men are suffering from impotence unnecessarily due to radical prostate surgery/robotic prostatectomy for cancer treatments that they did not need. These treatments cause pelvic trauma which isirreversible.

To learn more about the drawbacks of these treatments and what can be done for many Gleason 6 (3 + 3) patients, visit Dr. Bert Vorstman’s website, Dr. Vorstman also blogs at and Contact him directly at


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Causes and Treatment of Benign Prostatic Hyperplasia (BPH)

Bert Vorstman MD, MS, FAAP, FRACS, FACS


Benign prostatic hyperplasia, or BPH as it is more commonly known, is a condition that causes an enlargement of the prostate gland. While this condition is very common, in some men it leads to urinary dysfunction. When the problems associated with BPH begin to impact quality of life, most men will seek treatment.


Understanding the Causes of BPH


The causes of BPH are largely unknown. At this time, doctors know that age is one of the biggest risk factors of the condition, as the likelihood of BPH increases as a man ages. In fact, some doctors believe all men, if they live long enough, will have an enlarged prostate gland, and 90 percent of men over the age of 80 have the condition.


The second risk factor is the presence of dihydrotestosterone (DHT). DHT is a substance that comes from the prostate gland’s testosterone, and some medical professionals believe DHT controls growth of the prostate gland. An accumulation of DHT in the prostate gland may encourage cells to grow, eventually leading to a growth in the gland itself.


Treatments of BPH


BPH only needs to be treated if it is affecting quality of life. Most men can simply take an active surveillance approach to their condition. If, however, the prostate enlarges to the point that bladder function is lost or the urinary tract becomes obstructed, treatment is necessary. Common treatments include:

  • Herbal treatment – Saw palmetto has been used to ease the symptoms of BPH by those who prefer an alternative medicine approach. Scientific studies into the use of saw palmetto have been met with mixed results.
  • Medication – Medications cannot stop BPH, but it can control the urinary symptoms associated with the condition.
  • Surgery – Because surgery on the prostate gland has serious side effects that can destroy a man’s quality of life, it should only be considered if the effects of the BPH are impacting a man’s overall health or severely impacting quality of life. Surgery can be laser surgery, open surgery or transurethral surgery.
  • Transurethral microwave procedures – A minimally invasive procedure that uses microwaves to destroy excessive prostate tissue to alleviate symptoms of BPH.
  • Transurethral Needle Ablation – This minimally invasive treatment delivers low-level radiofrequency through needles to burn away a portion of the prostate.


For any BPH treatment, the potential risks must be weighed against the potential benefit. Like with treating Gleason 6 (3 + 3) prostate “cancers,” often the risks of treatment are actually must worse than the potential benefits.

To learn more about treating BPH and prostate cancer effectively without undue risk, and to learn about the dangers of radical prostate surgery, visit

Dr. Bert Vorstman’s website,

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