Ask the experts
How can a spinal cord injury impact my urinary health?
Your spinal cord lets your brain to talk with your bladder. When your spinal cord is injured, the signals that travel between your brain and your bladder can be damaged or cut off.
Neurogenic bladder is the health term used to describe urinary issues in people who lack bladder control due to a brain, spinal cord or nerve problem. It takes many muscles and nerves working together for your bladder to hold urine until you are ready to release it. If these nerves become damaged your muscles may not be able to tighten or relax at the right time, causing bladder problems.
Neurogenic bladder can result from Alzheimer’s disease, multiple sclerosis, Parkinson’s, a spinal cord injury, spina bifida or a stroke.
There are several treatment choices for neurogenic bladder. They include medications, surgery, electrical stimulation therapy or Kegel exercises. In some cases, wearing absorbent underwear and pads may be helpful in dealing with urinary leakage. Based on the severity of the spinal cord injury, your doctor will suggest which care plan is best for you.
Most often, spinal cord injury patients have trouble draining their bladder and may need a catheter. A urinary catheter is a hollow, flexible tube used to help empty the bladder. This option carries a higher chance of getting Urinary Tract Infections (UTIs). Your doctor may prescribe antibiotics at low doses to lessen the risk of UTIs.
Problems with your bladder can be life changing. Working with your healthcare provider to build a bladder care plan is a key part of living with neurogenic bladder.
For more information, visit: UrologyHealth.org/neurobladder
Michael J. Kennelly, MD is a urologist in Charlotte, North Carolina.
What is the difference between Genetic and Genomic Testing?
The terms “genetics” and “genomics” are often used interchangeably but, in fact, they are different. Our genetics (genes) are inherited at birth and will pass through generations. They explain why a person has dark skin, blue eyes or red hair. In the cancer world, genetic testing looks for certain genetic mutations a person may have inherited through his or her family that may increase the chances of that person getting cancer. For example, if a woman has a family history of breast cancer, she may want to consider genetic testing for the BRCA1 gene. Those who test positive for the BRCA1 gene have a higher chance of developing breast cancer.
Genomic testing, on the other hand, looks more closely at the cancer genes themselves, as well as their behaviors. Genomic testing can help determine why a tumor behaves the way it does, including how aggressive a cancer can be and whether the cancer has a higher chance of spreading to other parts of the body. Understanding how the cancer is likely to act can help suggest a path to better treating the cancer. For example, if your provider sees that a mutation matches a known cancer cell defect, they may suggest a certain targeted therapy designed to attack that defect without causing harm to normal cells. This can have a positive impact on a person’s cancer care.
Genetic and genomic testing is not for everyone. It is important to talk with your provider to determine if you would be a good candidate for either type of testing.
For more information, visit: UrologyHealth.org/genomic
Alexander Kutikov, MD is the chief of the Division of Urologic Oncology at Fox Chase Cancer Center in Philadelphia.
Can vaping be associated with an increased risk for Bladder Cancer?
The use of electronic cigarettes (e-cigarettes), which is also known as “vaping”, has grown largely since first coming into American culture more than a decade ago. While standard cigarette smoking is a clear cause of bladder cancer, much less has been studied about the bladder cancer risk linked to e-cigarettes. Vaping has been marketed as a way to bring the stimulating effects of tobacco smoke, without the harmful health risks.
Most e-cigarette liquid a user inhales has nicotine, which has been proven to be addictive. Enough evidence has not yet shown that nicotine alone can cause cancer in humans, but studies have shown harmful links between vaping and a patient’s bladder cancer risk.
Since 90 percent of inhaled nicotine is excreted into the urine, New York University researchers set out to test if e-cigarette smoke led to DNA harm in the bladder of humans. They found e-cigarette smoke led to DNA harm in the lining of the bladder.
In a different study, researchers found signs in otherwise healthy mice that nicotine from e-cigarettes could be changed into chemicals that harmed the mice’s DNA. Researchers found that these harmful DNA changes were much like the effects of secondhand smoke from standard cigarettes.
Cancer is often a slow process. This means studies involving cancer may take years—even decades—to give us facts we can trust. Since vaping is relatively new, it’s vital to note that major data are still lacking.
While studies have shown vaping might be useful to help some people quit smoking, the newest proof suggests e-cigarette use is not entirely risk free when it comes to a patient’s bladder cancer risk. There is still no such thing as “safe smoking”, and we need to still research vaping to find any more potential links to e-cigarette smoke and bladder cancer.
Angela B. Smith, MD is an assistant professor of urology at the University of North Carolina School of Medicine in Chapel Hill.
UrologyHealth.org | FALL 2018 | UROLOGYHEALTH extra