6 Reasons to See Your Urologist

Why this problem still exists is beyond me. So many times, whether on WebMD's Men's Health or Male Factor Infertility message boards or in my practice, I hear the same basic theme - a man has an obviously urologic problem, it is not resolving or appears to be serious, and yet his primary care doctor has not referred him to a urologist for evaluation and treatment as indicated.

Sometimes it may be for a nuisance problem - or it may be a warning sign of something potentially life threatening. So why would patients not be sent to a urologist at the first sign of something serious, potentially dangerous, and obviously urologic? Your guess is as good as mine.

I do know that many primary care doctors are under tremendous pressure by insurance companies to limit referrals to specialists. Other times it may simple ignorance by the primary doctor. Worse yet, it may be arrogance that the doctor thinks he or she knows everything urologic and so does not believe a urologist would add anything to the patient's care.

So what are a few problems that absolutely must be seen by a urologist? There are many, but here are some examples of signs or symptoms that absolutely should be seen by a urologist - nonnegotiable!

1. Any aspect of male infertility. A small percent of male factor infertility is because of testicular cancer. This is often missed by primary care doctors and totally missed when referred to an IVF fertility doctor.


2. Blood in the urine. Hematuria, whether visible (gross hematuria) or only seen under the microscope (microscopic hematuria) is not normal and can be an early warning sign of a bladder or kidney cancer. The work-up is basic, including urine tests, an x-ray such as CT scan and a look inside the bladder with a fiberoptic scope (cystoscopy). Waiting to see if the blood will go away is not smart. Blood one time is enough to see a urologist.


3. An elevated PSA or change in PSA. The PSA remains one of the most sensitive indicators of prostate cancer of all tests in medicine. The problem is that too many doctors don't understand what the PSA test is and probably even more and important, what the PSA test is not. Any elevation raises concerns so must be evaluated. Simply telling you to go away and let's see how high it goes or how fast it climbs is not smart. And if the PSA starts to climb, even if still within "normal "levels, the change may suggest cancer. So any change of significance should be evaluated as well.


4. An abnormal prostate exam. Any abnormality - firmness, small nodules, or irregularities - may be from a prostate cancer and so must be seen by a urologist. Likewise, any changed from prior exams must be seen. This is why it is so important that all men over the age of 40 to 45 get a yearly exam, ideally by the same doctor. As with all potentially serious problems, if detected early the cure rate is high.


5. Any abnormality of the kidney found on x-ray. It must be assumed that these are kidney cancers until proven otherwise. Do not let anyone biopsy a kidney mass unless you have seen a urologist. Biopsies of a kidney mass can actually cause more harm, and often do not provide the information desired.


6. A testicular mass or persistent pain. Because of the rare chances of having an underlying testicular cancer, any masses, firmness or nodules of the testicle must be seen by a urologist. This also includes men with testicular pain that does not resolve within a week or two. If caught early, testicular cancer is one of the most curable cancers in humans.

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Technorati Tags: urology, mens health, male infertility,testicular cancer, prostate cancer, PSA, hematuria, bladder, kidney

Penis Enlargement: Myths and Facts

Results in seconds. Wow.

I don't know about you but I am fast growing tired of the dozens of spam e-mails I get every day about the magic new penis enlargement pill, cream or device. But it is not limited to these anonymous e-mails. Now I have to watch or listen to these same scams on major prime time TV shows and radio. What amazes me most is that these advertisements must be making money, or they wouldn't still be on the air week after week, month after month.

Here's the kicker - there is no truth or science behind any one of them. They are all pure and simple scams, designed to separate out the foolish from their money. Nothing more than snake oil salesmen, and sadly as educated as we are, we still remain gullible. Hey, if I could find a way to feel comfortable stealing money from people I might too jump in and offer "Sheldon's secret penile enlargement formula- but don't' wait, because organized medicine wants to shut me down, so order before midnight tonight and we'll throw in a free spray-on window tinter". And here is how they promote an age-old gimmick - now they call it male enhancement - kind of like a used car is now called pre-owned so they can charge more. If I sell my own secret formula, then I can lie but it is a new lie so it will take a few years for it to catch up to me and maybe by then I will have my millions hidden away in an off-shore Caribbean island. But my ethics gets in the way.

So many times people ask "why doesn't the government step in an stop these quacks from making outright lies and false claims?" The reason is simple - the supplement industry has worked very hard to keep the FDA out of the supplement market. This way, they can sell anything to anyone and they don't have to prove that it is effective, that it is even helpful or that it is even safe. So anyone with some money can create a fake treatment and sell it, making wild and extreme claims.

And what better way to trick people than playing to the secret wish of many men - to have a bigger penis? Because, after all, we know that men with bigger penises must be happier, more successful and have happier wives. And who will complain that his penis enlargement pill didn't work? I would guess very few men.

But what is a normal sized penis? This is a subject that guys never seem to understand. First of all, the size of a non-erect penis has no relevance to an erect penis. Some guys who have small penises can get quite large and other guys who are large don't change much, and everything in between. Somewhere about 4 to 6 inches erect is what a normal penis is supposed to be.

Let me explain this as simply as I can. The penis you have is the one you are genetically designed to have. It is because of the DNA you inherited from your mother and father. It is also the reason you are as tall or short as you are as well as the color of your eyes.

After spending more than 20 plus years in urology, it is clear that no pill or cream or vacuum contraption will change your penis size. It is not like the penis is elastic and can be enlarged. It is what it is. If you have extra weight, then you can lose a few pounds and your penis will seem bigger. You could opt for disfiguring surgery to cut the ligament that will let your penis fall down, and give you the appearance of maybe 1/2 inch more for a lucky few, but that is about it. And so you know, most men who have penile enlargement surgery regret doing so. It must be something about all the scarring and pain.

So here is what it comes down to. You can spend lots of money trying to change something that can't be changed, or you can learn what is really important, be satisfied and save a few bucks.

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• 5 Things You Didn't Know About Your Penis
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Technorati Tags: mens health, urology, snake oil, advertising, scams

Foreskin Facts: Turtleneck or No, It All Feels the Same

Okay. It's official now. A study in the Journal of Sexual Medicine¹ looked at a question that has been plaguing men for thousands of years. I know I stay up many nights tossing and turning, wondering the answer to this question. As a urologist, I know in my heart that millions of other men also spend hours each day thinking about this timeless problem. But now we finally have an answer. We can all put this behind us and get on with our lives.

The study looked at the age old question, do circumcised men have less penile sensation than uncircumcised men? The answer, no. It appears that whether or not a man is circumcised, whether aroused or not, his penile sensation is the same. Thank God. I was so worried that because I was circumcised at birth, I have been missing out on lots of fun. And wouldn't you know. it's the Canadians that figured this one out. Another advantage to those long dark winters.
But wait, there was another interesting fact that Dr. Payne and others discovered. They found that the penile sensitivity of men, whether circumcised or not, is actually less than they had anticipated. I'm not sure how much sensitivity these researchers expected.

So now that we are all the same, will all those men who have wanted a foreskin rebuilt change their minds? What about all those that travel the world warning us about the horrible catastrophic hazards of circumcision? I have read accounts of men who just knew that they had dramatically reduced penile sensation since their newborn circumcision. Now they too can rest assured that they are fine...at least physically.

Thank you Dr. Payne. Thank you Canada. I am finally complete and ready to move on, circumcised on not.

¹Kimberley Payne PhD, Lea Thaler BA, Tuuli Kukkonen BA, Serge Carrier MD, Yitzchak Binik PhD (2007) Sensation and Sexual Arousal in Circumcised and Uncircumcised Men The Journal of Sexual Medicine 4 (3), 667-674. doi:10.1111/j.1743-6109.2007.00471.x


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Technorati Tags: foreskin, circumcision, sexual health

Testosterone, Tragedy and Responsibility

Well, they are at it again. Chris Benoit and his family are dead, and now it is time for the media to find someone or something to blame. After all, this is America and blame is what we are all about. No one ever needs to take responsibility for their own actions. It is always someone else's fault. A criminal can always blame his aloof stepfather. A drunk slams into a car, killing the occupants, and it is time to sue the car manufacturer. A criminal shoots someone during a robbery, and the gun manufacturer is guilty.

Now an entire family is dead and night after night, all we hear is how the doctor and the steroids are to blame. "Did the steroids kill his family?" we hear the experts debate. Sure, the doctor may have over-prescribed medications and steroids. Sure the steroids in excess could have played a role. Let's remember that doctors have no control of how their patients take their medications or even if the patients follow the instructions. Once again, responsibility for one's own health rests with the individual. Realistically the patient is only one that decides what to take and how often.

It seems to me that we should focus on making Mr. Benoit responsible for his actions. Was there some underlying mental health illness? Most certainly. Sane people don't kill their wife and child over 48 hours, then hang themselves. Normal people who take testosterone don't kill.

We know that men with low testosterone do indeed have a higher incidence of depression, which usually improves with correct testosterone replacement. Appropriate testosterone replacement doses bring the hormone levels back to normal. Yes, anyone started on testosterone replacement should have regular monitoring of testosterone levels. This testosterone replacement therapy is not associated with changes in behavior.

We also know that doses far above normal (supra-physiologic) can have an impact on behavior. Extremely high doses of testosterone in the body, much higher than the normal range, can lead to depression, suicidal tendencies and impulse control. Maybe the testosterone levels exacerbated an underlying mental illness. So perhaps the doctor contributed to what happened. Maybe he didn't monitor the testosterone levels enough. Then again, maybe he asked the patient to do so and Benoit never followed up. When it all comes down to it, the responsibility for this horrible tragedy still rests entirely with Chris Benoit- whether or not he was taking testosterone.

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Technorati Tags: chris benoit, steroids, testosterone, tragedy

Home Sperm Analysis: Beware the Pitfalls

"A little information can be a dangerous thing."

Once again, there is something new hitting the stores - a new test that measures sperm motility so couples at home can check their fertility status. Wow. At first this seems like a great idea. So easy, so comfortable, so inexpensive.

But there is a problem. In fact, a lot of problems. First, as a male fertility specialist that works with semen analysis daily as part of my vasectomy reversal program, motility alone is almost meaningless. What about the sperm count? What about semen volume? These numbers individually mean almost nothing. But when you look at the total count of motile sperm, which require all these numbers to be multiplied, then you have a number to start with. Then, anyone with any knowledge will tell you that you need two or three counts, each one after 3 days of sexual abstinence, each 8 weeks apart.

So how does this home quickie home test fit in? Especially since there are so many other important aspects of a semen analysis that are not addressed? My fear is that for most couples, they will assume that if their numbers come back "ok" then they will use that information to justify not seeing a male fertility specialist. Simply bad medicine.

But it gets worse. Many times men will have what looks like adequate numbers but could still have serious problems. Testicular cancer is found in one out of every 100 men that is evaluated at a specialty male fertility clinic - something that could not be detected on a home semen analysis kit. So what happens to those guys? Do they not know until the tumor has grown? Will men still go see a male fertility specialist for an exam? I doubt it.

Lastly, all the advances in human fertility and all the amazing miracles are a direct result and spin-off of animal/livestock fertility research. Yet something strange has happened over the past decade. Somehow, the human fertility specialists have lost touch with the animal researchers that are years ahead. Human fertility specialists still use sperm motility as a major marker for fertility. This has been shown to be of minimal importance in the animal world, which has now identified markers for fertility. Then why are we still looking at motility? That's a good question.

I am sure the kit will be a good tool to use in conjunction with a formal fertility evaluation. My experience suggests that most will not do this, and use the information from this home test to replace a doctor's exam and formal fertility testing. I hope I am wrong. A little information can be a dangerous thing.

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• WebMD Video: Male Infertility - Redefined to Bring New Hope
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Technorati Tags: male fetility, semen analysis, motility, testicular cancer, men's health, health and wellness