Yvette M. Manard

Yvette M. Manard

Did you know that approximately 1 of every 2 women experiences some form of urine leakage? This should never be considered a normal part of aging. Oftentimes, it can be treated non-surgically and without bladder control medication. Evans Tran, PA, at Pacific Coast Urology Medical Center’s Women’s Bladder Control Center, discusses this embarrassing condition and how Pelvic Floor Rehabilitation can help.

Q: What is urinary incontinence?

A: Urinary incontinence (UI) is a common condition defined as an involuntary leakage of urine. UI affects many daily living activities and a person’s quality of life.

Q: What causes urinary leakage?

A: Twice as many women are likely to be affected as men and the prevalence increases with age. However, younger women also experience urinary leakage. Common factors include pregnancy, labor and delivery, back injuries and weakening of the pelvic floor muscles that provide support and bladder control.

Q: How is UI commonly treated?

A: Unfortunately, many women are too embarrassed to talk to their doctor about this condition and wear pads and adult diapers to cope with UI. Other women try medications. The results are less than satisfactory for most patients. At the Women’s Bladder Control Center we successfully treat urinary leakage patients with Pelvic Floor Rehabilitation. This treatment has been used for many years and has a very high success rate in appropriate candidates.

Q: What is Pelvic Floor Rehabilitation?

A: This therapy is designed to strengthen the pelvic floor muscles with targeted in-office and home therapy. The first phase is to test, measure and document the strength of a patient’s pelvic floor muscles by sensors. The second step is to gently stimulate and contract the muscles. I personally guide each of our patients and show them how to contract these muscles. Then I give a personal “prescription” for a home exercise regimen. I see patients weekly for the first four weeks of the program and then on an as needed basis after that. The end result is strengthening the pelvic muscles and retraining them to hold a larger volume of urine.

Q: Are there any other benefits to Pelvic Floor Rehabilitation?

A: Yes. They include helping patients who have pain during intercourse, relieving certain types of constipation and alleviating chronic pelvic or lower abdominal pain.


EvansLabCoatLearn more about Pacific Coast Urology Medical Center’s Women’s Bladder Control Center, call 888.735.3336. Visit www.pacificcoasturology.com

Six years ago, the United States Preventive Services Task Force (USPSTF) ignited controversy in the medical community when they advised against most routine screening for prostate cancer with a PSA blood test.

Specifically, the recommendation set off a firestorm of debate in the urological community because most urologists are strong advocates of annual prostate testing with a PSA and a rectal examination.

Are you confused? Should men continue to have their annual prostate exam? I asked Dr. Robert Pugach, Medical Director of Pacific Coast Urology Medical Center, his opinion of the USPSTF’s finding and what he advises men to do.

Q: How did the USPSTF come to their conclusion that routine screening for most men for prostate cancer wasn’t necessary?

A: The rationale used by the USPSTF was that PSA testing leads to many prostate biopsies that do not show cancer and that many men are treated for prostate cancer with small, inconsequential cancers. They are correct! However, the problem is that we don’t have a better screening blood test than the PSA blood test. PSA, or Prostate Specific Antigen, rises not only in men with prostate cancer; it also increases with benign prostate growth and with prostate inflammation. So, a blood test doesn’t say if you have prostate cancer; it only says that you may have it. Only a biopsy can give a definitive answer.

Q: Given the fact that a PSA is still the best screening test for prostate cancer, do you recommend that men have an annual PSA blood test?

A: ABSOLUTELY! Prostate cancer is still CANCER! When the era of PSA blood tests started, 50,000 men died of prostate cancer every year. In 2011, when the USPSTF recommendations were released, that number had declined to 25,000. Cases of advanced (metastatic) prostate cancer had plummeted. Now that less men are being screened, that is no longer the case. Report after report now shows that the incidence of advanced, incurable prostate cancer is increasing. This year, the prostate cancer death rate is projected to increase to 29,000. We are literally throwing the advantages of early diagnosis away because of a misguided belief that we can afford to delay diagnosis and treatment of this deadly cancer

It’s not just Dr. Pugach who is taking a stand. The American Urological Association has now spoken out against the USPSTF’s recommendations. Urologists across the country are encouraging patients, and their primary care physicians, to resume annual prostate cancer screening with a PSA and prostate exam.

ABOUT DR. ROBERT PUGACH
The Prostate Center of Excellence at Pacific Coast Urology Medical Center is the leading private practice in Southern California for diagnosis and treatment of prostate cancer. It is also the most experienced practice west of the Mississippi providing the non-invasive HIFU procedure for prostate cancer. If you would like to learn more, call 888.735.4336.

Visit:​ www.pacificcoasturology.com/prostate-cancer/ OR www.hifuprostatecancermd.com

We can help! Call, 888-735-4336 for your personal consultation.
Pacific Coast Urology Medical Center is one of the leading medical practices in the US specializing in the minimally invasive treatment of urological conditions.

Learn why men are selecting this new treatment

In October, 2015 the Food & Drug Administration (FDA) approved High Intensity Focused Ultrasound (HIFU) for the treatment of localized prostate cancer.

For many men diagnosed with prostate cancer, HIFU is a new treatment that they haven’t heard about nor are they aware of its benefits, including avoiding permanent urine leakage and erectile dysfunction (ED) that surgery or radiation can cause. “Being able to offer my patients a treatment to cure their prostate cancer and maintain their quality of life was very important to me,” says Dr. Robert Pugach, Medical Director of Western States HIFU and Pacific Coast Urology Medical Center.

HIFU has been used in more than 40 countries. Because the FDA was slow to act to approve HIFU, Dr. Pugach travelled outside the U.S. to learn this remarkable, non-surgical, radiation free treatment for his patients’ prostate cancers. After treating patients for 10 years with this non-invasive procedure, Dr. Pugach is now one of the top 10 HIFU practitioners in the world and one of 8 doctors certified to teach other urologists how to perform HIFU.

Andy, diagnosed with prostate cancer at the age of 49, is typical of many men diagnosed with prostate cancer. “After the initial shock wore off, I began doing intensive research and scheduled appointments with leading urologists and radiologists,” he says. Andy was about to proceed with proton beam radiation when he heard about HIFU and scheduled a consultation with Dr. Pugach. “I had a fantastic meeting with Dr. Pugach and decided HIFU was the way to go. Today, I am cancer free and my quality of life is excellent.”

Whether you are undiagnosed, newly diagnosed or have been previously treated for prostate cancer, Dr. Pugach encourages you to get the facts. Learn more about HIFU and listen to Andy’s and other patient’s testimonials at www.pacificcoasturology.com and www.hifuprostateservices.com.

Remember early detection saves lives. Schedule your annual prostate cancer screening exam!

doctorPacific Coast Urology Medical Center is one of the leading medical practices in the US specializing in the minimally invasive treatment of urological conditions. If you would like to learn more about HIFU, call, 844-HIFUDOC or visit: www.pacificcoasturology.com

High Intensity Focused Ultrasound (HIFU), a non-invasive, radiation-free therapy to treat localized prostate cancer, was approved for use in the United States by the FDA in October, 2015.

This technology is not new to the United States as it originated in 1970’s at the Indiana University School of Medicine and has been in use throughout the world – from Europe to Asia, the Middle East, South and Central America, Mexico and Canada.

“Historically, the conventional treatment for prostate cancer is the surgical removal of the prostate,” explains Dr. Robert Pugach, Medical Director of Pacific Coast Urology Medical Center. “While this surgery is now done robotically, it still has the potential to cause significant side effects, such as permanent urine leakage and erectile dysfunction,” continues Dr. Pugach.

Consistent with his focus on bringing advanced, minimally invasive technologies to his patients, Dr. Pugach was an early adopter of HIFU technology. He has been traveling outside of the US once every two months to treat successfully patients with HIFU for 10 years. He is now the 4th most experienced HIFU urologist in the US and is in an elite group of less than 1% of the urologists in the US certified to perform HIFU.

Dr. Pugach is excited to now be able to offer HIFU to his patients locally at the Los Alamitos Surgery Center. Patients no longer have to travel to Mexico for this procedure. “HIFU fits perfectly within the focus of my minimally invasive urologic practice as small prostate cancers can be treated in less than an hour and patients can return to normal activities within a few days with a dramatic reduction in quality of life issues like erectile dysfunction or incontinence,” explains Dr. Pugach.

HIFU technology has been clinically tested for use to treat a wide variety of diagnoses, including localized whole gland prostate cancer, benign prostatic hyperplasia (BPH) and recurrent prostate cancer.

PugachPacific Coast Urology Medical Center is one of the leading medical practices in the US specializing in the minimally invasive treatment of urological conditions. If you would like to learn more about HIFU, call, 888-735-4336 or visit:
www.pacificcoasturology.com

An interview with Robert Pugach, MD - one of the most experienced HIFU surgeons in the United States

According to the American Cancer Society, almost 250,000 prostate cancer cases will be diagnosed annually in the United States and will result in 29,000 deaths every year. These are frightening numbers. But, with prevention strategies and education about new treatment options, you can help do a lot to prevent becoming one of
these statistics.

Dr. Robert Pugach, Medical Director of Pacific Coast Urology Medical Center, answers questions about concerns regarding the prevention, diagnosis and treatment of prostate cancer and how HIFU (High Intensity Focused Ultrasound) is advancing treatment and improving outcomes.

Q: Why are there so many cases of prostate cancer cases? Can it be prevented?

A: This common cancer strikes men far too often. One reason is our increasing life expectancy – prostate cancer is a disease of getting older and most men now live long enough to develop it. I am a strong advocate of annual PSA screening and a simple physical examination. Most cases of prostate cancer can be cured when it is detected at an early stage.

New research is showing us the genetic basis of prostate cancer. We’re now able to look at prostate cancer at a molecular level to understand which tumors are aggressive and which ones can be observed without treatment. Common substances like Vitamin E may actually increase the risk of developing prostate cancer while natural additives like flaxseed and lycopenes may help to prevent it.

Q: How is prostate cancer treated? I’m scared about the side effects!

A: Historically, the conventional treatment for prostate cancer is the surgical removal of the prostate. While, nowadays, surgery is done robotically, it still has the potential to cause significant side effects, such as permanent urine leak- age and erectile dysfunction. Radiation may slow the cancer growth but it often allows it to grow again, making future treatment difficult. At Pacific Coast Urology Medical Center, we’re focused on keeping you whole if you need treatment for prostate cancer.

Q: Are there non-surgical options to treat prostate cancer that don’t use radiation?

A: Yes! One procedure is called cryoablation. It utilizes sub- freezing temperatures to kill cancers cells. A more advanced,

minimally invasive procedure that I am very excited about is High Intensity Focused Ultrasound (HIFU). HIFU is a treatment for prostate cancer that utilizes ultrasound waves to heat and destroy cancer cells without an incision!

Q: How does HIFU work?

A: Precisely focused ultrasound waves raise the temperature of the targeted prostate tissue in a matter of seconds. It can destroy cancer cells while leaving structures outside the targeted tissue unharmed. Side effects of traditional treatments, like urine leakage and erectile dysfunction, are dramatically reduced.

Q: Since HIFU isn’t performed in the United States where do you treat your patients?

A: Currently HIFU isn’t being performed in the US as it is going through the rigorous FDA approval process. It’s un- fortunate that we don’t offer it here yet, and that’s due to our FDA. But it’s available throughout the world – from Europe to Asia, the Middle East, South and Central America, Mexico and Canada. The technology is not new to the United States as it originated in 1970’s at the Indiana University School of Medicine! I travel outside of the U.S. every 2 months to treat patients with prostate cancer with HIFU.

Q: I understand that you are the 4th most experienced HIFU urologist in the US. What has been your experience with this technology?

A: I am pleased to be among the most experienced urologists in the US to use HIFU technology. Many years ago, I became fascinated with the HIFU technology because it is a non-invasive treatment for prostate cancer that significantly improves outcomes related to a man’s quality of life issues. HIFU fit perfectly within the focus of my minimally invasive urologic practice and I gained a great deal of experience to offer this treatment to my patients. We are now at the cusp of being able to treat small prostate cancers in less than an hour and allow patients to return to normal activities within a few days without the side effects of erectile dysfunction or incontinence.

robert pugach

Connect with Dr. Pugach by calling (888) 735-4336 or visit www.pacificcoasturology.com

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