Male Sexual Dysfunction: A Predictor of Heart Disease

4 Feb 2019 Blog

Written by Dr. Andrew Siegel:

Having some fat on our bodies is not a bad thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs, provides insulation to conserve heat and it is a means of storing energy and fat-soluble vitamins. Fat is also part of the structure of the brain and cell membranes and is used in the manufacturing process of several hormones.

All fat is not created equal. It’s all about location, location, location.

Not all fat is the same. It’s important to distinguish between visceral fat and subcutaneous fat. Visceral fat– also referred to as a “pot belly” or “beer belly” – is internal fat located deep within the abdominal cavity. Subcutaneous fat – also known as “love handles,” “spare tires,” or “muffin top,” – is superficial fat located between the skin and the abdominal wall.

In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more hazardous to one’s health than subcutaneous fat. Visceral fat increases the risk of heart disease, diabetes and metabolic disturbances. Subcutaneous fat is inactive, relatively harmless, and generally does not contribute to health problems.

Factoid: A beer belly is called a beer belly for good reason. One of the real culprits in creating visceral fat is drinking liquid carbs, including sweetened beverages (sodas, iced tea, sports drinks), fruit juices (such as orange or cranberry) or alcoholic beverages. These liquid carbs have no fiber and are essentially pre-digested, stimulating an insulin surge and rapid storage as fat. It’s always better to eat the fruit rather than drink the juice because fruit is loaded with fiber that fills you up, slows the absorption process, and contains abundant phytonutrients.

Visceral fat essentially is a metabolically active endocrine “organ” that does way more than just create an unsightly protrusion from our abdomens. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body, including risk of diabetes, cardiovascular disease, low testosterone, erectile dysfunction (ED) and premature death.

Sexual dysfunction

Beer belly and metabolic syndrome are highly associated with low testosterone and poor erection and ejaculation function. The fatty tissue present in obese abdomens contains abundant amounts of the enzyme aromatase, which converts testosterone to estrogen —literally emasculating obese men. So, visceral fat can steal away our masculinity, male athletic form and body composition, mojo, strength, and the ability to obtain and maintain a good quality erection.

ED serves as a good proxy for cardiac and general health. The presence of ED is as much of a predictor of heart disease as is a strong family history, tobacco smoking, or elevated cholesterol.

FactoidThe penis can function as a “canary in the trousers.” Since the penile arteries are generally rather small (diameter of 1- 2 mm) and the coronary (heart) arteries larger (4 mm), it stands to reason that if vascular disease is affecting the tiny penile arteries and causing ED, it may affect the larger coronary arteries as well — if not now, then at some time in the future. In other words, the fatty plaque that compromises 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 genital “stress test.”

While the penis can genuinely shrink for a variety of reasons, most of the time it is a mere illusion — a sleight of penis. Obesity causes a generous pubic fat pad that will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding or buried behind the fat pad. Lose the fat and presto…the penis reappears. Yet another reason to remain lean!

Trivia: It is estimated that for every 35 lbs. of weight gain, there is a one-inch loss in apparent penile length.

What does this all mean?

  • Visceral fat is a bad, metabolically-active form of fat that is highly correlated with metabolic syndrome, diabetes, heart disease and sexual dysfunction.
  • ED often occurs in the presence of “silent” heart disease (no symptoms) and serves as a marker for increased risk for heart disease (as well as stroke, peripheral artery disease and death). ED will often occur 3-5 years before heart disease manifests. Early detection of ED provides an opportunity to decrease the risk of heart disease and the other forms of blood vessel disease. ED has a similar or greater predictive value for heart disease as do traditional factors including family history, prior heart attack, tobacco use and elevated cholesterol. The greater the severity of the ED, the greater the risk and extent of heart disease and blood vessel disease.

What can I do?

Lifestyle intervention has the potential for reversing visceral obesity, metabolic syndrome and sexual dysfunction. This lifestyle intervention involves achieving a healthy weight, losing the belly fat, eating healthy, exercising regularly, quitting smoking, limiting alcohol intake, and managing stress.

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.

10 Ways to Get Your Best Night’s Sleep

21 Jan 2019 Blog

Written by Dr. Andrew Siegel:

In addition to exercise and healthy eating as the key pieces to a healthy lifestyle, modern science supports quality sleep as a third piece of equal importance. According to the CDC, more than one third of Americans are not getting enough sleep on a regular basis. 

What’s obvious

Getting enough good quality sleep is important for our well-being and daily functioning. We’ve all enjoyed the joyous experience of a great night’s sleep, waking up well-rested, energetic and optimistic. On the other hand, we’ve all also experienced a poor night’s sleep, awakening feeling physically exhausted, mentally spent, and often in a disassociated “zombie” state.

The amount of sleep each person needs is biologically determined and different for everyone. Some can make do with five hours of sleep while others require ten hours. As a general rule, seven to eight hours of sleep is recommended. Regardless, sleeping has a restorative function as our brains and bodies require this important down time for peak performance.

What’s not so obvious

Good quality sleep is an important component of overall health, wellness, and fitness. Sleep deprivation can have a negative impact on numerous bodily functions, including:

  • Cognitive
  • Endocrine
  • Metabolic
  • Cardiovascular
  • Gastrointestinal
  • Immunity

While sleeping, there is an increased rate of anabolism (cellular growth and synthesis) and a decreased rate of catabolism (cellular breakdown). These processes are disrupted by sleep deprivation. Chronic sleep issues can result in making one feel ill and appearing much older than they are.

Sleep disruption results in decreased levels of leptin (a chemical appetite suppressant), increased ghrelin levels (a chemical appetite stimulant), increased corticosteroids (stress hormones) and increased glucose levels (higher amounts of sugar in the bloodstream). As a result, chronic sleep deprivation commonly gives rise to increased appetite, increased caloric intake and the disassociated “zombie” state – resulting in dysfunctional eating patterns, consumption of unhealthy foods, and weight gain. In addition, chronic fatigue impairs one’s ability to exercise properly, if at all.

Chronic sleep deprivation also results in irritability, impaired cognitive function and poor judgment. The inability to be attentive and focused interferes with work and school performance, causes increased injuries (such as falls), and motor vehicle accidents.

What to do

The good news is that sleep deprivation can be alleviated. Here are a variety of ways to get a good night’s sleep:

  1. Lead an active lifestyle with lots of exercise and stimulation.
  2. Whether you are an early riser or a night owl, try to be consistent with wake-up and bedtimes on both weekdays and weekends. If these times vary greatly, you’re setting yourself up for sleep problems by disturbing your body’s internal clock.
  3. Maintain a comfortable sleeping environment with a good quality supportive bed, comfortable pillows, a dark room, cool temperature and, if you like, “white noise” (I find that the monotonous sound of the sea produced by a sound machine, coupled with the gentle whirring of an overhead fan, is an instant relaxer).
  4. Avoid caffeine (coffee, tea, cola, etc.) particularly after 6 p.m. Herbal teas (like chamomile) can be soothing and relaxing.
  5. Avoid eating a large dinner or eating very late at night.
  6. Don’t drink too much alcohol.
  7. Avoid exercising late in the evening.
  8. Reduce the stress in your life as much as you can. Engage in a de-stressing activity immediately before sleep, such as reading, watching a movie or television show, or doing crossword puzzle.
  9. Try to minimize evening exposure to the bright light (“blue light”) of cell phones, tablets and computers that inhibits production of the sleep-promoting hormone melatonin. Under normal circumstances, melatonin levels rise with darkness. If possible, dim the light settings on electronic devices that are used at night.
  10. Supplemental melatonin seems to help some people, but is ineffective for many others (including myself), but may be worth a try.

Read more health and wellness tips on our blog >

Fluctuating Urine Color and Odor – What Does It Mean?

14 Jan 2019 Blog

Urine color can range from pale yellow to deep amber – but what does it mean? There are many factors that can affect urine color, including fluid balance, diet, medicine and disease.

Urine Color

How dark or light the color of your urine is depends on how much water you drink. Water and other fluids dilute the yellow pigments in urine, so the more you drink, the clearer your urine will be. In cases of dehydration, the urine can become a dark amber color.

Some vitamins and supplements – such as Vitamin B – can turn urine bright yellow. Some foods – such as blackberries, beets or rhubarb – can turn urine a reddish-brown. Having blood in your urine can also make it appear reddish-brown, so it’s important to observe and take note of these subtle signs and symptoms.

Urine Odor

Some foods (such as asparagus), vitamins, and antibiotics (such as penicillin) can cause urine to have a different odor. A sweet, fruity odor may be caused by uncontrolled diabetes. A urinary tract infection (UTI) can cause a foul odor.

When to See a Doctor

Sometimes, symptoms can be very vague or subtle which makes it very difficult to figure out what the problem is. If you are dehydrated your urine will be more concentrated and urinating may cause discomfort. Drink enough fluids to keep your urine light yellow or clear, this will help decrease discomfort.

Visible blood in the urine is often a sign of a urinary tract infection or kidney stone. Dark or orange urine may be a sign of liver malfunction. You should notify your doctor if you experience any of these symptoms.

Find a Urologist Near You >

10 Easy Food Substitutions for a Healthier Lifestyle

2 Jan 2019 Blog

Written by Dr. Andrew Siegel:

Today’s entry is about a healthy eating lifestyle—as opposed to a diet—that works for me and I promise will help you improve your body shape and shed excess pounds. I want to emphasize that this is not a fad diet, but a style of eating that can be easily incorporated to replace the typical calorie-rich, nutrient-poor Western diet that is overloaded with highly processed and refined foods, junk and fast foods, contributing to avoidable chronic health problems. As opposed to many weight loss programs that are gimmicky, unbalanced, unhealthy, and unsustainable, this approach is a no-nonsense, intelligent one—clean, lean, with plenty of green—that will stave off your hunger and hold caloric intake in balance with expenditure, making it effective and durable.

Bialy Diet

First I will introduce the bialy diet. It is sensible and nutritious eating, substituting less caloric and healthier foods for more caloric and unhealthier alternatives. For example, eating bialys instead of bagels. A bialy diet does not imply eating a bialy at every meal, but is simply code for substituting healthier choices for unhealthier ones!

A Few Words on Bialys

bialy | bēˈälē | noun (plural bialys) US a flat bread roll topped with chopped onions

Who doesn’t love a fresh, warm NY bagel with a smear of cream cheese? Sadly, the answer is our bodies and our health. The 360-calorie bagel with two tablespoons of cream cheese (100 calories) is 460 calories of mostly refined carbs and fat. A great alternative is a bialy (“bialystoker kuchen” from Poland where it originated), a delicious flat bread roll that contains no hole, is not over-stuffed and bulging like an overinflated tire and has a depressed middle that is flavored with cooked onions and poppy seeds. The 180-calorie toasted bialy with a teaspoon of light butter with canola oil (20 calories) is only 200 calories and smells and tastes delicious. It is crisp and chewy at the same time, totally satisfying and doesn’t leave you feeling bloated. This with a mug of strong black coffee and half a grapefruit with a few strawberries or blueberries thrown on top is my typical breakfast. Sometimes on the weekends I will have an egg white omelet on a bialy with a slices of NJ tomato and avocado, a heavenly treat.

Mediterranean Diet

Mediterranean style eating emphasizes less meat and more fish, an abundance of vegetables and fruits (rich in biologically active compounds including antioxidants, vitamins, minerals and fiber), whole (unrefined) grains, legumes and healthy vegetable fats from olives, avocados, nuts and seeds. Herbs and spices are used to flavor food, rather than salt. Dairy products are eaten in moderation.

80/20 Strategy

Another element of a healthy eating lifestyle is the 80/20 strategy. This means that 80% of the time you adhere to a healthy eating style, but 20% of the time you give yourself a break, jump off the wagon and indulge in limited amounts of whatever temptation indulgence you would like. This avoids deprivation and, in my opinion, is “an inoculation to prevent the disease.” On the limited list are sweets including cookies, cakes, donuts, candy and liquid carbohydrates such as sugary drinks including soda, ice tea, lemonade, sports drinks and fruit juices. The only liquid carbohydrate I consume is alcohol in moderation, wine being a component of the Mediterranean style eating.

Here are 10 easy substitutions that incorporate the above mentioned healthy-eating lifestyles:

  1. Bialys instead of bagels
  2. Seafood and lean poultry instead of red meat (if you do eat red meat, consume only the leanest cuts and opt for grass-fed instead of corn-fed)
  3. Vegetable protein (legumes such as peas, soybeans and lentils) instead of animal protein
  4. Olive oil instead of butter
  5. Real fruit instead of dried fruit or fruit juice
  6. Whole grains (wheat, brown rice, quinoa, couscous, barley) instead of refined grain products
  7. Flavored seltzers or sparkling water instead of soda
  8. Plain Greek yogurt instead of sour cream
  9. Soy, rice, almond or other nut-based milks instead of dairy
  10. Low-fat or non-fat dairy products instead of whole milk products

Other Nuggets of Advice:

  • The pathway to a healthy weight is slow and steady, demanding patience and time
  • Eat slowly, deliberately and mindfully
  • Get enough good quality sleep to help keep the pounds off
  • Avoid late night meals and excessive snacking
  • Stay well hydrated as it is easy to confuse hunger with thirst
  • Do not skip meals
  • Keep healthy foods accessible
  • Avoid foods that contain unfamiliar, unpronounceable, or numerous ingredients
  • Organic does not imply healthy or low-calorie
  • Let the last thing you eat before sleep be healthy, natural and wholesome (e.g., a piece of fruit)—you will feel good about yourself when you get into bed and even better in the morning

A lifestyle of healthy eating can improve your overall wellness, both physical and mental. Here’s to a happy, healthy new year!

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.

Six Surprising Reasons for Erectile Dysfunction (ED)

26 Nov 2018 Blog

Erectile dysfunction (ED) is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity. ED is very common, affecting approximately 40% of men at age 40 and nearly 70% of men at age 70 (source). Although increasing age is the biggest contributing factor for ED, here are six other causes that may surprise you.

  1. You have anxiety at work.
    Men who work in an environment that causes anxiety and/or depression are more likely to suffer from ED. Erections require the nervous system to trigger them, so if the system is depressed, it can be difficult to trigger and maintain an erection.
  2. You have diabetes.
    ED prevalence in men with diabetes ranges from 35-75% and occurs 10-15 years earlier than men without diabetes (source). Irregular blood sugar can damage the nerves and blood vessels that allow blood flow in the penis.
  3. You have bad oral hygiene.
    Research shows that men who suffer from chronic periodontitis are more likely to suffer from ED (source). Periodontitis is often associated with oral inflammation, which decreases nitric acid production and blood flow.
  4. You regularly add salt to food.
    High blood pressure and cholesterol are often associated with high-sodium intake, which restricts blood flow. Restricting blood flow to the penis may be a contributing cause of ED.
  5. You enjoy riding a bike.
    Bike riding can desensitize and damage the nerves in the pelvic floor, which can make it difficult for men to get an erection. Scale back on the number of miles you ride on your bike each week and focus on other kinds of exercise if ED is a problem for you.
  6. You’re trying to reverse hair loss.
    Certain medications for hair loss, such as Propecia and Avodart, can cause ED because they reduce the amount of dihydrotestosterone in the blood.

Learn more about Erectile Dysfunction treatment at New Jersey Urology >

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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