1.  Drink enough water to produce 2 to 3 liters of urine a day. This means you must drink more than 2 liters of water a day, because some of the water you take in is lost in sweat and stool. I recommend you actually measure how much urine you make in a 24 hour period to see how close to this you are.
2.  Add lemon to your water. Lemon juice contains citrate, which inhibits the formation of stones. This is also found in other citrus fruits, especially grapefruit or tangerine.
3. Eat a moderate amount of calcium, 800 – 1000 mg a day. The calcium should come from food, not supplements.
4. Eat a low sodium diet.
5. Eat less animal protein. This makes the urine acidic and increases stone formation. The recommended amount of protein is 0.8 – 1.0 grams of protein per kilogram of your body weight per day.
6. Eat less oxalate. Examples of high oxalate foods are black tea, spinach, and cocoa.

These guidelines are general and more specific information can be found by searching food contents online or from lists that my office carries. Other factors may be present and causing stones, and these are identified with a lab and urine evaluation.

Lifestyle Factors

1. Maintain a healthy weight. Eat a simple diet high in fruits and vegetables. Avoid factory-raised meats, which tend to contain large amounts of estrogen. Eliminate processed foods.
2. Avoid alcohol and drug use. Avoid sugar, salt, and caffeine.
3. Exercise regularly.
4. Cruciferous vegetables, such as broccoli, cauliflower, and kale, stimulate the liver’s P450 system, which breaks down excess estrogen. Avoid grapefruit, which inhibits the liver’s breakdown of estrogen.
5. Sleep at least 7.5 hours a night.

Supplements

1. Zinc deficiency is a common cause of estrogen excess. Take 50 mg of zinc twice daily to begin. After levels are corrected, once daily is sufficient.
2. Vitamin C increases testosterone production and eliminates excess estrogen. Take 1000 mg three times a day. Buy high quality vitamin C supplements or eat foods rich in vitamin C to ensure absorption.

Herbs

1. Ginkgo biloba improves circulation, has positive effects on sexual function, and stimulates the pituitary gland. Look for extracts with at least a 24% concentration and take a dose of 40 to 60 mg daily. Ginkgo biloba does affect platelet function and should not be used long-term if you are also taking blood thinners, aspirin, or anti-inflammatories such as ibuprofen on a regular basis.
2. Ginseng is also a pituitary stimulant and has been shown to improve sexual function. The ideal dosage is not known, but it may be tried at the usual doses recommended by the manufacturer.
3. Resveratrol is a grape skin extract that improves the livers P450 system, which helps get rid of excess estrogen. It is an excellent antioxidant. Again, the ideal dose is not known, but manufacturer’s guidelines can be followed.

Injections

This is probably the most common method of testosterone replacement used. However, it has many disadvantages. One of these is the rapid peaks and low valleys that occur during therapy. When the drug is first injected, testosterone levels rise very high, then they decline significantly before it is time for the next dose. This does not replicate your body’s natural rhythms.

Creams/Gels

These are available as a standard prescription medication, or as a natural testosterone prepared by a compounding pharmacy. These more closely mimic your body’s natural rhythm. The biggest disadvantage is that they must be applied daily and caution must be used to avoid exposing women or children to the areas of your skin to which it is applied.

Troches

These are a preparation that is held under the tongue until it dissolves. Using them 2 to 3 times a day mimics the body’s natural cycles very well. The testosterone can not be transmitted to someone else by physical touch. The biggest disadvantage is that they must be used so frequently. These can also be prepared by a compounding pharmacy.

Pellets

This is an implant performed on average every 4 months. Like the injections, it does produce a higher peak at the beginning of treatment and lower low towards the end, but the fluctuation is not as dramatic. The disadvantage is that this is a minor procedure performed in the office, in which the skin is anesthetized and several pellets are inserted. This is a great alternative to injections because levels do not fluctuate as often and the dose lasts much longer.

Lifestyle

One should NEVER use testosterone supplementation without also making lifestyle changes to support this. When one is on long-term testosterone supplementation, this can suppress the body’s production of its own testosterone and eventually make the supplementation less effective. The ideal approach is to make changes so your body can make more of its own testosterone, while using supplements to boost the amount and improve your overall well-being—without overriding your body’s natural abilities.

Urinary Tract

A urinary tract infection  (UTI) is a general term for infections anywhere within the urinary tract, usually in the bladder or kidney. A bladder infection is also called cystitis. A kidney infection is also called pyelonephritis.

Symptoms

UTIs typically cause burning with urination, a need to urinate very frequently and urgently but in small amounts, and pelvic pain. Some people also have low back pain with a UTI. Symptoms of fever and pain in one side of the back, just under the rib cage, suggest that the infection has spread to one of the kidneys.

Some patients do not have any of these symptoms. Involuntary leakage of urine (incontinence) is often caused by UTIs.

Causes

UTIs occur when bacteria that live in another part of the body make their way into the urine and are able to stay there and grow. In most cases, this is due to factors within the body, such as a bladder that has not yet healed from another infection. Certain blood types have been found to be associated with a higher chance of UTIs. Some people also express proteins in the bladder that make it easier for bacteria to stay in the bladder and grow.

On occasion, a patient will have an underlying anatomic problem that causes the infections to occur. These may include kidney stones, poor emptying of the bladder, or the presence of a foreign body, such as a catheter.

Recurrent infections tend to happen because of a vicious cycle of bladder inflammation and disruption of the normal bacteria in the body. Because infections come from bacteria that are normally present in the body, having unhealthy bacteria in the body is a set-up for infections. When the bladder is already inflamed from a recent infection, it becomes much easier to get another infection, and the cycle begins. Taking antibiotics kills the infection but also tends to kill the good bacteria in the body as well (those that do not cause infections), and these bacteria are then replaced by those that are more likely to cause infections.

Diagnosis

A UTI is suspected based on symptoms. A urinalysis can be performed immediately in the office, and certain findings on this suggest that an infection is present. However, the only way to know for sure if an infection is present is to perform a urine culture, in which the urine is sent to the lab and monitored to see if bacteria grow from it. When an infection is found in the urine, tests are run on the bacteria to determine which antibiotics can kill it.

Treatment

UTIs are typically treated with antibiotics. Studies show that for most women, who do not have underlying problems, a 3 day course of antibiotics is as effective as a longer course. In complicated cases and in men, a longer treatment is needed.

Mild infections can sometimes be cured with natural therapies, including the use of uva ursi and marshmallow root, two herbs that help to heal the urinary tract. A tea can be prepared by brewing 1 tablespoon of each of the herbs in 1 cup of water for several minutes. These herbs are available at the Brenham Health Food Store, located at 1011 W Main Street. These herbs can be tried at the first sign of an infection, but if symptoms are severe, fever is present, or symptoms are not improving within 1 or 2 days, it is important that a culture be obtained and antibiotics started to prevent more serious illness. The blended tea should be drank 4 times a day for 7 days to completely clear the infection.

Drinking large amounts of water, especially with lemon added, helps to flush the urinary tract.

Prevention

1. Cranberry products.

Both cranberry juice and tablets have been proven in multiple scientific studies to be as effective as daily antibiotics for preventing recurrent UTIs. Most cranberry juice, however, contains large amounts of acid and sugar and is not well-tolerated. Cranberry tablets are effective and do not have these side effects. One good brand is Nature’s Plus Cranberry 1000, which is available at the Brenham Health Food Store, and can be taken twice daily. More information on cranberry products is provided in this article. Cranberry products have been well-studied in children, young women, and elders and found to be effective in all groups.

2. Low dose antibiotics.

The standard treatment for recurrent UTIs over the past several years has been the use of low dose antibiotics taken daily or after sexual intercourse, if infections are associated with sex. Studies have now shown that cranberry tablets are at least as effective and have fewer side effects. However, antibiotics can still be used. It is best to take an antibiotic that has a minimal effect on the remainder of the body, so that the healthy bacteria in the body are not killed.

3. Probiotics.

Probiotics are pills that contain the healthy bacteria that normally are in the colon and vagina. When these places contain healthy bacteria, it is much less likely that you will get an infection. When you take antibiotics to kill an infection, these good bacteria are also killed. The bacteria that come back in their place are often bacteria that are more likely to cause infections. Taking probiotics helps to restore the healthy bacteria in your body. A good brand sold at the Brenham Health Food Store is Nutrition Now’s PB8, which is taken once a day. I recommend that you use this for several months to rebuild your system and then for at least a month every time you take antibiotics for any reason. This article discusses probiotics in more detail.

4. Boosting the immune system.

A healthy immune system helps you resist infections. Several vitamins help with immune system function. I recommend a regular daily dose of vitamins A, C, and zinc, and a higher dose when you have an infection. This handout provides details on the doses to use and other tips for having a healthy immune system.

5. Mind-body medicine.

Emotions and stress affect the body by causing the release of chemicals that affect physical processes. Many people believe that chronic illnesses such as recurrent UTIs are the body’s way of trying to get your attention. Unreleased anger is thought to be one emotion commonly associated with UTIs. A great book that goes into this further is Women’s Bodies, Women’s Wisdom by Christiane Northrup, MD.

6. Lifestyle factors.

Many other factors contribute to UTIs. These include constipation and diarrhea, vaginal health, and sex. Problems with the digestive tract tend to alter bladder function and increase the amount of bacteria present in the pelvic area. Anything that irritates the vagina makes it easier for infections to take hold–the use of douches or scented tampons, or having a dry and irritated vagina are both factors. Many women find that infections tend to occur after sex. Often, it is helpful to urinate before and after sex, to take a low dose antibiotic or cranberry tablet after sex, and to drink extra water afterwards to help flush your system.

Recurrent Infections Can Be Stopped

Having repeated urinary tract infections is very frustrating. The good news is that patients respond very well to a preventive program, and the infections will become less common and then very infrequent altogether. Once the bladder has a chance to heal and the body is restored to its normal balance, health can be enjoyed again.

PSA

PSA testing has been in use since the 1980s. This test, combined with a rectal exam to feel the prostate, is used to diagnose prostate cancer. It does not prevent it, however. If a man has an abnormal PSA or abnormal prostate exam, a prostate biopsy is recommended to see if prostate cancer is the cause.

PSA testing is recommended for men who are:

• Over 40 years of age
• Have a life expectancy of at least 10 years (it is unlikely that cancer detected with PSA testing will cause death in less than 10 years)

PSA testing is controversial because many more men have prostate cancer than will die of it. PSA testing clearly saves lives in some men, but it also leads other men to have unnecessary treatments. It can be difficult to know which men have a cancer that is likely to progress. A very close relationship between the patient and his urologist is important. Many factors, including health issues, the type and stage of cancer, and the patient’s personal values must be carefully weighed in making the decision on whether and how to treat prostate cancer.

Prevention

Because prostate cancer is very common but knowing who to treat and how to treat them is a challenge, prevention is an ideal way to avoid these challenges.

Diet

Numerous studies, both of men with prostate cancer and of prostate cancer cells in laboratories, have shown that certain diets can slow down, stop, or prevent prostate cancer growth. Nutrition is an extremely difficult area to study, however, so clear recommendations are hard to come by. Common sense tells us that a diet in which foods are as close to their natural state as possible will best support our bodies; it’s the way our species has been eating for centuries. This means a diet free of processed foods and high in natural foods. Some studies have reported success with low-carbohydrate diets and some with low-fat or vegan (no dairy, egg, or meat products) diets.

Exercise

Numerous studies have looked at exercise and prostate cancer risk. The majority of these studies show that men who exercise have a lower chance of developing prostate cancer, by about 10 to 30%. Exercise is a wonderful prevention tool because it is free, low-risk, and beneficial to many other areas of life as well.

Vitamins and Supplements

Many compounds have been studied for their effect on prostate cancer. One of the most striking is the effect of vitamin D levels on cancer development. Several studies have shown that men with low vitamin D levels (under 16 in some studies) have a much higher chance of having prostate cancer (3.5 times men with normal vitamin D levels in one study).

Flax seeds, selenium, vitamin E, lycopene (found in tomato products), and green tea are some of the other compounds that have been studied and found to have an effect on prostate cancer cell growth. Studies in humans over long periods of time would be necessary to prove these effects, but are unlikely to be done. At this point, there is no good evidence to recommend a particular treatment protocol over another.

Medications

5-alpha reductase inhibitors, drugs such as Proscar and Avodart, are used to treat enlarged prostate by blocking hormonal pathways within prostate tissue. A long-term study showed that taking them for 7 years decreased the chance of getting prostate cancer, but may have increased the chance of having a more aggressive cancer. There is not yet a consensus on whether the risks of these medications are worth the potential benefits for the prevention of prostate cancer.

Conclusion

Prostate cancer is a serious disease and requires a very careful approach. In general, maintaining a healthy lifestyle is an excellent way to prevent disease development and also to ensure better recovery if a disease is diagnosed.

The procedure is performed by placing a small catheter in the bladder and one in the rectum. These catheters have pressure monitors on them, which allows us to know whether the bladder muscles are working and how hard they must work to empty. We are able to see how much resistance to leakage you have and whether you have an unstable bladder.

Preparation

Please plan to arrive for the test with a full bladder. When you arrive at the office, you will first urinate into a special toilet. You will then be asked to undress from the waist down and lie on your back on an exam table. The catheters will be placed into your bladder and rectum. Your bladder will then be filled with warm water, and monitoring will begin. After your bladder is full, you will again urinate into the special toilet so that we can measure your urine flow.

If you have had a joint replaced within the last 2 years, are immunosuppressed, have recurrent urinary tract infections, have had a catheter in place before the procedure, or have certain other medical conditions, you may need to take an antibiotic before the procedure. This will be given at the office. Please let us know if you have one of these conditions.

Risks

The main risk of the procedure is urinary tract infection. Some patients who have this test need antibiotics to prevent infection.

Discomfort can occur during the test, but it is usually not painful.

After the Procedure

You will be given the results of the test immediately. You are able to drive yourself home. Most patients do not have any discomfort after the procedure, but some will have burning the first time they urinate or for a day or so. If you have more pain, burning, or discomfort than expected, please let us know.

More Information

This article, produced by the National Kidney and Urologic Diseases Information Clearinghouse, provides an excellent, detailed description of how and why this test is done.

Preparation

You do not need to do anything special to prepare for the test unless specifically asked to do so by your doctor. When you arrive at the office, you will be asked to empty your bladder and will need to undress from the waist down. You will lie on your back on a special table. Your genitals will be cleaned with a special soap before the camera is passed.

During the procedure, you have the option to watch on a monitor. If you do not wish to see the inside of your bladder, let us know.

If you have a history of joint replacement within the last 2 years, are immunosuppressed, have recurrent urinary tract infections, have had a catheter in place before the procedure, or have certain other medical conditions, you may need to take an antibiotic before the procedure. This will be given at the office. Please let us know if you have one of these conditions.

Risks

The main risk of the procedure is urinary tract infection. Some patients who have this test need antibiotics to prevent infection.

Discomfort can occur during the test, but it is usually not painful.

After the Procedure

You will be given the results of the test immediately. Sometimes a urine sample is collected and sent to the lab for special analysis. These results will be given to you when they are received, several days later.

You are able to drive yourself home. Most patients do not have any discomfort after the procedure, but some will have burning the first time they urinate or for a day or so. If you have more pain, burning, or discomfort than expected, please let us know.

How to Perform Clean Intermittent Catheterization

The steps for catheterizing are described very well in this article published by the University of Maryland Medical Center. Both men and women are able to self-catheterize.

If you are catheterizing for a temporary condition, such as the inability to empty the bladder after having surgery, it is important that you try to urinate before you catheterize. This will let you know whether your bladder is recovering.

It is also very helpful for you to record how much you urinate on your own and how much you get out through the catheter, and bring this information to your doctor’s visit. Two days worth of this information is enough for your doctor to get a good idea of how your bladder is working.

Prostate Illustration

The prostate gland is the only organ in the body that continues to grow throughout life. Its main function is to make fluids that help the body produce semen. When it becomes enlarged, some men develop troublesome urination. Common symptoms of an enlarged prostate include changes in the urine stream (weaker, harder to start, harder to keep going), having to go frequently in the day and night, having a strong urge to go, and dribbling urine after voiding. An enlarged prostate can also cause bleeding, retention of urine (inability to empty the bladder), and urine infections.

Many men with enlarged prostates do not have symptoms. The condition does not need to be treated if it is not causing problems. For those who do have symptoms, treatment options range from lifestyle changes (to help the bladder and prostate work more easily) to medications to surgery.

Natural Treatments

An enlarged prostate can put strain on the bladder. It is very important to pay attention to your bladder and make its job as easy as possible. Several factors, such as emptying your bladder regularly (and not holding your urine) and watching the types and amounts of fluid you drink, can make a tremendous impact on your symptoms. The Restoring Bladder Health hand-out provides details on these and other things you can do to keep your bladder healthy.

Other natural treatments may help ease prostate symptoms. UrologyChannel.org has a list of alternative treatments that many men have found effective. One of the most commonly used is saw palmetto, an herbal remedy that can be purchased over-the-counter.

Medications

Several medications are available to help ease enlarged prostate symptoms.

Alpha Blockers

This group of medications includes drugs such as Cardura, Hytrin, Flomax, and Uroxatral. They work by relaxing smooth muscle in the prostate and opening the urinary channel. Older drugs such as Cardura and Hytrin work on both the prostate and on blood vessels, so are sometimes used to treat both an enlarged prostate and high blood pressure. Sometimes, these drugs can cause dizziness and lightheadedness, and one must be cautious when beginning these medications.

Newer versions of alpha blockers, Flomax and Uroxatral, do not have an effect on blood vessels. They do not usually cause dizziness and lightheadedness and cannot be used to treat high blood pressure.

These drugs usually provide an improvement in symptoms very quickly. Men often find that they need to stay on them indefinitely to keep symptoms under control.

5-alpha Reductase Inhibitors

These are medications that stop the conversion of testosterone into dihydrotestosterone, a form of the hormone that works in the prostate gland. Examples are Proscar and Avodart. Over time, these drugs result in shrinkage of the prostate gland and a lowering of the PSA levels in the blood. They do not usually provide immediate results and must be taken for several weeks before an effect is seen.

These drugs are effective in combination with alpha blockers and are particularly recommended for men with very large prostates.

It is important for men on these drugs to know that the PSA is artificially lowered, and, therefore, PSA values that are usually considered normal can be a sign of a problem in men taking 5-alpha reductase inhibitors.

Anticholinergics

This is a group of medications designed to relax bladder contractions. Examples are Ditropan (oxybutynin), Detrol, Enablex, Sanctura, and Vesicare. These drugs are particularly helpful for symptoms of urgency and frequency. They must be used with caution, however, because they can make it more difficult to empty the bladder in men who are already retaining urine. They are usually combined with other drugs, such as alpha blockers.

Procedures

Some men do not wish to take medications for the rest of their lives or wish to stop them because of side effects. If symptoms are very bad, surgery may be recommended (see below). However, men whose symptoms can be controlled with medications, but who do not wish to take them, now have the option to undergo office procedures that can result in effective relief of prostate symptoms without the need for drugs.

Available treatments work by delivering energy to the prostate in a variety of ways in order to help open the channel. These treatments have been found to have very good results. Two of these treatments, Prolieve and Prostiva, are available in our office. Prolieve, which uses microwave therapy to dilate and treat the enlarged prostate, often results in immediate improvement. The procedure is done in the office and does not typically require wearing a catheter afterwards. They typically produce relief that lasts for at least 2 to 3 years. 

Prostiva works by delivering heat in the form of radiofrequency to destroy enlarged prostate tissue. It does require wearing a catheter for a few days afterwards, but may also be more durable than other therapies; in studies, it has been reported to last several years.

Surgery

Men who have very bothersome symptoms from enlarged prostate, such as urinary troubles that do not improve with medication, infections, inability to empty the bladder, or bleeding, are very likely to benefit from surgery of the prostate. This surgery is usually done endoscopically, through a camera which is passed through the urethra. The surgery can be done using electrocautery or laser therapy. Both result in effective and durable cures in many cases. These operations are described in further detail in the articles titled Laser Resection of the Prostate and TURP (Transurethral Resection of the Prostate).

The ultimate decision of which treatment to pursue depends on the level of your symptoms and how much they are bothering you. Enlarged prostate has troubled many men for centuries, and we are very fortunate to be able to offer a variety of effective therapies today.

Probiotics: Consumer Information
This article, provided by the International Scientific Association for Probiotics and Prebiotics, has excellent guidelines for choosing a probiotic formula.

Probiotics Information Page
This fact sheet, published by the American Gastroenterological Association, also provides great information on probiotics and our current understanding of them.