Posts Tagged ‘urology’

What is Urology?

September 8, 2018

Andrew Siegel MD   9/8/2018

Fact: Chances are that if you haven’t yet seen a urologist, you will at some point in your life.  Sooner or later human plumbing problems surface!

 

900px-Urinary_System_(Male)

Image above by-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)%5D, from Wikimedia Commons

Male_reproductive_tract

Male Reproductive System

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

“Urology” (“uro”—urinary tract and “logos”—study of) is a surgical specialty concerned with the diagnosis and treatment of diseases of the urinary tract in females and of the urinary and genital tracts in males. Urology uses both medical and surgical strategies to treat a variety of conditions and employs many minimally-invasive technologies including fiber-optic endoscopy that enables visualization of the entire inner lining of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics.  Today’s entry explores what urologists do, how they are trained, and demographics.

Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health. Organs under the “domain” of urology include the adrenal glands, kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder and the urethra (the channel that conducts urine from the bladder to the outside).  The male reproductive organs include the testicles, epididymides (structures located above and behind the testicles where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (the structures that produce the bulk of semen), prostate gland and, of course, the scrotum and penis.  The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as “genitourinary” specialists.

There is overlap in what urologists do with other medical and surgical disciplines, including nephrology (doctors who specialize in medical diseases of the kidney); oncology (cancer specialists); radiation oncology (radiation cancer specialists); radiology (imaging); gynecology (female genital specialists); and endocrinology (hormone specialists).

Urologists treat many serious and potentially life-threatening illnesses, particularly cancers of the genital and urinary tracts. In the United States, prostate cancer accounts for almost 20% of new cancer cases in men, bladder cancer for 7%, and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) for 5%.  Testicular cancer is relatively rare but is also under the treatment domain of urologists.  Urologists treat women with kidney and bladder cancer, although the prevalence of these cancers is much less so in females.

Common reasons for a referral to a urologist are the following: blood in the urine, whether visible or picked up on a urinalysis; blood in the semen, an elevated PSA (Prostate Specific Antigen) or an accelerated PSA over time; prostate enlargement; irregularities of the prostate on digital rectal examination; urinary difficulties ranging from urinary incontinence to the inability to urinate (urinary retention) and urinary tract infections.

Urologists manage a variety of non-cancer issues. Kidney stones, which can be extraordinarily painful, are especially prevalent in the hot summer months. Infections are a large part of urology practice and can involve the bladder, kidneys, prostate, testicles and epididymis. Sexual dysfunction is a very common condition managed by the urologist—under this category is erectile dysfunction, ejaculation problems, and libido and testosterone issues. Urologists treat not only male infertility, but also create male infertility when it is desired by performing voluntary male sterilization (vasectomy).  Urologists are responsible for caring for many scrotal issues including testicular pain and swelling.

Training to become a urologist involves attending 4 years of medical school following college and 1–2 years of general surgery training followed by 4 years of urology residency. Thereafter, many urologists like myself pursue additional sub-specialty training in the form of a fellowship that can last anywhere from 1–3 years.  Urology board certification can be achieved if one graduates from an accredited residency and passes a written exam and an oral exam and has an appropriate log of cases that are reviewed by the board committee.  Thereafter, one must maintain board certification by participating in continuing medical education and passing recertification exams.  Becoming board certified is the equivalent of a lawyer passing the bar exam.

In addition to obtaining board certification in general urology, there are two specialties in which specialty board certification can be obtained—pediatric urology, which is the practice of urology limited to children, and female pelvic medicine and reconstructive surgery (FPMRS), which involves female urinary incontinence, pelvic organ prolapse and other urological/gynecological issues.

Urology is largely a male specialty, although women have been entering the urological workforce with increasing frequency because female students now comprise more than 50% of the United States medical school population. There are approximately 10,000 practicing urologists in the USA, of which about 500 are women. The aging population will demand more urological services; this coupled with the aging of the urological workforce and the contraction of the number of practicing urologists due to retirement does not bode well for the balance of supply and demand in the forthcoming years.  Hopefully, there will be enough urologists to provide the urological care to those that need it.

finger-2

The index finger (nice and narrow) of yours truly, one of the most vital instruments used by the urologist

 

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

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Try This First Before Seeing A Urologist

June 9, 2018

Andrew Siegel MD  6/9/2018

Picture1

Many suffer with urinary urgency and frequency, requiring repeated trips to the bathroom.  Although not serious or life-threatening, it is annoying and inconvenient.  After happening repeatedly, it can be become an ingrained habit that is difficult to break.  Concerns surface about sitting in traffic, traveling, seeing a Broadway show, getting the right seat on an airplane, etc.

 If you are dealing with an urgency/frequency issue, you may benefit from “bladder retraining.”  It is relatively simple, requires neither medication nor surgery, and can help you control when you urinate, how often you urinate and allow you to delay urinating. 

What happens under normal circumstances

As the bladder gradually fills, most people ignore the initial sense of urgency, continuing to go about their life and carrying on with their activities.  As the bladder continues to fill, they continue to tune out the sense of urgency until the point that it becomes compelling enough so that they are motivated to leave their activity and go to the bathroom to empty their bladder.

What happens to the frequent urinator

For one reason or another, the frequent urinator often becomes “hyper-vigilant” about their sense of urinary urgency.  For him or her, the bladder is “front burner” and not “back burner.”  This may be based on a previous physical bladder problem that gave rise to the hyper-focus, commonly a urinary infection. The frequent urinator often responds to the initial sense of urgency by acting upon it and heading to the bathroom to empty their bladder.  When this behavior is habitually repeated, it becomes a dysfunctional ingrained habit—the “new normal,” and again, a habit that is tough to break. The bottom line is that when there is excessive focus on the sensations arising from the bladder (or for that matter, any part of the body), one will be hyper-acutely aware of sensations that they normally are not cognizant of.

As another example of this, if you focus on the weight of your watch on your wrist or your ring on your finger, within a matter of minutes, their presence will start annoying you.  No good comes of when background becomes foreground!

A 24-hour bladder diary (log of urination recording time of urinating and the volume of each urination) is a simple but helpful tool in sorting out the different causes of urgency/frequency.  Since normal bladder capacity is about 12 ounces, if the diary shows frequent voids of full volumes, the problem is most likely related to excessive fluid intake (or rarely a kidney or hormonal problem that can cause excessive urinary production).  However, if the diary shows frequent voids of small volumes (e.g., 4 ounces), the problem can often be improved with bladder retraining. If the diary shows frequent voids of small volumes during the day, but full volume voids while sleeping or no voids while sleeping, it points to frequency on a psychological basis and also can often be improved with bladder retraining. It is important to know that frequent voiding of smaller volumes is not always a dysfunctional habit and may be on the basis of prostate or bladder issues that might require the services of your friendly urologist.  However, no harm can come from an initial attempt at bladder retraining.

Fixing it

The goal of bladder retraining is to break the dysfunctional habit and restore normal—or at least better—bladder functioning.  Bladder retraining can be challenging, yet rewarding, and requires a positive attitude and being willing, informed and engaged.

  1. FLUID AND CAFFEINE IN MODERATION

Urgency will often not occur until a “critical” urinary volume is reached, and by limiting fluid intake, it will take a longer time to achieve this volume. Try to sensibly restrict your fluid intake (without causing dehydration) in order to decrease the volume of urinary output. Caffeine (present in tea, coffee, colas, some energy drinks and chocolate) can increase urinary output and is a urinary irritant, so it is best to limit intake of these beverages/foods.  Additionally, many foods—particularly fruits and vegetables—have hidden water content, so moderation applies here as well.  It is important to try to consume most of your fluid intake before 7:00 PM to improve nighttime frequency.

  1. ASSESS MEDICATIONS

Diuretic medications (water pills) can contribute to frequency by design. If you are on a diuretic, it may be worthwhile to check with your medical doctor to see if it is possible to change to an alternative, non-diuretic medication. This will not always be feasible, but if it is, may substantially improve your frequency.

  1. AVOID BLADDER IRRITANTS

Irritants of the urinary bladder may be responsible for worsening your symptoms.  Consider eliminating or reducing one or more of the following irritants and then assessing whether your frequency improves:

Tobacco

Alcoholic beverages

Caffeinated beverages: coffee, tea, colas and other sodas and certain sport and energy drinks

Chocolate

Carbonated beverages

Tomatoes and tomato products

Citrus and citrus products: lemons, limes, oranges, grapefruits

Spicy foods

Sugar and artificial sweeteners

Vinegar

Acidic fruits: cantaloupe, cranberries, grapes, guava, peaches, pineapple, plums, strawberries

Dairy products

  1. URGENCY INHIBITION

The act of reacting to the first sense of urgency by running to the bathroom needs to be modified.  Stop in your tracks, sit, relax and breathe deeply. Pulse your pelvic floor muscles rhythmically to deploy your own natural reflex to resist and suppress urinary urgency (more about this below).

  1. INTERVAL TRAINING

Imposing a gradually increasing interval between urinations will help establish a more normal pattern of urination. If you are urinating small volumes on a frequent basis, your own sense of urgency is not providing you with accurate information about the status of your bladder fullness.  Urinating by the “clock” and not by your own sense of urgency will keep your voided volumes more appropriate. Voiding on a two-hour basis is usually effective as a starting point, although the specific timetable has to be tailored, based upon the bladder diary.  A gradual and progressive increase in the interval between voiding can be achieved by consciously delaying urinating.  A goal of an increase in the voiding interval by 15-30 minutes per week is desirable.  Eventually, a return to more acceptable voiding intervals is possible. The urgency inhibiting techniques mentioned above are helpful with this process.

  1. BOWEL REGULARITY

A rectum full of gas or fecal material can contribute to urinary difficulties. Because of the proximity of the rectum and bladder, a full rectum can put internal pressure on the bladder, resulting in worsening of urgency and frequency.

  1. PELVIC FLOOR MUSCLE TRAINING (PFMT)

The pelvic floor muscles (PFM) play a VITAL role in inhibiting urgency and frequency.  Voluntary rhythmic pulsing of the PFM can inhibit urgency and frequency and PFMT hones the inhibitory reflexes between the pelvic floor muscles and the bladder.

Initially, one must develop an awareness of the presence, location, and nature of the PFM and then train these muscles to increase their strength and tone.  These are not the muscles of the abdominal wall, thighs or buttocks.  A simple means of recognizing the PFM for a female is to insert a finger inside her vagina and squeeze the PFM until the vagina tightens around her finger.  Another means of identifying the PFM for either gender is to start urinating and when about half completed, to abruptly stop the stream. It is the PFM that allows one to do so.  When feeling the urge to urinate, rhythmic pulsing of the PFM–“snapping” the PFM several times—can diminish the urgency and delay a trip to the bathroom.

  1. LIFESTYLE MEASURES: HEALTHY WEIGHT, EXERCISE, TOBACCO CESSATION

The burden of excess pounds can worsen frequency by putting pressure on the urinary bladder, similar to the effect that excessive weight has on your knees. Even a modest weight loss may improve the situation.  Pursuing physical activities can help maintain general fitness and improve frequency. Lower impact exercises–yoga, Pilates, cycling, swimming, etc.–can best help alleviate pressure on the urinary bladder by boosting core muscle strength and tone and improving posture and alignment. The chemical constituents of tobacco constrict blood vessels, impair blood flow, decrease tissue oxygenation and promote inflammation, compromising the bladder, urethra and pelvic muscles.  By eliminating tobacco, symptoms can be improved.

Bottom Line: Bladder retraining can be an effective means of whipping your bladder (and your mind) into shape to help convert dysfunctional habits into more normal and appropriate voiding patterns.  This has the potential of helping many people. However, if the aforementioned strategies fail to improve your situation, you should have a basic urological evaluation, including a urinalysis (dipstick exam of the urine), a urine culture (test for urinary infection) if indicated, and determination of how much urine remains in your bladder immediately after emptying.  At times, tests such as cystoscopy (a visual inspection of the urethra and bladder with a narrow, flexible instrument) and urodynamics (sophisticated tests of bladder function) will need to be done as well. Urologists have the wherewithal to improve this situation and your quality of life.

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

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: PelvicRx

Female version in the works: Female PelvicRx

Chronic Testes Pain

March 7, 2018

Andrew Siegel MD    3/7/2018

New Jersey is shut down because of the impending Nor’easter, surgery and office hours are cancelled, so I have plenty of free time and am going to post this entry today rather than on Saturday morning.

Orchialgia is medical-speak for chronic testes (ball) pain, defined as constant or intermittent pain perceived in the testicles, lasting for 3 or more months and interfering with one’s quality of life.  It is a not uncommon problem of men of all ages, but is more frequently seen in young adults.  It certainly keeps us busy in the office…some morning sessions seem like “ball clinics”!

Testes 101

4.0.4

Image above, public domain from Wikipedia

The testes are paired, oval-shaped organs that are housed in the scrotal sac. They have two functions, testosterone and sperm production.  Encased within the tough and protective cover of the testes (tunica albuginea) are tiny tubes called seminiferous tubules which make sperm cells.  The testes also contain specialized cells called Leydig cells that produce testosterone.  Sperm from the testes travels to the epididymis for storage and maturation. The epididymis empties into the vas deferens, which conducts sperm to the ejaculatory ducts.

The testes are suspended in the scrotal sac via the spermatic cord, a “rope” of tissue containing connective tissue, the vas deferens, the testes arteries, veins, lymphatics, and nerves. The spermatic cord is enveloped by tissues that are extensions of the connective tissue coverings of three of the abdominal core muscles. The most important of these coverings surrounding the spermatic cord is the cremaster muscle, which elevates the testes in a northern direction when it contracts.

The scrotal sac has several roles, packaging the testes as well as aiding in their function by regulating their temperature. For optimal sperm production, the testes need to be a few degrees cooler than core temperature.  The dartos muscle within the scrotal wall relaxes or contracts depending on the ambient temperature, allowing the testes to elevate or descend to help maintain this optimal temperature. Under conditions of cold exposure, the dartos contracts, causing the scrotal skin to wrinkle and to bring the testicles closer to the body.  When exposed to heat, dartos relaxation allows the testicles to descend and the scrotal skin to smoothen.

Good news/bad news:

The good news about the testes location dangling between one’s legs is is ready and easy access for examination, unlike the female counterpart (ovaries), which are within the abdomen.  This is one reason why testes cancer is so much easier to diagnose at an early stage than ovarian cancer.

The bad news is that their precarious location dangling between one’s legs as well as their delicate packaging in the thin sac makes them subject to trauma and injury.

Chronic orchialgia

Chronic testes pain can be caused by numerous different conditions and it is important to rule out the following possibilities:

  • Infection: An infection of the testes (orchitis), epididymis (epididymitis), both (epididymo-orchitis), or the spermatic cord (funiculitis). Infections can be bacterial, viral, and at times inflammatory without an actual infection.
  • Tumor: A benign or malignant mass of the testes or epididymis.
  • Groin hernia: A prolapse of intra-abdominal contents through a weakness in the connective tissue support of the groin.
  • Torsion: A twist of the testes or one of the testes or epididymal appendages.
  • Hydrocele: An excess fluid collection in the sac surrounding the testes.
  • Spermatocele: A cyst resulting from a blockage of one of the sperm ducts within the epididymis.
  • Varicocele: Varicose veins of the spermatic cord.
  • Trauma: Injury.
  • Prior operations: Groin hernias are most commonly associated with chronic testes pain; less commonly, vasectomies and any other type of groin or pelvic surgery.
  • Referred pain: Pain perceived in the testes, but originating elsewhere, e.g., a kidney stone that has dropped into the ureter, or a lower spine issue affecting the nerves to the testes.
  • Tendonitis: There are numerous muscles with tendons that insert into the pubic bone region that can be subject to injury and inflammation.
  • Pelvic floor muscle tension myalgia: Excessive muscle tension in these muscles can cause pelvic pain, including pain in the testes.
  • Idiopathic: This fancy medical term means that we are clueless about the origin of the pain. Unfortunately, many men have idiopathic orchialgia, a distressing and frustrating experience for both patient and urologist.

Evaluation

The evaluation of the patient with chronic testes pain includes a detailed history, a careful examination of the scrotal contents, groin and prostate, if necessary, as well as a urinalysis and possibly urine culture. It is helpful to obtain an ultrasound of the scrotum, a study which utilizes sound waves to image the testicle and epididymis. On occasion, it is warranted to obtain imaging studies of the upper urinary tract and pelvis and possibly a CT or MRI of the spine if there is back or hip pain.

Management

The management of chronic testis pain is directed at the underlying cause, although unfortunately this cannot always be precisely determined. Often, a course of antibiotics may prove helpful even if the physical findings are indeterminate.  Anti-inflammatory medications such as Advil and ibuprofen are often useful in the short-term management. Supportive, elastic jockey shorts as well as local application of a heating pad can be helpful. At times, amitriptyline or Neurontin can be helpful for neurologically-derived pain.  If the source of the pain is felt to be tension myalgia, referral to a pelvic floor physical therapist can be beneficial.  A referral to a pain specialist, typically an anesthesiologist who focuses on this discipline, can be advantageous.

An injection of a local anesthetic into the spermatic cord (spermatic cord block) can be a useful diagnostic test and a means of alleviating the pain.  If spermatic cord block proves successful in relieving the pain, it may be necessary to surgically denervate the spermatic cord, a procedure in which the nerve fibers in the spermatic cord are divided.  Under extremely rare circumstances, removal of the epididymis or the testicle is necessary. Often chronic testis pain remains elusive with the source undetermined and is thought to be similar to other chronic inflammatory conditions.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as 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 that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

 

Bloody Semen: Frightening, But Usually Not To Worry

September 2, 2017

Andrew Siegel MD  9/2/17

Hematospermia is medical speak for a bloody ejaculation. It is a not uncommon occurrence, usually resulting from inflammation of one of the male reproductive parts, typically the prostate or seminal vesicles.  As scary as it is, it is rarely indicative of a serious underlying disorder.  Like a nosebleed, it can be due simply to a ruptured blood vessel. It is almost always benign and self-limited,  typically resolving within several weeks. On occasion it may become recurrent or chronic, causing concern and anxiety, but again, rarely due to a serious problem.

Factoid: The most common cause of a bloody ejaculation is following a prostate biopsy.

 

Illu_repdt_male

Thank you, Wikipedia, for image above, public domain

What is semen?

Semen is a nutrient vehicle for sperm that is a concoction of secretions from the testes, epididymis, urethral glands, prostate gland, and seminal vesicles.  The clear secretions from the urethral glands account for a tiny component, the milky white prostate gland secretions for a small amount of the fluid, and the viscous secretions from the seminal vesicles for the bulk of the semen. Sperm makes up only a minimal contribution.

Factoid:  After vasectomy the semen appears no different since sperm make up a negligible portion of the total seminal volume.

What exactly occurs during ejaculation?

After a sufficient level of sexual stimulation is achieved (the “ejaculatory threshold”), secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the part of the urethra within the prostate gland.  Shortly thereafter, the bladder neck pinches closed while the prostate and seminal vesicles contract and the pelvic floor muscles spasm rhythmically, sending wave-like contractions rippling down the urethra to propel the semen out.

Factoid:  Ejaculation is an event that takes place in the penis; orgasm occurs in the brain.

Factoid: It is the pelvic floor muscles that are the muscle power behind ejaculation.  Remember this: strong pelvic muscles = strong ejaculation.

Since the prostate and seminal vesicles contribute most of the volume of the semen, bleeding, inflammation or other pathology of these organs is usually responsible for bloody ejaculations. The bleeding may cause blood in the initial, middle, or terminal portions of the ejaculate.  Typically, blood arising from the prostate occurs in the initial portion, whereas blood arising from the seminal vesicles occurs later. The color of the semen can vary from bright red, indicative of recent or active bleeding, to a rust or brown color, indicative of old bleeding.

What are some of the causes of blood in the semen?

  • Infection or inflammation (urethritis, epididymitis, orchitis, prostatitis, seminal vesiculitis, etc.)
  • Ruptured blood vessel, often from intense sexual activity
  • Reproductive organ cysts or stones
  • Following prostate biopsy (from numerous needle punctures); following vasectomy
  • Pelvic trauma
  • Rarely malignancy, most commonly prostate cancer and less commonly, urethral cancer
  • Coagulation issues or use of blood thinners

 How is hematospermia evaluated and treated?

A brief history reveals how long the problem has been ongoing, the number of episodes, the appearance of the semen and the presence of any inciting factors and associated urinary or sexual symptoms. Physical examination involves examination of the genitals and a digital rectal examination to check the size and consistency of the prostate. Laboratory evaluation is a urinalysis to check for urinary infection and blood in the urine, and a PSA (prostate specific antigen) blood test.  At times a urine culture and/or semen culture needs to be done.

Hematospermia is typically managed with a course of oral antibiotics because of the infection/inflammation that is often the underlying cause.  In most cases, the situation resolves rapidly.

If the bloody ejaculations continue, further workup is required.  This may involve imaging with either trans-rectal ultrasonography (TRUS) or magnetic resonance imaging (MRI) and at times, cystoscopy. TRUS is an office procedure in which the prostate and seminal vesicles are imaged by placing an ultrasound probe in the rectum. MRI imaging is performed at an imaging center under the supervision of a radiologist. The MRI provides a more thorough diagnostic evaluation, but is more expensive and time consuming.  Both TRUS and MRI can show dilated seminal vesicles, cysts of the ejaculatory ducts, prostate or other reproductive organs, and ejaculatory or seminal vesicle stones.  MRI can also show sites suspicious for prostate cancer. Cystoscopy is a visual inspection of the inner lining of the urethra, prostate and bladder with a small-caliber, flexible instrument. Treatment is based on the findings of the imaging and diagnostic studies, but again, it is important to emphasize the typical benign and self-limited nature of hematospermia.

Bottom Line: Blood in the ejaculation is not uncommon and is frightening, but is usually benign and self-limited and easily treated. In the rare situation where it persists, it can be thoroughly evaluated to assess the underlying cause.  If you experience hematospermia, visit your friendly urologist to have it checked out.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as 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 that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

The aforementioned books will teach men and women, respectively, how to strengthen their pelvic floor muscles.

Men’s Health: Holistic Urology Approach

August 19, 2017

Andrew Siegel MD   8/19/17

pixabay

Thank you, Pixabay, for image above

Men Don’t Ask For Directions, Etc…

With respect to their health, women are usually adept at preventive care and commonly see an internist or gynecologist regularly.  On the other hand, men—who could certainly take a lesson from the fairer sex—are generally not good at seeing doctors for routine checkups. Not only has our culture indoctrinated in men the philosophy of “playing through pain,” but also the lack of necessity of seeking medical care when not having a specific problem or pain (and even when men do develop dangerous health warning signs, many choose to ignore them.). Consequently, many men have missed out on some vital opportunities: To be screened for risks that can lead to future medical issues; be diagnosed with problems that cause no symptoms (such as high blood pressure, glaucoma and prostate cancer); and counseled regarding means of modifying risk factors and optimizing health.

Many Men Don’t Have A Doc

Urologists evaluate and treat a large roster of male patients, a surprising number of whom have not sought healthcare elsewhere and do not have a primary physician. Urological visits offer an opportunity to not only focus on the specific urological complaint that drives the visit (usually urinary or sexual problems), but also to take a more encompassing holistic health approach, emphasizing modifications in diet, physical activity, and other lifestyle factors that can prevent many untoward consequences and maximize health. By getting men engaged in the healthcare system on a timely basis, they can be helped to minimize those risk factors that typically cause the illnesses that afflict men as they age.

Identifying and modifying risk factors can mitigate, if not prevent, a number of common maladies.  Modifiable risk factors for the primary killer of men—cardiovascular disease—include poor diet, obesity, physical inactivity, excessive alcohol, tobacco consumption, stress, high blood pressure, high blood glucose and diabetes, high cholesterol, obstructive sleep apnea, low testosterone and depression. The bottom line is that every patient contact provides an opportunity for so much more than merely treating the sexual or urinary complaint that brought the patient into the office. Furthermore, many systemic disease processes—including diabetes, obstructive sleep apnea, cardiovascular diseases, etc.—have urological manifestations and symptoms that can be identified by the urologist who in turn can make a referral to the appropriate health care provider.

Erections are an Indicator of Health

Many men may not cherish seeing doctors on a routine basis, but a tipping point occurs when it comes to their penises not functioning!  Erectile dysfunction (ED) is a common reason for men to “bite the bullet” and call their friendly urologist for a consultation. The holistic approach by the consultant urologist is to not only manage the ED, but to diagnose the underlying risk factors that can be a sign of broader health issues than simply poor quality erections. Importantly, ED can be a warning sign of an underlying medical problem, since the quality of erections serves as a barometer of cardiovascular health.

    “A man with ED and no known cardiovascular disease                                                                      is a cardiac patient until proven otherwise.”

Graham Jackson, M.D., cardiologist from the U.K.

Since the penile arteries are small in diameter and the coronary (heart) arteries larger, it stands to reason that if vascular disease—generally a systemic process that is diffuse and not localized—is affecting the tiny penile arteries, it may affect the larger coronary arteries as well, if not now, then at some time in the future. In other words, the fatty deposits that compromise blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus ED may be considered a “stress test.” In fact, the presence of ED is as much of a predictor of cardiovascular disease as is a strong family history of cardiac problems, tobacco smoking, or elevated cholesterol.

Dr. Jackson cleverly expanded the initials ED to mean: Endothelial dysfunction (endothelial cells line the insides of arteries); early detection (of heart disease); and early death (if missed). For this reason, men with ED should undergo a medical evaluation seeking arterial disease elsewhere in the body (heart, brain, aorta, and peripheral blood vessels).

Urologists have a broad network of colleagues (including internists, cardiologists, pulmonologists, gastroenterologists, medical oncologists, radiologists, radiation oncologists, general surgeons, etc.) that can be collaborated with and to whom patients can be referred to if and when their expertise is needed.

Urine is Golden

Of all the bodily secretions that humans produce, urine uniquely provides one of the best “tells” regarding health.  A simple and inexpensive urinary dipstick can diagnose diabetes, kidney disease, urinary tract infection, the presence of blood and hydration status, in a matter of moments.

What a dipstick can reveal:

specific gravity… hydration status

pH…acidity of urine

leukocytes…urinary infection

blood…many urological disorders including kidney and bladder cancer

nitrite…urinary infection

bilirubin…a yellow pigment found in bile, a substance made by the liver; its presence may be indicative of jaundice

protein…kidney disease

glucose…diabetes

Case report of a recent patient

54-year-old male with six-month history of frequent daytime urination as well as awakening 3-4 times during sleep hours to urinate. Additionally, he has difficulty maintaining erections and premature ejaculation. Physical examination of the abdomen, genitalia and prostate was unremarkable. Urinalysis showed large glucose. Lab studies showed glucose 204 (normally < 100); HbA1c 10.6% (normally < 5.6); testosterone 202 (normally > 300) and PSA 4.2 (elevated for his age). 

He was referred to an internist for management of diabetes that manifested with urinary frequency, elevated urine and blood glucose and elevated HbA1c (a measure of blood glucose levels over the past 6 weeks).  With appropriate management of the diabetes, the urinary frequency resolved. Because of the PSA elevation he is scheduled for an MRI of the prostate, and because of the low testosterone, he is undergoing additional endocrine testing to see if the problem is testicular or pituitary in origin and certainly will be a candidate for medical therapy if improved lifestyle measures fail to sufficiently elevate the testosterone.

Bottom Line: Preventive and proactive care—as many pursue regularly for their prized automobiles (e.g., lubrication and oil changes, replacing worn belts before they snap while on the road, etc.)—provides numerous advantages.  The same strategy should be applied to the human machine!  Since contact with a urologist may be a man’s only connection with the healthcare system, a vital opportunity exists for the urologist to offer holistic care in addition to specialty genital and urinary care.  The goal is to empower men by getting them invested in their own health in order to minimize disease risk and optimize vitality. 

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as 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 that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

 

Urology 101:  Much More Than “Pecker Checking”!

August 5, 2017

Andrew Siegel MD  8/5/17

CME2P

I am a second-generation urologist. It is unlikely that there will be a third-generation urologist as my oldest child is a film-maker, my middle child works in tech marketing and my youngest is off to college later this month, intent on becoming a child psychologist. After she spent a day in the office with me, she told me that the experience caused her to have post-traumatic stress disorder!

As a youngster, I attended summer camp in New Hampshire at Camp Moosilauke . My friends made fun of my father’s profession, referring to him as a “pecker checker.”  Today’s entry is a brief review of what urology really is and what urologists do for a living. One thing is for sure…sooner or later most everyone will need the service of a urologist. 

“Urology” (uro—urinary tract and logos—study of) is the branch of medicine that deals with the diagnosis and treatment of diseases of the urinary tract in males and females and of the reproductive tract in males. The urinary organs under the “domain” of urology include the kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder, and the urethra (channel that conducts urine from the bladder to the outside).  These body parts are responsible for the production, storage and release of urine.

The male reproductive organs under the “domain” of urology include the testes, epididymis (structures above and behind the testicle where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (structures that produce the bulk of semen), prostate gland and, of course, the scrotum and penis.  These body parts are responsible for the production, storage and release of reproductive fluids.  The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as “genitourinary” specialists.

Urology is a balanced specialty– urologists treat men and women, young and old, from pediatric to geriatric.  Whereas most physicians are either medical doctors or surgeons, a urologist is both, with time divided between a busy office practice and the operating room.  Although most urologists are men, more and more women than every before have been entering the urological workforce.

Factoid: My pathway to urology was 4 years of college, 4 years of medical school, 2 years of general surgery residency, 4 years of urology residency and 1 year of specialty fellowship in pelvic medicine and reconstructive urology.  I started practicing at age 33.

Factoid: Becoming board certified is the equivalent of a lawyer passing the bar exam. There are three possible board certifications in urology: general urology, pediatric urology, and female pelvic medicine and reconstructive surgery.  Thereafter, one must maintain board certification by participating in continuing medical education and pass a recertification exam every ten years.  I am dually certified in general urology as well as female pelvic medicine.  The common problems I take care of in my female pelvic medicine practice are urinary incontinence (stress urinary incontinence and overactive bladder), pelvic organ prolapse and recurrent urinary tract infections

Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health.  Urological surgery involves operating on patients with potentially life-threatening illnesses, particularly cancers of the genital and urinary tracts.  In terms of new cancer cases per year in American men, prostate cancer is number one accounting for almost 30% of cases; bladder cancer is number four accounting for 6% of cases; and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) is number six accounting for 5% of cases.  Urologists are also the specialists who treat testicular cancer.  Urologists also treat women with kidney and bladder cancer, although the prevalence of these cancers is much less in women than in males.

Urology has always been on the cutting edge of surgical advancements (no pun intended) and urologists use minimally invasive technologies including fiber-optic scopes to view the entire inside of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics.  There is overlap in what urologists do with other medical and surgical disciplines, including nephrology (doctors who specialize in medical diseases of the kidney); oncology (medical cancer specialists); radiation oncologists (radiation cancer specialists); radiology (imaging); gynecology (female specialists); and endocrinology (hormone specialists).

Common reasons for a referral to a urologist include: blood in the urine, whether it is visible or picked up on a urine test; an elevated or an accelerated PSA (Prostate Specific Antigen); prostate enlargement; irregularities of the prostate on digital rectal examination; and urinary difficulties ranging the gamut from urinary leakage to the inability to urinate (urinary retention).

Urologists manage a variety of other issues. Kidney stones, which can be extraordinarily painful, keep us very busy, especially during the hot summer months when dehydration is more common. Infections are a large part of our practice and can involve the bladder, kidneys, prostate, testicles and epididymis.  Sexual dysfunction is a very common condition that occupies much of the time of the urologist—under this category are problems with obtaining and maintaining an erection, problems of ejaculation, and testosterone issues. Urologists treat not only male infertility, but also create male infertility when it is desired by performing voluntary male sterilization (vasectomy).   Urologists are responsible for caring for scrotal issues including testicular pain and swelling. Many referrals are made to urologists for blood in the semen.

 

RUPNOK

 

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as 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 that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

Amazon page for Dr. Siegel’s books

Putting Some “Lead” In Your Pencil: A Fix For The “Innie” Penis

April 29, 2017

Andrew Siegel MD   4/28/2017

pencil pixbay

Thank you, Pixabay, for image above

As Multi-Functional as a Swiss Army Knife

The penis is an extraordinary organ with urinary, sexual and reproductive functions. The possession of a penis endows man with the ability to stand to urinate and direct his urinary stream, a distinct advantage over the clumsy apparatus of the fairer sex that generates a spraying, poor-directed stream that demands sitting down on a toilet seat. The advantage of being able to stand to urinate (and keep one’s body appropriately distanced from the horrors of many public toilets) is priceless. Although man does not often have to employ this, the capability (when necessary) of urinating outside is another benefit of our design.  Many find the outdoor voiding experience pleasing, observing the pleasant sounds and visuals of a forceful stream striking our target (often a tree) with finesse, creating rivulets and cascades to show for our efforts.

Getting beyond the urinary, the most dramatic penis magic is its ability to change its form in a matter of seconds, morphing into an erect “proud soldier” and enabling the wherewithal for vaginal penetration and with sufficient stimulation, for ejaculation.  All that fun, but really serving the purpose of the passage of genetic material and ultimately the perpetuation of our species…reproductive wizardry!

The water tap that could turn into a pillar of fire.”

Eric Gill

tap pixabay

pixabay pillar

Thank you, Pixabay, for images above

 

The Sometimes Cruel Process of Aging Does Not Spare the Penis

 “Getting older is an honor and a privilege, but getting old is a burden.”

Beverly Radow (my aunt, who will turn 90-years-old this year)

Long after our reproductive years are over and fatherhood is no longer a consideration, most men still wish to be able to achieve a decent-enough erection to have sexual intercourse.  As well, we still desire to be able to urinate standing upright with laser-like urinary stream precision.

However, the ravages of time (and poor lifestyle habits) can wreak havoc on penile anatomy and function.  Many middle-aged men typically gain a few pounds a year, ultimately developing a bit of a pubic fat pad–the male equivalent of the female mons pubis– and before you know it the penis appears shorter and becomes an “innie” as opposed to an “outie.”  In actuality, penile length is usually more-or-less preserved, with the penis merely hiding behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. This is why having a plus-sized figure is not a good thing when it comes to size matters.

Useful Factoid: The Angry Inch…It is estimated that there is a one-inch loss in apparent penile length with every 35 lbs. of weight gain.

One of the problems with a shorter and more internal penis is that the forceful and precise urinary stream of yesteryear gives way to a spraying and dribbling-quality stream that can drip down one’s legs, spray over the floor and onto one’s feet (and even at times towards or on the gentleman next to you at the urinal!).

Almost Useless Factoid: Water Sports…Turkey vultures pee on themselves to deal with the heat of the summer on their dark feathers, since they lack sweat glands.  By excreting on their legs, the birds use urine evaporation to cool themselves down in the process of “urohidrosis.”  Unless you are a turkey vulture, peeing on yourself or others is rather undesirable!

The solution to having a recessed penis that is often hidden from sight and has lost its aiming capabilities is to sit on the toilet bowl to urinate, joining the leagues of our female companions who are “stream-challenged” because of their anatomy.

With aging (and poor lifestyle habits) also comes declining sexual function and activity as rigid erections going by the wayside.  However, like any other body part, the penis needs to be used on a regular basis—the way nature intended—in order to maintain its health. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile erectile tissues can occur, resulting in a de-conditioned and smaller penis that does not function like it used to.

Factoid: Disuse Atrophy…If one goes too long without an erection, collagen, smooth muscle, elastin and other erectile tissues may become compromised, resulting in a loss of penile length and girth and limiting one’s ability to achieve an erection.  Conversely, sexual intercourse on a regular basis protects against ED issues and the risk of ED is inversely related to the frequency of intercourse.

The point I am trying to hammer home is that aging, weight gain and poor lifestyle habits often render men with penises that are:

  1. Shrunken and recessed
  2. Unreliable in terms of ability to pee straight, requiring sitting down on the toilet bowl like women
  3. Unreliable with respect to sexual function

Factoid: Point 1 + Point 2 + Point 3 = EMASCULATION (depriving man of his male role and identity)

What To Do?

The first step is to keep one’s body (and penis) as healthy as possible via intelligent lifestyle choices. These include the following: smart eating habits; maintaining a healthy weight; engaging in exercise (including pelvic floor muscle training); obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction. The use of ED medications on a low-dose, daily basis can sometimes help all 3 issues.

In the event that the aforementioned means fail to correct the problem, a virtually sure-fire way of rectifying all three issues is by a simple surgical procedure.  Malleable penile implants (penile rods) are surgically placed into each erectile chamber of the penis (the two inner tubes of the penis that under normal circumstances fill with blood to create an erection). The implants act as skeletal framework for the penis (“bones” of the penis). Two USA companies, Coloplast and AMS (American Medical Systems) manufacture the rods that are in current use. They are very similar with subtle differences.

464x261_GenesisColoplast Genesis implant

AMS Spectra

American Medical Systems Spectra implant

The implant procedure of these two stiff-but-flexible rods into the erectile chambers of the penis is performed by a urologist on an outpatient basis.  Like shoes, the penile rods come in a variety of lengths and widths and fundamental to the success of the procedure is to properly measuring the dimensions of the erectile chambers in order to obtain an ideal fit. The small incision needed to implant the rods is closed with sutures that dissolve on their own. Healing typically takes about 6 weeks, after which sexual relations can be initiated.

An erection suitable for penetration and sexual intercourse is available 24-7-365, simply by bending the penis up. The penis is angled down for concealment purposes. It is flexible enough to be comfortably flexed up or down, while rigid enough for intercourse, the best of all worlds.

Print

Penile rods in action, bent down for concealment and up for urination and sex

Bottom Line:  It is not uncommon for aging, weight gain and unhealthy lifestyle factors to conspire to compromise penile anatomy and function with respect to apparent penile size, urinary stream precision and erectile rigidity.  This leaves one emasculated with a penis that is often concealed, shortened and habitually limp, impeding the ability to have sexual intercourse, as well as a spraying quality urinary stream necessitating sitting to urinate.  If lifestyle improvement measures do not correct the situation, literally and figuratively “putting some lead in your pencil” using a simple malleable penile implant can “kill three birds with one stone.” (I could not resist the very mixed metaphor.)  Confidence can be restored with the conversion of the “innie” penis to an “outie,” the ability to resume sexual intercourse and the reestablishment of a directed, non-spraying stream to permit standing to urinate.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as 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 that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Prostate Steaming For Better Urinary Streaming

November 12, 2016

Andrew Siegel MD 11/12/2016

A new, minimally invasive procedure for treating symptomatic prostate enlargement has been tested in clinical trials and has been shown to be safe and effective. I was informed about it at a recent urology meeting in Prague and was intrigued because of its simplicity. The prostate steaming procedure–called “Rezum”–takes less than 15 minutes and uses convective heat energy in the form of steam to open up the obstructed prostate gland. 

Convection Versus Conduction

Convection is the transfer of thermal energy by heating up a liquid, resulting in currents of thermal energy traveling away from the heating source.  This type of energy is used for the Rezum prostate steaming procedure.

This is as opposed to conduction, which is heat transfer via molecular agitation. Thermal energy that is directly applied to tissues heats up molecules and is transferred through tissues as higher-speed molecules collide with slower speed molecules. Conduction energy is commonly used in surgery to cut or coagulate tissues.

Benign Prostate Enlargement (BPH)

BPH is a common condition in men above the age of 50. Based upon aging, genetics and testosterone, the prostate gland enlarges to a variable extent. As it does so, it often compresses the urinary channel (like a hand around a garden hose), causing urinary obstructive and irritative symptoms that can be quite annoying.  Obstructive symptoms include: a weak, prolonged stream that is slow to start and tends to stop and start (to quote my patient: “peeing in chapters”) and incomplete emptying. Irritative symptoms include: strong urges to urinate, frequent urinating, nighttime urinating and possibly urinary leakage before arrival at the bathroom.

pre-treatment_v2

BPH (note the tissue compressing the urinary channel)

Medications or surgical procedures are often used to alleviate the symptoms of BPH.  One class of medication relaxes the muscle tone of the prostate (Flomax, Uroxatral, Rapaflo, etc.); another class shrinks the prostate (Proscar, Avodart). The erectile dysfunction medication Cialis has also been used (daily dosing) to help manage symptomatic BPH. Commonly performed procedures to improve the symptoms of BPH include Greenlight laser photovaporization of the prostate, Urolift procedure and TURP (transurethral resection of the prostate). The Rezum prostate steam procedure is a new addition to the BPH armamentarium.

Rezum Prostate Steaming

The prostate is a compartmentalized organ with discrete anatomical zones (compartments). The transition zone is the area responsible for benign enlargement. In the Rezum procedure, radio-frequency energy is used to convert a small volume of water to steam, which is injected within the  transition zone of the prostate via a retractable needle under direct visual guidance (cystoscopy). The steam adheres to the anatomy of the prostate zones, its spread limited by the zonal anatomy. Each steam (convective water vapor thermal energy) injection takes less than 10 seconds and utilizes no more than a few drops of water. The number of injections necessary is based upon the size of the prostate gland, but it generally requires only a few.

watervaportreatment

Steam being injected into prostate tissue via a retractable needle

Convection uniformly disperses the steam, causing targeted cell death of prostate cells. This slowly and gradually will un-obstruct the prostate and alleviate the symptoms of BPH.

It is unusual for the actual procedure to take much longer than a few minutes, although the patient will need preparation time before and recovery time after the procedure. After the Rezum is completed, a catheter is placed for a few days. Common temporary side effects include inability to urinate (the reason for the catheter), discomfort with urination, urinary urgency, frequency, and blood in the urine or semen. Symptomatic improvement may be noted as early as two weeks after the procedure, but it may take up to 3 months before maximal benefits are derived.

tissue_resorption_v2

Prostate anatomy 3-months following Rezum procedure

A multi-center, randomized, controlled study was recently reported in the Journal of Urology. 200 men were randomized to active treatment with Rezum versus control. The study concluded that convective water vapor energy provides durable improvements in the symptoms of BPH, preserving erectile and ejaculatory function.

Bottom Line: This quick outpatient procedure for BPH  is safe and effective, can be performed in an office setting using sedation and can treat certain anatomical variations (e.g. middle lobe prostate enlargement) that cannot be treated by some of the alternative methods. Erectile and ejaculatory functions are preserved in most patients, which is often not the case with the BPH medications, Greenlight laser and TURP. A disadvantage is that the Rezum is not immediately effective, requiring a catheter for several days and a period of several weeks before symptomatic improvement is evident. Our urology practice is now offering this procedure to patients.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

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

http://www.TheKegelFix.com

 

 

More About Pelvic Organ Prolapse (POP)

October 22, 2016

Andrew Siegel MD 10/22/2016

This is the second entry in a three-part series about pelvic organ prolapse.  It is important to understand that the issue in POP is NOT with the pelvic organ per se, but with the support of that organ. POP is not the problem, but the result of the problem. The prolapsed organ is merely an “innocent passenger” in the POP process.

How Much Of A Vaginal Bulge Can POP Cause?

The extent of prolapse can vary from minimal to severe and can vary over the course of a day, depending on position and activity level.  POP is more pronounced with with standing (vs. sitting or lying down) and with physical activities (vs. sedentary).

The simplest system for grading POP severity uses a scale of 1-4:

grade 1 (slight POP); grade 2 (POP to vaginal opening with straining); grade 3 (POP beyond vaginal opening with straining); grade 4 (POP beyond vaginal opening at all times).

Which Organs Does POP Affect?

POP can involve one or more of the pelvic organs including the following: urethra (urethral hypermobility); bladder (cystocele); rectum (rectocele); uterus (uterine prolapse); intestines (enterocele); the vagina itself (vaginal vault prolapse); and the perineum (perineal laxity).

Urethra

The healthy, well-supported urethra has a “backboard” or “hammock” of support tissue that lies beneath it. With a sudden increase in abdominal pressure, the urethra is pushed downwards, but because of the backboard’s presence, the urethra gets pinched closed between the abdominal pressure above and the hammock below, allowing urinary control.

When the support structures of the urethra are weakened, a sudden increase in abdominal pressure (from a cough, sneeze, jump or other physical exertion) will push the urethra down and out of its normal position, a condition known as urethral hypermobility. With no effective “backboard” of support tissue under the urethra, stress urinary incontinence will often occur.

sui

Urethral hyper-mobility causing stress urinary incontinence (the gush of urine) when this patient was asked to cough.

Bladder

Descent of the bladder through a weakness in its supporting tissues gives rise to a cystocele, a.k.a. “dropped bladder,” “prolapsed bladder,” or “bladder hernia.”

A cystocele typically causes one or more of the following symptoms: a bulge or lump protruding into or even outside the vagina; the need for pushing the cystocele back in in order to urinate; obstructive urinary symptoms (a slow, weak stream that stops and starts and incomplete bladder emptying) due to the prolapsed bladder causing urethral kinking; urinary symptoms (frequent and urgent urinating); and vaginal pain and/or painful intercourse.

untitled

Cystocele

Rectum

Descent of the rectum through a weakness in its supporting tissues gives rise to a rectocele, a.k.a. “dropped rectum,” “prolapsed rectum,” or “rectal hernia.” The rectum protrudes into the floor of the vagina. A rectocele typically causes one or more of the following symptoms: a bulge or lump protruding into the vagina, especially noticeable during bowel movements; a kink of the normally straight rectum causing difficulty with bowel movements and the need for vaginal “splinting” (straightening the kink with one’s fingers) to empty the bowels; incomplete emptying of the rectum; fecal incontinence; and vaginal pain and/or painful intercourse.

rectocele

Rectocele with perineal laxity

Perineum

Often accompanying a rectocele is perineal muscle laxity, a condition in which the superficial pelvic floor muscles (those located in the region between the vagina and anus) become flabby. Weakness in these muscles can cause the following anatomical changes: a widened and loose vaginal opening, decreased distance between the vagina and anus, and a change in the vaginal orientation such that the vagina assumes a more upwards orientation as opposed to its normal downwards angulation towards the sacral bones.

Women with vaginal laxity who are sexually active may complain of a loose or gaping vagina, making intercourse less satisfying for themselves and their partners. This may lead to difficulty achieving orgasm, difficulty retaining tampons, difficulty accommodating and retaining the penis with vaginal intercourse, the vagina filling with water while bathing and vaginal flatulence (passing air through the vagina). The perception of having a loose vagina can often lead to low self-esteem.

Small Intestine

The peritoneum is a thin sac that contains the abdominal organs, including the small intestine. Descent of the peritoneal contents through a weakness in the supporting tissues at the innermost part of the vagina (the apex of the vagina) gives rise to an enterocele, a.k.a. “dropped small intestine,” “small intestine prolapse,” or “small intestine hernia.”

An enterocele typically causes one or more of the following symptoms: a bulge or lump protruding through the vagina, intestinal cramping due to small intestine trapped within the enterocele, and vaginal pressure/pain and/or painful intercourse.

enterocele

Enterocele

Uterus

Descent of the uterus and cervix because of weakness of their supporting structures results in uterine prolapse, a.k.a. “dropped uterus,” “prolapsed uterus,” or “uterine hernia.” Normally, the cervix is situated deeply in the vagina. As uterine prolapse progresses, the extent of descent into the vaginal canal will increase.

Uterine POP typically causes one or more of the following symptoms: a bulge or lump protruding from the vagina; difficulty urinating; the need to manually push back the uterus in order to urinate; urinary urgency and frequency; urinary incontinence; kidney obstruction because of the descent of the bladder and ureters (tubes that drain urine from the kidneys to the bladder) that are dragged down with the uterus, creating a kink of the ureters; vaginal pain with sitting and walking; painful intercourse; and spotting and/or bloody vaginal discharge from the externalized uterus, which becomes subject to trauma and abrasions from being out of position. The most extreme form of uterine POP is uterine “procidentia,” a situation in which the uterus is exteriorized at all times and, because of external exposure, has a tendency for ulceration and bleeding.

 

uterus

Uterine prolapse

ulcerated-procidentia

Severe uterine prolapse (procidentia) with ulcerative inflammation surrounding cervix

Vagina

The most advanced stage of POP occurs when the support structures of the vagina are weakened to such an extent that the vaginal canal itself turns inside out. Vault prolapse, a.k.a. “dropped vaginal vault,” “prolapsed vaginal vault,”or “vaginal vault hernia,” is rarely an isolated event, but often occurs coincident with other forms of POP and most often is a consequence of hysterectomy. If the vagina is likened to an internal “sock,” vaginal vault prolapse is a condition in which the sock is turned inside out. When I explain vaginal vault prolapse to patients, I demonstrate it by turning a front pocket of my pants inside out.

To be continued…

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Much of the content of this entry was excerpted from his recently published book: The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health. For more info: http://www.TheKegelFix.com.

He has previously authored Male Pelvic Fitness: Optimizing Sexual & Urinary Health; Promiscuous Eating: Understanding And Ending Our Self-Destructive Relationship With Food; and Finding Your Own Fountain Of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro. Area and 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 that is in such dire need of bridging.

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: www.TheKegelFix.com. The e-book offers discretion, advantageous for books about personal issues, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources.  The book was written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

 

What’s That Bulge Coming Out Of My Vagina?

October 15, 2016

Andrew Siegel MD   10/15/2016

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Photo above: typical appearance of  a vaginal bulge (in this case a dropped bladder)

“The thought was delivered just after my newborn’s placenta: A sneaking suspicion that things were not quite the same down there, and they might never be again…my daughter had finished using my vagina as a giant elastic waterslide.”

-Alissa Walker, Gizmodo.com, April 2, 2015

Between A Rock And A Hard Place

The bony pelvis provides the infrastructure to support the pelvic organs and to allow childbirth. Adequate “closure” is needed for pelvic organ support, yet sufficient “opening” is necessary to permit vaginal delivery. The female pelvis evolved as a compromise between these two important, but opposing functions.

The pelvic floor muscles (PFM) divide the abdominal and pelvic cavities above from the perineum below, forming an important structural support system that keeps the pelvic organs in place. Many physical activities result in significant increases in abdominal pressure, the force of which is largely exerted downwards towards the pelvic floor, especially when upright. This pelvic floor “loading” puts the PFM at particular risk for damage with the potential for pelvic organ prolapse, a.k.a. pelvic relaxation or pelvic organ hernia.

Pelvic Organ Prolapse (POP)

POP is a common condition in which there is weakness of the PFM and other connective tissues that provide pelvic support, allowing the pelvic organs to move from their normal positions into the space of the vaginal canal and, at its most severe degree, outside the vaginal opening. It is a situation in which the pelvic organs go wayward, literally “popping” out of place. POP often causes a bulge outside the vaginal opening, appearing like a man’s scrotum…little wonder why most women are disturbed by this condition.

Two-thirds of women who have delivered children have anatomical evidence of POP (although most are not symptomatic) and 10-20% will need to undergo a corrective surgical procedure. POP is not life threatening, but can be a distressing and disruptive problem that negatively impacts quality of life. Despite how common an issue it is, many women are reluctant to seek help because they are too embarrassed to discuss it with anyone or have the misconception that there are no treatment options available or fear that surgery will be the only solution.

POP may involve any of the pelvic organs including those of the urinary, intestinal and gynecological tracts. The bladder is the organ that is most commonly involved in POP. POP can vary from minimal descent—causing few, if any, symptoms—to major descent—in which one or more of the pelvic organs prolapse outside the vagina at all times, causing significant symptoms. The degree of descent varies with position and activity level, increasing with the upright position and exertion and decreasing with lying down and resting, as is the case for any hernia.

POP can give rise to a variety of symptoms, depending on which organ is involved and the extent of the prolapse. The most common complaints are the following: a vaginal bulge or lump, the perception that one’s insides are falling outside, and vaginal “pressure.” Because POP often causes vaginal looseness in addition to one or more organs falling into the space of the vaginal canal, sexual complaints are common, including painful intercourse, altered sexual feeling and difficulty achieving orgasm as well as less partner satisfaction.

When one’s bladder or rectum descends into the vaginal space, there can be an obstruction to the passage of urine or stool, respectively. This often requires placing one or more fingers in the vagina to manually push back the prolapsed organ. Doing so will straighten the “kink” in order to facilitate emptying one’s bladder or bowels. Pushing (and holding in place) a prolapsed organ back into position with one’s finger(s) is called “splinting.”

Why Do I Have A Bulge Coming Out Of My Vagina?

POP results from a combination of factors including multiple pregnancies and vaginal deliveries (especially deliveries of large babies), menopause, hysterectomy, aging and weight gain. Additionally, conditions that give rise to chronic increases in abdominal pressure contribute to POP. These include chronic constipation, asthma, bronchitis and emphysema (chronic wheezing and coughing), seasonal allergies (chronic sneezing), high-impact sports, and repetitive heavy lifting, whether work-associated or due to weight training. Other causes are genetic predispositions to POP and connective tissue disorders.

Childbirth is one of the most traumatic events that the female body experiences and vaginal delivery is the single most important factor in the development of POP. Passage of the large human head through the female pelvis causes intense mechanical pressure and tissue trauma (stretching, tearing, compression and crushing) to the PFM and PFM nerve supply. This results in separation or weakness of connective tissue attachments and alterations and damage to the integrity of the pelvis. POP that occurs because of a difficult vaginal delivery may not manifest until decades later. It is unusual for women who have not had children or who have delivered by elective caesarian section to develop significant POP.

To be continued…

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Much of the content of this entry was excerpted from his recently published book: The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health. For more info: http://www.TheKegelFix.com.

He has previously authored Male Pelvic Fitness: Optimizing Sexual & Urinary Health; Promiscuous Eating: Understanding And Ending Our Self-Destructive Relationship With Food; and Finding Your Own Fountain Of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro. Area and 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 that is in such dire need of bridging.

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The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: www.TheKegelFix.com. The e-book offers discretion, advantageous for books about personal issues, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources.  The book was written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.