MRSA Infections and Urology

MRSA is a resistant form of the Staph bacteria, an organism commonly found on human skin. Staph can cause a variety of infections, and occasionally can cause a severe scrotal infection known as Fournier’s Gangrene. Fournier’s Gangrene typically starts as a “pimple” on the scrotum, but can quickly spread to cause gangrene of the scrotal skin.

When caught in the pimple stage, Fournier’s Gangrene is easy to treat. If not diagnosed in a timely manner, however, treatment involves surgical removal of all infected tissue, including the scrotum.

If you see a lesion that you are concerned with, please call Dr Schoor.

Varicoceles on ultrasound

Varicoceles can cause male infertility.

This is a right side varicocele. It was palpable and quite large on exam. Varicoceles are more common on the left side only, but can occur on both sides. Varicoceles on the right side only are very rare. Occasionally, varicoceles can recur after a varicocelectomy--the surgery to fix varicoceles. They may recur due to the presence of gubernacular veins, or veins that run in a structure just under the testicle.

This patient had a large left varicocele. The color images reflect blood flowing through the veins. I use a doppler ultrasound unit in my office to detect the blood flow.

Correcting varicoceles can improve a couple's chance to achieve pregancy, either naturally or with the aid of assisted reproductive techniques.

Varicocelectomy is a safe, outpatient procedure that has minimal side-effects. Varicocelectomy results are best when the surgeon uses a high power operating microscope and a doppler probe. Both of those tools allow the surgeon to detect all the veins that need ligating and the testicular artery and lymphatic channels that ought to be spared.

Thanks,

The IU.

Robotic Radical Prostatectomy: Is it the new TURP?

It is my great privilege to have a guest blogger today, Dr Robert Batler. Robert Batler MD is a urologist in Indiana who specializes in robotic radical prostatectomies. Dr Batler has performed hundreds of robotic radical prostatectomies with exceptional success rates. and has become an internation leader in the field. Last week, Bob and I were discussing BPH, or benign prosate enlargement, when he made a comment that I found, to say the least, controversial.
Bob has agreed to publish his thoughts here, on Dr Schoor's Urology Blog. So here it is.

From Dr Batler's Blog:

Increasingly, patients are being diagnosed with early organ confined and in some circumstances incidental prostate cancer. Prostate screening programs have led to what some would say is an overly aggressive campaign in which we are diagnosing insignificant prostate cancers. Without a doubt this may be true in some circumstances. Conversely, we are diagnosing aggressive disease earlier and we have observed a stage migration. Ultimatley this should lead to less morbidity and lower death rates from prostate cancer within the screening population.However, what is the morbidity of treating incidently discovered prostate cancer? Any form of treatment carries the risk for potential urinary incontinence, lower urinary tract symptoms and erectile dysfunction. Could there be a hidden benefit?An interesting thought recently occurred to me. Do patients whom have had a laparoscopic robotic radical prostatectomy have fewer urinary complaints than most of our patients that are being treated medically for BPH or who have undergone a transurethral prostatectomy (TURP)? Without having done a prospective randomized trial, I would say my personal experience is that most patients undergoing robotic radical prostatectomy on the whole have far fewer urinary complaints and thus lower AUA (urinary complaint) scores than our average patient who is being medically treated or previously undergone a TURP.Am I suggesting we perform robotic radical prostatectomy in our patients with bladder outlet obstruction secondary to BPH? Certainly, I am not making that recommendation. However, I am intrigued by the question. Is incidently discovered prostate cancer treated with radical prostatectomy (particularly in the often impotent male) any more morbid than a TURP? Is there greater risk?Would urinary outcomes be better?We may never have the answer to these questions. As ridiculous as it may seem, there may be a day when laparoscopic robotic prostatectomy replaces TURP. In many circumstances, in practice, is already has replaced the TURP.

Thanks Bob.

I think it is an interesting question that you pose, though I am not sure that I agree with you. In my view, you are using a "big gun" to treat a "little" problem. Advances in BPH treatment have largely made invasive therapies, like TURP and open prostatectomy, a thing of the past. The average urologist does less than 10 TURP's per year and and instead treats BPH with other methods. Outcomes with other modalities, such as HOLAP and Greenlight Laser Therapy are excellent with minimal morbidity. In addition, medical treatments with alpha blockers and 5-alpha-reductase inhibitors often prevent progression of disease to the point of surgical intervention. Finally, when surgical intervention is needed, the cost of robotic radical prostatectomy outweighs the cost of a HOLAP, Greenlight, or even a TURP, by multiples of 10. Perhaps when the technology becomes more readily available and less expensive, robotic radical prostatectomy will be adopted for benign disease. Until then, I believe that standard BPH therapies will prevail.

Again, I thank you for this provocative post and for "stirring the pot."

The IU.

UTI's Part 2: UTI vs Positive Urine Cultures

Not all positive urine cultures indicate that the patient has a UTI. Positive urine cultures can result from improper, non-aseptic collection technique, improper specimen handling, or the presence of an indwelling urinary catheter, in addition to an actual infection.

Signs that the positive urine culture is actually a false positive one include:

• multiple positive cultures, each one with a different bacterial species
  
• cultures with multiple organisms
• positive cultures in the face of a normal UA
• positive cultures in the absence of symptoms
• urine cultures that grow atypical organisms
• positive cultures in patients with chronic indwelling catheters and no symptoms
• cultures with low levels of bacterial growth
  

Any of the above should alert the physician to the fact that the culture may not be accurate. Use of antibiotics in these cases may not be indicated and can actually promote subsequent bacterial resistance.

Thanks for listening.

Dr S.