Documentation

CT SCAN
What is CT?
Computed Tomography, commonly called CT or CAT scan, is a diagnostic procedure that uses specialized x-ray equipment to obtain cross-sectional pictures of the body. The machine rotates continuously around the body in a spiral path. The CT computer then displays these pictures as detailed images of organs, bones, and other tissues. Three-dimensional images can also be obtained with the images.

It is easiest to understand if you can imagine your body like a loaf of bread. Each set of images obtained through your body represents a slice of bread. The computer then takes those slices and can change them into various types of images that your physician can use for evaluation and diagnosis.

How CT is Performed?
You will be asked to lie on you back on the CT table. The table moves through a large hole in the middle of the machine.

It will be important to remain still while the pictures are being taken. You will also be asked to hold your breath at various times throughout the exam preventing the blurring of your images.

Depending on the type of exam you are having, the test can last from a few minutes up to 45 minutes.

The x-rays are painless. You may have some discomfort if it is difficult for you to lie on your back for extended periods of time.

Preparation for Your Exam
If possible, you should wear loose, comfortable clothing. You will be asked to remove any articles of clothing or jewelry that have metal on them and may need to wear a hospital gown for the exam.

Depending on the type of exam you are scheduled for you may have specific instructions regarding holding food and or fluids as well as contrast that you may need to drink. Exam specific instructions will be provided to you.

Two types of contrast may be used for you exam. One is oral and the other is administered intravenously (through an IV).

Oral contrast is a barium based contrast that you drink prior to your exam. It will be excreted from your body with your stool. IV contrast will be given through a catheter that is placed in a vein in your hand or arm. This contrast will pass unnoticed with your urine. The IV contrast can cause a warm flushing feeling. It is also common to have a metallic taste in your mouth. These symptoms should only last for a couple of minutes. If you should experience any other symptoms, please let the technologist know.

It is very important that you notify the staff if you have a known allergy to iodinated contrast media. It is also important that we are aware of any oral diabetic medications you are on.

Renal Calculus Survey
This scan is done when kidney or ureteral stones are suspected. Pictures will be taken from your kidneys to your bladder. The exam takes from 5-10 minutes. No contrast or pre exam preparation is required for this exam.

Urogram
A Urogram is done to examine the kidneys, ureters, and bladder. IV contrast is used to look at the function of your urinary tract. An IV will be placed into a vein in your hand or arm.

Various sets of pictures are then taken both without and with the contrast. This scan takes about 30 minutes.

A set of specific instruction regarding the pre exam preparation for this exam will be given to you.

Following the exam there are no restrictions to your activity. We will ask you to drink plenty of fluids the next couple of days. This will help to clear the contrast from your system.

Our office will contact you with the results of your exam. Please call our office if you have not been notified of your results within a week of your test.

CT of the Abdomen and Pelvis
This exam is to look at the abdominal and pelvic anatomy. In most cases you will be asked to drink oral contrast as well as have the IV contrast given. The contrast is used to distinguish the bowel from other anatomy, as well as, looking at the function of some organs.

Various sets of pictures will be taken both without and with the contrast. This exam takes about 20-30 minutes.

A set of specific instructions regarding pre exam preparation for this exam will be given to you.

Following the exam there are no restrictions to your activity. We will ask you to drink plenty of fluids the next couple of days. This will help to clear the contrast from your system.

Our office will contact you with the results of your exam. Please call our office if you have not been notified of your results within a week of your test.

We hope that this information was helpful to you. Please call our office if you have any questions or concerns regarding your CT and we will be happy to answer those for you.

Some of the above information was obtained from the National Cancer Institute web site. This can be found at www.cancer.gov/cancertopics/factsheet/Detection/CT

INTERSTIM

Millions of people suffer from frustrating and embarrassing bladder control problems such as retention and overactive bladder. Effects of bladder control problems can be devastating. These conditions prevent you from controlling when and how much you urinate and can make simple everyday activities a challenge and social lives very difficult. You may have to cut back on your hobbies or stop working. You may feel trapped by a fear of leaking accidents, the need to be close to a bathroom at all times, and an overall, preoccupation with your bladder. Treatments such as drugs, behavior modification, diet changes, pelvic floor exercises, or the use of a catheter to empty the bladder may not effectively treat these symptoms. In the past there were few options for patient who did not respond to these therapies. Now, however we are able to consider a therapy called sacral nerve stimulation (SNS). SNS involves the use of a device that can be thought of as a pacemaker for the bladder.
SNS therapy is not experimental. InterStim® Therapy (InterStim® is a registered trademark of Medtronic, Inc.), is a sacral nerve stimulation therapy made by Medtronic. It was approved by the U.S. Food and Drug Administration (FDA) in 1997 and has been used successfully to treat thousands of patients worldwide.

InterStim therapy is indicated for people with urinary retention and the symptoms of overactive bladder including urinary urge incontinence and significant symptoms of urgency, frequency in selected individuals. At the heart of this therapy is an innovative and implantable neurostimulator about the size of a stop watch. The therapy uses a small implanted medical device to send mild electrical pulses to a nerve located just above the tail bone. These nerves are called sacral nerves. The sacral nerves [specifically S2, S3 and S4] activate or inhibited muscles and organs that contribute to urinary control, the bladder, sphincter and pelvic floor muscles. The electrical stimulation may eliminate or reduce certain bladder control functions in some people. This stimulation may facilitate the communication between the brain and bladder, and may relieve the symptoms of urinary retention or symptoms of overactive bladder, including urinary urge incontinence and significant symptoms of urgency-frequency in some patients.

InterStim therapy does not treat symptoms of stress incontinence. It is not intended for patients with mechanical obstruction such as benign prostatic hypertrophy, cancer, or urethral strictures.

SNS therapy is delivered in two procedures. The first is the test to see if the therapy will work. A test [temporarily test stimulation] is used before implantation of the InterStim Neurostimulator to see what the effect of the stimulation is on the symptoms. If this test is positive the lead will stay in place and you proceed to the permanent implant. The Interstim lead is not actually touching the nerves and is not anywhere near the spine.

The next step, the implant of the SNS system, may be done after a successful test stimulation. It involves placement of a neurostimulator (electronics and battery). The implanted system is entirely under the skin. Interstim stimulation introduces gentle, soothing stimulation or pulsing just below the surface of the skin over the sacrum (tailbone) where the sacral nerves reside. The unit is placed underneath the skin so as not to place limitations of any kind on the activities of the patient.
Urology PC offers sacral nerve stimulation (SNS) as well as Pelvic Floor Rehabilitation and Surgery for Incontinence in Men and Women.

Effects of bladder control problems can be devastating. More than 50% of woman age 55 and older suffer one or more problems caused by pelvic floor dysfunction. One out of every 9 woman will undergo surgery for pelvic floor disorder. Thirty percent of woman with overactive bladder also suffer from loss of bladder control or urinary incontinence. It is estimated that 3% of men between 15 and 44 are affected by urinary incontinence, if more came forward seeking help, that figure could be dramatically higher.

Click on the link below to hear about real patient experiences with InterStim:
http://www.everyday-freedom.com/women/patients/index.htm

Low Testosterone
Advanced Prostate Cancer

Advanced Prostate Cancer orCastrate Resistant Prostate Cancer– This is the stage of prostate cancer when some of your prostate cancer cells have stopped responding to hormonal therapy as indicated by a rising PSA level. During this stage men may have new complaints of pain, fatigue, or an increase in urinary symptoms. Imaging scans are needed to determine whether the cancer has spread to other parts of the body. Additional treatment is required to help slow the cancer’s growth. However, hormone injections are still need as this medication is still effective in treating some of the prostate cancer cells.

Provenge (Sipuleucel-T) is Immunotherapy to treat prostate cancer. Your own immune cells are removed, modified and re-infused into your body to fight your cancer. There are 6 total appointments, broken into three cycles that include: An appointment for blood cell removal at the Red Cross in Omaha (Leukapheresis) followed 3 days later by an appointment for cell re-infusion at our office. This can be completed in 5-6 weeks. A special type of IV catheter may be need to be placed for the duration of this therapy.

Oral medications- Two oral medications are available that assist with treatment of prostate cancer. Xtandi (enzalutamide) and Zytiga (abiraterone acetate). These medications act in slightly different ways to prevent prostate cancer cells from growing and spreading. One medication may be more appropriate for you than another based on your particular medical history. They are very expensive medications, but assistance may be available from cancer foundations. Additional information will be provided about administration if your medical provider prescribes this for you. A common side effect is fatigue.

Xofigo (Radium 223) is a once a month injection (given for 6 months) used to help with pain and symptoms associated with metastatic disease (for cancer that has spread to your bones). This will have little to no effect on PSA level but has shown in clinical trial to improve survival, and may help with discomfort. This IV injection takes about 15 minutes to administer, and is given by a nuclear medicine physician, here in our facility. The most common side effect is diarrhea, lasting 1-2 days.

Palliative Care is an option where you elect to receive minimal cancer therapy and allow the disease to slowly progress. Treatments or medications would be to treat pain or other side effects of the cancer. Your provider may refer you to a hospice organization as needed.