Blood in urine? Get it checked
Professor Mark Frydenberg AM, talks about the importance of seeing your GP and urologist if you notice blood in your urine. Video Transcript I’m Mark Frydenberg, one of the urologists at Australian Urology Associates and I wanted to talk to you about a condition called haematuria which is blood in the urine. [Follow our YouTube Channel] This is in fact an extremely common urinary symptom and is something that is often not associated with serious pathology. Indeed, the most common cause of blood in the urine in both men and women is not serious in that the most common cause in the male is simply a burst blood vessel from their prostate gland and usually the most common cause in a female is from an infection. Having said that the reason that it’s very important this is investigated is that in a small five to ten percent of patients it can be due to something more serious, and this means a malignancy or a cancer in the kidney or a cancer in the bladder and these absolutely need to be excluded even if there’s only one single episode of bleeding in the urine. As such, bleeding in the urine should never be ignored and should always be presented to your general practitioner, who should refer you on to urologists such as ourselves. Typically, you will be ordered to have some sort of imaging to look at your kidneys and this would either be in the form of a CT scan or alternatively a urinary tract ultrasound and this is specific specifically done in order to try and rule out a kidney tumour. In addition to that, you will often have a urine test called the urine cytology as well as a urine culture to rule out an infection. The urine cytology is looking for malignant cells in the urine, so we want to try and determine whether there’s any of these present, which would obviously raise the possibility of a malignancy within the urinary tract. The last thing that would be recommended is a cystoscopy, which is a very simple telescopic examination of the bladder which is often done under local anaesthesia and can even be done in our offices. The purpose of this is to make sure that we’re not missing a polyp or growth within the bladder that could potentially be malignant and cause harm. If there are any questions about this, please don’t hesitate to ask the urologist at Australian Urology Associates, and thanks very much for your attention.
Cabrini leads the charge in Prostate Cancer Research during awareness month
As originally published by Cabrini Health at cabrini.com.au During Prostate Cancer Awareness Month, we are reminded that Cabrini stands at the forefront of ground-breaking research and treatment, offering hope to thousands of Australian men affected by this pervasive disease. Prostate cancer remains the most diagnosed cancer in Australian men, with alarming statistics: 1 in 12 men will be diagnosed with prostate cancer by age 70 1 in 5 men will face a prostate cancer diagnosis in their lifetime Approximately 25,500 new cases are diagnosed in Australia each year Tragically, 10 men die each day from prostate cancer The hospital’s Department of Urology, led by the esteemed Professor Mark Frydenberg AM, treats an impressive 700 prostate cancer patients annually representing 13% of all cases in Victoria. “Our vision is clear,” states Professor Frydenberg. “We aim to improve both survival rates and quality of life for patients with prostate cancer. This involves enhancing early detection, reducing treatment side-effects, expanding options for advanced cases, minimising invasive interventions, and providing personalised care.” Cabrini’s Department of Urology is revolutionising prostate cancer research through five key pillars: Preclinical Models: The MURAL Collection, a library of patient-derived xenografts, allows researchers to replicate the diverse biology of prostate cancer in laboratory settings. Theranostics: In partnership with GenesisCare, Cabrini is pioneering the use of theranostics—a cutting-edge approach that combines diagnostics and therapeutics to precisely target cancer cells. Precision Therapies: The Cabrini Focal Therapy Database is enhancing patient selection for targeted treatments, while research into radioligand therapy aims to make this treatment accessible to more patients. Advanced Imaging: Cabrini leads in the application of MRI and PET/CT scans for improved diagnostic accuracy and treatment guidance. Machine Learning: Collaboration on projects like ArteraAI is streamlining diagnoses through sophisticated AI models, revolutionising how prostate cancer is detected and assessed. As we commemorate Prostate Cancer Awareness Month, Cabrini’s work reminds us of the power of research and innovation. However, this vital endeavour relies heavily on the generosity of donors who understand that today’s investments pave the way for tomorrow’s breakthroughs. Cabrini’s Department of Urology, in partnership with Monash University BDI, are reducing the burden of prostate cancer and improving outcomes for countless Australian men and their families. Remember, early detection saves lives. This Prostate Cancer Awareness Month, let’s spread the word, support cutting-edge research, and stand united in the fight against prostate cancer. Learn more about Cabrini Urology Department
Recognising Dr Adam Landau for his contribution to rural communities
Outstanding Contribution by a Rural Medical Specialist Congratulations to Dr Adam Landau, who is a finalist in the Victorian Rural Health Awards, which recognises the outstanding contributions made by health professionals working in rural communities. This nomination recognises Dr Landau’s ongoing commitment to providing exceptional care to the Bairnsdale community.
Sexual Function. What you need to know
What causes erectile dysfunction? Erectile dysfunction (ED) is a prevalent issue among men over 40. ED can understandably impact your self-perception and overall quality of life. Addressing erectile dysfunction is a deeply personal journey. At AUA, we endeavour to understand your unique goals, while upholding professional and confidential conduct to provide you with privacy. Whether you aim to achieve erections suitable for sexual activity, maintain penile health and length, satisfy yourself, or boost your self-esteem, we have the expertise to support you throughout your journey of penile rehabilitation and sexual recovery. Furthermore, if you have a partner, their involvement is invaluable, and we encourage you to include them in your appointments if you wish. Sexual function following radical prostatectomy for prostate cancer After prostate cancer surgery, ED can occur due to the proximity of the erectile nerves to the sides of the prostate. As such, these nerves can often be damaged with prostate cancer treatments – both surgery and radiotherapy. Even with nerve-sparing surgery, nerve function may take several months and up to two years to fully recover. Recovery varies among individuals and depends on factors such as age, baseline sexual function, other medical conditions, and surgical considerations. There are several interventions available for post-prostatectomy ED, and we’ll work with you to establish your specific goals and create a tailored treatment plan. For many men, the goal is to regain erections suitable for sexual activity, while others, who may not be sexually active, aim to preserve penile length and optimize penile health. Early penile rehabilitation, including pharmacological (tablets and injections) or the use of a vacuum device, is crucial to prevent adverse structural changes like penile fibrosis and loss of length and girth. Research suggests that a penile rehabilitation program can prevent permanent damage and improve the chances of restoring normal erectile function. We strive to provide you with a fully supportive and collaborative environment to help manage any anxiety related to ED and performance issues, as high anxiety levels can further hinder the ability to achieve and sustain erections. Erectile dysfunction treatment Treatment options for ED range from non-pharmacological interventions like vacuum devices to tablet medications, injectable medications, or penile prostheses. Intracavernosal injections (ICI) involve injecting medication into the penile spongy tissue, producing a rigid erection within minutes. ICI is not dependent on functioning nerves, making it more reliable in achieving an adequate erection, but is dependent on having healthy blood vessels to the area. It’s an excellent choice for men experiencing side effects with tablet medications, or for those where the tablets are not effective, and is particularly helpful in the first few months after surgery whilst the nerves are slowly recovering. It is very common to experience some apprehension of self-injecting, and this will be addressed during the education process in our clinic, providing you with the confidence to continue with the treatment when you’re at home. Penile injections are an option whether you are sexually active or not, as many patients opt for them to maintain self-esteem, self-satisfaction, or restore bodily function. For men with post-prostatectomy ED, this treatment option is often preferred as it doesn’t depend on functional nerves like tablet medications. Therefore, it’s especially beneficial in the early weeks to months post-surgery during nerve recovery or in the case of a non-nerve sparing surgery. Our sexual function program at AUA ensures patients receive comprehensive education on medication preparation and safe self-injection. You’ll be supported throughout the process of incorporating penile injections into your life, with a point of contact for troubleshooting. Surgical options An alternative approach to addressing ED is with a penile prostheses. This is a surgically implanted device placed into the corpora cavernosa, connected to a fluid reservoir and activation button in the scrotum. It’s a viable option for men who have not responded to less invasive treatments. Penile prostheses are considered a last-line treatment option, as other options become ineffective once the prosthesis is implanted. However once implanted, satisfaction rates are extremely high in this motivated group of patients. Our Sexual Function Clinic at AUA is run by our Nurse Practitioner, Mr Adam Cuthbertson-Chin, who works in collaboration with our Urologists and possesses extensive knowledge and expertise in assisting men with erectile dysfunction. For further information, please contact our rooms on (03) 8506 3600.
PSA Prostate Cancer Test Explained
Professor Mark Frydenberg AM discusses the PSA blood test used to detect prostate cancer. Video Transcript My name is Professor Mark Frydenberg, and I am one of the urologists at Australian Urology Associates. I wanted to briefly discuss with you today a very common topic in urology, namely the PSA blood test, otherwise known as prostate-specific antigen test. This is a very common blood test ordered by general practitioners and urologists as a screening tool for early prostate cancer. It’s been well recognised for at least 30 years that an elevated PSA blood test does signify prostate cancer in a proportion of men, and it does lead to the early diagnosis of prostate cancer, and therefore earlier treatment. It is however important not to be alarmed if you do have an elevated PSA, because there are other non-cancerous causes that could also cause the PSA to be elevated. Such causes could be just an enlarged benign prostate, or simple things like a urinary infection, or even some activity such as bicycle riding, or if you do a blood test soon after an ejaculation. All of these things can cause a temporary rise in the PSA and as a result of that it’s important to simply repeat the PSA in the first instance to ensure that it is a consistent, elevated reading. If the PSA is elevated, however, your general practitioner is likely to refer you to urologists such as myself and my colleagues at Australian Urology Associates for investigation. Again, this is nothing to be alarmed about, as in many cases it is not related to prostate cancer. Generally what will happen is that the urologist will examine you to determine if there’s any abnormal finding within the prostate or an abnormal area of firmness or hardness within the gland, and we’ll often send you for an x-ray called the Multiparametric MRI of your prostate. This is a very simple scan, it is non-invasive, it takes about 30 to 45 minutes to complete and will often give very good information about the likelihood of cancer being present. When you have an MRI performed they will give it a risk score called a PI-RADS score and the PI-RADS score goes from two to five, with a score of two signifying essentially a normal prostate with a very low likelihood of cancer being present up to five where there’s a very high risk of cancer being present. Depending on where you fall on that risk scale, your urologist may recommend a biopsy to further investigate it. Learn more about prostate cancer.
Bladder Health – When perseverance pays off
While others might have given up decades ago, 80-year-old Diane remained steadfast in her quest to find the best treatment for her faulty bladder. After teaming up with an equally persistent urological surgeon, Diane has now reclaimed her continence and her vibrant, active lifestyle. She speaks to MARIA WHITMORE. Eighty-year-old Diane* from the Melbourne bayside suburb of Hampton has an insatiable thirst for knowledge. If she’s not at the library researching her favourite subjects (such as archaeology, psychology, anthropology or the latest neuroscience or medical research) she’s reading books or watching documentaries on the subjects. It is thanks to Diane’s inquiring mind that she can now live her life fully and completely dry – something she feared would never be the case 16 years ago. Diane, a retired nurse and mother of six, began having problems in her mid-40’s, after having a hysterectomy to treat endometriosis. “I was going through eight heavyduty incontinence pads a day. It was just coming out all the time ” – Diane. Back then, her urologist’s diagnosis was stress incontinence, but Diane had her doubts. “I told them it was not necessarily only when I sneezed; it was all the time. But that’s what they said.” Doctors performed a colposuspension, a major operation to treat stress incontinence, which lifts the bladder neck by stitching the lower part of the front of the vagina to a ligament behind the pubic bone. Although the procedure initially improved her urinary incontinence, over time the problem reoccurred, and then “things deteriorated quickly” when she reached her early 60s. By now, Diane was experiencing severe urinary incontinence, only able to pass small amounts of urine, with ongoing leakage between toilet visits. “I was going through eight heavy-duty incontinence pads a day. It was just coming out all the time,” she said. The impact on her life was significant. “I stopped going to yoga classes; I used to go swimming, but had to give it away because I didn’t want to pass urine in the pool. I used to go the sauna but stopped that too.” Diane was also forced to give up much of her volunteer work, which included visiting nursing homes and delivering library books to the aged. Even simple tasks such as supermarket shopping became major strategic exercises. “I’d have to go to the toilet beforehand, shop as quickly as I could, then I would have to leave my trolley at the service desk and go to the toilet again before I went to the checkout queue.” Diane was constantly excusing herself for pad changes when she was out with family and friends. “Or I’d be getting ready to go out, and would think, ‘I can’t face this’, or ‘I can’t wear light-coloured clothes’, and often I wouldn’t go,” she said. Further compounding her problems were the frequent urinary tract infections, which were becoming increasingly resistant to all but three antibiotics. Eventually her doctor referred her to Melbourne-based urological surgeon Dr Karen McKertich, who asked Diane to complete a bladder diary. She also conducted a fluoroscopic urodynamics test, which would take pressure readings of her bladder and urethra using computerised equipment and X-rays. Dr McKertich diagnosed Diane as having a bladder that didn’t contract properly to empty, a condition known as an acontractile bladder causing chronic retention. “The underlying problem is with the muscle of the bladder and/or the nerves to the bladder, which are responsible for an effective bladder contraction, which should normally empty the bladder completely during urination,” Dr McKertich said. Diane was started on a regime of twicedaily self-catheterisations; one first thing in the morning, and the next about 12 hours later. The results were immediate and dramatic, with Diane having little or no leakage between catheterisations. Dr McKertich said that catheterisation works by mimicking the process of normal bladder emptying. It also prevents the bladder from becoming over-distended, which further exacerbates bladder-emptying problems. “The more women persevere, the more they’re informed, the more they will ask the right questions” – Diane. “Self-catheterisation also helps by reducing the number of urinary tract infections caused by a continual stagnant pool of urine sitting in the bladder, from which bacteria cannot be cleared. It also improves overflow incontinence, caused by leakage of urine (like overflow from a full dam) due to the continual high volumes of urine in the bladder,” Dr McKertich said. After a few months of self-catheterisation, Dr McKertich was hopeful Diane’s bladder had recovered enough to fill and empty on its own. “Diane’s bladder function had improved and the amounts drained were minimal,” Dr McKertich said. Diane ceased self-catheterisation and managed for the next few years or so, with only occasional leakage incidents. However, her bladder-emptying function gradually deteriorated, and by the time she saw Dr McKertich again early last year, she had very little bladder control. Again, Diane was asked to complete a bladder diary by Dr McKertich, who was surprised by what it revealed. “She said, ‘oh dear, it’s continuous’. She couldn’t believe how much I was leaking,” Diane said. After another fluoroscopic urodynamics test, Diane was recommenced on her twice-daily self-catheterisation regime. Since then, Diane’s world has opened up, and she has become an active participant in life again. An early riser, Diane gardens early every day, walks or takes public transport wherever she goes, and enjoys social and family engagements without giving her bladder a moment’s thought. “It’s absolutely wonderful. I now have my life back. I can’t tell you how highly I respect Dr McKertich. She’s tenacious. I told her, ‘I don’t know how to thank you’.” Dr McKertich is full of praise for Diane’s positive can-do attitude, and her willingness to undergo the challenge of self-catheterisation, which she describes as “understandably, initially, a very confronting treatment” “ I can’t tell you how highly I respect Dr McKertich. She’s tenacious” – Diane. “Diane has taken her health issues in her stride and has been willing to try different assessments and treatments. The pay-off for investing time and effort,
