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.

NJU Physicians Selected as New Jersey Monthly’s 2018 Jersey Choice Top Doctors

27 Nov 2018 News

We’re proud to announce that several New Jersey Urology physicians have been named New Jersey Monthly’s 2018 Jersey Choice Top Doctors. More than 24,000 New Jersey doctors were polled on which of their fellow practitioners they consider New Jersey’s best, resulting in the state’s 1,077 Top Doctors, as chosen by their peers.

New Jersey Monthly 2018 Jersey Choice Top Doctors:

View the complete list here >

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.

Find a urologist that’s right for you >

NJU Physicians Selected as SJ Mag 2018 Top Docs

13 Nov 2018 News

We’re proud to announce that three New Jersey Urology (formerly Delaware Valley Urology) physicians have been named SJ Mag 2018 Top Docs. Two of our physicians were chosen by South Jersey doctors, who were asked to nominate doctors they would recommend to their family members. One of our physicians was nominated by SJ Mag’s readers, who were asked to nominate physicians who they think are Top Docs.

SJ Mag 2018 Top Docs (chosen by South Jersey doctors):

2018 Top Doc Patient Poll (chosen by SJ Mag readers):

Read SJ Mag’s complete list here >

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

12 Nov 2018 Blog

Written by Dr. Andrew Siegel

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!

Should You Be Screened for Prostate Cancer?

5 Nov 2018 Blog

According to the American Cancer Society, about 1 man in 9 will be diagnosed with prostate cancer during his lifetime. Other than skin cancer, prostate cancer is the most common cancer in American men.

It’s recommended that beginning at age 40 (depending on risk level), men should have a discussion with their health care provider about prostate cancer screening. It’s up to each individual to make an informed decision carefully considering the uncertainties, risks, and potential benefits of screening.

Benefits of Prostate Cancer Screening

Although screening is an individual decision, there are potential benefits to getting screened for prostate cancer:

  • The 5-year relative survival rate of prostate cancer is nearly 100%. 15-year is about 95%. This means that the survival rate is very high, it just needs to be detected first and early on.
  • Since the recent push to prevent prostate cancer, tests have become more diverse and more accurate. While they still aren’t 100% accurate, they can provide good insight to your urologist on whether further testing or other actions need to be taken.

What are the Screening Options for Prostate Cancer?

There are a couple options for prostate cancer screening, including:

  • Prostate Specific Antigen (PSA) – This blood test measures how much PSA is in a man’s blood.
  • Digital Rectal Exam (DRE) – Your doctor will insert a gloved, lubricated finger into the rectum to feel the prostate gland. They will assess if the shape, size and texture and feel normal.

Early detection can save lives. Visit our locations page to make an appointment with one of our urology specialists to decide if prostate cancer screening is right for you.

5 Diet Changes That May Reduce the Risk of Kidney Stones

22 Oct 2018 Blog

Urine consists of many dissolved minerals and salts. When there are high levels of minerals and salts in the urine, stones may form in the kidneys. Kidney stones may not cause any symptoms until they move around within the kidney or pass into the ureter (the tube that connects the kidney and the bladder).

While kidney stones are usually are a minor problem and pass on their own, they can cause severe pain. Medication is an option to improve the chance of passing a stone and offer pain relief. Surgery may be necessary for stones that affect kidney function, do not pass on their own, or cause severe pain that can’t be managed with medication.

Although there is no one-size-fits-all diet for preventing kidney stones, there are changes you can make to your diet that will reduce your risk of developing new stones.

  1. Stay Hydrated. Adults should drink about 2 liters of liquid daily (eight 8-ounce glasses). Remember to replace liquids that are sweat out (through exercise or hot weather) in addition to the daily recommended intake. Stick to mainly water and no-calorie or low-calorie beverages.
  2. Reduce Sodium Intake. Avoid salty foods that have a lot of sodium (the C.D.C. recommends staying under 2,300 mg per day). The following foods are high in salt and should be eaten in moderation:
    1. Cheese
    2. Frozen foods and meats
    3. Canned soups and vegetables
    4. Bread (bagels, rolls, baked goods)
    5. Salty snacks
    6. Read the full list here
  3. Eat the Recommended Amount of Calcium. If you take daily supplements, make sure you aren’t getting too much calcium. Eating calcium-rich foods and beverages daily is recommended, and you can usually get enough daily calcium without supplements.
  4. Eat More Fruits and Vegetables. At least five servings of fruits and vegetables daily are recommended (especially those who form kidney stones). Fruits and vegetables provide potassium, fiber, magnesium, antioxidants, phytate, and citrate, which may keep stones from forming. One serving equals one piece of fresh fruit or one cup of raw vegetables. Learn more here.
  5. Eat Less Meat. Animal protein (including meat, fish, poultry, pork) can raise your levels of uric acid, which can cause stones to form. Your healthcare provider may recommend limiting the amount of meat you eat on a daily or weekly basis and recommend eating more plant-based protein options.

Visit our locations page to make an appointment with one of our urology specialists.

Vasectomy – Myth or Fact?

15 Oct 2018 Blog

Because it is a permanent form of birth control, many men have questions or concerns before having a vasectomy. This is normal and to be expected.

To help you on your journey, our physicians are de-bunking these common vasectomy myths:

Myth: Vasectomy is a risky surgery.

Truth: Although vasectomies are a safe and effective surgery, all surgeries have risks. After a vasectomy procedure, mild discomfort, bruising, and swelling is normal. Most men recover within one to two weeks.

Myth: Vasectomy can always be reversed.

Truth: While many men are good candidates for a vasectomy reversal procedure, only about half of these procedures are successful. The tube that the sperm passes through, called the vas deferens, is reconnected during a vasectomy reversal. It is a more complicated surgery because there are different ways to reconnect the vas deferens. Because there is no guarantee that a vasectomy reversal will be successful, it is important to be sure that you want to get a vasectomy in the first place.

Myth: You’ll lose sexual function.

Truth: A vasectomy does not hinder your sex life as the production of testosterone is not affected. The procedure blocks sperm but does not reduce the amount of semen produced, so there is no noticeable difference when you ejaculate.

Myth: Vasectomy is 100% effective right away.

Truth: It can take two to three months following a vasectomy to ensure there is no live sperm. A backup form of birth control should be used during this time. After a year, only 15-20 out of 10,000 couples experience a pregnancy.

Have other questions about vasectomies and vasectomy reversals?

If you have questions about getting a vasectomy, contact your local NJU office to schedule a consultation with a urology specialist.

Dr. Scott Asroff Named Best of Burlington County 2018

2 Oct 2018 News

We’re pleased to announce that Scott W. Asroff, MDhas been named a 2018 Best of Burlington County winner by the Burlington County Times.

Honored as an Industry Leader, Dr. Asroff was named “Best Of” in Urology for 2018.  Read the complete list >

The Best of Burlington County is a list, compiled annually, of readers’ favorite businesses, products, and services in the community. More than 130,000 reader votes were cast in 2018.

Dr. Asroff practices general urology, with special interest in male reproductive health, stone disease, and urologic cancers. He practices in BordentownMount Laurel and Willingboro.

To make an appointment, please call 877-388-2778.

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