One Elite Sperm Wins the Marathon: Understanding Semen Analysis

January 19, 2019

Andrew Siegel MD  1/19/2019

The journey of sperm from ejaculation to egg fertilization is an arduous process that is nothing short of a marathon, or perhaps more like a “tough mudder” race. The pilgrimage covers challenging and demanding terrain with abundant obstacles and impediments — the hills and valleys of the vaginal canal, the unwelcoming and entrapping cervical slime, and in the final leg, the extreme narrows and expanse of the fallopian tubes. The few mighty sperm that are capable of overcoming these formidable obstacles and stumbling blocks are not always able to cross the finish line and penetrate the egg, so there is often no winner in this marathon. In that case, these elite sperm perish, having been so close, but so far away.

Health Sport Marathon Team Athletics Run Runners

 Image above, Xenzo at English Wikipedia [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D

A semen analysis is the best test to check a male’s fertility status and potential (or lack thereof when done following a vasectomy).  Although a specimen is easily obtained and analyzed, the results can be complex and nuanced.  Therein lies the utility of the marathon metaphor as an aide to help explain the complexities and meaning of the results.

Egg Sex Cell Sperm Winner Fertilization

Thank you, maxpixel for image above, https://www.maxpixel.net/Egg-Sex-Cell-Sperm-Winner-Fertilization-956481

How does one provide a specimen for a semen analysis?

Most men are highly skilled and experienced at this activity.  It requires a minor modification from the usual routine.  Instead of cleaning up with tissues, carefully deposit the specimen into the specimen cup provided, seal the top and place the cup into a paper bag and hustle it off to the lab with the accompanying prescription ASAP.  The semen will be placed on a slide and examined microscopically.  Note that it is important to abstain from ejaculating for at least 48 hours prior to providing the specimen in order for the volume of the reproductive juices to be optimized.

What information will be obtained from the semen analysis?

  1. Volume of semen (1.5 – 5 cc)
  2. Number of sperm (> 20 million/cc)
  3. Forward movement of sperm (> 50%)
  4. Appearance of sperm, a.k.a. morphology (> 30% normal forms)
  5. Clumping of sperm, a.k.a. agglutination (should be minimal)
  6. White blood cell presence in semen (should be minimal)
  7. Thickness of semen

Marathon metaphor

A marathon is a long-haul endurance race (26.2 miles) with many participants (sperm) and usually only a single winner who crosses the finish line (fertilizes the egg). A sufficient number of participants (sperm count) ensure a competitive race to the finish line with the more participants, the greatly likelihood of a quality finish.

There are about 30,000 runners in the Boston Marathon, but in the fertility marathon there are millions and millions of participants. A fertile male can easily have over 300 million sperm in his semen (that’s 10,000 times the number of participants in the Boston Marathon).  If only a minimal number of participants show up on race day (oligospermia), there may be no one capable of crossing the finish line or doing so on a timely enough basis.

The runners need to stay on course, pace themselves and run in a forward direction. If the participants have poor mobility and move erratically without attention to direction (asthenospermia), they doom themselves to losing the race.

A quality runner most commonly has the characteristic size and shape (morphology) of an endurance athlete, which for a long-distance runner is typically long and lean.  If one has a build that deviates (head and tail defects) from that of the elite runner, it is likely that they will not finish the race, or not finish on a timely basis.

Runners need to focus and make every effort to meet the challenge.  However, if they are not serious about racing and instead of doing business decide to hang out and socialize (clumping together—a.k.a., agglutination) instead of pursuing the task at hand, the outcome will not be favorable.

If marathon security lapses and uninvited stragglers (white blood cells in semen, a.k.a. pyospermia) cross the mechanical barriers and infiltrate the course, the dynamics of the race are altered and the uninvited guests can cause direct harm to the participants, interfering with their ability to complete the marathon.

The runners (sperm) can be affected by the environment (semen) in which they participate.  Although these endurance athletes can deal with a variety of weather conditions, if conditions are extreme enough, the pathway to the finish line will be impaired.  Severe humidity (semen too thick, a.k.a. hyperviscosity), can be a substantial impediment to a competitive race time. In a severely dry and arid environment (minimal semen volume, a.k.a. hypospermia), the sub-optimal race conditions can also impair the race to the finish line.  Similarly, in severe rainy weather (too much seminal volume, a.k.a. hyperspermia), the route can literally be flooded with the marathoners’ capacity for finishing the race compromised.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Amazon author page with all books authored  including the following:

PROSTATE CANCER 20/20: A Practical Guide To Management Options For Patients And Their Families

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MPF cover 9.54.08 AM

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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Why Is My Prostate Growing When Everything Else Is Shrinking?

January 12, 2019

Andrew Siegel MD  1/12/2019

The prostate is one of the few organs that gets bigger over time.  Meanwhile, there is  shrinkage, loss of tissue mass and recession going on elsewhere, e.g., bones, muscles, gums, hairlines, etc. 

Normal-vs-enlarged-prostate

Attribution of image above: Akcmdu9 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, from Wikimedia Commons

The following paragraph from Gabriel Garcia Marquez’s Love in the Time of Cholera (an awesome read) colorfully sums up the aging prostate:

“He was the first man that Fermina Daza heard urinate. She heard him on their wedding night, while she lay prostrate with seasicknessin the stateroom on the ship that was carrying them to France, and the sound of his stallion’s stream seemed so potent, so replete with authority, that it increased her terror of the devastation to come. That memory often returned to her as the years weakened the stream, for she never could resign herself to his wetting the rim of the toilet bowl each time he used it. Dr. Urbino tried to convince her, with arguments readily understandable to anyone who wished to understand them, that the mishap was not repeated every day through carelessness on his part, as she insisted, but because of organic reasons: as a young man his stream was so defined and so direct that when he was at school he won contests for marksmanship in filling bottles, but with the ravages of age it was not only decreasing, it was also becoming oblique and scattered, and had at last turned into a fantastic fountain, impossible to control despite his many efforts to direct it. He would say: ‘The toilet must have been invented by someone who knew nothing about men.’ He contributed to domestic peace with a quotidian act that was more humiliating than humble: he wiped the rim of the bowl with toilet paper each time he used it. She knew, but never said anything as long as the ammoniac fumes were not too strong in the bathroom, and then she proclaimed, as if she had uncovered a crime: ‘This stinks like a rabbit hutch.’ On the eve of old age this physical difficulty inspired Dr. Urbino with the ultimate solution: he urinated sitting down, as she did, which kept the bowl clean and him in a state of grace.”

The prostate is a mysterious-to-many, deep-in-the-pelvis male reproductive organ that can be the source of trouble and angst.  It functions to produce a milky liquid that is a nutrient and energy vehicle for sperm. Similar to the breast in many respects, the prostate consists of numerous glands that produce this fluid and ducts that convey the fluid into the urethra (urinary channel that runs from the bladder to the tip of the penis). At the time of sexual climax, the muscle within the prostate squeezes the glandular fluid into the prostate ducts and then into the urethra, where it mixes with secretions from the other male reproductive organs to form semen.

The prostate completely envelops the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between prostate and urethra can potentially be the source of many issues for the aging male. In young men the prostate gland is the size of a walnut.  Under the influence of three factors—aging, genetics, and the male hormone testosterone—the prostate gradually and insidiously enlarges.

Prostate enlargement is highly variable from man to man, depending upon the aforementioned factors.  As the prostate gland enlarges, it often—but not always—squeezes the section of the urethra that runs through it, making urination difficult and resulting in a number of annoying symptoms and disturbed sleep.  The effect of the enlarging prostate on urinary flow is similar to that of stepping on a garden hose, obstructing the flow. The resultant situation can be anything from a tolerable nuisance to one that has a huge impact on one’s daily activities and quality of life.

The condition of prostate enlargement is known as BPH—benign prostate hyperplasia—one of the most common plagues of aging men. Other processes that can mimic the symptoms of BPH include urinary infections, prostate cancer, urethral stricture (scar tissue causing obstruction), and impaired bladder contractility (a weak bladder muscle that does not squeeze adequately to empty the bladder).

Although larger prostates tend to cause more crimping of urine flow than smaller prostates, the relationship is imprecise and a small prostate can, in fact, cause more symptoms than a large prostate, much as a small hand squeezing a garden hose tightly may affect flow more than a larger hand squeezing gently. The factors of concern are the precise anatomical location of the prostate enlargement and the extent of the compression on the urethra. In other words, prostate enlargement in a location immediately adjacent to the urethra will cause more symptoms 
than prostate enlargement in a more peripheral location. Also, the prostate gland and the urethra contain a generous supply of muscle and, depending upon the muscle tone, variable symptoms may result.

Symptoms that develop as a result of BPH are commonly “obstructive” as the prostate becomes, in the words of one of my patients: “welded shut like a lug nut.”  These symptoms include a weak stream that is slow to start, a stopping and starting quality stream, prolonged time required to empty, and at times, a stream that is virtually a gravity drip with no force.  Another patient described the urinary intermittency as “peeing in chapters.”  Many men have to urinate a second or third time to try to empty completely, a task that is often impossible. Not only may the stream be slow to start, but also may continue after urination is thought to be completed, a condition known as post-void dribbling.  At times, one cannot urinate at all and ends up in the emergency room for relief of the problem by the placement of a catheter, a tube that goes in the penis to drain the bladder and bypass the blockage. BPH can be responsible for bleeding, infections, stone formation in the bladder, and on occasion, kidney failure.

The other type of symptoms that can develop with BPH are “irritative” as opposed to “obstructive” and may include the following: an urgency to urinate requiring hurrying to the bathroom, frequent daytime and nighttime urinating, and at times, urinary leakage before arriving to the bathroom.  As a result of these “irritative” symptoms, some men have to plan their routine based upon the availability of bathrooms, sit on an aisle seat on airplanes and avoid engaging in activities that provide no bathroom access.  One symptom in particular, sleep-time urination—a.k.a. nocturia—is particularly irksome because it is sleep-disruptive and the resultant fatigue can make for a very unpleasant existence.

Not all men with BPH need to be treated; in fact, many can be observed if the symptoms are tolerable. There are effective medications for BPH, and surgery is used when appropriate. There are three types of medications used to manage BPH: those that relax the prostate muscle tone; others that shrink the enlarged prostate; and Cialis that has been FDA approved to be used on a daily basis to treat both erectile dysfunction as well as BPH.  There are numerous surgical means of alleviating obstruction and currently the most popular procedure uses laser energy to vaporize a channel through the obstructed prostate gland.

In terms of the three factors that drive prostate growth: aging, genetics and testosterone– There is nothing much we can do about aging, which is quite a desirable state!  We cannot do a thing about inherited genes.  Having adequate levels of testosterone is a positive in terms of general health.

So what can be done to maintain prostate health? The short answer is that a healthy lifestyle can lessen one’s risk of BPH.  Regular exercising and maintaining a physically active existence results in increased blood flow to the pelvis, which is prostate-healthy as it reduces inflammation. Sympathetic nervous system tone tends to increase prostate smooth muscle tone, worsening the symptoms of BPH; this sympathetic tone can be reduced by exercise.  Maintaining a healthy weight and avoiding abdominal obesity, will minimize inflammatory chemicals that can worsen BPH.  Vegetables are highly anti-inflammatory and consumption of those that are high in lutein, including kale, spinach, broccoli and peas as well as those that are high in beta-carotene, including carrots, sweet potatoes and spinach, can lower the risk of BPH.

Bottom Line: BPH is a common problem as one ages, oftentimes negatively impacting quality of life.  There are medications as well as surgery that can help with this issue; however, a healthy lifestyle that includes exercise, avoidance of obesity, and a diet rich in vegetables can actually help lower the risk for developing bothersome prostate symptoms.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MPF cover 9.54.08 AM

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Seasonal Weight Gain, Pre-diabetes and E.D.: The Hard Facts

January 5, 2019

Andrew Siegel MD  1/5/2018   Happy New Year!

As reviewed in the last entry, many factors over the past few months have conspired to add inches to our waistlines…Halloween sweets, Thanksgiving treats, December feasts, New Years celebrations, etc., with ample opportunities for over-indulging.  Then there is the added element of the cold and dark season that make exercising outside challenging and fueling the desire for comfort foods.  Before you know it, our pants are snug and we discover that we have gained 10 pounds or so.  

Today’s entry is on the topic of how gaining weight—the possible beginning of the journey to diabetes—can affect one’s manhood and vitality. While optimal sexual function is based on many factors, it is important to recognize that diet and physical activity play a vital role. What we eat—or don’t—and how much we exercise—or don’t—impacts our health and sex lives significantly.  For many, 2019 is a time for New Year’s resolutions, which often involve weight loss and a healthier lifestyle. Yet another benefit of becoming leaner and fitter is improved sexual function.

fat belly

Image above: visceral obesity, often associated with pre-diabetes or diabetes and a disaster for health in general and function “down below”

 

A Canary in Your Trousers

The penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline.  This surge happens within seconds and responsible for the remarkable physical transition of the penis from flaccid to erect. This healthy sexual response is a clear indication of robust blood flow to the genital and pelvic area and intact sexual function serves as an excellent marker of overall cardiovascular health.

Eating Yourself Limp

Weight gain and obesity steal one’s manhood. Men with large bellies are likely to have fatty plaque deposits that clog blood vessels–including the arteries to the penis–making it difficult to obtain and maintain good quality erections. Additionally, as one’s belly gets bigger, one’s penis appears smaller, lost in the protuberant roundness of the large midriff and the abundant pubic fat pad. Furthermore, abdominal fat contains the enzyme that converts the male hormone testosterone to the female hormone estrogen, accounting for low testosterone levels and man-boobs in obese men. The combination of a big belly, a small and poorly functional penis and the presence of man boobs translates to emasculation– essentially “eating oneself limp.”  The bottom line is that poor dietary choices with meals full of calorie-laden, nutritionally-empty selections (e.g., fast food, processed foods, excessive sugars or refined anything), puts one on the fast track to weight gain and obesity and clogged arteries that can make your sexual function as small as your belly is big.

Pre-diabetes and Diabetes

Glucose is the body’s main fuel source.  Diabetes is a disease in which blood glucose levels become elevated. Insulin, a hormone secreted by the pancreas, is responsible for moving glucose from the blood into the body’s cells so that life processes can be fueled. In diabetes, either there is no insulin, or alternatively, plenty of insulin, but the body cannot use it properly. Without functioning insulin, the glucose stays in the blood and not the cells that need it, resulting in potential harm to many organs.

Type 1 diabetes is an autoimmune condition in which the body’s immune system destroys insulin-producing cells, severely limiting or completely stopping all insulin production.  It is often inherited, is responsible for 5% of diabetes, and is managed by insulin injections or an insulin pump.

Type 2 diabetes is caused by overeating and sedentary living and is responsible for 95% of diabetes. This form of diabetes is caused by insulin resistance, a condition in which the body cannot process insulin and is resistant to its actions. Anybody with excessive abdominal fat is on the pathway from insulin resistance towards diabetes.  Type 2 diabetes is a classic example of an avoidable and “elective” chronic disease that occurs because of an unhealthy lifestyle.

Diabetes is the most common cause of erectile dysfunction (E.D.) in the U.S.A. Since Type 2 diabetes is often an evolving process, gradually progressing from a normal metabolic profile to pre-diabetic status to diabetes, it should be no surprise that pre-diabetic status can be associated with E.D. In fact, studies have shown that one in five men with new-onset E.D. have unrecognized pre-diabetes.

Pre-diabetes is characterized by elevated serum glucose levels (100-125 mg/dL) and hemoglobin A1c values of 5.7-6.4%.  Pre-diabetes is also associated with other metabolic abnormalities, including higher body mass index, elevated cholesterol and triglycerides, and lower testosterone.

Chances are that if you have a big abdomen (“visceral” obesity marked by internal fat) you are pre-diabetic. This leaves you with two pathways: the active pathway – cleaning up your diet, losing weight and getting serious about exercise, in which this potential problem can be nipped in the bud and the progression to diabetes can be reversed. However, if you take the passive pathway, you’ll likely end up with full-blown diabetes.

Healthy lifestyle choices are of paramount importance towards achieving an optimal quality and quantity of life. It should come as no surprise that the initial approach to managing pre-diabetes (and sexual issues) is to improve lifestyle choices. These include proper eating habits, weight loss and thereafter maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and minimizing stress.

Fueling up with wholesome, natural and real foods helps prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish. Animal products—including lean meats and dairy—should be eaten in moderation. The Mediterranean-style diet is an excellent one for helping to reverse the non-inevitable course towards diabetes and E.D.

Bottom Line:  Diabetes progresses in a step-wise fashion from pre-diabetes and is considered to be an “elective” chronic disease caused by an unhealthy lifestyle.  Accompanying a myriad of potentially serious medical problems are sexual consequences that rob men of their manhood and masculinity.  The good news is that lifestyle modifications can reverse this situation.  

 Wishing you a healthy, peaceful, happy (and sexy) 2019,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MPF cover 9.54.08 AM

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

2019 Healthy Eating New Year’s Resolution

January 1, 2019

Andrew Siegel MD  1/1/2019  Happy New Year!

The last few months have been a difficult time of the year for staying fit and trim, with many factors conspiring to add inches to our waistlines. It starts off with Halloween sweets and shortly thereafter, the bounty of Thanksgiving. This segues into the December holidays, which provide ample and constant opportunities for over-indulging. The cold and dark season make it more challenging to exercise outside and fuel desire for comfort foods.  So, what to do?

No carb diet?Paleo diet?Keto diet?…really?  Are they sustainable?  Not a chance!

Today’s entry is about a healthy eating lifestyle—as opposed to a diet—that will help improve your shape and shed those excess pounds that crept on over the past few months. This is a style of eating that can be easily incorporated to replace calorie-rich, nutrient-poor diets that are overloaded with processed and refined junk and fast foods.  As opposed to many fad weight loss programs that are gimmicky, unbalanced, unhealthy, unsustainable and frankly ridiculous, this approach is a no-nonsense, intelligent one—clean, lean, with plenty of green—that will stave off hunger and hold caloric intake in balance with expenditure, making it effective and durable.

The keys are sensible and nutritious eating, substituting less caloric and healthier foods for more caloric and unhealthier alternatives as well as incorporating Michael Pollen’s philosophy, Mediterranean-style eating and an 80/20 strategy.

Substitutions

  • Seafood and lean poultry instead of red meat (when you do eat red meat, consume only the leanest cuts and grass-fed is preferable to corn-fed)
  • Lean turkey meat instead of beef for hamburgers, meatballs, chili, etc.
  • Vegetable protein sources (e.g. legumes—peas, soybeans and lentils) instead of animal protein sources
  • Avocados instead of cheese
  • Olive oil instead of butter
  • Real fruit (e.g. grapes, plums, apricots, figs) instead of dried fruit (raisins, prunes, dried apricots, dried figs) that are energy-dense
  • Real fruit (e.g. orange, grapefruit, apple, etc.) instead of fruit juice (OJ, grapefruit juice, apple juice, etc.) since real fruit has less calories, more fiber and phyto-nutrients and is more filling than the refined juice products
  • Whole grains (e.g. wheat, brown rice, quinoa, couscous, barley, buckwheat, oats, spelt, etc.) instead of refined grain products
  • Tomato sauces instead of cream sauces
  • Vegetable toppings (e.g. broccoli) on pizza instead of meat toppings (pepperoni)
  • Unshelled peanuts instead of processed peanuts (unshelled are usually unprocessed and are difficult to over-consume because of labor-intensity of shelling, the act of which keeps us busy and occupied)
  • Flavored seltzers or sparkling water instead of soda (liquid candy) with its empty calories
  • Baked, broiled, sautéed, steamed, poached or grilled instead of fried, breaded, gooey
  • Baked chips instead of fried
  • Bialys instead of bagels
  • Wild foods instead of farmed (e.g. salmon)
  • Plain Greek yogurt instead of sour cream on baked potatoes and instead of mayo in salad dressings and dips
  • Frozen yogurt bars, which make a delicious 100 calorie or so dessert instead of ice cream
  • Soy, rice, almond or other nut-based milks instead of dairy
  • Low-fat or non-fat dairy products instead of whole milk products

Michael Pollen’s philosophy can be summed up with his famous seven words: “Eat food, not too much, mostly plants.”  Food translates to real, natural, wholesome and unprocessed nourishment (as opposed to processed, refined, fast foods); not too much obviously means in reasonable quantities (as opposed to consuming massive quantities); and mostly plants emphasizes eating foods grown in the soil– whole grains, vegetables, fruits, legumes, seeds, nuts, etc. (with animal sources in moderation).

Mediterranean style eating is healthy, tasty, filling and enjoyable.  It incorporates an abundance of vegetables and fruits that are rich in phyto-chemicals (biologically active compounds such as anti-oxidants, vitamins, minerals and fiber), whole grains, legumes, nuts and seeds.  Seafood, legumes and poultry (in moderation) are the key sources of protein with red meat eaten on a limited basis. Healthy vegetable fats are derived from olives, nuts, seeds, avocado, etc., replacing animal fats (e.g. butter).  Herbs and spices are used to flavor food, rather than salt. Dairy products are eaten in moderation. The Mediterranean style drink of choice is red wine in moderation.

The other element is the 80/20 (or 85/15 or 90/10 or 95/5) strategy.  This means that 80-95% of the time you adhere to a healthy eating style, but 5-20% of the time you give yourself a break, temporarily jump off the wagon and indulge in limited amounts of whatever temptation indulgence you would like. This avoids deprivation and serves as “an inoculation to prevent the disease.”  On the limited list are sweets including cookies, cakes, donuts, candy, etc. and liquid carbohydrates such as sugary drinks including soda, ice tea, lemonade, sports drinks, fruit juices, etc.

Additional Valuable Nuggets of Advice

  • Pathway to a healthy weight is slow and steady, demanding patience and time
  • Cook healthy meals at home instead of dining out
  • Eat slowly, deliberately and mindfully
  • Eat as if you were dining with your cardiologist and dentist
  • Get sufficient quality and quantity of sleep to help keep the pounds off
  • Avoid late night meals and excessive snacking
  • Eat only when physically hungry with the goal of satiety and not fullness
  • Stay well hydrated as it is easy to confuse hunger with thirst
  • Exercise portion control, especially at restaurants where portions are often supersized
  • Order dressings and sauces on the side to avoid drowning salads and pasta meals in needless calories
  • Do not skip meals
  • Keep healthy foods accessible
  • Perishable food with a limited shelf life is much healthier than a non-perishable item that lasts indefinitely, as do many processed items
  • Read nutritional labels as carefully as if you were reading the label on a bottle of medicine
  • Avoid foods that contain unfamiliar, unpronounceable, or numerous ingredients
  • Avoid foods that make health claims, since real foods do not have to make claims as their wholesomeness is self-evident
  • Avoid food with preservatives, hormones, antibiotics, pesticides, artificial colors, etc.
  • Plants that are naturally colorful are usually extremely healthy
  • “Organic” does not imply healthy or low-calorie
  • Use small plates and bowls to create the illusion of having “more” on your plate
  • Let the last thing you eat before sleep be healthy, natural and wholesome (e.g., a piece of fruit)—you will feel good about yourself when you get into bed and even better in the morning

Wishing you the best of health and happiness in 2019,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.  He is the author of 5 books, including PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Promiscuous Eating

 

Urethral Stricture: What You Need to Know

December 29, 2018

Andrew Siegel MD  12/29/2018

A urethral stricture is scarring within the urethra (the channel that conducts urine out of the bladder), resulting in a narrowed diameter and obstructive lower urinary tract symptoms.  The urethra is one of the parts of the body that is a particularly bad place for scarring, since it is a highly functional structure that is put into use numerous times daily.

The Male Urethra

2603_Male_Urethra_N

Attribution  of image above: OpenStax Anatomy and PhysiologyOpenStax [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)%5D, via Wikimedia Commons

 

urethral stricture

Image above indicates the great variety of strictures in terms of length and depth

 

Urethral strictures, although occasionally present in females, are much more common in males. The male urethra begins at the neck of the urinary bladder and ends at the tip of the penis. The innermost portion of the urethral is enveloped by the prostate gland. Thereafter the urethra runs through the perineum (between scrotum and the anus) where it is enveloped by the corpus spongiosum–a thick, vascular, cushiony structure– and thereafter the urethra extends through the penis (also surrounded by the corpus spongiosum) where it ends at the urethral meatus (the slit-like opening).

Urethral scarring results in a narrowed or blocked passageway that can give rise to obstructive voiding including one or more of the following symptoms: slow, weak, hesitant, spraying and intermittent urinary stream, prolonged emptying, incomplete emptying or inability to empty, painful urination and blood in the urine.  It can also cause urinary infections, bladder stones and cause difficulties/pain with ejaculation.

Urethral strictures often result from trauma, infection or inflammation.  External trauma can be caused by either a straddle injury (when the perineum abruptly strikes a fence or bicycle top tube) or a crush injury. Internal injury is often due to passage of urethral instruments, indwelling urethral catheters, or transurethral surgery. Inflammatory processes such as urethritis and sexually transmitted diseases also can result in urethral stricture formation.

When a urethral stricture is suspected, a urinary flow rate and an ultrasound-guided determination of how much urine is left in the bladder after urinating are obtained. These painless and noninvasive procedures will precisely characterize the extent of compromised urinary flow as well as the ability to effectively empty the bladder. Most strictures cause poor flow rates and elevated bladder residuals. Urethroscopy is a procedure in which a narrow, flexible, lighted instrument is placed in the urethra in order to directly examine it, ascertaining the location, extent and length of the stricture.  At times, imaging studies of the urethra–retrograde urethrogram, voiding cysto-urethrogram, or urethral ultrasound are performed to gain further information.  With urethroscopy and imaging studies, the location, length, and depth of the scar and degree of extension into the spongy tissue that surrounds the urethra can be deduced.

Mild strictures can be managed with simple urethral dilation that may be curative. This involves the passage of sequentially larger dilating instruments through the stricture to open up the scar tissue. If a urethral stricture is short and involves only the urethra or superficial spongy tissues in the bulbar urethra (the portion that travels through the perineum), optical internal urethrotomy is often the treatment of choice. This is a procedure done under anesthesia that utilizes an endoscopic instrument to incise open the urethra. Typically, a catheter is left in the urethra for several days thereafter to maintain the opening that has been made.  This procedure can be performed on an outpatient basis.  It will not always be curative because scar tissue can and often does recur. Dilation and optical urethrotomy are best for relative short strictures located in the bulbar urethra with success rates in the 35-70% range, often with the need for a repeat procedure because of recurrent scarring.

A useful tool after dilation or optical urethrotomy is to teach the patient self-catheterization to maintain the urethral opening. If obstructive symptoms recur and studies demonstrate little or no improvement, an open surgical treatment called urethroplasty can be a consideration. It is rarely necessary as an initial therapeutic option, but is appropriate for longer and recurrent urethral strictures or those involving extensive scarring. Excision of the stricture with urethroplasty has a 90-95% success rate, although it is a much more involved procedure than dilation or optical urethrotomy. If the stricture is located in the penile urethra as opposed to the bulbar urethra, urethroplasty should be offered since strictures at this location are less likely to respond to dilation or optical urethrotomy. Lengthy strictures require graft material to repair, often buccal mucosa ( graft material harvested from inside the mouth).

At times the stricture is confined to the part of the urethra located at the tip of the penis where it is known as a urethral meatal stricture.  This situation can be rectified with dilation or a minor procedure called a meatotomy/meatoplasty.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MPF cover 9.54.08 AM

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Female “Prostatitis”: How Is That Possible?

December 22, 2018

Andrew Siegel MD  12/22/2018

The prostate gland is that mysterious male reproductive organ that can be a source of curiosity, anxiety, fear and potential trouble.  Although women do not have a prostate gland, they have a female equivalent, known as the Skene’s glands.  Like the prostate, these glands can be a source of maladies resulting from their infection/inflammation, the female version of prostatitis.

Image below: note Swedish “slida” is vagina (literally “sheath”); note Skenes and Bartholins gland  openings, “urinrorsmynning” = urethra; “klitoris” = clitoris

Skenes_gland-svenska

Attribution of image above: By Nicholasolan (Skenes gland.jpg) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5 (https://creativecommons.org/licenses/by-sa/2.5)%5D, via Wikimedia Commons

The Skene’s glands, a.k.a. the para-urethral glands, are present in all females and are the female equivalent of the male prostate gland. They were first described in 1880 by Dr. Alex Skene, a Brooklyn gynecologist.  These paired glands are located within the top wall of the vagina near the urethra and drain into the urethra and to tiny openings near the urethral opening (see image above).  Like the prostate, these glands envelop the urethra and contain prostate-specific antigen (PSA), an enzyme that can indicate prostate health in males. Although their precise function is unknown, they are thought to provide genital lubrication. At the time of sexual climax, they can release a small amount of fluid into the urethra, paralleling the male release of prostate fluid at the time of ejaculation.

Similar to the male prostate that is subject to inflammation and infections (prostatitis), the Skene’s glands can be similarly afflicted, a condition known as Skenitis.  Skenitis can give rise to the following symptoms:

  • A urinary infection that fails to be cured or reoccurs after appropriate treatment with a course of antibiotics
  • Pain at the urethral opening or at the top wall of the vagina
  • Pronounced tenderness with contact, e.g., touch, tampon insertion, sexual intercourse, tight clothing

Pelvic examination in a patient suffering with Skenitis usually shows the following:

  • Tenderness at the urethral opening or just within the vagina
  • A discharge of pus from the Skene’s glands ducts (tiny openings visible at 10 o’clock and 2 o’clock relative to the urethral opening) that can be expressed by compressing the urethra
  • A red and inflamed mass around the urethra (para-urethral mass)

Treatment of Skenitis usually involves a prolonged use of a potent antibiotic in conjunction with supportive measures, including warm, moist compresses and sitz baths. A 4-week course of antibiotics is often required (similar to the prolonged course necessary for treating prostatitis). At times a Skene’s abscess needs to be aspirated with a needle and syringe, or alternatively drained.  If the Skenitis does not respond satisfactorily to antibiotics and supportive measures, a surgical procedure may be required to remove the diseased portion of the urethra with the infected Skene’s gland.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Female Urethral Diverticula: What You Need to Know

December 15, 2018

Andrew Siegel MD  12/15/2018

This is a continuation of entries that deal with female urogenital maladies.  Today’s entry is on the topic of urethral diverticula, out-pouchings of the inner lining of the urethral channel that cause a vaginal bulge and often makes for an unhappy patient.  The good news is that this situation can be readily fixed.  (For the record, diverticulum is singular, diverticula is plural.)

IMG_0452

I’m not much of an artist, but I tried my best.  On left is cross section of the urethra and on right side view of bladder and urethra. 

The urethra is the channel that conducts urine from the urinary bladder to its external opening on the vestibule.  A urethral diverticulum is an out-pouching or herniation of the inner lining (mucosa) of the urethra through a defect in the outer urethral supporting tissue (peri-urethral fascia) causing a mass in the top wall of the vagina.  Most urethral diverticula are located in the mid or terminal part of the urethra.

Urethral diverticula, many of which are small and not symptomatic, occur in up to 5% or so of adult females. The average age at presentation is 40 years old. They commonly cause a mass or lump in the anterior (top) vaginal wall as well as dribbling of urine after urinating, burning or pain with urination and pain with sexual intercourse.  They often cause urinary infections that are unresponsive or poorly responsive to antibiotic treatment. On occasion, a urethral diverticulum may cause obstructive lower urinary tract symptoms (a hesitant, weak, intermittent spraying quality urinary stream) and rarely, the inability to urinate.

The classic 3 Ds of urethral diverticula:

  • dysuria (painful and burning urination)
  • dribbling (urinary leakage after finishing urinating)
  • dyspareunia (painful sexual intercourse)

The underlying cause of urethral diverticula is often infection and/or obstruction in the para-urethral glands.  These glands surround the urethra and communicate with it via ducts.  When these ducts become obstructed, the glands can become infected and lead to abscess formation which subsequently ruptures into the urethra. During the healing phase, the cells that line the urethra can then grow out into the cavity formed by the ruptured abscess, forming a urethral diverticulum.

Pelvic exam typically reveals a tender, firm, cystic swelling of the anterior vaginal wall. When the swelling is manipulated, urine or possibly pus may be expressed through the urethra. MRI is the imaging test of choice for further evaluating the anatomical details, location and complexity of urethral diverticula. The MRI will show whether the diverticulum is simple or complex, as occasionally they may be multiple, may encircle the urethra (“saddlebag” diverticulum) or may involve the bladder neck or sphincter. Another important test is urethroscopy, a visual inspection of the urethra using a small, lighted instrument to establish the location of the connection site between the diverticulum and the urethra.

Not all urethral diverticula require treatment, particularly if they are small and not symptomatic. Conservative measures that may relieve symptoms include compressing the diverticulum after urinating to preclude the post-void dribbling, antibiotics and using a needle and syringe to aspirate the contents.

Surgical management of symptomatic urethral diverticula involves excision of the diverticulum (urethral diverticulectomy) with repair of the urethra (urethroplasty). The surgery is performed via a vaginal incision and requires complete removal of the diverticular sac(s) down to the connection with the urethra with a multi-layered, tension-free closure. In the event of an infected diverticulum, it is important to treat with antibiotics prior to the surgery to eradicate the infection as best as possible. The procedure is generally done on an outpatient basis and requires a urinary catheter (typically for 7–14 days) antibiotics, pain medication, and a bladder relaxant.

Urethral diverticulectomy has a high success rate with respect to alleviation of the presenting symptoms and resumption of normal urinary function. As in any surgical procedure, there is always a small risk of complications. In general, the closer a urethral diverticulum is located to the bladder neck (where the urethra and bladder meet), the greater the risk for complications. Risks include bladder or ureteral injury, urinary incontinence, urethral stricture (scarring resulting in narrowing of the channel), urethral-vaginal or vesico-vaginal fistulas (abnormal connection between the vagina and the urethra or the vagina and bladder) and recurrence of the urethral diverticulum.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Vesico-Vaginal Fistula (VVF): What You Need to Know

December 8, 2018

Andrew Siegel MD 12/8/2018

The last few entries have been geared towards men.  This week’s and next week’s entries address female urogenital maladies.  Today I cover a specific type of fistula–an abnormal connection between two body parts that are normally not connected –specifically one that occurs between the bladder and the vagina and that often leads to miserable urinary leakage issues. 

Vesicovaginal_Fistula

By BruceBlaus [CC BY-SA 4.0  (https://creativecommons.org/licenses/by-sa/4.0)%5D, from Wikimedia Commons

A vesico-vaginal fistula (VVF) is an abnormal hole or connection between the bladder and the vagina that causes continuous and persistent urinary leakage. Urine from the bladder drains from the fistula into the vagina, resulting in high-volume, continuous urinary leakage out of the vagina.

In the USA the most common cause is gynecological surgery, with abdominal hysterectomy accounting for the majority.  Other causes are urological and pelvic surgery, pelvic cancers and radiation therapy. My most recent patient with a VVF had a retained (long forgotten about) pessary used to treat her pelvic organ prolapse, which eroded from the vagina into the urinary bladder creating the fistula.

However, on a worldwide basis, the most common cause of VVF is an obstetrical fistula that occurs in third-world nations, particularly in West Africa. This is the most extreme form of birth trauma, a not uncommon, horrific problem endemic in poverty-stricken countries where pregnant women have poor access to obstetric care. It happens after enduring days of “obstructed” labor, with the baby’s head persistently pushing against the mother’s pelvic bones during labor contractions. This prevents pelvic blood flow and causes tissue death, resulting in a fistula between the vagina and the bladder and/or vagina and rectum. These fistulas are often huge and are totally different entities compared to the fistulas resulting from hysterectomies that are seen in first-world nations. When birth finally occurs, the baby is often stillborn.  The long-term consequences for the mother are severe urinary and bowel incontinence, shame and social isolation.

Fistulas can vary in size from tiny, pinpoint fistulas to those that are several centimeters in diameter.  A simple fistula is solitary and small in diameter; complex fistulas include those that are large, multiple, recurrent after previous repairs and those associated with pelvic radiation.  Most fistulas occur because of tissue “necrosis” (tissue death) and do not cause symptoms for several days to several weeks following the initial instigating surgery. The tissue necrosis is often caused by sutures inadvertently placed in the bladder wall in an effort to control pelvic bleeding.

The classic presentation of a VVF is urinary leakage from the vagina that occurs a few days to a few weeks following a hysterectomy. Evaluation is via pelvic examination in conjunction with cystoscopy (using a small lighted instrument to visualize the bladder) and vaginoscopy (using a small lighted instrument to visualize the vagina).  The location, size and number of fistulas present are determined as well as the extent of inflammation associated with the VVF.

Small fistulas may occasionally heal spontaneously with prolonged urinary catheter drainage.  Tiny fistulas can sometimes be dealt with via cauterization (searing them with electrical current), although most fistulas will be need to be repaired with surgery.

Surgical repair of a VVF can be via a vaginal or abdominal approach depending on circumstances and surgeon preference. In general, simple fistulas involving the more superficial vagina can be treated using vaginal approaches. Advantages of the vaginal approach are avoiding opening the bladder, minimal blood loss and less post-operative discomfort and the ability to do the procedure on an outpatient basis.

Complex fistulas that involve the deeper vagina can be repaired vaginally, although the abdominal approach is often preferred.  Vaginal repair can be facilitated with the use of either a flap of the labial fat pad (Martius repair) or alternatively, with the use of a flap of muscle tissue attached to its blood supply (often gracilis muscle).  Nowadays, the abdominal approach is often a robotic-assisted laparoscopic technique that has numerous advantages over the older, open technique.

In either case, important principles of surgical repair of a VVF are the following:

  • Waiting a sufficient time period after diagnosis to allow the inflammation and tissue swelling to subside to optimize tissue health and suppleness. The repair should not be attempted if devitalized tissues, infection, inflammation or encrusted deposits on the tissues are present. The timing needs to find middle ground between optimal conditions for closure and the desire to minimize the duration of the annoying and distressing constant urinary leakage.
  • Any urinary infection needs to be treated with antibiotics in advance of the surgery
  • Topical estrogen can be used to optimize vaginal tissue integrity
  • Careful tension-free closure of the VVF in several non-overlapping suture lines (bladder layer and vaginal layer) often with interposition of additional tissue (interposition flaps include omentum or peritoneum for abdominal repairs; peritoneum or labial fat for vaginal repairs) between the bladder and vaginal walls to buttress the repair. A flap of vaginal wall is advanced to cover the repair.
  • Urinary catheter for several weeks after the repair for purposes of continuous urinary drainage to facilitate the healing process by keeping the bladder decompressed of urine
  • Bladder relaxant medication post-operatively to minimize involuntary bladder contractions
  • Post-operative antibiotics

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Medical “Urban” Myths in Urology

December 1, 2018

Andrew Siegel MD  12/1/2018

I am pleased to announce that with this entry I have surpassed 400 blogs composed over the past seven years.

Myth:  a widely held but false belief or idea; a misrepresentation of the truth; a fictitious or imaginary thing; exaggerated or idealized conception

thank you Pixabay for image above

Part I of today’s entry confronts widely held but false medical concepts that run rampant in the general population. Part II addresses widely held but false medical concepts that run rampant within the medical field. The medical mythology I attempt to debunk is largely urological in nature.

General population medical myths: Some myths are perpetuated by the general (non-medical) community, consisting of erroneous beliefs and inaccurate presumptions. These falsehoods often require a great deal of physician time in an effort to disabuse patients of them. 

Medical community medical myths: Some aspects of the practice of medicine are on the basis of customs perpetuated by medical personnel (most often not physicians) that seem logical or justified and ultimately become accepted dogma. However, they often do not hold muster, crumble under scientific scrutiny and can be categorized as medical myths.   

GENERAL POPULATION MEDICAL MYTHS

“A vaccine caused my child’s autism.”

(This is a non-urological myth, but nonetheless needs to be addressed.)

Myth: Vaccines, particularly MMR (measles, mumps, rubella) cause neurological injuries including autism spectrum disorder.

Reality: Scientific evidence overwhelmingly shows no correlation between vaccines in general, MMR vaccine in specific, and thimerosal (a mercury-based preservative) in vaccines with autism spectrum disorders or other neuro-developmental issues. 

We have come a long way on the immunization and vaccination front, wiping out a significant number of diseases completely.  In children, vaccines have been among our most effective interventions to protect individual as well as public health. What a great means of reducing  risk for certain infections that are potentially lethal, if not capable of incurring significant morbidity.  Vaccinations are now available for hepatitis A and B, diphtheria, tetanus, pertusis, polio, hemophilus, measles, mumps, rubella, varicella, meningitis, cervical cancer/human papilloma virus, influenza and pneumococcal pneumonia and herpes zoster (shingles).

“Doing a prostate biopsy will spread any cancer that may be present.”

Myth: Using a needle to obtain tissue samples of the prostate allows cancer cells to seed and implant along the needle track, or alternatively, into blood or lymphatic vessels. 

Reality: Although this is a theoretical consideration, the truth of the matter is that based upon millions of prostate biopsies performed annually in the USA, the incidence of seeding is virtually non-existent and the potential risk can be thought of as being negligible at best.

“Cancer spreads when exposed to oxygen.”

Myth: When a body is opened up and exposed to oxygen any cancer present can readily spread.

Reality: There is no scientific evidence that supports cancer advancing because of exposure to air/oxygen.  At times, upon doing an exploratory surgery, more cancer is discovered than was anticipated based upon imaging studies. This has nothing to do with the surgical incision nor exposure to air/oxygen, but is simply on the basis of cancer that did not show up on the diagnostic evaluation.

“All prostate cancer is slow growing and can be ignored.”

Myth: Prostate cancer grows so slowly that it can be disregarded. 

Reality:  Every case of prostate cancer is unique and has a variable biological behavior.

Yes, some are so unaggressive that no cure is necessary and can be managed with surveillance; however, others are so aggressive that no treatment is curative, and many are in between these two extremes, being moderately aggressive and highly curable. A major advance in the last few decades is the vast improvement in the ability to predict which prostate cancers need to be actively treated and which can be watched, a nuanced and individualized approach.

Those who feel that prostate cancer should not be sought out and treated should be attentive to the fact that it is the second leading cause of cancer death, with an estimated 30,000 deaths in 2018, and furthermore, that death from prostate cancer is typically an unpleasant one

MEDICAL COMMUNITY MEDICAL MYTHS

“Drink lots of fluids to flush out kidney stones.”

Myth: Drinking copiously will help promote passage of kidney and ureteral stones. The rationale of this advice is that by hydrating massively, a head of pressure will be created to help passage of a stone present in the kidney or ureter.

Reality: The presence of a stone often causes urinary tract obstruction.  Over-hydration in the presence of obstruction will further distend the already bloated and inflated portion of the urinary collecting system located above the stone. This increased distension can exacerbate pain and nausea that are often symptoms of colic. The collecting system of the kidney and the ureter have natural peristalsis—similar to that of the intestine—and over-hydration has no physiological basis in terms of helping this process along, being pointless and perhaps even dangerous.  Drinking moderately in the face of a kidney or ureteral stone is sound advice.

“Everyone must drink 8-12 glasses of water a day.”

Myth: Many sources of information (mostly non-medical and of dubious reliability) dogmatically assert that humans need 8-12 glasses of water daily to stay well hydrated and thrive.

Reality: Many people take the 8-12 glass/day rule literally and as a result end up in urologists’ offices with urinary urgency, frequency and often urinary leakage. The truth of the matter is that although some urinary issues are brought on or worsened by insufficient fluid intake–including kidney stones and urinary infections–other urinary woes are brought on or worsened by excessive fluid intake, including the aforementioned “overactive bladder” symptoms.  Water requirements are based upon ambient temperature and activity level. If you are sedentary and in a cool environment, your water requirements are significantly less than when exercising vigorously in 90-degree temperatures.

Humans are extraordinarily sophisticated and well-engineered “machines” and your body lets you know when you are hungry, ill, sleepy, thirsty, etc.  Heeding your thirst is one of the best ways of maintaining good hydration status, in other words, drinking when thirsty and not otherwise. Another method of maintaining good hydration status is to pay attention to your urine color.  Urine color can vary from deep amber to as clear as water.  If your urine is dark amber, you need to drink more as a lighter color is ideal and indicative of satisfactory hydration

“When a patient needs to have a catheter placed because he or she is unable to urinate, clamp the catheter intermittently to allow for gradual drainage instead of allowing it to drain at once.”

Myth: Rapid bladder decompression with a catheter can cause problems including bleeding that may require intervention, kidney failure and circulatory collapse. 

Reality: Science has clearly shown that concerns for kidney failure and circulatory collapse due to rapid bladder decompression are untruths.  Yes, on occasion some bleeding can occur (with or without) rapid decompression, but it is usually self-limited and inconsequential.

“A patient is experiencing leakage around a urinary catheter, so it must be too small and replaced with a larger one.”

Myth: A catheter that leaks needs to be replaced with a larger bore catheter so as to provide a better seal and reduce the leakage. This practice is commonly applied in nursing homes where many patients have long-term indwelling catheters for a variety of reasons.

Reality:  Leakage of urine around indwelling catheters is a common scenario. Although it can be due to a blocked catheter, most often the cause is bladder spasms induced by the catheter or catheter balloon irritating the bladder. The sensible management is to irrigate the catheter to ensure no obstruction, deflate the balloon to some extent, and thereafter consider the use of a bladder relaxant medication to minimize the bladder spasms.  The best practice is always to use the smallest catheter that is effective and remove it as soon as feasible. The longer a catheter stays in, the greater the chance for infections and long-term catheters that are upsized are clearly associated with urethral erosion and urethral stricture (scarring).

“If a patient has bacteria in the urine they must have a urinary infection that needs to be treated.”

Myth: There are bacteria present in the urine on urinalysis, so there must be an underlying infection that demands antibiotic treatment.  This is one of the medical myths perpetuated by internists and general practitioners.

Reality: The thought process that the presence of bacteria in the urine without symptoms means an infection is erroneous. It is vital to distinguish a symptomatic urinary infection from asymptomatic bacteriuria. Asymptomatic bacteriuria, common in elderly and diabetics, is the presence of bacteria within the bladder without causing an infection. This does not require treatment, which is futile and promotes selection of resistant bacteria.  Asymptomatic bacteriuria should be treated only in select circumstances:  pregnant women; in patients undergoing urological-gynecological surgical procedures; and in those undergoing prosthetic surgery (total knee replacement, etc.).

An extension of this myth is that bacteria in the urine in the face of an indwelling catheter is an infection that must be treated. The reality is that in the vast amount of cases, this is bacterial colonization without infection.

Bottom Line: Lay and even medical populations are subject to medical myths—mistaken beliefs that are often passed down like memes with little to no basis in fact. These myths have no place in the art and craft of medicine and need to be challenged with real science.  

“What is dogma today is dog crap tomorrow.”

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area,Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Big Ball Series: How To Examine Your Testes (And What You Need to Know About Testicular Cancer)

November 24, 2018

Andrew Siegel MD  11/24/2018

This is the concluding segment of the “Big Ball” series of entries, which provide information about maladies of the male gonads.

Image below: testes cancer occupying entire testicle (pathology: seminoma)

Seminoma_of_the_Testis_(with_ruler)_(267781611) Attribtion: Ed Uthman from Houston, TX, USA [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

Most testes lumps, bumps and growths are benign and not problematic. Although cancer of the testicle is rare (< 9000 cases/ year in the USA), it is the most common solid cancer in young men age 15-40, with the greatest incidence in the late 20s, striking men at the peak of life.  Notable men who are members of the testes cancer club include the following: Tour de France Champion Lance Armstrong; baseball player Scott Shoenweis; skater Scott Hamilton; MTV Host Tom Green; comedian Richard Belzer; sportswriter Robert Lipsyte; and Olympian Eric Shanteau.  The great news is that it is a highly curable cancer, especially so when picked up in its earliest stages, and also potentially curable even at advanced stages.

Testes cancer has a predilection for occurring more commonly in Caucasian men as compared to African-American or Asian men and is seen more commonly in men with undescended testes and Klinefelter’s syndrome.

In its early phase, testes cancer causes a lump, irregularity, asymmetry, enlargement, heaviness or a dull ache of the testicle. It most often does not cause pain, so the absence of pain should not dissuade you from getting evaluated if you are concerned about something that does not feel right.

 Note well: If you feel that there is a lump or bump in or on your testes that was not present previously, please see a urologist. You will never be chided for being a “hypochondriac” for getting checked out; it is truly better to be safe and cautious.

Testes cancer can also present with a sudden fluid collection around the testes, breast enlargement and/or tenderness, back pain and rarely shortness of breath, coughing up of blood or a lump in the neck.

The testicles have two functions, the manufacture of sperm (via germ cells) and the manufacture of testosterone (via Leydig cells).  Most testes cancers (about 95%) are of germ cell origin.  Germ cell cancers consist either of seminomas or non-seminomas.  Non-seminomas include embryonal cell cancers, choriocarcinomas, yolk sac tumors and teratomas. Many testes cancers are mixed germ cell tumors consisting of several of the sub-types. 5% of testes cancers are of stromal cell origin, including Leydig or Sertoli cell tumors.

If a patient complains of an abnormality of the testes, the first step is a careful physical examination, usually followed by an ultrasound of the scrotum. The ultrasound will confirm if the mass is solid versus cystic (fluid-filled) and determine its precise location and size.  If the mass is suspicious for a malignancy, blood tests—known as tumor markers—consisting of alpha-feto protein (AFP), human chorionic gonadotropin (B-HCG) and lactate dehydrogenase (LDH) are routinely obtained.

An outpatient surgical procedure is necessary to remove the diseased testicle along with the spermatic cord that contains the blood and lymphatic supply of the testicle.  This is accomplished via a relatively small groin incision.  A pathologist examines the testes microscopically and determines the precise diagnosis.  At the time of surgery, some men will elect to have a testicular prosthesis implanted, whereas others are not concerned about an empty scrotal sac on one side.   Additional staging studies—repeat tumor markers after testes removal and computerized tomogram (CT) of the abdomen and pelvis as well as a chest x-ray—are often necessary to determine if there is any spread of the cancer to remote areas of the body.

Note: Stage I is confined to the testes; stage II to the regional lymph nodes (abdominal lymph nodes); stage III is distant spread.

Depending on the final pathology report and the staging studies, additional treatments may  be required.  At times chemotherapy is the treatment of choice, the go-to cocktail of medications often a combination of bleomycin, etoposide and cisplatinum (BEP).  At other times, sampling of the abdominal lymph nodes is necessary (retroperitoneal lymph node dissection) and depending on the specific pathology, at other times, radiation therapy is necessary.  In addition to the urologist, a medical oncologist and radiation oncologist often are involved with the treatment process.

The Sean Kimerling testicular cancer foundation is an awesome resource for learning more about this disease.

How to do a testes self-exam, a simple task that can be lifesaving

Since only 5% or so of men with testes cancer are diagnosed by a physician on routine physical exam and 95% are picked up in the followup of a testes abnormality noted by a man or his partner, it makes a lot of sense to learn how to do a good self exam. 

Note: For most men, touching/manipulating/rearranging their nether parts is a natural and almost reflex activity that—supplemented with a little instruction, knowledge and direction—can be put to some practical clinical use. What follows is appropriate for the partner of the man in question.  If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.  Several times in my career as a urologist, it was the man’s partner that was astute enough to recognize a problem that prompted the patient visit that determined the diagnosis of testicular cancer. 

The goal of self-exam is to pick up an abnormality– in a very early and treatable stage–at a time when testes cancer is a localized issue that has not spread to the lymph nodes or lungs, which are common sites of metastasis.

Because sperm production requires that testes are kept cooler than core temperature, nature has conveniently designed men with testicles dangling from their mid-sections. There are no organs in the body—save female breasts—that are more external and easily accessible to examination. One of the great advantages of having one’s gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to the ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at a more advanced stage.

The testicles can be examined anywhere, but a warm shower or bath is an ideal setting as the warm water tends to relax and thin the scrotal sac and allow the testes to descend to a position that is most accessible.  Soapy skin will eliminate friction and allow the examining fingers to easily roll over the testicles.

The exam is best performed with the thumb in front and the remaining fingers behind the testicles.  The four fingers immobilize and support the testicle and the thumb does the important work in examining the front, sides, top and bottom of the testicle; then the thumb immobilizes the front while the four fingers examine the back of the testes.  When examining the back surface of the testicle, the index and middle fingers will do most of the work. The motion is a gentle rolling one, feeling the size, shape, and contour and checking for the presence of lumps and bumps.

Compare the two testes in terms of size, shape and consistency.  Generally, the testicles feel firm, similar to the consistency of hard-boiled eggs, although this can vary between individuals and even in an individual.  Lumps can vary in size from a kernel of rice to a large mass many times the size of the normal testes.  The epididymis is a comet-shaped structure located above and behind the testes that is responsible for sperm storage and maturation.  It has a head, a body and tail, and it is worthwhile running your fingers over this structure as well.

This exam should be done regularly—perhaps every couple of weeks or so—such that you get to know your (or your partner’s) anatomy to the extent that you will be attuned to a subtle change.  Once you get in the habit of doing this on a regular basis, it will become second nature and virtually a subconscious activity that only takes a few moments.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

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These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor