Posts Tagged ‘Andrew Siegel MD’

The Prostate Gland: Man’s Center of Gravity

February 16, 2019

Andrew Siegel MD  2/16/19

This entry can be considered to be “Prostate 101: Introductory Level.”  The prostate gland is a mysterious male reproductive organ that can be a source of curiosity, anxiety, fear and potential trouble. Since this gland is a midline organ nestled deep within the pelvis, I like to think of it as man’s “center of gravity.”  

Center_of_pressure_in_relation_to_center_of_gravity_while_off_balance

Attribution: Jasper.o.chang [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D; image unmodified; COG = center of gravity, COP = center of pressure

Where exactly is the prostate gland?

The prostate gland is located behind the pubic bone and is attached to the bladder above and the urethra below. The rectum is directly behind the prostate (which permits access for prostate exam).  The prostate is situated at the crossroads of the urinary and reproductive tracts and completely envelops the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of problems for the older male. With the aging process, this gland gradually enlarges and as it does so, this prostate enlargement can compress and obstruct the urethra, giving rise to bothersome urinary symptoms.  Note normal prostate on left and enlarged prostate on right in image below.

Benign_prostatic_hyperplasiaImage above, public domain, Wikipedia, illustrator unknown

What is the prostate, what purpose does it serve, and how does it function?

The prostate is a male reproductive gland that functions to produce prostate fluid, a nutrient and energy vehicle for sperm. The prostate consists of glandular and fibro-muscular tissue enclosed by a capsule of collagen, elastin and smooth muscle. The glandular tissue contains the secretory cells that produce the prostate fluid.

Semen is a “cocktail” composed of prostate fluid mixed with secretions from the seminal vesicles and sperm from the epididymides. The seminal vesicle fluid forms the bulk of the semen. The seminal vesicles and vas deferens (tubes that conduct sperm from testes to prostate) unite to form the ejaculatory ducts.

Prostate And Seminal Vesicles

At the time of sexual climax, prostate smooth muscle contractions squeeze the prostate fluid through prostate ducts at the same time as the seminal vesicles and vas deferens contractions squeeze seminal fluid and sperm through the ejaculatory ducts. These pooled secretions empty into the urethra (channel that runs from the bladder to the tip of the penis).  Rhythmic contractions of the superficial pelvic floor muscles result in the ejaculation of the semen.

What are the zones of the prostate gland?

The prostate gland is comprised of different anatomical zones. Most cancers originate in the “peripheral zone” at the back of the prostate, which can be accessed via digital rectal exam. The “transition zone” surrounds the urethra and is the site where benign enlargement of the prostate occurs. The “central zone” surrounds the ejaculatory ducts, which run from the seminal vesicles to the urethra.

Prostate Zones

Curious Facts About the Prostate

  • The prostate functions to produce a milky fluid that serves as a nutritional vehicle for sperm.
  • Prostate “massage” is sometimes done by urologists to “milk” the prostate to obtain a specimen for laboratory analysis.
  • The prostate undergoes an initial growth spurt at puberty and a second one starting at age 40 or so.
  • A young man’s prostate is about the size of a walnut, but under the influence of aging, genetics and testosterone, the prostate gland often enlarges and constricts the urethra, which can cause annoying urinary symptoms.
  • In the absence of testosterone, the prostate never develops.
  • The prostate consists of 70% glands and 30% muscle. Prostate muscle fibers contract at sexual climax to squeeze prostate fluid into the urethra.  Excessive prostate muscle tone, often stress-related, can give rise to the same urinary symptoms that are caused by age-related benign enlargement of the prostate.
  • Women have a female version of the prostate, known as the Skene’s glands.

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. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

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Preview of Prostate Cancer 20/20

3-minute video trailer for Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

 

 

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Nubbins On Your Nuts: What You Should Know About Tunica Cysts

February 9, 2019

Andrew Siegel MD    2/9/2019

Gray1149

Image of testes and its tunics (covering sheaths) from Gray’s Anatomy (public domain)

The tunica albuginea is the dense fibrous sheath that surrounds, covers and protects the delicate contents of each testicle. The tunica albuginea is surrounded by a second layer, the tunica vaginalis. Benign cystic masses may arise from either tunic.

Cysts originating from the tunica albuginea are the most common benign masses that originate external to the testicle. They are small, firm, irregular, plaque-like nubbins located on the surface of the testes ranging from 2-5 mm in size.  They are often described as feeling like a “grain of rice.” They are most often found  on the upper front or upper side aspect of the testicle. In most cases they are minimally symptomatic and are discovered incidentally by the patient, who is typically around 40 years of age.

These cysts can cause a great deal of concern and worry because of the fear of testes cancer, but they are distinguished from testes cancer by being cystic (not solid) and on the outer surface of the testes as opposed to being within the testes.  Ultrasonography is the imaging study of choice for evaluating testicular masses and can differentiate cystic, benign masses from solid, malignant masses.

On ultrasound the tunica albuginea can be seen as a 2-layered echogenic (containing lots of echoes) structure surrounding the testicle and the cyst as a small, regular fluid-filled structure abutting the surface of the testicle (see below).  On occasion, a tunica cyst may calcify. Microscopically, they are seen to contain fluid and cellular debris.  Although these cysts can be surgically excised, it is only rarely necessary to do so because ultrasound can reliably confirm their benign diagnosis.

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Tunica albuginea cyst on ultrasound
       (cyst is black oval structure)

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. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

Dr. Siegel is the author of 5 books: FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

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

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

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

 and hot off the press is PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

Andrew Siegel MD Amazon author page 

 

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Ouch…Male Pain Down Below: What You Need To Know

February 2, 2019

Andrew Siegel MD  2/2/2019

Pelvic floor tension myalgia is often the root cause of many common “male problems,”  yet remains a mysterious, misunderstood, misdiagnosed and mistreated condition. 

shutterstock_side view manjpeg

 

“Chronic prostatitis” is a frequently bandied about term–a diagnosis tagged to a variety of different conditions having in common discomfort or pain perceived in the pelvic, groin, genital and perineal (“taint”) regions. It is often considered to be a “wastebasket” diagnosis, a diagnostic consideration after other processes are ruled out.  Chronic prostatitis is a term as commonly used by the urologist as “irritable bowel syndrome” is by the gastroenterologist.  In chronic prostatitis the prostate is treated as the source of the pelvic pain, but the truth of the matter is that the prostate is rarely the source.

The term “itis” refers to infection or inflammation of the organ in question… but 90%  of men diagnosed with “chronic prostatitis” do not have an infected or inflamed prostate gland! What many actually have is tension myalgia of the pelvic floor muscles, a condition in which the pelvic floor muscles are tense, spastic and hyper-contractile. Essentially, this is a “headache” or “Charley horse” of the pelvis driven by spastic pelvic floor muscles.

IMG_1544

Tension myalgia is an unrelaxed state of muscle tone, similar to a fist clenched tightly

Muscle tension anywhere in the body is not a favorable state of affairs.  (I sometimes get muscle spasms in my neck muscles that causes a tension headache that requires ibuprofen, a heating pad and massaging to relieve.  However, the neck is not a terrible place for muscle spasm, certainly minor compared to the pelvis.)  The pelvis is a particularly unfortunate place for spastic muscles because it is home to urinary, sexual and bowel function.  The pelvic floor muscles form the floor of the pelvis (and the floor of the “core” group of muscles) and have openings for the urinary and intestinal tracts that pass through these muscles, so you can imagine how tension and spasm may affect the function of these systems.

This spasticity of these muscles makes one feel that their pelvic muscles are “tied in a knot.” The resulting pain is often perceived in the genitals, lower urinary tract, and rectal/anal areas, and accompanying the pain are often adverse effects on sexual, urinary, and bowel function.  The situation can give rise to voiding difficulties (difficulty starting or emptying, poor quality stream, post-void dribbling), overactive bladder (urgency, frequency, urgency incontinence), erectile dysfunction, ejaculatory dysfunction (premature ejaculation, painful ejaculation, reduced ejaculatory strength), and bowel difficulties (constipation, hemorrhoids, fissure, etc.).

What causes this situation of taut and spastic pelvic floor muscles?  The answer is  anything that can give rise to muscle tension anywhere else in the body, some of the key triggers being stress and anxiety.  Stress and anxiety “turned inward” is thought to trigger dysfunction of the nerve pathway that regulates muscle tone.

Characteristically, the pain of pelvic floor tension myalgia waxes and wanes in intensity over time and wanders to different locations in the pelvis, possibly involving the lower abdomen, groin, pubic area, penis, scrotum, testicles, perineum, anus, rectum, hips, and lower back. The pain is often described as “stabbing” in quality and can be provoked by urination, bowel movements or sexual activity/ejaculation or even activities including driving a car or wearing tight clothing.

Because of the variable, vague and “wandering” manifestations of this condition, patients often have difficulty in precisely articulating their symptoms, although they usually have a fairly long list of issues, numerous prior interventions and have seen many physicians.  After identifying this condition in a number of patients, in retrospect it seems to be an obvious diagnosis.  To make the diagnosis, it is vital to take a careful history and do a tailored physical exam, which includes an evaluation for “trigger points” of the pelvic floor muscles that, when examined, cause tremendous pain.

The patient profile of a man suffering with this condition is often predictable. A thirty-something or forty-something, well-dressed male with excellent posture and a type A personality (competitive, ambitious, organized, impatient, etc.) presents with vague pelvic pain symptoms that he has difficulty in describing. In addition to the pain he often notes urinary, rectal, erectile and ejaculatory issues. He usually has a professional, high-level, stressful occupation and his physical appearance and body language is “tight,” paralleling the tone of his pelvic floor muscles. He tends to be “driven” and have a compulsive, controlling and disciplined personality and typically exercises on a regular basis and is in good physical shape. He has been evaluated by numerous urologists and has been treated with many courses of prolonged antibiotics (to minimal benefit) and has been labeled as having chronic prostatitis. He is often miserable and perhaps at wits end because of having endured years of episodic pain. He is worried and emotionally stressed about his pain. It is not uncommon to discover that the pain seemed to be precipitated by a situation deemed to be a personal failure such as involvement in a divorce, loss of a job or other event. On digital rectal exam, he has very tight anal tone and has tenderness, spasticity and often knots that can be felt within the levator ani muscles, similar to the tension knots that can develop in one’s back muscles.

The current theory is that this chronically over-contracted group of muscles is a manifestation of stress and anxiety turned inwards, a classic example of the mind-body connection in action. This state of chronic “over-vigilance” seemingly serves the purpose of guarding and protecting the genital and rectal regions. When anxiety expresses itself through tension in the pelvic floor, the physical tension further contributes to the emotional anxiety and stress, which creates a vicious cycle.  The pelvic floor muscles are responsible for tail wagging in canines and tension myalgia of the pelvic floor parallels what a frightened dog does when it pulls its tail between its legs, protecting the genital and anal regions.

Conventional urologic practice is nuts-and-bolts-mechanistic–slow to accept the concept that stress and other psychosocial factors can give rise to genuine urological conditions–and has a dismissive attitude towards psychosomatic symptoms.   However, an understanding of the issue of tension myalgia of the pelvic floor muscles is slowly gaining traction and recognition and in 2019 we are approaching a tipping point in which this type of diagnosis is a more frequent consideration in those men presenting with pelvic pain.

To manage tension myalgia, it is necessary to relax the spastic pelvic floor muscles and untie the “knots.” There are a variety of means of doing so, including relaxation techniques, stretching, hot baths, massage, and muscle relaxants. Many men respond well to physical therapy sessions with skilled pelvic physiotherapists who are capable of trigger point therapy, which involves compressing, massaging and elongating the knotted and spastic muscles.

Those who are so inclined can treat themselves with a therapeutic internal trigger point release rectal wand that aims to eliminate/mitigate the knots. This treatment is referred to as the Stanford pelvic pain protocol or alternatively, the Wise-Anderson protocol (designed by David Wise, a psychologist, Rodney Anderson, a urologist, and Tim Sawyer, a physiotherapist).

When used judiciously, pelvic floor muscle training programs can be of benefit to patients suffering with this condition.  Pelvic training serves to instill awareness of and develop proficiency in relaxing the pelvic muscles (as opposed to more typical purpose of such a program, which is strength and endurance training.)

Bottom Line: The diagnosis of pelvic floor muscle tension myalgia should be a primary consideration for all men presenting with pelvic pain. Physical interventions can be extremely helpful in alleviating the pain and untying the pelvic floor “knots.” By making the proper diagnosis and providing pain relief, the vicious cycle of anxiety/pain can be broken.

For a wonderful reference, consult: Dr. Wise and Anderson’s book, A Headache in the Pelvis: A New Understanding and Treatment for Chronic Pelvic Pain Syndromes.

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. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

Dr. Siegel is the author of 5 books: FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

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

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

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

 and hot off the press is PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

Andrew Siegel MD Amazon author page 

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

January 26, 2019

Andrew Siegel MD    1/26/2019

NEW BOOK!

front 3d smallFor the past year I have been busy writing a book on prostate cancer geared for newly diagnosed patients and their families. It originated in the form of a 50-page monograph  that I crafted about a decade ago, conceived out of frustration from the lack of availability of a streamlined, practical, accessible and trustworthy medical resource to help patients and their families navigate through the formidable process of prostate cancer diagnosis and management. The manual proved to be beneficial for my urology patients and was reprinted in 2011.

In early 2018, with few copies remaining and time for a reprint, I recognized that since the previous iteration there had been an unprecedented number of advances in prostate cancer diagnosis and management. These included improvements in screening, increasingly sophisticated imaging techniques, the development of genomic and genetic testing, the availability of an array of new medications, continued technical advances in surgical, radiation and focal therapies and the blossoming of the era of “active surveillance.”

Because of the need for a major content update, I decided to expand the monograph into a more comprehensive format that could be of value not only to the patients in my urology practice, but also to any man confronting the challenges of a prostate cancer diagnosis. I aimed to stay true to my original goals of providing a concise, straightforward and easily understandable resource.

I had numerous medical colleagues help me to bring this book to fruition: my robotic urology partners (Drs. Wright, Christiano, Lovallo, Ahmed, Esposito, Goldstein, Lanteri),  radiation oncologists (Dr. Harrison and Dr. Gejerman), medical oncologists (Dr. Alter and Dr. Orsini), a urologist with expertise in high intensity focused ultrasound (Dr. Grunberger), a radiologist with expertise in prostate MRI (Dr. Waxman) an anatomical pathologist (Dr. Peters), a sexual educator who is the president of the E.D. foundation (Paul Nelson) and a pelvic floor physiotherapist (Niva Herzig).

Because most patients with prostate cancer have an excellent prognosis, the long-term consequences of the disease are often, in fact, the side effects of treatment.  Therefore, I considered it vital to provide in-depth information on the most common complications following treatment, namely sexual dysfunction and urinary incontinence, quality of life issues that are sometimes given short shrift or neglected in the patient education process. Furthermore, I elected to cover the important topic of bone health, which can be compromised by prostate cancer itself, as well as by some of the treatments for the disease.  Perhaps the most challenging area to cover was castrate resistant prostate cancer, made complex by the profusion of exciting new treatment options.

The title of the book— PROSTATE CANCER 20/20: A Practical Guide To Understanding Management Options For Patients And Their Families—is the same as that of the preceding monograph with the exception of the addition of “20/20.”  I did so to specify the year that looms in the near future, signifying the up-to-date content, and secondly to refer to “20/20” vision, the clarity and perspective that I wish to impart.

Along with my professional relationship with prostate cancer, I also have a personal relationship with it. In 1997, the senior partner in my urology group practice—my father—was diagnosed with prostate cancer.  The news was shocking to me and I clearly remember the day of diagnosis and the long run I went on to help me process it. Fortunately, he was successfully treated with an open radical prostatectomy and today is a thriving octogenarian.  Despite this, the emotional events of the day of his surgery, my interaction with his surgeon, his time in the hospital, the drive home on his day of discharge, and my removal of his surgical drain, skin staples and catheter will be forever seared into my memory.

Every case of prostate cancer is unique and has a variable biological behavior, which creates the need for treatment that is individualized and nuanced. The bewildering array of management options available can cause a great deal of confusion for the individual (and his family, friends and others who support him) grappling with trying to determine how best to be treated. My intent of the book is to provide knowledge and information to help guide the reader and his loved ones through his therapeutic journey, reviewing the advantages and disadvantages of each management option in as impartial a means as is possible. Being informed empowers the prostate cancer patient to be actively involved as a participant in decisions about his care, which enables making the choice of the best option in order to minimize decisional conflict and regret.

Prostate Cancer 20/20 preview

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. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

Andrew Siegel MD Amazon author page 

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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

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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

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