7 Symptoms of Enlarged Prostate (BPH)

8 Apr 2019 Blog

Benign Prostatic Hyperplasia, or BPH, is the enlargement of the prostate gland. The prostate gland surrounds the urethra and assists in reproduction. As a man ages, the prostate gets larger and begins to put pressure on the bladder and urethra, causing uncomfortable symptoms.

About half of men over age 75 will experience symptoms of BPH. BPH is a very minor condition and is not related to prostate cancer. However, symptoms can cause discomfort and be inconvenient.

Many of the symptoms of BPH tend to relate to urination. Here are the 7 most common symptoms:

  1. Difficulty starting urination. The enlarged prostate alters the pressure of your bladder to pass urine. This can have damaging effects on your kidneys.
  2. Weak urine stream. As the urethra becomes constrained, urine passes at a much slower rate.
  3. Urgent need to urinate. You may go from not needing to urinate to suddenly needing to go because of how the bladder gets constrained.
  4. Issues with sleeping. Pressure from the enlarged prostate can mess with nerve signaling in the middle of the night. This leads to you thinking you have to urinate when you don’t.
  5. Feeling unable to completely empty your bladder. You may not be able to completely empty your bladder, which can lead to Urinary Tract Infections (UTI) and stone issues.
  6. Urinary tract infection. A UTI is caused by the urine that sits in your bladder which you can’t fully empty, creating an environment for bacteria to thrive.
  7. Bladder stones. The leftover urine in your bladder can also crystallize to create bladder stones.

BPH can cause these symptoms, but having these symptoms doesn’t necessarily mean you have BPH. There are many reasons why you may have urinary issues. Talk to your urologist about proper diagnosis.

Treating BPH

BPH treatment entirely depends on the individual case. Very minor cases may just need changes in lifestyle. In other cases there are medication and surgery options available. Keep in mind, there is no permanent cure for BPH, but treatment options are meant to lessen the symptoms caused by BPH to help improve your quality of life.

Learn more about men’s health services at New Jersey Urology >

Heart Healthy is Prostate Healthy

1 Apr 2019 Blog

Written by Dr. Eric Seaman:

Author Mark Moyad, MD, has coined the expression  “Heart healthy is prostate healthy.” At a recent speaking engagement for the physicians at New Jersey Urology, Dr. Moyad spoke of nutrition, overall health and its relationship to mortality from all causes – including prostate cancer. For example, statins (which lower cholesterol levels in the blood) may, for some patients, be both heart healthy and prostate healthy.

A group from the University of Wisconsin-Madison reports support for this statement. Reports found that men who were taking androgen deprivation therapy (also known as hormonal therapy) for prostate cancer not only had improved cancer-specific survival, but also overall survival. Dr. I. Anderson-Carter et al published an article titled “The Impact of Statins in Combination with Androgen Deprivation Therapy in Patients with Advanced Prostate Cancer: A Large Observational Study” in the February 2019 Journal of Urologic Oncology.

The study involved a retrospective review of records of more than 87,000 men on hormonal (or androgen deprivation) therapy for advanced prostate cancer. Out of those men, the patients who were also taking statins (more than 53,000) had a significantly longer average survival rate than those who did not. In fact, according to the report, not only was statin use associated with a 44% decreased risk of death from prostate cancer, but it was also associated with a 34% decreased risk of death from any cause.

These findings were true even after adjusting for possible confounding information related to age, race, PSA blood test results and Gleason score of the tumor (the appearance of the cells within the tumor which usually correlates with the aggressiveness of the tumor) as well as the Charlson Comorbidity Index (CCI). The CCI predicts one-year mortality for patients who may have other medical conditions such as heart disease or stroke.

The authors acknowledge the limitations of their report and conclude by stating that statins are “inexpensive, well-tolerated medications that offer a promising adjunct to ADT but require further prospective studies.”

Learn more about Men’s Health at New Jersey Urology >

Should I See a Doctor for Erectile Dysfunction?

18 Mar 2019 Blog

Some medical conditions are easy to ignore, especially when they seem as common as erectile dysfunction (ED). Although commercials may normalize the condition, it’s important to schedule an appointment with your urologist if you start experiencing signs and symptoms of ED.

Causes of Erectile Dysfunction

Causes of erectile dysfunction may include:

  • Increased nicotine usage
  • Increased alcohol consumption
  • Using new prescription medication
  • Fatigue

These causes can be temporary. However, ED can also be the result of a psychological or physical imbalance.

Psychological Causes of ED

Depression, anxiety, stress, and relationship problems can affect sexual performance. Your physician might suggest therapy to deal with anxiety caused by depression, or medication to lessen anxiety if it’s causing erectile dysfunction.

Physical (Organic) Causes of ED

Physical causes of ED are more common than psychological. Some medical conditions that cause ED include:

  • High blood pressure
  • High cholesterol
  • Heart and vascular disease
  • Diabetes
  • Kidney Failure
  • Liver Cirrhosis
  • Stroke
  • Epilepsy

Treating Erectile Dysfunction

The first step in treating erectile dysfunction is making an appointment with a urologist. Depending on the cause, one of our specialists will analyze your symptoms and come up with the proper treatment. Most physicians will also suggest that you get into a regular exercise routine and eat healthier. Living a healthy lifestyle can help reduce the frequency of ED.

Learn more about Men’s Health Services at NJU >

Can Varicocelectomy Improve In Vitro Fertilization (IVF) Outcomes? 

11 Mar 2019 Blog

Written by Dr. Eric Seaman:

Varicoceles are enlarged scrotal veins that lie next to the testicle or testicles. Varicoceles can be associated with loss of testicular size, testicular pain and infertility. Varicocele repair, also known as varcocelectomy, has been reported to improve results of semen analysis and its use in the treatment of male factor infertility has been well established.

In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) has also been used very effectively in the treatment of male factor infertility. IVF with ICSI involves the injection of single sperm into individual eggs in order to produce embryos. These embryos are allowed to mature outside the body into blastocysts. A single blastocyst is then, typically, transferred back to the female partner.

Because so few sperm are required for IVF-ICSI, many have questioned whether varicocelectomy has any role in improving outcomes. Even in cases where sperm counts are too low to pursue the more primitive technique of Intrauterine Insemination (IUI), there are often a million sperm or more beyond what is necessary to pursue IVF with ICSI. So even if varicocele repair results in improved semen parameters, does it actually matter? Are IVF pregnancy results improved?

The surprising answer is that literature supports the fact that it does. A 2016 retrospective meta analysis by Kirby at al, (Fertil Steril. 2016;106(6):1338) examined the effect of varicocelectomy repair on pregnancy rates after IVF with ICSI. Although pregnancy rates did not show significant improvements, live birth rates actually did.

Within that meta-analysis, one study cited, Esteves et al (J Urol. 2010; 184: 1442), revealed significantly higher pregnancy and live birth rates in a report comparing results of 80 men who underwent varicocelectomy prior to IVF vs162 men who did not.

Still, the decision of whether to perform varicocelectomy involves additional considerations. First, it is a minor surgical procedure for the male. Every procedure (including IVF with ICSI) involves risks and benefits. Second, improvements in semen parameters usually don’t occur for at least 3 months after the procedure is performed, adding more waiting time for the couple.

On the other hand, varicocelectomy sometimes offers a chance at avoiding IVF-ICSI altogether. I have personal recent experience in performing varicocelectomy on a patient who had a sperm count well below one million per ml (referred as severe oligospermia). The patient elected to have a microsurgical varicocelectomy. Four months after surgery, his sperm density increased to nine million per ml and a few months later, he and his wife conceived naturally. Certainly, that is not what always happens, but it is important to realize that sometimes it can.

Learn more about men’s health services at New Jersey Urology >

Why You Should Exercise the Pelvic Floor Muscles

28 Jan 2019 Blog

Written by Dr. Andrew Siegel:

We hear much about the importance of strengthening our “core” muscles. Most core exercise programs focus on the abdominal, hip, and back muscles. However, there are deeper core muscles that form the floor of the core muscles–the pelvic floor muscles—that are often neglected. These muscles play a vital role in sexual, urinary, and bowel health and in maintaining proper form, balance and posture during virtually every form of exercise.

The Pelvic Floor Muscles

The pelvic floor muscles are not well-respected external glamour muscles. However, these often-ignored pelvic muscles are hidden gems that work diligently behind the scenes. These muscles have a role that goes way beyond the joint movement and locomotion function of the external muscles. Although concealed, the pelvic muscles have a profoundly important role in sexual, urinary, and bowel function as well as in supporting our pelvic organs.

Use Them Or Lose Them

The pelvic floor muscles, as with other muscles in the body, are subject to adaptation. Unused as intended, they can become thin, flabby and poorly functional as happens with aging, weight gain, a sedentary lifestyle, poor posture and other forms of injury and trauma, chronic straining, and surgery. Used appropriately as designed by nature, they can remain healthy in structure and function. When targeted exercise is applied to them, particularly against the forces of resistance, they can be enhanced. Diligently practiced pelvic exercises will allow one to reap tangible rewards, as having fit pelvic muscles is the essence of functional fitness.

Pelvic Floor Muscle Training: In Isolation and Integrated With Other Workouts

There are two means of working out the pelvic floor muscles: in isolation and integrated. In order to become the master of your pelvic domain, it is initially important to isolate the pelvic floor muscles. Once pelvic floor muscle competence is established, pelvic exercises can then be integrated into other exercise routines and workouts. In real life, muscles do not work in isolation but rather as part of a team, the pelvic muscles being no exception. The pelvic floor muscles often contract in conjunction with the other core muscles in a mutually supportive and synergistic fashion. In fact, many Pilates and yoga exercises emphasize consciously contracting the pelvic muscles simultaneously with the other core muscles during exercise routines.

Engaging the pelvic floor muscles while doing squats, lunges, etc., serves not only to integrate the lower regions of the core and provide optimal support and “lift” of the floor of the core, but also as a means of exercising the mind-body connection. It is important to avoid overexertion of the pelvic floor muscles and awareness directed towards this region is sufficient without the necessity for a forceful contraction.

Dynamic exercises in which complex body movements are coupled with core and pelvic stabilization—such as squats and deadlifts—enhance non-core as well as core strength and function to the maximum. The core muscles, including the pelvic floor, stabilize the trunk when our limbs are active, enabling us to put great effort into limb movements. It’s impossible to use the arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a platform from which to push off (think martial arts). Normally this happens without conscious effort, but with some focus and engagement, the core and pelvic floor contraction can be optimized. The stronger the platform, the more powerful the potential push off that platform can be.

Pelvic Contractions To Counteract Intense Training Regimens

Weight training and other forms of intense exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity also comes into play. Engaging the pelvic floor during such efforts will help counteract the vector of downwards forces exerted on the pelvic floor.

Knack Maneuver

Many females and certain males (particularly after radical prostatectomy) suffer with stress urinary incontinence, a spurt-like urinary leakage that occurs at times of increased abdominal pressure such as with sports and other high impact activities including jumping and kickboxing. For years, urologists and gynecologists have advocated the “knack” maneuver to counteract this, a technique in which the pelvic muscles are braced and briskly engaged at the time or just before any activity that triggers the stress incontinence. When practiced diligently, this can ultimately become an automatic behavior.

Bottom Line: The pelvic floor muscles are out of sight and therefore out of mind. However, these muscles that form the floor of the core are fundamental to many important body functions (sex, urinary and bowel). Pelvic floor muscle conditioning will not only help keep these functions in working order, but also is a vital component to the performance of complex movements that require engagement and stabilization of the core muscles.

6 Kidney Stone Symptoms and When to See a Urologist

17 Dec 2018 Blog

Kidney stones can happen to adults of any age and can be extremely inconvenient. If diagnosed early, stones can be treated more quickly. About 11% of men and 7% of women in the United States will experience a kidney stone at some point, and approximately half of those who experience kidney stones will get them again. It’s important to know what the symptoms are, and when to see a urologist.

Kidney stones can be debilitating and painful (sometimes very painful). While a stone forms in the kidney, there may be no signs or symptoms. Most people start experiencing symptoms once the stone is formed and passes into the ureter (the tube that connects the kidney to the bladder). The most common kidney stone symptoms include:

  1. Pain in the side and/or back
  2. Pain in the lower abdomen and/or groin
  3. Painful urination
  4. Discoloration of urine
  5. Nausea and vomiting
  6. Frequent urination

You may be experiencing one or more of the above symptoms and think, “Should I see a doctor? Are my symptoms that bad?” You should make an appointment with a urologist when you experience any of the above symptoms for an extended period of time. If you are worried about your symptoms and think you may have kidney stones, don’t hesitate to call and make an appointment. You should especially seek a urologist if you experience:

  • Pain so extreme that it’s hard to move or get up
  • Blood in the urine
  • Consistent nausea and vomiting in combination with urination symptoms

Your urologist will conduct an imaging test to diagnose your kidney stones if they think your symptoms warrant it. This can be done early on and can help treat the stone(s) sooner. It’s better to get an appointment early on rather than wait until the last minute.

Learn more about Kidney Stones >

How To Do a Monthly Testicular Self Exam

10 Dec 2018 Blog

Written by Dr. Andrew Siegel

Most testes lumps, bumps and growths are benign and not problematic. Although cancer of the testicles is rare (less than 9,000 cases a year in the USA), it is the most common solid cancer in young men age 15-40, with the greatest incidence in the late 20s, striking men at the peak of life.

Notable men who are members of the testicle cancer club include: Tour de France Champion Lance Armstrong, baseball player Scott Shoenweis, skater Scott Hamilton, MTV Host Tom Green, comedian Richard Belzer, sportswriter Robert Lipsyte, and Olympian Eric Shanteau.

The good news is that it is a highly curable cancer, especially so when picked up in its earliest stages, and also potentially curable even at advanced stages.

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

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

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

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

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

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

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

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

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

To make an appointment with a urologist, visit our locations page to find an office near you.>

6 Urological Medical Myths Debunked

3 Dec 2018 Blog

Written by Dr. Andrew Siegel

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

Myth 1: A vaccine caused my child’s autism.

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

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

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

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

Myth 2: Doing a prostate biopsy will spread any cancer that may be present.

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

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

Myth 3: Cancer spreads when exposed to oxygen.

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

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

Myth 4: All prostate cancer is slow growing and can be ignored.

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

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

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

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

Myth 5: Drink lots of fluids to flush out kidney stones.

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

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

Myth 6: Everyone must drink 8-12 glasses of water a day.

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

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

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

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

A Urological Approach to Men’s Preventative Health

19 Nov 2018 Blog

Written by Dr. Andrew Siegel

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.

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. 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

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.

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Is This Normal? 10 Common Penile “Flaws” You May Have

A penis is a special organ—a man’s joy, if not pride—and certainly one of his most prized, appreciated and cherished possessions, to which he has a significant attachment. As multifunctional as a Swiss Army knife, it allows him to stand to urinate (an undervalued capability), rises and firms to the occasion to allow for sexual penetration, and ejaculates genetic material–the means to perpetuate the species. A marvel of hydraulic engineering, within nanoseconds of sexual stimulation it is uniquely capable of increasing its blood flow 50 times over baseline, transforming its shape and size. Penis magic!

Each and every penis is unique. As variable as snowflakes, they come in every size, shape, and color. Beyond “size matters”—often a source of male preoccupation—men are often obsessed, if not preoccupied, with the appearance of their genitals. In my interactions with patients, concerns are often voiced about symmetry, color, pigmentation, angulation, spots, blemishes, vein patterns, shrinkage, and other oddities. Unless you are in the habit of closely inspecting other men’s genitals (as urologists are), you are unlikely to realize how common and completely normal most of these genital variations are.

10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

  1. Penis leans to one side. No human is perfectly symmetrical and the flaccid penis rarely hangs perfectly centered. Wherever your penis naturally lies when you are clothed—whether left or right—is not indicative of your political leaning or left vs. right-sided brain predominance and is of absolutely no significance or consequence whatsoever!Interesting trivia: “Throckmorton’s sign” is a term used jokingly by medical students, residents and attending physicians. A positive Throckmorton sign is when the penis points to the side of the body where the pathology is, e.g., if a man is getting surgery for a right groin hernia and the penis points to the right side. The Throckmorton sign indicates the proper side of the pathology at least 50% of the time! Operating room humor!
  2. Slight penile curvature when erect. Again, although perfect symmetry may be desirable, the norm for the erect penis is not to be perfectly straight. There is often a subtle bend to the left, right, up or down. Some men have a penis that has a banana-like curvature. Slight bends—considered totally normal—are to be distinguished from Peyronie’s disease, a condition in which there is significant angulation due to scarring of the sheaths of the erectile chambers. It is a potentially serious condition that can cause painful erections and erectile dysfunction.
  3. One testicle hangs lower. If you ever wondered why one of your testes is slightly bigger or heavier and hangs lower than the testes on the other side, you are in good company. Paralleling women with breast asymmetry, the vast majority of men have testes asymmetry, so your mismatched gonads are perfectly normal.
  4. Dark genital skin. Hyperpigmentation (darkening) of the median raphe (the line running from anus to perineum to scrotum to undersurface of the penis) and other areas of the penis is extremely common. In fact, it is normal for the penile skin color to be darker than other areas of the body, because of the effect of sex hormones on the cells that produce pigment (melanocytes). The circumcision line, as well, is often deeply pigmented
  5. Freckles, moles and skin tags. The penis is covered by skin–just like the rest of the body–and is therefore subject to common benign skin growths, including moles, freckles and skin tags. These are generally harmless and usually, do not require any treatment unless desired for cosmetic reasons. However, if you have a growth that changes in size, color or texture, you should have it checked out because penile cancers do occur on occasion. Skin tags are small fleshy protuberances and can be confused with genital warts, so if you have any doubt, get checked.
  6. Other penis and scrotal bumps and lumps. Pearly penile papules are raised “pearly” bumps that appear around the corona (the base of the head of the penis). They consist of one or more rows of small, fleshy, yellow-pink or transparent, smooth bumps surrounding the penile head. They are benign and do not cause harm, but sometimes are treated for cosmetic reasons, usually with freezing or lasering. Sebaceous glands produce oil that nourishes the hair follicles of the genitals. These glands appear as numerous small yellowish bumps on the scrotum and penile base. In some men, they are prominent and referred to as sebaceous gland hyperplasia. At times, they can exist without a hair follicle even being present. Regardless, they are a normal occurrence.
  7. Scattered scrotal spots. Angiokeratomas are benign purplish skin growths with a scaly surface that are not uncommonly present on the scrotum. They consist of dilated thin-walled blood vessels with overlying skin thickening. These skin lesions can occasionally bleed and also cause fear and anxiety since they can resemble more serious problems such as melanoma. If in any doubt, get it checked out.
  8. Veiny vanity. Every man has a unique penile venous pattern, the anatomy as unpredictable as the distinctive venous anatomy of the hand and wrist. In some men, the veins are twisted and prominent and in other men, they are barely noticeable. No matter what the pattern, venous anatomy is highly variable and individualized and is normal.
  9. Loose skin. Unlike most other skin on the body that is more tightly attached, penile skin is loosely attached to underlying tissues, allowing for expansion with erections. Since the physical state of the penis can vary from totally flaccid to totally rigid, when the penis is fully deflated, the skin may appear to be somewhat floppy and redundant, which is absolutely normal. Scrotal skin often becomes increasing lax with the aging process, such that the testicles typically hang quite low in the elderly male, paralleling the common situation of pendulous breasts of the elderly female.
  10. Shrinkage. Penile size in an individual is quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” can be provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves temporarily reduced blood circulation. Don’t worry, that sorry and spent looking penis can magically be revived with some TLC!

Bottom line: If you have an imperfect penis…welcome to the club! No penis or scrotum is perfect. Far from being an object of beauty, genital imperfections are the norm, so there is no need for feeling self-conscious. Just be happy that your little “fella” can function properly and enjoy his own happiness from time to time! Function over form!

Written by Dr. Andrew Siegel


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