World’s Top Urological Specialists Meet • After testing 492 men in various age brack- in San Diego to Hear Latest Scientific ets ranging from 40 to 73, re s e a rchers con- I n f o rma tion on Genitourinary cluded that, at the same PSA level, older M o r e than 1,800 original re s e a r ch studies men are more likely to have extensive aimed at preventing, diagnosing, and tre a t i n g p ros tate cancer than younger men. adult and childhood of the , ure- H o w e v e r, the investigators did not advo- thra, and genitals, plus dozens of state-of-the-art cate setting higher PSA thresholds for education presentations, highlighted the 93rd older men because such a change might Annual Meeting of the American Uro l o g i c a l c o m p r omise the cure rate. Association® at the San Diego Convention Center, • Working with beagle dogs, medical scien- San Diego, California, May 30-June 4, 1998. tists have reconstructed a bladder from a With an expected overall attendance of 14,000, biodegradable polymer that delivere d m o r e than 7,500 urologists, other physicians, bio- regenerated cells from the interior lining of medical re s e a r chers, and health care pro f e s s i o n a l s the dog’s original bladder. They believe participated in the world’s largest and most com- that their tissue engineering can cre a t e p r ehensive urologic educational and scientific functional, anatomically normal bladder forum. These individuals attended plenary ses- for replacement or augmentation. sions, lectures, panel discussions, point/counter- point debates, poster and podium sessions, video p r esentations, and instructional courses. General According to The National Association For topic areas featured included prostate cancer, Continence, Spartanburg, SC; and the “Clinical benign prostatic hyperplasia (BPH), erectile dys- Practice Guidelines of Urinary Incontinence in function (impotence), , uri- Adults,” The U.S. Agency for Health Care Policy nary incontinence, , infertility, and Researc h : bladder cancer, and kidney cancer. • Urinary incontinence — a loss of bladder Some of the important original re s e a r ch find- c o n t rol — is a symptom, not a disease. ings presented at the meeting included: • Causes of incontinence: • In a study involving 909 African American Birth defects men and 2,131 white males, each man Pelvic surg e r y received a prostate specific antigen (PSA) to the pelvic region or spinal cord test and a digital rectal exam or negative N e u r ological diseases p r ostate biopsy. None had known pro s t a t e Multiple sclero s i s c a n c e r. PSA levels in African American I n f e c t i o n men rose significantly at age 50, compare d Degenerative changes associated with to whites, and continue to escalate consid- a g i n g erably as the men aged. P r egnancy or childbirth • In double-blind, -contro l l e d • 13 million Americans are incontinent — re s e a r ch that involved over 3,100 men 85% of them are women. with severe erectile dysfunction, 46% of • One in four women ages 30-59 have expe- those on oral sildenafil had much higher rienced an episode of urinary stress incon- s c o res for sexual penetration and for main- t i n e n c e . taining an erection than they had at the • 50% or more of elderly persons living at beginning of the study. home or in long-term care facilities are • Fifteen years after diagnosis, cancer mor- i n c o n t i n e n t . tality was dramatically affected by biopsy • Many people affected by loss of bladder grade at diagnosis for men with localized c o n t rol lose self-esteem and isolate them- p r ostate cancer which had been tre a t e d selves for fear of ridicule. conservatively with hormone therapy. Men • A p p r oximately 80% of those affected by with lower grade tumors encountered a incontinence can be cured or impro v e d . modest risk of death while those with high • Treatment options range from simple s c o res faced significant risk. changes in diet or medication to a combi-

UROLOGIC NURSING / September 1998 / Volume 18 Number 3 209 Betsy J. Nielsen, BSN, RN (left), was the proud winner of a painting raffled to benefit the Jan LeBouton schol - arship fund. CBUNA President Cathie Green, MSN, A N P, CUNP, presented the award at SUNA’s 29th Annual Conference.

and conducted by Louis Harris and Associates, Patricia Bates, BSN, RN, CURN, Urologic Nursing Inc. highlighted this link between health care and Editor from 1982 to 1998, received the Outstanding embarrassment. More than 90% of physicians sur- Contribution to SUNA award at SUNA’s 29th Annual veyed agreed that serious medical problems could Conference in San Diego. Accepting the award for Ms. be averted if patients were more willing to talk Bates was journal editor Catherine-Ann Lawrence, MA, RN (left). The award was presented by SUNA President about their pro b l e m s . Jan Giroux, MSN, RN,C, CURN. Embarrassment was the primary re a s o n patients were reluctant to talk with their doctors about health problems, garnering a rating of 25%. Embarrassment far out paced other leading factors nation of drugs, behavioral modification, such as thinking symptoms are unimportant pelvic muscle exercise, absorbent pro d- (11%), fear of bad news (8%), not wanting to ucts, surgery, and collagen injections. waste the doctor’s time (8%), and fear of tre a t m e n t • Despite the high success rates in tre a t i n g options (7%). incontinence, only one out of every 12 Loss of bladder control is one of those condi- people affected seeks medical help. tions that often causes people embarrassment. The Harris survey revealed that of those re s p o n d e n t s Incontinence Embarrassment Can Have who avoided talking to their physician about med- Serious Health Implications ical control, 52% said they would feel embarrassed As teenagers it seemed everything made us if their doctor asked them about bladder contro l . cringe in embarrassment. As adults, there are still Many people with bladder control pro b l e m s embarrassing subjects that even the most open- cope in silence because they fear ridicule. They try minded adults find difficult to broach with family, to change their lives to cope as best they can, self- friends, and even physicians. t reating or ignoring the problem rather than facing Undue embarrassment becomes a pro b l e m their doctor. However, not seeking treatment for when it affects our health and enjoyment of life. If bladder control problems can drastically re d u c e patients are unable to talk about bladder contro l quality of life, according to Dr. Leroy Nyberg , p r oblems with their health care pro v i d e r, they may d i rector of and Women’s Health at the try to ignore or self-manage the problem, but they National Institutes of Health. “Many people with a re very unlikely to solve it independently. incontinence experience adverse psychosocial A recent survey on patient-physician commu- e ffects ranging from embarrassment to depre s s i o n nication issues sponsored by Pharmacia & Upjohn and social withdrawal,” said Dr. Nyberg. “Often,

210 UROLOGIC NURSING / September 1998 / Volume 18 Number 3 they stop exercising, traveling, or working because they live in fear that they will have ‘an accident’ in public.” By conquering embarrassment and seeking help, these problems often can be effectively tre a t- ed. Patients need to realize that they will not be the first or the last person to have this common p r o b l e m . Study Examines Patterns of Exercise and Fatigue in Physically Active Cancer S u r v i v o r s The April 1998 issue of the Oncology Nursing F o r u m has published the results of the study “Pattern s SUNA’s 29th Annual Conference offered many valuable of Exercise and Fatigue in Physically Active Cancer opportunities to network and reunite with friends and colleagues. Don’t miss SUNA’s 30th Anniversary Survivors.” The project provides support for exerc i s e Convention April 30-May 4, 1999 in Dallas. as an intervention for cancer- r elated fatigue (CRF). As the most common side effect of cancer, CRF has been reported to affect 40% to 90% of patients. The impact of CRF on patients’ quality of life and physical and emotional; and various psychosocial ability to carry out activities of daily living has sig- i n t e r v e n t i o n s . nificant implications for patients who experience a The text also covers several special topics, notable decline in functional ability during cancer such as psychosocial implications of genetic test- t r eatment. Exercise has been one of the few inter- ing and susceptibility, experimental therapy, alter- ventions suggested to prevent or decrease CRF. This native and complementary therapies, and physi- particular re s e a r ch describes how CRF affects the cian-assisted suicide. e x e r cise patterns of physically active individuals The book is $29.95 for ONS members and who received cancer tre a t m e n t . $36.00 for nonmembers. To order a copy of The re s e a r ch examined the physical activity pat- Psychosocial Nursing Care Along the Cancer t e r ns of cancer survivors who identify themselves as C o n t i n u u m , contact ONS Customer Service at athletes. The purpose of the study was to assess 501 Holiday drive, Pittsburgh, PA 15220 or call how much exercise athletic patients with cancer (412) 921-7373. engaged in during treatment, to determine how CRF a f fects athletic patients’ ability to exercise, and to A . F.U.D. Issues Statement Regard i n g d e t e rmine common problems and patterns associat- Vi a g r a ® ed with CRF experienced by athletic patients. Thomas M. Bruckman, executive dire c t o r, The study concluded that the majority of the American Foundation for respondents reported decreasing their activity level (AFUD), stated that “the FDA approval of Vi a g r a during treatment, but they believed that re g u l a r is exciting news because it increases the number e x e r cise would make them less likely to have health of treatment options for the millions of men who p r oblems. Respondents used exercise both as an s u f fer from impotence. It is the first treatment for intervention to reduce CRF and as a means to have impotence available in the form of a pill. It will m o r e energy. Patients with breast cancer re p o r t e d also encourage many new patients to visit their m o r e benefits from exercise than patients with non- doctor or urologist for consultation. That is Hodgkins lymphoma. encouraging news since currently only 5% to 10% of men affected by impotence seek tre a t- New Book Addresses Psychosocial ment. We believe that the intense media intere s t Nursing Care of Individuals with Cancer in this new treatment will create a wonderf u l The Oncology Nursing Press, Inc. announces unique education opportunity for men, and their the publication of Psychosocial Nursing Care doctors, to address the overall issue of impo- Along the Cancer Care Continuum, a text pro- tence which is often the result of an underlying viding in-depth information about the issues re l a t- medical condition that should be addressed. We ed to psychosocial nursing care of patients with encourage men seeking treatment for impotence c a n c e r. to see a urologist and investigate all possible The book addresses various topics such as the causes and available treatment options. While psychosocial impact of cancer on the individual, we expect this new therapy will be effective for family, and society; psychosocial experiences of many men, there are others who can benefit

UROLOGIC NURSING / September 1998 / Volume 18 Number 3 211 F i g u r e 1. fer from the kinds of conditions — such as arthri- The Aging Population of America tis, bone and joint disorders, and back pro b l e m s — that are not readily resolved and are accompa- nied by mild, moderate, or severe pain. Older people are also likely to have multiple medical p r oblems requiring diff e rent drug regimens that may interact with pain medications. The AGS clinical practice guidelines re c o m - mend nonpharmacologic strate- gies including patient and caregiver education, cognitive-behavioral therapy, exercise pro g r a m s , and other modalities. However, the guidelines note that these strategies often work best to i m p rove overall pain management when used in combination with appropriate drug re g i m e n s . The most common strategy to manage pain is to use medications. The guidelines emphasize that analgesic drugs should supple- ment other medications directed at the tre a t m e n t or management of the underlying disease. The AGS clinical practice guidelines recommend the use of acetaminophen, such as Tylenol®, under the direction of a health care pro v i d e r, as first-line p h a r macologic therapy for mild to moderate mus- culoskeletal pain, the most common pain condi- tions in older Americans. S o u rce: U.S. Census Bureau—Federal Interagency The clinical practice guidelines advise F o rum On Aging-Related Statistics e x t rem e caution in the use of nonsterioidal anti- inflammatory drugs (NSAIDs), such as aspirin and i b u p rof en, for treating intermittent chronic pain, f rom a host of other effective medical and psy- as they are associated with a higher frequency of chological therapies for impotence. We encour- adverse effects in older adults to varying degre e s . age men to take this opportunity to openly dis- The AGS clinical practice guidelines also urge cuss all symptoms, causes, and treatment options regulatory agencies to change existing policies to with their physicians and have an overall health improve access to narcotic, analgesic examination to select the most appro p r i a t e drugs for older patients in pain, and recommend course of tre a t m e n t . ” health systems that care for older people to allow For further information, please call A.F. U . D . for more aggressive treatment of chronic pain. at (410) 468-1800. Chronic pain is a critical issue to the aging population. A recent Louis Harris survey found New Clinical Practice Guidelines Addre s s that one in five older Americans is taking anal- C h ronic Pain in Older People gesic medications several times a week or more. On May 7, 1998, improved understanding, There are currently 33.2 million Americans age 65 assessment, and treatment of chronic pain in older or older, representing 13% of the population, and people were the goals of new clinical practice more than 70 million adults over age 50, account- pain management guidelines announced by the ing for more than a quarter of the population American Geriatrics Society (AGS) at its annual (see Figure 1). By 2011 the number of Americans meeting. These were the first clinical practice 65 and older will have doubled and the number guidelines that focused specifically on pain man- of adults over 50 is expected to increase by 30%. agement in older Americans — the fastest gro w i n g Free information for consumers on the guide- segment of the population, and the most likely to lines is available by calling (888) 432-PAIN. s u ffer from chronic, painful conditions that are often under- t r e a t e d . Facts The AGS clinical practice guidelines were According to the Interstitial Cystitis Association: developed in recognition of several factors that are • Interstitial cystitis (IC) is a chronic inflam- specific to pain management in the older popula- matory condition of the bladder wall. tions. As people age, they are more likely to suf- continued on page 214

212 UROLOGIC NURSING / September 1998 / Volume 18 Number 3 Current Affairs continued from 212 • T h e r e is no known cause or cure. IC fre- quently goes undiagnosed. • Symptoms include bladder pain, urinary u rgency, day and night frequency (up to 60 times per day), suprapubic or perineal pain and pre s s u r e. Intercourse can be painful. • An estimated 450,000 American victims; 90% a r e women. • Average age of onset is 40; 25% are under Informative and dynamic clinical information, present - the age of 40. ed by the leaders in the urologic industry, can be found IC is frequently misdiagnosed as an acute uri- in the exhibit hall during SUNA’s Fall Institute and nary tract infection or cystitis, a disorder which can Annual Conference. be successfully treated with antibiotics. A cys- toscopy under general is re q u i red to disc disorders. The new findings of a link make a diagnosis of IC. The bladder is distended between impotence and heart disease pro v i d e to check for pinpoint hemorrhages on the bladder another important reason why men should under- wall that are the hallmark of IC. A number of other go a thorough health examination rather than diseases must be ruled out, such as bladder infec- simply take measures or medications like Vi a g r a ® tion, bladder cancer, sexually transmitted diseases, to treat the impotency,” said Dr. John Mulhall, n e u rologic disorders, , and vaginal d i rector of Loyola’s Center for Male Sexual Health. i n f e c t i o n s . Mulhall presented at the 93rd Annual Meeting Treatments can successfully relieve symptoms of the American Urological Association in San in many patients and include: Diego, CA, his study of 42 men, who ranged in • Bladder hydro d i l a t a t i o n . age from about 35 to 55. He found that those • E l m i r on® (pentosan polysulfate ), patients whose impotence was associated with a oral medication specifically for IC. p r oblem of penile blood flow were more likely to • Other oral medications such as tricyclic have an abnormality discovered by a cardiologist a n t i d e p r essants, , anti- during a stress test even though they reported no inflammatories, and antihistamines. symptoms other than the impotence. • DMSO® (dimethyl sulfoxide), instilled “Potentially, some of these individuals could medication specifically for IC. re q u i re an gioplasty, bypass surgery, or other pro- • Other instilled medications: heparin, c e d u res in order to prevent a heart attack or heart Clorpactin WCS-90®, silver nitrate, f a i l u re,” said Dr. Mulhall. “This study re i n f o rc e s Cystistat (experimental); BCG (pro m i s i n g our contention that impotence can be linked to medication now in clinical trials). even more serious medical conditions that must • TENS (transcutaneous electrical nerve be investigated and tre a t e d . s t i m u l a t i o n ) / b i o f e e d b a c k . “ A p p r oximately half of all men between the • Diet modification. ages of 40 and 70 in the suffer fro m • S u r gery is a last re s o r t . some degree of impotence. Seventy percent of For more information, contact: Interstitial those whose impotence is due to physical pro b l e m Cystitis Association, P.O. Box 1553 Madison have vascular disease, including coronary artery S q u a r e Station, New York, NY 10159; (212) 979- disease, peripheral vascular disease,” Mulhall said. 6057; FAX (212) 677-6139; E-mail: [email protected]; “This study indicated that certain patients with w w w . i c h e l p . c o m impotence diagnosed as being the result of serious penile blood flow problems, particularly those Impotence May Be Wa rning Signal for men who also have a first-degree blood re l a t i v e Heart Disease with coronary artery disease, could benefit fro m Men who develop impotence because of evaluation by a cardiologist,” stated Dr. Mulhall. blood flow problems may have underlying heart disease even though they are not experiencing Viagra Alternative Oral Medication for any other symptoms, according to a re s e a rch at Impotence Found Successful, Safe Loyola University Medical Center in Maywood, IL. According to the re s e a r ch presented at the 93rd “ We already know that impotence can be the Annual Meeting of the American Uro l o g i c a l first sign of , , or neuro l o g- ical diseases such as multiple sclerosis and lumbar continued on page 223

214 UROLOGIC NURSING / September 1998 / Volume 18 Number 3 Current Affairs their options carefully and select aggressive tre a t - continued from 214 ment only if they face significant risk of pro s t a t e cancer pro g re s s i o n . Association in San Diego, CA, about half the men who took oral phentolamine (Vasomax®) were less Pelvic Muscle Rehabilitation Audio likely to experience problems in having ere c t i o n s , P r ogram for Men with no reports of serious side effects. This offers an According to the Clinical Practice Guideline on a l t e r native to Viagra®, the first oral medication Urinary Incontinence in Adults released in Marc h a p p r oved by the Food and Drug Administration, for 1996, medical experts contend that pelvic muscle men who suffer from impotence. rehabilitation is beneficial for men who develop In two multi-center re s e a r ch trials, investigators urinary incontinence following prostatectomy. The found that about 35% of men with mild to moder- National Association for Continence supports this ate erectile dysfunction successfully responded to a statement, and has released a new audio cassette 40 mg dose of Vasomax. In one of the trials, 45% tape targeted specifically for men with post-pro s t a- of the participants who used a 80 mg dose showed tectomy incontinence that provides verbal instruc- i m p r ovement. tion on the correct way to perf o rm pelvic muscle “ We ’ re pleased that the trials on Vasomax have e x e r cises. shown it to be an affective medication,” said Irwin When done correctly and diligently before and Goldstein, MD, professor of surgery at Boston after prostate surgery, pelvic muscle exerc i s e s , University School of Medicine. also called Kegel exercises, help re s t o r e or P r ostate Cancer — To Treat or Not to Tre a t i m p rove control. This program has been Men of re t i rement age and beyond, who have made possible by an education grant fro m been diagnosed with low-grade prostate cancer, Kimberly-Clark Corporation, makers of Depend® often show favorable outcomes with little or no Guards for Men. For additional information call 1- t r eatment, according to re s e a r ch results from a 8 0 0 - B L A D D E R . • study conducted at the University of Connecticut Health Center by Peter C. Albertsen, MD, an asso- ciate professor at the department of surg e r y . Results showed that men who were diagnosed with low-grade prostate cancer had only a 4% to 7% chance of dying from prostate cancer within 15 years of diagnosis, depending on their age. A g g ressive treatment, like radiation or surg e r y , could negatively affect his quality of life and not add to his longevity, since risk of death is higher after age 75 from other health diff i c u l t i e s . Conversely, men with high-grade prostate cancer who are diagnosed even as late as age 75 have a significant risk of dying from prostate cancer rather than other causes. Men with moderate- grade cancer face a modest risk of death fro m p r ostate cancer that increases slowly over at least 15 years of followup. According to Dr. Albertsen, more re s e a r ch is needed to study the outcomes of patients with high-grade prostate cancer to determine whether therapies such as surgery or radiation help them live longer. Other studies have shown that men with low- grade prostate cancer treated with radiation or s u rgery had a very good survival rate. But Dr. Albertsen’s study shows how the competing risks of prostate cancer and other medical conditions a ffect men as they age. Since the more aggre s s i v e therapies like radiation and surgery can cause other complications such as impotence and incon- tinence, Dr. Albertsen said men should consider

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