Kidney Stones And What Causes Them

Kidney stones many times have no particular, single trigger, although a number of factors might increase your chances. Here’s some information from Metropolitan Urological Specialists in St. Louis, MO about some of those factors.

Kidney stones form whenever your urine contains more crystal-forming substances -- such as calcium, oxalate, and uric acid -- than the fluid in your urine can dilute. At the same time, your urine might lack substances that prevent crystals from sticking together, creating a perfect environment for kidney stones to form.

Knowing the kind of kidney stone helps identify the cause and may also give clues on exactly how to lower your risk of getting more kidney stones. Varieties of kidney stones include:

•   Calcium stones. Most kidney stones are calcium stones, normally as calcium oxalate. Oxalate is a natural substance found in food. Some fruits and veggies, and nuts and chocolate, have high oxalate levels. Your liver also generates oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery, and numerous metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones might also show up in the form of calcium phosphate.
•   Struvite stones. Struvite stones form in response to an infection, like a urinary tract infection. These stones can grow quickly and get quite large, sometimes with very few symptoms or little warning.
•   Uric acid stones. Uric acid stones can develop in individuals who don't drink enough fluids or who lose too much fluid, those who have a high-protein diet, and those who have gout. Certain genetic factors can also boost your risk of uric acid stones.
•   Cystine stones. These stones form in individuals with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).
•   Other stones. Other, rarer types of kidney stones also can occur.

Factors which increase kidney stone risk for people in St. Louis, Creve Coeur, Florissant, and Kirkwood, MO include:

•   Family or personal history. If somebody in your family has kidney stones, you're more likely to develop stones, as well. And if you have already had one or more kidney stones, you are at increased risk of developing another.
•   Dehydration. Not drinking enough water each day increases your chance of kidney stones. People who live in warm environments and those who sweat a good deal might be at greater risk than other people.
•   Certain diets. Eating a diet that is loaded with protein, sodium, and sugar may raise your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium in what you eat raises the amount of calcium your kidneys must filter and substantially increases your risk of kidney stones.
•   Obesity. High body mass index (BMI), large waist size, and gaining weight have been connected to a greater risk of kidney stones.
•   Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease, or chronic diarrhea can cause changes in the digestive process which affect your absorption of calcium and water, increasing the levels of stone-forming substances within urine.
•   Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, specific medications, and some urinary tract infections.

If you think that you might have a kidney stone, the best thing you can do is see a doctor. The experts at Metropolitan Urological Specialists have many years of combined experience helping patients with kidney stones and a number of other urological health problems.

Tips for Talking to Your Doctor about OAB

If you've got urinary symptoms, make bladder worries the main target of your next doctor appointment.

Overactive bladder is a common problem. Generally, people wait seven years prior to seeking treatment for urinary control problems, according to a recently available survey by the National Association For Continence. If you've got OAB, these basic steps from Metropolitan Urological Specialists in St. Louis, Missouri will help you get the best results from your next doctor's appointment.

1. See an expert. Your primary care physician could be a good place to start. Nevertheless, not all doctors are well-trained in diagnosing and treating incontinence. If your family doctor or gynecologist isn't, consider going to Metropolitan Urological Specialists if you live in St. Louis, Creve Coeur, Florissant, Kirkwood, Crestwood, Chesterfield, or Washington, Missouri.

2. Take note. One of the most important things to do is log your bathroom habits. This gives your physician an extensive picture of the symptoms you're experiencing and can help her get right to the source of the problem. Keep a bladder diary for two or three days prior to your visit. In it, note:

•   when you urinate,
•   whether you urinate a lot or a little every time,
•   what you eat and drink throughout each day,
•   the number of accidents you experience,
•   activities that seem to lead to leakages, and
•   whether each leak is small, moderate, or large.
In addition to a bladder diary, give your doctor a list of all medications you take, including over-the-counter and herbal products. Also, list medical procedures you have had (including vaginal births).

3. Know yourself. Create a list of the 3 to 5 most annoying problems related to your bladder problems and share it during your appointment. Maybe you do not leave home without knowing the precise location of every toilet along your route or you no longer get involved in activities that you enjoy, like tennis or golf.

4. Set goals. Come into your appointment with a couple of very clear goals in mind. Maybe you want to be taken seriously or you want to leave the office with a game plan, or you have a very personal goal, like being able to wear white pants without fear of leakage. Remember, you and your doctor are a team, so be open with her about your wishes.

5. Train your bladder with an expert. If you've had little success with the pelvic floor exercises known as Kegels, tell the doctor. Many times, women who are self-taught have been doing them incorrectly. Your physician can make it easier to find out how to do them properly and can teach you proper technique and how to hone in on the right muscle groups.

If you've got overactive bladder, take the first step and visit a doctor. Metropolitan Urological Specialists in St. Louis, MO is a group of dedicated and experienced doctors ready to help you stop thinking about your overactive bladder and get back to thinking about living your life.

Overactive Bladder Diagnosis

Diagnosis of overactive bladder is step one to finding the right treatment for it. Here are some of the tests that will be considered if you visit Metropolitan Urological Specialists. They serve patients in St. Louis, Creve Coeur, Florissant, and Kirkwood, Missouri.

A complete health history, including a voiding diary; a physical assessment; and one or more diagnostic procedures can help your health care provider diagnose any underlying condition and devise a suitable treatment plan for overactive bladder.

Medical History

The medical history includes information regarding bowel habits, patterns of urination and leakage (when, how often, how severe), and whether there is pain, discomfort, or straining when voiding. A history of health complications, pelvic surgeries, pregnancies, and list of medications (prescription and over-the-counter) also can supply information relevant to creating a diagnosis. In seniors, a mental status evaluation and evaluation of social and environmental factors also may be performed.

Physical Examination

A physical examination includes a neurologic status evaluation and examination of the abdomen, rectum, genitals, and pelvic area. The cough stress test, where the patient coughs forcefully while the physician observes the urethra, enables observation of urine loss. Immediate leakage with coughing indicates a diagnosis of stress incontinence. Leakage which is delayed or persistent after the cough indicates urge incontinence.

The physical examination also helps the physician identify health problems which can be the cause of overactive bladder. For example, poor reflexes or sensory responses may suggest a neurological disorder.

Urinalysis

Examination of the urine might identify health problems connected with overactive bladder, including the following:

•   Bacteriuria-presence of bacteria in urine; indicates infection
•   Glycosuria-excess glucose within urine; may indicate diabetes
•   Hematuria-blood in urine; may indicate kidney disease
•   Proteinuria-excess protein within urine; might point to kidney disease, cardiac disease, blood disease
•   Pyuria-presence of pus in urine; suggests infection

Specialized Testing

If overactive bladder continues on after diagnosis and treatment, further testing may be required. Urologists perform urodynamic, endoscopic, and imaging tests to obtain a more extensive evaluation of the lower urinary tract to figure out a new treatment plan.

Postvoid Residual Volume (PRV)

This procedure requires catheterization or pelvic ultrasound. The patient voids right before the PRV is measured. This initial void is observed for hesitancy, straining, or interrupted flow. A PRV lower than 50 mL indicates adequate bladder emptying. Recurring measurements of 100 to 200 mL or higher represent inadequate bladder emptying. The clinical setting and the individual's readiness to void might affect the test result; therefore, repeated measurements may be necessary.

Urodynamic Testing

Cystometry might be used to appraise the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle. Simple cystometry detects unusual detrusor compliance, but abdominal pressure isn't included and the results need to be evaluated with caution.

The multichannel, or subtracted, cystometrogram concurrently measures intra-abdominal, total bladder, and true detrusor pressures. This allows involuntary detrusor contractions to be differentiated from increased intra-abdominal pressure. The voiding cystometrogram registers outlet obstruction in patients who are able to void.

Uroflowmetry identifies unusual voiding patterns. Urethral pressure profilometry measures the resting and dynamic pressures within the urethra.

Endoscopic Tests

Cystoscopy may be carried out when urodynamic testing fails to duplicate symptoms, when the patient encounters new symptoms (e.g., cystitis, pain), or whenever urinalysis reveals a disease process (e.g., henaturia, pyuria). Cystoscopy identifies the presence of bladder lesions (e.g., cysts) and foreign bodies (e.g., stones).

Imaging Tests

X-rays and ultrasound can be used to evaluate anatomic conditions connected with overactive bladder. Imaging of the lower urinary tract before, during, and after voiding is useful in examining the anatomy of the urinary bladder and urethra.

If you think that you may have overactive bladder and want answers, visit Metropolitan Urological Specialists in St. Louis, MO and schedule an appointment.

Vasectomy Information

A vasectomy is a permanent method for birth control. A vasectomy prevents the release of sperm whenever a man ejaculates. Metropolitan Urological Specialists in St. Louis, Missouri would like to give you the following information so that you can make the right decision for you and your partner.

During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen that is ejaculated from the penis. An egg cannot be fertilized when there aren't any sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. (This also happens to sperm that are not ejaculated after a while, no matter if you've had a vasectomy.) Because the tubes are obstructed before the seminal vesicles and prostate, you will still ejaculate about the same amount of fluid.

It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. You have to use another method of birth control until you have a semen sample analyzed and it shows a zero sperm count. Otherwise, it is possible to still get your partner pregnant.

What Happens

In a vasectomy:

•   Your testicles and scrotum are cleaned with an antiseptic and probably shaved.
•   You may be given an oral or intravenous (IV) medication to reduce anxiety and make you sleepy. If you do take this medication, you may not remember much about the procedure.
•   Each vas deferens is located by touch.
•   A local anesthetic is injected into the area.
•   Your doctor makes one or two small openings within your scrotum. Through an opening, both vas deferens tubes are cut. The 2 ends of the vas deferens are tied, stitched, or sealed. Electrocautery can be utilized to seal the ends with heat. Scar tissue from the procedure helps block the tubes.
•   The vas deferens is then replaced inside the scrotum and the skin is closed with stitches that dissolve and don't have to be removed.

The treatment takes about 20 to 30 minutes and can be carried out in an office or clinic such as Metropolitan Urological Services in St. Louis, MO. It may be done by a family medicine doctor, a urologist, or a general surgeon.

No-scalpel vasectomy is a method that utilizes a small clamp with pointed ends. Instead of using a scalpel to cut the skin, the clamp is poked through the skin of the scrotum and subsequently opened. The benefits of this procedure include less bleeding, a smaller sized hole in the skin, and fewer complications. No-scalpel vasectomy is as effective as regular vasectomy.

In the Vasclip implant procedure, the vas deferens is locked shut with a device known as a Vasclip. The vas deferens is not cut, sutured, or cauterized (sealed by burning), which possibly reduces the potential for pain and complications. Some research shows that clipping isn't as effective as other ways of sealing off the vas deferens.

What You Should Expect After Surgery

Your scrotum will be numb for 1 to 2 hours after a vasectomy. Apply cold packs to the area and lie face up as much as possible for the rest of the day. Wearing snug undergarments or a jockstrap will help ease discomfort and protect the area.

You may possibly have some swelling and minor pain in your scrotum for a number of days following the surgery. Unless of course your work is strenuous, you'll be able to return to work in one or two days. Avoid heavy lifting for a week.

You can go back to sexual activity when you are comfortable, normally in about a week. But you can still get your partner pregnant until your sperm count is zero. You should use another method of birth control until you have a follow-up sperm count test 2 months after the vasectomy (or after 10 to 20 ejaculations over a shorter period of time). When your sperm count is zero, no other birth control method is needed.

Most men go back to the physician's office to get their sperm count checked. But there is also a home test available.

A vasectomy will not affect your sex drive, capacity to have erections, feeling of orgasm, or capability to ejaculate. You may have occasional mild aching in your testicles in sexual arousal for just a few months following your surgery. If you think that a vasectomy may be something worth exploring for you or your partner, get a hold of Metropolitan Urological Specialists and set up an appointment. Metropolitan Urological Specialists serves St. Louis, Creve Coeur, Florissant, and Kirkwood, MO with the latest in non-invasive surgical and nonsurgical urological solutions.

Causes Of Male Infertility

Male fertility is a complicated process, which is why the professionals at Metro Urological Specialists in St. Louis, MO have this important information for your use. In order to get your partner pregnant, the following need to occur:

•   You need to make healthy sperm. At first, this requires the growth and formation of the male reproductive organs during puberty. One or both of your testicles need to be working properly, and your body needs to produce testosterone and other hormones to trigger and maintain sperm production.

•   Sperm need to be carried into the semen. When sperm are made in the testicles, delicate tubes transport them until they combine with semen and are ejaculated from the penis.

•   There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it reduces the chances that one of the sperm will fertilize your partner's egg. A low sperm count is under 15 million sperm per milliliter of semen or fewer than thirty-nine million per discharge.

•   Sperm have to be functional and able to move. If the movement (motility) or function of your sperm is unusual, the sperm might not be able to reach or penetrate your partner's egg.

Medical Causes

Problems with male fertility may be the result of a number of health issues and medical treatments. Metro Urological Specialists, serving the folks of St Louis, Creve Coeur, Florissant, and Kirkwood, has the ability and experience to deal with all of these issues, including:

•   Varicocele. A varicocele is a swelling of the veins which drain the testicle. It's the most common correctable cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it might be related to irregular testicular temperature regulation. Varicoceles lead to reduced quality of the sperm. Treating the varicocele can improve sperm numbers and function, and may possibly improve outcomes when using assisted reproductive techniques such as in vitro fertilization.

•   Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that hinders the passing of sperm. These include irritation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transferred infections, including gonorrhea or HIV. Although some infections can bring about lasting testicular damage, usually sperm may still be retrieved.

•   Ejaculation issues. Retrograde ejaculation occurs when semen goes into the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can lead to retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate, or urethra. Some men with spinal cord injuries or certain diseases can't ejaculate semen, even though they still generate seminal fluid. Often in these instances sperm can still be retrieved for use in assisted reproductive techniques.

•   Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as dangerous invaders and attempt to eliminate them.

•   Tumors. Cancers and nonmalignant tumors could affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In many cases, surgery, radiation, or chemotherapy to handle tumors can affect male fertility.

•   Undescended testicles. In some males, during fetal development one or both testicles fail to come down from the abdomen into the sac that usually contains the testicles (scrotum). Lowered fertility is much more probable in men who've had this problem.

•   Hormone imbalances. Infertility can be a consequence of disorders of the testicles themselves or an irregularity affecting other hormonal systems including the hypothalamus, pituitary, thyroid, and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of potential root causes.

•   Defects of tubules that transport sperm. A variety of tubes carry sperm. They can be obstructed due to various causes, including accidental injury from surgery, previous infections, trauma, or abnormal development, such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including within the testicle, within the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts, or within the urethra.

•   Chromosome defects. Inherited disorders like Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause unusual development of the male reproductive organs. Other genetic syndromes related to infertility include cystic fibrosis, Kallmann's syndrome, and Kartagener's syndrome.

•   Difficulties with sexual intercourse. These can include difficulty keeping or maintaining an erection adequate for sex (erectile dysfunction), early ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship issues that affect sex.

•   Celiac disease. A digestive disorder triggered by sensitivity to gluten, celiac disease can result in male infertility. Fertility might improve after implementing a gluten-free diet.

•   Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medicines can impair sperm production and decrease male fertility.

•   Previous surgeries. Some surgeries may prevent you from having sperm in your semen, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries done for testicular and rectal cancers, among others. Usually, surgery can be performed to either reverse these obstructions or to retrieve sperm directly from the epididymis and testicles.

Environmental Causes

Overexposure to certain environmental elements like heat, toxins, and chemicals can reduce sperm production or sperm function. Specific causes include:

•   Industrial chemicals. Extensive exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials, and lead may contribute to low sperm counts.

•   Heavy metal exposure. Exposure to lead or other heavy metals also may result in infertility.

•   Radiation or X-rays. Exposure to radiation can lessen sperm production, although it will often eventually return to normal. With high doses of radiation, sperm production may be permanently decreased.

•   Overheating the testicles. Elevated temperatures hinder sperm production and function. Even though research is limited and inconclusive, recurring utilization of saunas or hot tubs may briefly reduce your sperm count. Sitting for extended periods, wearing tight clothing, or working on a laptop for long periods of time also may increase the temperature in your scrotum and may somewhat lessen sperm production.

Health, Lifestyle, and Other Causes

Some other causes of male infertility include:

•   Illicit drug use. Anabolic steroids taken to provoke muscle strength and growth might cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.

•   Alcohol use. Consuming alcohol can lower testosterone levels, trigger erectile dysfunction, and decrease sperm production. Liver disease as a result of excessive drinking may also lead to fertility problems.

•   Smoking cigarettes. Men who smoke may have a lower sperm count than do those that don't smoke. Secondhand smoke also may influence male fertility.

•   Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including difficulties with fertility, can impact your sperm count.

•   Weight. Obesity can impair fertility in many ways, including directly impacting sperm themselves and by causing hormone changes that reduce male fertility.

•   Some occupations including welding or those involving extended sitting, such as truck driving, may be associated with a risk of infertility. Nevertheless, the research to support these links is mixed.

As you can see, there are numerous factors that can play a role in infertility. If you feel that you are infertile or you've got any questions relating to infertility, Metro Urological Specialists in Washington, Florissant, and St. Louis, Missouri is the perfect place to go to get the help you need.

Basic Facts About Prostate Cancer

Prostate cancer is an unusual growth of cells in a man's prostate gland that many older men in the St. Louis area are afflicted with. The prostate rests just below the bladder. It produces a portion of the liquid for semen. In young men, the prostate is about the size of a walnut. As men age, the prostate generally grows larger.

Prostate cancer is normal in men older than 65. It normally grows slowly and can take many years to grow big enough to bring about any problems. As with other cancers, treatment for prostate cancer works best when the cancer can be found early. Often, prostate cancer which has spread responds to treatment. Older men who've prostate cancer typically die from other causes.

Experts do not know what causes prostate cancer, but they believe that your age, family history (genetics), and ethnicity determine your chances of getting it. What you eat, such as foods loaded with fats, can also play a role.

Prostate cancer normally does not lead to symptoms in its early stages. Most men do not know they've got it until it's found during a regular medical exam.

When problems are noticed, they are most often problems urinating. But these same symptoms can also be attributed to an enlarged prostate (benign prostatic hyperplasia). An enlarged prostate is common in older men who live in St. Louis, Creve Couer, Florissant, and Kirkwood, Missouri.

See your physician for a checkup if:
•   You have urinary problems, such as:
      o   Not being able to urinate at all.
      o   Having difficulty starting or halting the flow of urine.
      o   Having to urinate many times, particularly at night.
      o   Having pain or burning during the course of urination.
•   You have difficulties having an erection.
•   You have blood in your urine or semen.
•   You have deep and recurring pain in your lower back, stomach, hip, or pelvis.

The most common way to test for prostate cancer is to have a prostate-specific antigen (PSA) blood test. An increased level of PSA could mean that you've got prostate cancer. But it could also mean that you've got an enlargement or infection of the prostate.

If your PSA is high, you might need a prostate biopsy to figure out the cause. A biopsy means that your physician takes tissue samples from your prostate gland and sends them to a lab for evaluation. Your treatment depends on what sort of cancer cells you've got, how far they have spread, your age and general health, and your preferences.

You and your doctor might choose to treat your cancer with surgery, radiation, hormone therapy, or a combination. Or if you have cancer that's low-risk and has not spread (early stage), you might be able to wait and watch with active monitoring to discover what happens. Throughout active surveillance, you will have regular checkups with your doctor to see if your cancer has changed.

Choosing treatment for prostate cancer can be complicated. Speak with a medical professional like those at Metropolitan Urological Specialists to determine the treatment that is right for you.

Your age and general health will make a big difference in how treatment may affect your quality of life. Any health issues you've got before you are treated, specifically urinary, bowel, or sexual function problems, will determine how you recover.

Both surgery and radiation may cause urinary incontinence (leaking urine) or impotence (being unable to have an erection). The level of urinary incontinence and the length of time it lasts and the quality of the erections a man has following procedures will depend on whether or not the tumor has spread. These also depend upon what treatment solutions are utilized.

Nerves that help a man have an erection are right next to the prostate. Surgery to remove the cancer could damage these nerves. Many times a special type of surgery, known as nerve-sparing surgery, can preserve the nerves. But if the cancer has spread to the nerves, they may need to be taken out during surgery. These same nerves can also be damaged by the X-rays that are used in radiation therapy.

Medicines and mechanical aids may help men who're impotent as a result of treatment. Some men recover a portion or a majority of their capability to have an erection months or even years after surgery.

If you live in St. Louis, Washington, Creve Couer, Crestwood, or Chesterfield, Missouri and you believe that you may be experiencing any of the symptoms of prostate cancer, contact Metropolitan Urological Specialists today and schedule an appointment.

Bladder Incontinence and the Percutaneous Nerve Evaluation

There's a lot of important matters that you need to think about prior to having a permanent bowel implant operation. Metropolitan Urological Specialists in St. Louis, Missouri wants to furnish you with an introduction to some of the symptoms that could lead to this kind of procedure and then let you know about a very important test that your physician may advise that you take before the procedure.

What are “bothersome” bladder symptoms?

•   Leakage of large or small amount of urine
•   Urinating often
•   Urinating urgently
•   Waking up at night to urinate
•   Inability to completely empty the bladder, or may be not able to urinate at all

What are “bothersome” bowel symptoms?

•   Fecal leakage
•   Fecal smearing
•   Diarrhea
•   Constipation

How common are bladder control problems?

•   Over thirty-three million people (1 in 6 adults) suffer from urinary control issues in the United States alone.
•   These issues may affect both males and females.
•   It may affect people of all ages; it isn't just a normal part of the aging process.
How common are bowel control issues?
•   Over 18 million individuals or 8.3% of adults suffer from symptoms of bowel control.
•   Likely more prevalent than reported due to the embarrassing nature of condition.

What are the causes of “bothersome” bladder and bowel symptoms?

•   There could be multiple causes; including, injury, side effects from particular medications, neurologic diseases, infection, bearing children, pelvic pain, and others.
•   Dr. Naughton, one of Metropolitan Urological Specialists’ top doctors makes it a priority to rule out medical causes of “bothersome” bladder and bowel symptoms.  Then, based on how these symptoms affect quality-of-life of the person, she will make suggestions on treatments.

Before placement of the permanent implant, your doctor may recommend a Percutaneous Nerve Evaluation. A Percutaneous Nerve Evaluation (PNE) is a simple office test which allows you a chance to test two temporary leads (or wires) into the pelvic nerves.  Under local anesthesia in an office setting, two temporary leads are positioned on each side of the pelvic nerves.  The leads are fixed to the back and connected to an external battery the size of a beeper.  The patient will have the opportunity to test both leads over the next 3-5 days to determine if there are any changes to the bladder and/or bowel symptoms.  We look at a fifty percent improvement in symptoms a positive test, which makes the patient a prospect for implantation of the permanent device.

What to know about the Percutaneous Nerve Evaluation (PNE) Procedure

1.   Please show up thirty minutes before your scheduled appointment time.
2.   You might drive yourself to the procedure; however, it is considerably better to have somebody drive you both to and from the procedure.
3.   This procedure is completed in the office under local anesthesia.
4.   Don't eat 2 hours prior to your procedure.  A light snack or meal is acceptable 2 hours before your procedure.
5.   Give up aspirin and ibupfren products (Motrin, Alleve, etc.) no less than five days before your procedure.
6.   Let our scheduler know whether you're taking blood thinners, such as Coumadin (warfarin), Xaralto, etc.
7.   No baths or showers during the test period.
8.   Abstain from heavy lifting or excessive bending during the trial.

What you should expect on the day of the PNE procedure:

1.   You will meet a medical assistant and agent(s) from Medtronic; the product company.
2.   You're going to be told to lie on your stomach.  The medical assistant will wash off your back and buttocks.
3.   Dr. Naughton will perform the procedure with the help of the Medtronic agent.
4.   The Medtronic agent and the medical assistant will secure the leads to your back, wipe off the cleaning solution on your back and buttocks before you get dressed.
5.   Following the process, you will talk with the Medtronic representative to review voiding and bowel diary instructions and set up contact plans with the representative to go over changes in your urinary and bowel function during the trial period.
6.   You will make an appointment to see Dr. Naughton in 3 to 5 days in the office before you leave to remove the leads and talk about the results of your trial.

If you have any questions before the procedure, call the procedure scheduler at the offices of Metropolitan Urological Specialists at 314-315-9933 during regular business hours. If you have questions about this procedure or anything else associated with bladder problems, schedule an appointment with one of our offices in the St. Louis area, including Washington, Florissant, and Creve Couer, Missouri.