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Transcript
Online Chat with Dr. Jeffrey Ranta, Chief of Urology at Greenwich Hospital

Thursday, May 29, 2008
12 Noon – 1pm

Disclaimer: All information provided during this chat is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.

Moderator: The moderated chat will start in 3 minutes. All questions will be queued for the moderators to pass to Dr. Ranta.

Moderator: Thank you for coming to our first online chat with Dr. Jeffrey Ranta, Chief of Urology at Greenwich Hospital. We will take as many questions as we can in the one hour time period. Within a week, an archive of the chat will be available. Just click on the link on the greenhosp.org web site.

Question: What, if any, is the efficacy of drinking pomegranate juice for a patient who has been diagnosed with prostate cancer and is in "watchful waiting" mode?

Dr. Ranta: There is no known benefit to drinking pomegranate juice. The key to watchful waiting is close follow-up with blood tests, physical examinations, and repeat biopsies.

Question: Is it necessary to have severe erectile dysfunction to be a candidate for Viagra?

Dr. Ranta: Viagra, and Viagra-type medicines, can be used for any severity of erectile dysfunction as long as the patient is an appropriate candidate, as determined by his physician.

Question: I have been taking a combination of Sanctura and Flomax to control BPH and it has been only mildly effective. Is there anything better out there?

Dr. Ranta: There are many options for BPH symptoms, including other medications, minimally-invasive procedures, laser procedures, or surgery. Again, consult with your physician to find your best option.

Question: I have never had any children, but I still have occasional leakage problems. Why does this happen?

Dr. Ranta: There are several causes for urinary leakage. The treatment has to be appropriate for the cause. Physical examination, history, and leakage studies can determine the cause and treatment will be dependent upon why the person is leaking.

Question: What are the symptoms of a benign enlarged prostate?

Dr. Ranta: The symptoms of BPH are difficulty initiating stream, getting up at night, going to the bathroom too frequently, slow stream, and urgency to go the bathroom.

Question: At what age do men begin having erectile dysfunction?

Dr. Ranta: Men can begin having ED at any age, once they have begun having erections. The frequency of ED increases with age.

Question: How would you describe urinary incontinence???

Dr. Ranta: Urinary incontinence is the unexpected and uncontrolled loss of urine.

Question: What are the side effects of Viagra or other oral medication?

Dr. Ranta: The most common side effect of Viagra-like medicines includes nasal stuffiness, headache, or flushing. Uncommonly, people can have a drop in blood pressure, or prolonged erections.

Question: I'm concerned about getting prostate cancer because my father and one of my brothers had it. Can prostate cancer be prevented?

Dr. Ranta: Prostate cancer is the most common male cancer. There are hereditary tendencies. Careful screening with annual examinations and blood tests are critical to early diagnosis. There is a study, released in 2003, that shows a 25% decrease in prostate cancer rates in men who take finersteride. Speak to your physician about this very important study.

Question: Does BPH cause a rise in PSA readings?

Dr. Ranta: PSA is a specific test for the prostate. Anything that irritates the prostate will cause the PSA to rise. BPH will cause the PSA to rise, but differentiating this from prostate cancer needs to be done by your physician.

Question: Is there anything I can do besides medication to control urinary incontinence, for example abdominal or vaginal exercises?

Dr. Ranta: Controlling urinary incontinence depends upon the cause of the incontinence. Lifestyle changes such as exercise, biofeedback, timed voidings, acupuncture, peripheral nerve stimulation, medications, minimally-invasive procedures or operations can help. The key is the appropriate treatment for the appropriate cause.

Question: In Tuesday's New York Times there was an article that stated that men undergoing laparoscopic or robotic prostate surgery had a 40% greater risk of complications from scarring and that 25% needed hormonal therapy within 6 months. Could you comment on this? How does this bode for the future of da Vinci robotic surgery?

Dr. Ranta: Dr. Hu's recent study in the Journal of Clinical Oncology is a very important early study, comparing minimally-invasive radical prostatectomies to open operations. The key of the study shows the rapid increase in number of minimally-invasive surgeries compared to open operations. The study shows many facts that we already know, specifically the rapid recovery, the significant decrease in early complications, and the minimal increase (3%) in late complications. Long-term data is still too early to tell. The study was done from 2003 - 2005. There were certain study design flaws. But the bottom line of the study shows the rapid acceptance of minimally-invasive prostate procedures and the decrease in complication rates. Many further studies are being done that will better answer questions about robotic-assisted surgery. Stay tuned.

Question: I see some blood when I urinate. What could be wrong with me?

Dr. Ranta: There are many causes of blood in the urine. Many are benign. Infections, kidney stones, inflammation, trauma can cause blood in the urine. Unfortunately, blood in the urine may also be from cancer of the urinary tract. Kidney, bladder, prostate cancer can all cause blood in the urine. Any patient with blood in the urine needs to be evaluated to find out why.

Question: At what age should I get a prostate exam?

Dr. Ranta: The American Cancer Society and the American Urologic Association recommend annual physical exams and blood tests for low risk men beginning at age 50. High-risk men (family history or African-American descent) should be screened beginning at age 45.

Question: Do you use robotic surgery at Greenwich Hospital? How successful has your experience been with robotic surgery?

Dr. Ranta: The surgeons at Greenwich Hospital have been using the da Vinci robotic system since November 2006. Urology, general surgery, and gynecology have all had extensive experience. Our patients have done very well and our outcomes are consistent with national data.

Question: For a lay lady like me, what are timed voidings?

Dr. Ranta: Timed voidings are a schedule of going to the bathroom at specific times, such as every 2 hours or as determined by your doctor.

Question: Who is at risk for testicular cancer?

Dr. Ranta: Testicular cancer is the most common form of solid cancer in men from 15 to 35 years of age. It is critical for these men to be aware of testes cancer and to self-check themselves every month. If uncertain how to self-check, talk to your doctor. Testes cancer can also occur at other ages. Any question of testes lumps should be referred to your doctor.

Question: What is a vasectomy?

Dr. Ranta: A vasectomy is the cutting and dividing of the vas deferens. This small duct carries sperm from the testes to the prostate. This procedure is done to prevent pregnancies. It is done under local anesthesia and generally should be considered not reversible.

Question: What are the common causes of erectile dysfunction?

Dr. Ranta: The common causes of ED are cigarette smoking, diabetes, high blood pressure, medications, trauma, or surgery. The most common preventable cause of ED is cigarette smoking.

Question: What is PSA?

Dr. Ranta: PSA is a protein that is only made by the prostate gland. Hence the term "prostate specific antigen". Anything that irritates the prostate will cause a rise in PSA. PSA is specific for the prostate gland, but not for prostate cancer. The elevated PSA can be from causes other than prostate cancer, but it needs to be evaluated. The PSA test is most valuable when combined with the digital rectal exam. The PSA velocity is the tract of PSA over time and this is even more valuable a single PSA value.

Question: Speaking of Viagra, in commercials they warn to see a doctor if an erection lasts more than 4 hours. Does a man become erect right after taking Viagra and remain erect until it wears off?

Dr. Ranta: Viagra-like medicines begin to work after about 20 minutes. They require usual stimulation and will last for the usual duration of erections. Rarely, prolonged erections can occur. If this does happen, the patient should contact his doctor.

Moderator: We have a few minutes left in this chat session, time for one more question for Dr. Ranta.

Question: Can women develop urinary cancers?

Dr. Ranta: Women can develop kidney cancer, bladder cancer, and urethral cancer. These cancers present generally with blood in the urine. The best prevention for these types of cancers is to avoid cigarette smoking.

Moderator: Thank you very much for participating in our online chat session. A transcript of the discussion will be available in a few days on the home page of www.greenhosp.org. under Calendar & Events. Please feel free to e-mail this archive to others who may be interested in this subject. If you wish to schedule an appointment with Dr. Ranta, please call his office at 203-869-1285. He is located at 49 Lake Avenue in Greenwich, right by Greenwich Hospital.