Dr. Angel A. Alvarado - Urologist

The aging population makes urologic health care needs a priority. Although urology is often considered a small subset of medical care, it is important to remember that almost 45% of men in their 60s are affected by erectile dysfunction, nearly 30% of all men will require intervention for benign prostatic disease during their lifetime and prostate cancer is the most commonly diagnosed non-skin cancer in men. A high proportion of women are affected by urinary problems, including incontinence. All of these fields and others fall within the domain of the urologic specialist. Urologists are surgeons devoted or dedicated to prevention and treatment of diseases of the urinary tract. Dr. Angel A. Alvarado is a Board Certified Urologist and Surgeon in Panama City. He has been practicing medicine for more than 30 years, studied and practiced in the United States, is completely bilingual, and remains current in of the new advances in medicine in his field. Dr. Alvarado is the "doctor of choice" for these types of problems in Panama, and counts on the enthusiastic recommendations of his patients. Urology compasses 8% of all diseases and abnormalities occurring in mankind. Within the course of a lifetime, there is a great chance that everyone will need a urologist and his expertise for advice, treatment and hopefully for the curing of urological diseases. The facts are overwhelming:

• Urological abnormalities comprise close to 50% of all congenital abnormalities, the majority of which are today discovered before birth.
  
  
• Urinary tract infection is still the most frequently encountered infectious disease.
  
  
• Urinary lithiasis is still an common disease in both industrialised and non-industrialised countries.
  
  
• Most of the systemic diseases related to the aging population have direct or indirect urological consequences; these include diabetes, Alzheimer`s disease, Parkinson`s disease, arteriosclerosis, etc.
  
  
• Prostate disease today affects 75% of the male population over the age of 50, while benign prostatic hyperplasia is the most common disease in this age group.
  
  
• Urological cancers are the leading cause of cancer deaths in the male population, and prostate cancer is the most common malignant disease.

The Prostate Gland:

The prostate is a gland of the male reproductive system. The prostate produces some of the fluid for semen, which transports sperm during the male orgasm.


The Prostate Gland

Normally, the prostate is quite small—it is nearly the same size and shape as a chestnut. It is located in front of the rectum, just below the bladder, and wraps around the urethra, the tube that carries urine from the bladder out through the tip of the penis. The prostate is made up of approximately 30% muscular tissue, and the rest is glandular tissue.

Benign Prostatic Hyperplasia (BPH):

As a man gets older, his prostate may increase in size. This condition is called benign prostatic hyperplasia (BPH). By age 70, more than 40% of men will have enlargement of the prostate that can be felt during a physical examination. If the prostate grows large enough, it may press against the urethra and make the flow of urine weaker or slower.


Benign Prostatic Hyperplasia (BPH)

An increase in the size of the prostate and a change in urine flow do not necessarily mean you have cancer; you may have BPH, an infection or another urologic condition. It is important to note that BPH is not cancer, nor has it been shown to increase the risk of prostate cancer. However, a man can have both BPH and prostate cancer. Each of these conditions affects the prostate differently.

Benign prostatic hyperplasia is the enlargement of the prostate, frequently occurring in men over the age of 50. The enlargement can result in a gradual squeezing of the urethra, sometimes causing difficulty in urinating.

Many men may not have any symptoms of BPH. If you do have symptoms, they may include: a weak urinary stream, difficulty starting urination, frequent urination, or frequently awakening at night to urinate. Blockage of the urethra from BPH may lead to repeated urinary tract infections, a sudden inability to urinate, or gradual bladder and/or kidney damage.

Since the prostate lies in front of the rectum, your doctor will most likely perform a digital rectal examination (DRE) by inserting a gloved, lubricated finger into the rectum. By doing this, he or she will be able to feel the prostate and determine if it is enlarged or if it has lumps or other abnormalities. Many doctors perform a prostate exam for men over the age of 50, or over the age of 45 for those with risk factors for prostate cancer, such as family history or African-American ethnicity.

BPH is not cancer and has not been shown to increase the risk of prostate cancer. However, both conditions can exist together. Check with your doctor about your concerns. Also, BPH generally does not interfere with sexual functioning.

An enlarged prostate is not reason enough to consider treatment. You and your doctor may decide on "watchful waiting," in which you are examined periodically to check the status of your prostate. Sometimes symptoms may lessen without active treatment. However, if symptoms from BPH are bothering you or are severely affecting the urinary tract, treatment may be required.

BPH can be treated with medications, nonsurgical procedures that use heat to destroy excess tissue, or surgery. Medications work to relax the muscle tissue in the prostate or by reducing the amount of the hormone dihydrotestosterone (DHT). Most doctors recommend the removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. With surgery for BPH, the enlarged tissue that is pressing against the urethra is removed. The rest of the prostate tissue and the outside capsule are left intact. For a man whose symptoms are not severe enough to be bothersome, he and his physician may choose watchful waiting. This involves an exam by the physician to carefully monitor the progression of symptoms and possible complications.

Many patients may require some form of treatment for prostatic diseases, ranging from simple medications to intervention. The thought of "intervention" makes many people very nervous because it sounds like surgery. Nowadays, there are many less invasive options to address prostatic diseases, such as medical treatment, laser ablation, and others which can be used to correct the problem.

Prostatitis:

To put it simply, prostatitis is inflammation of the prostate gland. Acute bacterial prostatitis is an acute infection of the prostate gland, caused by bacteria and may be accompanied by chills and fever. Chronic bacterial prostatitis is a recurrent infection of the prostate, is associated with chronic urinary infection. Bacterial prostatitis is caused by organisms commonly associated with urinary tract infections. Non-bacterial prostatitis is inflammation without any evidence of infection present. The cause of non-bacterial prostatitis is unknown.


Prostatitis

Each type of prostatitis has a slight variation in signs and symptoms, but could include fever and chills, pain in lower back or rectum, urinary symptoms, relapsing urinary tract infections , painful urination or other voiding problems, or genital pain.

New research indicates that prostatitis is a much broader health problem than was once considered. It is one of the most common urologic diagnoses. Acute and chronic bacterial prostatitis is routinely treated with antibiotics. If you have non-bacterial prostatitis, your doctor might prescribe medications to reduce the difficulty in urination or anti-inflammatory drugs for pain. Lifestyle changes (diet, stress management) may be suggested by your doctor.

Erectile Dysfunction:

Erectile dysfunction, sometimes called "impotence," is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.


Erectile Dysfunction

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile function became accepted. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis other than ED.


Viagra

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Urologists, who specialize in problems of the urinary tract, have traditionally treated ED; however, urologists accounted for only 25 percent of Viagra mentions in 1999.

Viagra was the first oral treatment available and approved by FDA for treating ED, but there are now other options such as Cialis which lasts 36 hours and Levitra. All of them are inhibitors of an enzyme that allows the wall of the penile blood vessels to relax and facilitate the appearance of an erection when sexually stimulated. These products are contraindicated in patients who use NITRATES (dilators of heart blood vessels), because they might increase the risk of low blood pressure and syncope.

All of these product must be used under strict medical supervision. The proper treatment of ED requires the examination of a couple's sexual behavior. We evaluate both partners to determine whether the problem is caused by a medical, psychological or inter-relational problem. In addition, ED might indicate the existence of another medical problem related to aging, cardiovascular disease, high blood pressure, narrowing of blood vessels, or diabetes. ED can also be caused by the use of certain drugs, alcohol consumption, and cigarette smoking.

Urinary Incontinence:

Of the estimated 19 million North American adults who have urinary incontinence, 80 percent are women. It's important to understand that incontinence is not an inevitable part of aging, nor is it necessary to accept long-term incontinence after bearing a child. In many cases, it can be cured, and it can always be managed.


Urinary Incontinence

Your urinary tract is a system for collecting, storing and expelling liquid waste, or urine, from your body. The bladder stores the urine. When the bladder is full, a continent person feels the urge to expel the stored urine through the urethra. Special muscles called sphincter muscles hold the urethral tube closed so that the person can control the release of urine. Another muscle group, the pubococcygeus (PCG), also helps in maintaining continence. It encircles the urethra, vagina and rectum. Many women with incontinence have weakened or damaged muscles, and may not be able to sense when their bladders are full, which leads to difficulty in controlling urination.

Urine is about 95 percent water and five percent waste. Some people incorrectly believe that by drinking less fluid, they will reduce their incontinence. In fact, urine that is more concentrated due to lack of fluid intake can irritate the bladder and cause more serious problems such as infection and dehydration. In addition, inadequate fluid intake can cause constipation which may also make incontinence worse.

Urinary Tract Infections:

Urinary tract infections are a serious health problem affecting millions of people each year. Infections of the urinary tract are the second most common type of infection in the body. Urinary tract infections (UTIs) account for about 8.3 million doctor visits each year.* Women are especially prone to UTIs for reasons that are not yet well understood. One woman in five develops a UTI during her lifetime. UTIs in men are not as common as in women but can be very serious when they do occur.


The Urinary Tract

Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi but does contain fluids, salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. The urethra is the tube that carries urine from the bladder to outside the body. Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon.

In many cases, bacteria first travel to the urethra. When bacteria multiply, an infection can occur. An infection limited to the urethra is called urethritis. If bacteria move to the bladder and multiply, a bladder infection, called cystitis, results. If the infection is not treated promptly, bacteria may then travel further up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis.

Microorganisms called Chlamydia and Mycoplasma may also cause UTIs in both men and women, but these infections tend to remain limited to the urethra and reproductive system. Unlike E. coli, Chlamydia and Mycoplasma may be sexually transmitted, and infections require treatment of both partners.

The urinary system is structured in a way that helps ward off infection. The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur.

Kidney Stones:

Kidney stones, one of the most painful of the urologic disorders, are not a product of modern life. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. In 2000, patients made 2.7 million visits to health care providers and more than 600,000 patients went to emergency rooms for kidney stone problems. Men tend to be affected more frequently than women.


Kidney Stones

Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation.

Prevention:

Ultra-prevention is a term we use to describe a system of health promotion that surpasses commonly held concepts of prevention in traditional medicine. The current model of health care relies on the presence of a disease. Without a disease, there can be no diagnosis. Without a diagnosis there can be no treatment. "Prevention" is felt to be detection when there are no symptoms. Common examples of traditional preventive measures include mammography, PAP smears, PSA tests, colonoscopy and sigmoidoscopy, stress test, etc. Although these are important and essential measures, they are not truly preventive, but rather methods of screening and detection.

Often, years before any disease can be detected, biochemical imbalances exist that trigger and eventually lead to illness. These imbalances are chemical and energetic in origin and are affected by nutrients, genetics, energy, environment and the mind. By identifying and correcting these imbalances early, then nutritional and lifestyle changes can be successful in restoring balance and truly preventing the development of disease. This is what we call ultraprevention.

Chances are very good that at some time during your stay here in Panama you will eventually need the services of a good urologist. Please do not hesitate to call if you have questions or concerns.

Dr. Angel A. Alvarado bio and resume:

• Graduated from the University of Panama in March of 1983 with a Doctorate in Medicine.
• Fellow of Pediatric Urology from the Addenbrookés Hospital of Cambridge, England.
• Fellow of Endourology, Institute of Urology, London, England
• Fellow of Oncological Urology, Radboud University Hospital, Holland
• Fellow of Andrology and Disfunctions, University of California, San Francisco
• Laser Surgery, Tulane Medical Center, New Orleans
• Surgical Laparoscopy, Santiago, Chile
• Urology Resident, Hospital del Niño, Panamá
• Urology Resident, Social Security Hospital, Panama City, Panama
• Chief of the Urology Department, Gorgas Army Hospital, Panama Canal Zone, 1989 - 1997
• Private Practice in the Medical Offices of Paitilla
• Private Practice in the Punta Pacifica Hospital (Johns Hopkins Medical International)
• Ex-President of the Panamanian Society of Urology
• Active Member of:
  • Panamanian Urological Society
  • Panamanian National Medical Association
  • American Urological Association
  • American Fertility Society
  • International Society for the Study of Impotence
  • American Confederation of Urology
• Investigator, author, and co-author of several scientific works in the field of Urology
• Attended the annual meeting of the European Association of Urology in Paris, France. More than 11,000 participants around the world met to discuss the latest treatments and techniques in surgery. There I attended a seminar on anti-aging and testosterone sponsored by the International Society for the Study of the Aging Male. While in Paris I also attended a hands-on training session on laser surgery for prostate and laparoscopinc surgery. During the same meeting we also had some discussions on prostate cancer, erectile dysfucntion and urinary incontinence. I also was appointed as a member of the association.
• In early march I went to Bogota, Colombia to the Centro de Fertilidad y Esterilidad (CECOLFES), one of the most well recognized and prestigious centers in the world and the first in Latin America under the direction of Dr. Elkin Lucena, for a refreshement course on the latest techniques in diagnosis and treatment of male infertility. They are also working on a line of stem cells for future medical purposes.

Contact Information:

• Dr. Angel A. Alvarado
• Paitilla Medical Clinics, Third Floor, Office #313
• Punta Pacífica Hospital, First Floor office #125, Tel. 204-8000
• Office Telephone Number: *011 (507) 263-2795
• Office Fax: *011 (507) 263-3090
• Cell Phone: *011 (507) 6-612-6404
• Emergencies (Beeper Service): 811 or 265-5155
• Email: aalvarado@clinicasurologicas.com
• Web Page: www.clinicasurologicas.com (Spanish)

*Note: Be sure to obtain a copy of your complete medical history and records, and reports from your current physician on existing conditions and medications to ensure proper follow-up treatment.