Urology Clinic of Lake Charles, LA

Dr. Reed Fontenot, Jr.
Dr. Stacy McBroom
Dr. John Upshaw

News

July 18, 2008
Computerized Tomography Findings In Pediatric Renal Trauma - Indications For Early Intervention?
UroToday.com - The study out of Children's Hospital of Pittsburgh evaluated CT scans for blunt renal trauma to see if they correlated with the need for operative intervention when urinary extravasation was present.

A total of 17 patients with grade IV blunt renal trauma and urinary extravasation were identified between 2000 and 2007. Each CT scan was reviewed to determine location, size and number of sites of extravasation, as well as the presence of contrast material in the ipsilateral ureter. These were then compared to the findings at the time of surgery - whether surgey included stent placement, percutaneous urinoma drainage, angiographic embolization and nephrectomy. Read entire article here.

July 15, 2008
Increased Risk Of Kidney Stone Disease Due To Global Warming, Predicts UT Southwestern Researchers
Global warming is likely to increase the proportion of the population affected by kidney stones by expanding the higher-risk region known as the "kidney-stone belt" into neighboring states, researchers at UT Southwestern Medical Center and UT Dallas have found.

Dehydration is one of the risk factors linked to kidney-stone disease, and the paper suggests global warming will exacerbate this effect. The researchers predict that by 2050, higher temperatures will cause an additional 1.6 million to 2.2 million kidney-stone cases, representing up to a 30 percent growth in some areas. Read entire article here.

Information
Prostate cancer is the second leading cause of death among men. In 2002 it is estimated that 30,200 men will die from prostate cancer and 189,000 men will be diagnosed (American Cancer Society Facts & Figures 2002). The incidence of prostate cancer increases with age with 75% of all prostate cancers being diagnosed in men over the age of 65.

Prostate Cancer Management
The critical focus for the treatment of prostate cancer is to treat those cancers where it is necessary, and not to treat those that do not need it.

Decisions about the best management of prostate cancer can be complex and depend upon the:

Pathology of the cancer (unlike other cancers, prostate cancer often progresses very slowly)
Stage of the disease (non-metastatic (localized or locally advanced), metastatic or hormone refractory)
Age and general health of the patients at diagnosis
The impact that treatment can have on quality of life, including sexual activity.
Patient's preference for treatment
PSA at diagnosis

Please visit the National Prostate Cancer Coalition for more information.

August is National Immunization Awareness Month
Vaccine-preventable disease levels are at or near record lows. However, we cannot take high immunization coverage levels for granted. To continue to protect America's children and adults, we must obtain maximum immunization coverage in all populations, establish effective partnerships, conduct reliable scientific research, implement immunization systems, and ensure vaccine safety.
Read more ....

Testosterone Deficiency

Overview

Testosterone production declines naturally with age. Testosterone deficiency (TD) may result from disease or damage to the hypothalamus, pituitary gland, or testicles that inhibits hormone secretion and testosterone production, also known as hypogonadism. Depending on age, insufficient testosterone production can lead to abnormalities in muscle and bone development, underdeveloped genitalia, and diminished virility.

Testosterone is the androgenic hormone primarily responsible for normal growth and development of male sex and reproductive organs, including the penis, testicles, scrotum, prostate, and seminal vesicles. It facilitates the development of secondary male sex characteristics such as musculature, bone mass, fat distribution, hair patterns, laryngeal enlargement, and vocal chord thickening. Additionally, normal testosterone levels maintain energy level, healthy mood, fertility, and sexual desire.

The testes produce testosterone regulated by a complex chain of signals that begins in the brain. This chain is called the hypothalamic-pituitary-gonadal axis. The hypothalamus secretes gonadotropin-releasing hormone (GnRH) to the pituitary gland in carefully timed pulses (bursts), which triggers the secretion of leutenizing hormone (LH) from the pituitary gland. Leutenizing hormone stimulates the Leydig cells of the testes to produce testosterone. Normally, the testes produce 4–7 milligrams (mg) of testosterone daily.

Click here to complete the Androgen Deficiency in Aging Males (ADAM) questionnaire.

Incidence and Prevalence

Testosterone production increases rapidly at the onset of puberty and decreases rapidly after age 50 (to 20% to 50% of peak level by age 80). Approximately 8 million men in the United States experience testosterone deficiency; approximately 600,000 receive treatment.

Types and Causes

Hypogonadsim is classified by the location of its cause along the hypothalamic-pituitary-gonadal axis:

Primary, disruption in the testicles
Secondary, disruption in the pituitary
Tertiary, disruption in the hypothalamus

Disease, injury, surgery, and drug side effects can cause hypogonadism and testosterone deficiency. Hypogonadism is congenital or acquired, depending on the nature of the underlying condition.

Congenital causes include the following:

Anorchia (vanishing testes syndrome; causing primary hypogonadism)
Cryptorchidism (failure of testicles to descend into scrotum; causing primary hypogonadism)
Hormonal deficiency (e.g., deficiency of leutenizing hormone releasing hormone; causing secondary or tertiary hypogonadism)
Kallmann syndrome (insufficient hypothalamic GnRH production; causing tertiary hypogonadism)
Klinefelter syndrome (underdeveloped testicles; causing primary hypogonadism

Acquired causes include the following:

Chemotherapy
Damage occurring during surgery involving the pituitary gland, hypothalamus, or testes
Glandular malformation
Head trauma (affecting the hypothalamus)
Infection (e.g., meningitis, syphilis, mumps)
Isolated LH deficiency (e.g., fertile eunuch syndrome)
Radiation
Testicular trauma
Tumors (of the pituitary gland, hypothalamus, or testicles)

Signs and Symptoms

Signs depend on the age of onset and the duration of hormonal deficiency. Congenital hypogonadism is generally characterized by underdeveloped genitalia (testes that do not descend into the scrotum) and, occasionally, undeterminable genitalia. The development of hypogonadism near puberty can result in gynecomastia (enlargement of breast tissue), sparse or absent pubic and body hair, and underdeveloped penis, testes, and muscle. Adult men may experience diminished libido, erectile dysfunction, muscle weakness, loss of body hair, depression, and other mood disorders.

Complications

Testosterone deficiency has been linked to muscle weakness and osteoporosis. In one study, proximal and distal muscle weakness was detected in 68% of men with primary or secondary hypogonadism. Spinal, trabecular, and radial cortical bone density may also be significantly reduced in testosterone-deficient men. Thirty percent of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of men have subnormal bone density that puts them at risk for fracture.