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This is maybe the most common question I get. The answer is far from straight forward and usually a combination of patient-specific factors.

Kidney stones form when, if the urine chemistry is just right, substances combine, crystallize, and then those crystals bind together to form stones.

There are many different types of stones: Calcium Oxalate, Uric Acid, Calcium Phosphate, Magnesium Ammonium Phosphate, and Cystiene stones make up the majority of stone types. About 80-85% of stones are calcium based but it is a common misconception that these calcium-based stones are caused by too much dietary calcium (milk, cheese, yogurt, etc.). Usually it is a problem with the way your body handles the calcium. Abstaining from dietary calcium in these circumstances can do more harm than good.

When looking at ways to prevent stones, I focus on common dietary factors that can increase risk. High sodium intake is probably the biggest contribution to stone risk. Excessive sodium from canned foods, processed meats, restaurants, prepared boxed or frozen meals…all contributes to increased stone risk. I try to get my patients to A) recognize where the sodium in their diet is coming from (rarely just the salt-shaker) and B)keep their sodium intake to <2500mg/day.

Sodium is a big culprit, but chronic dehydration is probably the other most common problem. Stone formers should drink no less than 64oz/day of water, ideally with up to 4oz of lemon juice. Lemon juice is high in citrate which is a potent stone inhibitor. Excessive protein consumption can also lead to a more acidic urine, predisposing to certain types of stones.

If a patient has had more than one stone, or if they are young with a strong family history, I usually recommend blood and 24 hour urine testing for a custom stone prevention workup.

If you or a friend/loved one have lived with recurrent stones and haven’t been evaluated for prevention, give us a call.

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I’m sure many readers have seen or heard the commercials featuring law firms that do not have many very nice things to say about “mesh”.

So what is mesh and what should I do about it?

“Mesh” often refers to a web-like sheet of a kind of plastic, polypropylene, that has been used medically for various reasons for many years. This mesh is woven into various shapes and sizes. It is used for large blood vessel reconstruction, hernia repair (umbilical, inguinal, ventral, etc.), incontinence and pelvic organ prolapse.

The controversy surrounding mesh focuses on mesh products that were placed vaginally for pelvic organ prolapse. Prolapse is a condition where the bladder, bowel, or uterus is literally falling out of the vagina, usually causing a prominent bulge. These prolapse-fixing products are often large sheets of oddly-shaped mesh meant to reinforce weakened vaginal tissues. If used properly, they helped many women with their prolapse problems. If used improperly and in the wrong patients, the mesh could erode into structures nearby such as the bladder, the ureter, vagina, or bowel. Usually this requries an additional surgical procedure to remove the mesh. This need for re-operation due to mesh complications led the the Food and Drug Administration (FDA) to issue a “Safety Communication” regarding vaginal mesh for pelvic organ prolapse.

Once again, the mesh “controversy” is regarding mesh used for pelvic organ prolapse. The small pieces of mesh desiged to treat female incontinence are not implicated as problematic and still remain an excellent option for treating stress incontinence. This is a type of incontinence that is often best treated with surgery as no medications are effective. Pelvic exercises (kegels) are often tried first but some women remain bothered by the incontinence and surgery is the next step.

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If you find yourself emptying your bladder before you leave the house, only to have to stop three times between here and Madison, you have an overactive bladder.  “Overactive Bladder” is a term we use to describe a strong, frequent, bothersome urge to go to the bathroom.  It is very, very common but it is NOT necessarily a “normal” part of aging.  Sometimes the urge is so great folks have trouble making it to the bathroom fast enough.  That’s called Urge Incontinence and it is at the far end of the wide spectrum of overactive bladder symptoms.

It is really important to bring up these symptoms to your doctor.  The symptoms of having to urinate often and urgently could represent a bladder infection.  If you have any blood in your urine associated with these symptoms you should be seen by your doctor right away.  Cancers can develop in the bladder and sometimes the only symptom is the constant urge of having to void. 

Ruling out something dangerous is usually as simple as an office-based urine test.  Once you have ruled out an infection or other trouble, there are many different reasons to look into about why your life revolves around where the next bathroom might be.

You see, the bladder is meant to have a pretty boring existence.  Ninety-nine percent of the day, the bladder should be spending its time filling with urine.  That’s it, just hanging out.  It’s supposed to wait until it is full before giving your brain the signal that “it’s time to go”.  At that point, you should have plenty of time to get the bathroom without having an accident.  Even if you’re 80 years old, you should have plenty of time to get to the bathroom without having an accident.  You might say “Well, I’ve always been rushing to the bathroom”.  If that’s the case, then we really should talk.  Bad habits can seriously affect bladder function and with early intervention, we can prevent permanent bladder damage.

A lot of different things can interfere with normal bladder function:  volume of fluid intake, type of liquid (Coffee caffeinated/decaf), bathroom posture, bowel function (especially constipation), nerve damage from prior pelvic surgery, other neurologic conditions like Parkinson’s Disease…the list goes on.  Although treatment sometimes requires a medication, some patients do really well with some simple exercises and behavioral modifications.

Fort HealthCare Urology Associates

We’ve all been bombarded by the ads on TV of sad middle-aged men that are tired.  Tired and they can’t get erections and have a decreased libido (sex drive).  Then there’s a promise of a virtual “fountain of youth” in the form of a daily gel applied to the underarm, groin, or shoulders…sometimes all three.  Sad man turns into happy, newly moustached, fully-restored man that can now throw a football again.

Low Testosterone is not a new medical diagnosis, but there just so happens to be four relatively new brands of testosterone gel, all vying for your (or your insurance company’s) dollars, hence the deluge of direct-to-consumer advertisements. 

It’s important to remember that Low Testosterone is a lab value.  If your testosterone is found to be abnormally low and you have symptoms, you could be a candidate for testosterone replacement therapy.  Amazingly, over 25 percent of men prescribed testosterone replacement have not had their blood testosterone levels checked! 

The symptoms of low testosterone include decreased libido, erectile dysfunction, difficulty recovering from exercise, decreased muscle mass, and decreased energy or “get up and go”.  As you can see, many of the symptoms of low testosterone overlap with other unrelated conditions. 

If you’re meeting with your primary care physician for an annual physical, do not assume that testosterone will part of the normal panel of labs.  This is a separate, specific test done only in situations of men that are symptomatic.  If you do have your lab work done, make sure to have your T checked within three hours of waking.  This guarantees an accurate reading when your T is at its highest (there’s a scientific explanation for morning wood!)  Usually there are follow up labs to determine if there is any other correctable cause to the low testosterone.

There are several potentially harmful side effects to testosterone replacement therapy.  These may include fueling the growth of prostate cancer, worsening urinary symptoms related to enlarged prostate, and potentially an increased risk of cardiovascular disease.  The effects of treating large populations of men with testosterone has not been extensively studied.  In addition to the physiological side effects, testosterone gel is usually pretty expensive, so keep that in mind if you’re considering therapy. 

As much as there is controversy to diagnosing and treating men with low testosterone (for good reason) some men truly benefit from carefully directed therapy.

Fort HealthCare Urology Associates

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Fort HealthCare Urology Associates - FREE Prostate ScreeningProstate cancer. Besides skin cancer, it is the top cancer diagnosis for men. While it can be a very aggressive type of cancer, it often doesn’t appear in men they’ve reached at least 50 years of age. It is important that men start receiving regular screenings at age 40 to prevent or stop the progression of prostate cancer later in life.

A Prostate Specific Antigen (PSA) is one of the tests that can be performed by a family physician or urologist to help detect any benign or cancerous conditions.

What is PSA testing?

  • PSA is a protein that is made in the cells of the prostate gland that can help detect a disease.
  • The simple test specifically measures the amount of PSA in the blood.
  • A doctor takes a sample of the blood and it is then measured in the lab. (It is normal for men to have a low level of PSA in their blood. Once the level increases, it could be a sign of prostate cancer or other benign conditions, meaning it will not destroy or invade any cells or tissues.)

Recently, there has been a lot of attention regarding PSA testing and whether or not it is an accurate way to detect prostate cancer.  For instance, the PSA test can tell a doctor whether a patient’s PSA level is normal or too high, but it cannot tell if someone has cancer or if their condition is benign. Some people believe that this can cause high levels of anxiety for people diagnosed with higher levels of PSA.  Also, results may be misleading; a person may show a normal level of PSA in the blood when prostate cancer is actually present. Since prostate cancer is a slow growing cancer, it is possible for false-negatives to occur.

Because of all of the factors involved in testing for prostate cancer, it is still important to continue regular prostate screenings, including PSA testing for men over the age of 40. If you are age 40 or older, it is important to talk to your doctor or a urologist about screening.

FREE Prostate Cancer Screening

September is Prostate Cancer Awareness Month and we are offering FREE prostate cancer screenings on Saturday, September 22. Appointments are available between 7:30 a.m. and 11:30 a.m. at Fort HealthCare Urology Associates, 520 Handeyside Lane, Suite 2, Fort Atkinson. Free screening includes a PSA test, a digital rectal exam and written information about prostate cancer, valued at $140. Appointments are REQUIRED and can be made by calling Fort HealthCare’s Community Health & Wellness department at (920) 568-5244.

Fort HealthCare Urology Associates offer diagnosis and treatment for men and women with conditions involving the bladder and kidneys, and provides the best possible outcomes for men with prostate or genital issues. Fort HealthCare Urology Associates has offices in Fort Atkinson and Whitewater, and in Johnson Creek as of October 1. Visit to learn more, or call (920) 563-7744 to make an appointment.

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Incontinence treatmentAlmost 12 million people in the United States experience urine control issues. Many things contribute to the condition:

  • Enlargement of the prostate (men)
  • Narrowing of the urethra due to scar tissue
  • Obesity
  • Older age
  • Bladder stones
  • Blockage
  • Frequent bladder infections

Stress Incontinence
This is the most common type of incontinence. It means urine is lost with activity like coughing, exercising or laughing. Any activity increasing pressure on the bladder will cause a urine leak. Many people go years without telling their physician or loved ones about this form of incontinence, because they don’t realize that it’s a treatable condition.

Urge Incontinence
Remember those commercials, “Gotta go, gotta go, gotta go right now?” That’s what urge incontinence feels like. The bladder muscle contracts spontaneously, causing a sudden strong urge to urinate which results in a sudden, uncontrollable rush of urine. With an overactive bladder, you may even feel the urge to urinate if you hear water running or you put your hands in water.

Overflow Incontinence
Overflow incontinence is usually experienced as a frequent or constant dribble, in which the bladder is unable to empty itself and the urine just “overflows.” A Neurogenic Bladder is a condition where the nerve supply to the bladder is disrupted, causing multiple bladder problems, depending on injury or disease.

November is Bladder Awareness Month, now is the time to take charge of these bothersome issues. To receive the best possible treatment, it’s important to talk openly and honestly with a physician or urologist. A Fort HealthCare urologist is a specialist in the treatment of genital and urinary conditions and can suggest many non-surgical and surgical options to treat incontinence.

In the meantime, some therapies that you can put into practice on your own include:

  • Drinking water. It seems counter-intuitive, but some beverages can act as a diuretic, making the urge to go even stronger. Two-thirds of what you drink during the day should be water.
  • Avoid bladder irritants if struggling with excessive urges, such as: caffeine, aspartame, carbonated beverages, alcohol, chocolate, spicy foods, sharp cheese, tea, citrus fruits and juices, tomatoes, vinegar, plums, strawberries, lemon juice, onions, tobacco and pineapple. 
  • Go to the bathroom no more than every 2-4 hours. Your bladder should empty for at least 8 seconds or it was “too soon” to go.
  • If you have the urge to go but it is too soon, stop moving, sit or stand still, contract you pelvic floor four to six times, breathe deeply and relax until the urge passes. Suppress the urge if it is less than two hours since you last went to the bathroom.

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