NJU Physicians Selected as South Jersey Magazine 2019 Top Physicians

27 Aug 2019 News

We’re proud to announce that three New Jersey Urology physicians have been honored as South Jersey Magazine 2019 Top Physicians. These physicians were chosen by South Jersey Magazine readers, who were asked to nominate doctors they trust in their time of need.

South Jersey Magazine 2019 Top Physicians in Urology:

Read South Jersey Magazine’s complete list here >

What to Expect After Adult Circumcision

26 Aug 2019 Blog

What is a circumcision?

Circumcision is the surgical removal of the foreskin. The procedure takes about thirty minutes and is performed under general anesthesia. The entire foreskin is removed using an incision just behind the head of the penis. This leaves the head of the penis completely exposed. Local anesthesia will be used to relieve discomfort after the operation.

Why is circumcision performed?

Circumcision is usually performed on newborns for medical, social, or cultural purposes. According to the CDC, more than 58% of newborns in the United States are circumcised. However, people with an uncircumcised penis may choose to become circumcised later in life for many reasons, including:

  • Phimosis (tight foreskin cannot be retracted to expose head of penis)
  • Paraphimosis (retracted foreskin cannot be brought back to cover head of penis)
  • Balanitis (inflammation of head of penis)
  • Posthitis (inflammation of the foreskin—pronounced pos-THI-tis)
  • Cosmetic or personal reasons
  • Tearing of the penile skin when sexually active

Although circumcision is a simple procedure, it’s a larger surgery for adults than it is for newborns.

What can I expect afterwards?

You will be sent home with a compression dressing that can be removed in 48 hours. If it falls off sooner than that it’s not a problem. Absorbable stitches are used that do not require removal. After the dressing is removed, petroleum jelly can be applied to the stitch line to prevent the penis from sticking to your underwear.

You will likely experience pain for a few days that can be managed with analgesics that will be prescribed. Anti-inflammatories such as Advil and Ibuprofen are preferred to the narcotics as they are equally effective and have less side effects. You should not drive a car or operate machinery if you are using a narcotic for pain relief.

Activities need to be restricted for a few days. Sexual activity cannot be pursued for at least six weeks to allow full healing. You may experience pain with spontaneous erections.

When do I need to follow-up in the office?

You will need to be checked back in the office a week or two after the circumcision, and at the six-week point.

Written by Dr. Andrew Siegel

What to Expect: Botox Injection for Overactive Bladder (OAB)

19 Aug 2019 Blog

You’ve probably heard of Botox being used to improve the cosmetic appearance of facial wrinkles. However, botox has many medical uses that go beyond improving one’s appearance. For example, botox is commonly used to improve internal body functions. In the field of urology, it can be injected into the bladder muscle to improve symptoms of overactive bladder (OAB).

What is botox?

Botox is derived from the most poisonous substance known to man—botulinum toxin. This neurotoxin is produced by the Clostridium bacterium, responsible for botulism. Botulism is a rare but serious illness that can result in paralysis. Botulinum toxinwhen used in minute quantities in a derivative known as botox, is a magically effective and powerful potion.

How does botox work?

Botox is a neuromuscular blocking agent that weakens or paralyzes muscles. Beyond cosmetics, it can be beneficial for a variety of medical conditions that have some form of localized muscle overactivity. Botox is generally used to improve conditions with muscle spasticity, involuntary muscle contractions, excessive sweating and eyelid or eye muscle spasm.

Botox to treat Overactive Bladder (OAB)

Overactive Bladder (OAB) syndrome can be described by the symptoms of urinary urgency (the sudden desire to urinate), with or without urgency incontinence (urinary leakage associated with urgency). It’s usually accompanied by frequent urination during both day and night hours. OAB has been described as the “bladder squeezing without your permission to do so.”

When botox is injected into the bladder muscle, it treats the thick muscle bands, known as trabeculation. These are typically present in conditions that cause obstruction to the outflow of urine or bladder overactivity. By temporarily paralyzing a portion of the bladder muscle, OAB symptoms can improve dramatically.

The goal of botox in the bladder is to effectively treat persistent and disabling urinary urgency, frequency and urgency incontinence. Botox can be used to treat OAB for both males and females. It’s usually a plan B treatment for those who haven’t responded well or have been intolerant to bladder relaxant medications. Botox is FDA approved in the USA in a 100-unit-dose for OAB and 200-unit-dose for OAB associated with neurological conditions.

What to expect during a bladder botox injection

Bladder botox injection is a brief office procedure usually done under light sedation. It involves placing a cystoscope into the bladder and injecting botox into numerous sites in the bladder via a needle that fits through the cystoscope. The entire procedure takes about 10 minutes.

How to prepare for your bladder botox injection, and what to expect after the procedure:

  1. Stop blood thinner medications one week before botox injection
  2. Start antibiotics 2 days before and continue for 2 days after
  3. You may experience blood-tinged urine, burning with urination and pelvic pain for a day or so after the procedure.
  4. You may experience difficulty urinating and feel that you are not emptying completely. If so, you may require a catheter or learn how to temporarily do self-catheterization.
  5. It may take 1 -2 weeks to notice improvement. Although botox is highly effective, it’s not so in everyone.
  6. A follow up appointment with urinalysis and check of the post-void residual volume (how much urine is left in the bladder after voiding) will be scheduled for two weeks.
  7. Botox should last 6-9 months or so. After the improvement wears off, the injection can be repeated. If ineffective or only partially effective, the botox dosage can be increased.

Visit our locations page to find a urologist near you.

Written by Dr. Andrew Siegel

6 Reflexes That are Vital to Your Pelvic Health

12 Aug 2019 Blog

A reflex is an automatic response to a stimulus, an action that occurs without conscious thought. Many of us are familiar with the knee jerk reflex, in which the knee straightens as a result of the quadriceps muscle contracting in response to the tendon of our kneecap being tapped with a reflex hammer.

Here are six reflexes that you probably aren’t aware of, but are vital to your urinary and sexual health:

  1.  Guarding Reflex. The sphincter muscles guard the entrance to the urinary bladder. The voluntary sphincter muscle—the one that you have control of and are capable of contracting at will—is largely composed of the deep pelvic floor muscles (PFMs). The deep PFMs are your friends, helping you store urine while the bladder fills up. Even when you are not actively squeezing the PFMs, they have a baseline tone, working to provide resistance that keeps you from leaking urine as the bladder becomes fuller. They only relax completely when you urinate. The guarding reflex is the increase in the contraction strength of these “guarding” PFMs as the bladder gets fuller and fuller, with stronger PFM tone as the volume of urine in the urinary bladder increases.
  2. Cough Reflex. This reflex increases the contraction of the PFMs when you cough—above and beyond their resting tone—preventing you from leaking urine. This is nature’s way of protecting you from leaking urine when there is a sudden increase in your abdominal pressure, as occurs with a cough. This protects against cough-related stress urinary incontinence.
  3. Pelvic Floor Muscle-Bladder Reflex (PFM-BR). The PFM-BR is a unique reflex that you are capable of engaging voluntarily, resulting in the relaxation of a muscle as opposed to its contraction.  Anyone who has ever experienced an urgent desire to urinate or move their bowels will find it of great practical use. When the reflex is deployed, it will result in relaxation of both the urinary bladder and rectum and a quieting of the urgency. It works when you feel the sudden and urgent desire to urinate—pulse the pelvic floor muscles (PFMs) five times—brief but intense contractions.  When the PFMs are so deployed, the bladder muscle reflexively relaxes and the feeling of intense urgency disappears. Likewise, when the PFMs are deployed, the rectum relaxes and the feeling of intense bowel urgency should diminish. This reflex is a keeper when you are stuck in traffic and have no access to a toilet!
  4. BulboCavernosus Reflex (BCR). The BCR is a contraction of the bulbocavernosus and its mates, the ischiocavernosus (IC) muscles when the glans (head) of the penis in a male or the clitoris in a female is squeezed. This reflex is important for maintaining erectile rigidity, since with each contraction of the BC and IC muscles there is a surge of blood flow to the penis/clitoris, maintaining the high blood pressures within the erectile chambers necessary for engorgement of these organs. Sexual stimulation can be thought of as a chain of linked BCRs.
  5. Double reflex. Did you ever experience an urgent desire to urinate and find relief by squeezing the head of the penis?  If so, you have discovered the linkage of two reflexes—the BCR coupled with the PF-MBR. Here’s what happens: A strong urge to urinate occurs and is managed by squeezing the head of the penis, which makes the urgency dissipate. What’s actually happening is that the squeeze of the penis triggers a PFM contraction via the BCR. In turn, the PFM contraction relaxes the bladder muscle via the PFM-BR and makes the urgency either improve or disappear. Reflex magic!
  6. Cremasteric reflex. The cremaster muscle surrounds the spermatic cord (the cord-like structure that contains the testicular blood supply, nerves, etc.). The cremasteric reflex occurs when the inner thigh is stroked and the testicle pulls up towards the groin via a contraction of the cremaster muscle. This is a brisk reflex in boys and tends to become less active with aging. It is a natural protective reflex that helps us avoid testicular injury when danger approaches, like a turtle pulling its head into its protective shell.

The reflexes described above are vital to your sexual and urinary health. Being aware of them, and knowing how to tap into them can be used to your advantage!

Written by Dr. Andrew Siegel 

Is Active Surveillance the Best Treatment for My Prostate Cancer?

5 Aug 2019 Blog

Prostate cancer is the second leading cause of cancer death in men. There are 240,000 new prostate cancer cases diagnosed annually, and it accounts for 30,000 deaths per year. However, unlike many other cancers, prostate cancer is often not a fatal disease and may never need to be treated.

Patients with slow-growing, early stage prostate cancer as well as older men with other health issues may be put on active surveillance, also known as watchful waiting, as opposed to traditional treatment with surgery or radiation.

The problem is that not all prostate cancer cases are slow-growing and early stage. The challenge is predicting the future behavior of the cancer so it can be treated appropriately – offering cure to those with aggressive cancer, but sparing the side effects of treatment in those who have non-aggressive cancer.

What is active surveillance?

About 1 in 6 men will be diagnosed with prostate cancer during his lifetime, yet only 1 in 40 men will die from it. These statistics point out that many men with prostate cancer have a slow growing cancer. Because of this fact, an alternative strategy to aggressive management of prostate cancer is active surveillance, which includes careful follow-up with strict monitoring and immediate intervention should signs of progression develop.

The goal of active surveillance is to allow men with low risk prostate cancer to avoid radical treatment with its associated morbidity and/or delay definitive treatment until signs of progression occur. This involves two things:

  1. Vigilant monitoring
  2. A compliant patient who is compulsive about follow-up

Which patients are good candidates for active surveillance?

Being a candidate for this approach is based upon the results of the PSA blood test, findings on the digital rectal exam, and the details of the prostate biopsy. General eligibility criteria for active surveillance include all of the following:

  • PSA (Prostate Specific Antigen) less or equal to 10 (PSA is the blood test that when elevated or accelerated indicates the possibility of a problem with the prostate and is often followed by a prostate ultrasound/biopsy)
  • Gleason score 6 or less (possible score 2-10, more about this below)
  • Stage T1c-T2a

 (T1c = picked up by PSA with normal prostate on rectal exam; T2a = picked up by abnormal prostate on rectal exam, involving only one side of the prostate)
  • Less than 3 of 12 biopsy cores involved with cancer
  • Less than 50% of any one core involved with cancer

Note that these are basic guidelines and need to be modified in accordance with patient age and general health— certainly if one has a life expectancy of less than 10 years, he would be a good candidate for active surveillance, regardless of the above.

How is prostate cancer grade determined?

Prostate cancer grade is often the most reliable indicator of the potential for growth and spread. The Gleason Score provides one of the best guides to the prognosis and treatment of prostate cancer and is based on a pathologist’s microscopic examination of prostate tissue. This score can predict the aggressiveness and behavior of the cancer.

To determine a Gleason Score, a pathologist assigns a separate numerical grade to the two most predominant architectural patterns of the cancer cells. The numbers range from 1 (the cells look nearly normal) to 5 (the cells have the most cancerous appearance). The sum of the two grades is the Gleason Score. The lowest possible score is 2, which rarely occurs; the highest is 10. High scores tend to suggest a worse prognosis than lower scores because the more deranged and mutated cells usually grow faster than more normal-appearing ones.

Prostate cancers can be “triaged” into one of three groupings based upon Gleason Score. Scores of 2-4 are considered low grade; 5-7, intermediate grade; 8-10, high grade.

What is involved in active surveillance?

The active surveillance monitoring schedule is typically:

  • PSA and DRE every 3-6 months for several years, then annually
  • Prostate biopsies: once a year after initial diagnosis, then periodically until age 80 (this depends on the patient)

As long as the cancer remains low-risk, active surveillance may be continued, sparing the patient the potential side effects of surgery or radiation.

Approximately half of men on active surveillance remain free of progression at ten years, and definitive treatment is most often effective in those with progression. The absence of cancer on repeated prostate biopsies (because the cancer is of such low volume) identifies men who are unlikely to have progressive prostate cancer.

Written by Dr. Andrew Siegel

How Much Water Do You Really Need To Drink?

29 Jul 2019 Blog

Many sources of information say that humans need 8-12 glasses of water daily to stay hydrated and thrive. Some people take that rule literally and end up in a urologist’s office complaining of urinary urgency, frequency and leakage. Clearly, the 8-12 rule is not appropriate for everyone!

Why do humans need so much water?

Water is a vitally important part of our bodies that promotes optimal organ and cellular function. It also regulates temperature, transports nutrients and waste, provides joint lubrication, and facilitates thousands of chemical reactions that occur within our bodies.

More than half (60%) of our body weight is water. Two-thirds of which is within our cells, and one-third of which is in the blood and tissues between cells. For a 165-lb. man, that translates to 100 lb. of water weight. For a 125-lb. woman, that translates to 75 lb. of water weight.

Water intake comes from beverages AND food.

Many foods have a high water content and can be a significant source of water intake. In general, the healthier the diet (the more the fruit and veggie intake) the higher amount of dietary water. For example, melons, citrus fruit, peaches, strawberries and raspberries are about 90% water, with most fruits over 80% water. The same is true for vegetables, with lettuce, tomatoes, cucumbers, celery, radishes and zucchini comprised of about 95% of water, with most veggies over 85% water.

Our body needs water “equilibrium,” with water intake balancing water losses. Most people need a total of 65-80 ounces daily, although this can vary greatly depending upon one’s size, the ambient temperature and level of physical activity. Water losses are both “sensible,” consisting of water in the urine and stool, and “insensible,” from skin (evaporation and sweating) and lungs (moisture exhaled).

Again, water intake comes from beverages and foods consumed, with many foods containing a great deal of water (particularly fruits and vegetables, as mentioned). So the 65-80 ounces includes both beverage and food sources.

However, caffeinated beverages (such as coffee, tea, colas, energy and sports drinks and other sodas) as well as alcohol both have diuretic effects, causing you to urinate more volume than you take in. So, if you consume caffeine or alcohol, you will need additional hydration to maintain equilibrium.

How much water do I really need?

The formula that doctors use for figuring out daily fluid requirements is 1500 cc (50 ounces) for the first 20 kg (44 lb.) of weight, and an additional 200 cc (7 ounces) for each additional 10 kg (22 lb.) of weight.

So for a 125-lb. woman, the daily fluid requirement is 2250 cc (75 ounces). For a 165 lb. man, the daily requirement is 2600 cc (87 ounces). It’s important to remember that these fluid requirements include both beverages and food. If one has a very healthy diet with lots of fruits and vegetables, there will be less need for drinking water and other beverages.

The other important factors with respect to water needs are ambient temperature and activity level. If you are reading or doing other sedentary activities in a cool room, your water requirements are significantly less than someone exercising vigorously in 90-degree temperatures.

How will I know if I’m well-hydrated?

Humans are extraordinarily sophisticated and well-engineered “machines.” Your body lets you know when you are hungry, ill, tired and thirsty. Paying attention to your thirst is one of the best ways of maintaining good hydration status.

Another great method is to pay attention to your urine color. Depending on your hydration status, 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.

Advantages of staying well-hydrated include:

  • Avoids dehydration and all its consequences (this is pretty obvious)
  • Dilution of urine helps prevent kidney stones
  • Dilution of urine helps prevent urinary infections
  • Helps bowel regularity
  • Maintains hydrated and supple, less wrinkled skin
  • Helps keep weight down because of the filling effect of drinking; also, thirst can be confused with hunger and some people end up eating when they should be hydrating

The only disadvantage to staying well-hydrated is that you may urinate a lot, which is not good for those with overactive bladder symptoms.

Written by Dr. Andrew Siegel

Nocturia: 7 Ways to Improve Frequent Nighttime Urination

22 Jul 2019 Blog

Nocturia is the medical term for the need to awaken from sleep to urinate. Getting up once to relieve your bladder during sleep hours is usually not particularly troublesome. However, when it happens two or more times it can negatively impact one’s quality of life because of sleep disruption, an increased risk of fall-related nighttime injuries, daytime fatigue and an increased risk of fatigue-related accidents.

What causes nocturia?

Nocturia correlates with aging and the associated decline in kidney function and decreased ability to concentrate urine. Although having an enlarged prostate may contribute to nocturia, it’s much more complicated than that since women do not have prostates and nocturia is equally prevalent in men and women.

Nocturia is based on multiple factors that require careful evaluation in order to sort out and treat appropriately. As a urologist, my goal is to distinguish between urological and non-urological causes for nighttime urinating. It often comes down to one of three factors:

  1. Nighttime urine production by the kidneys
  2. Urinary bladder capacity
  3. Sleep status.

In the elderly population, excessive nighttime urine production is a factor almost 90% of the time.

Nocturia can be classified into 5 categories:

  • Global polyuria (making too much urine, day and night)
  • Nocturnal polyuria (making too much urine at night)
  • Sleep disorders
  • Reduced bladder capacity

Global polyuria can result from excessive fluid intake or from dehydration from poorly controlled diabetes mellitus. The pituitary gland produces an important hormone responsible for water regulation — ADH (anti-diuretic hormone) — and it works by giving the message to the kidneys to concentrate urine. Diabetes insipidus is a disease of either kidney origin in which the kidneys do not respond to ADH, or pituitary origin in which there is deficient secretion of ADH. In either case, lots of urine will be made, resulting in frequent urination, both daytime and nighttime. Medications including diuretics, SSRIs (selective serotonin reuptake inhibitors), calcium blockers, tetracycline and lithium may induce global polyuria.

Nocturnal polyuria may be on the basis of excessive fluid intake, especially diuretic beverages including caffeine and alcohol. It may also occur because of  a nocturnal defect in the secretion of ADH, and unresponsiveness of the kidneys to the action of ADH. Congestive heart failure, sleep apnea and kidney insufficiency also may play a contributory role. Certain conditions result in accumulation of fluids in the tissues of the body, particularly the legs (peripheral edema); when lying down to sleep, the fluid is no longer under the same pressures as determined by gravity, and returns to the intravascular (within the blood vessels) compartment. It is then subject to being released from the kidneys as urine. Such conditions include heart, kidney and liver impairment, nephrotic syndrome, malnutrition and venous stasis.

Primary sleep disorders may also cause nocturia, including insomnia, restless leg syndrome, narcolepsy, and arousal disorders (sleepwalking, nightmares, etc.)

Reduced bladder capacity may be caused by numerous urological issues. Many processes can occur within the bladder that can irritate its delicate lining, causing a reduced “functional” capacity: bladder infections, bladder stones, bladder cancer, bacterial cystitis, radiation cystitis, and interstitial cystitis.

An overactive bladder—a bladder that “squeezes without its owner’s permission”—can give rise to nocturia.  Some people have small “anatomical” bladder capacities on the basis of scarring, radiation, or other forms of damage. Prostate enlargement commonly gives rise to nocturia, as can many neurological diseases that often have profound effects on bladder function. Incomplete bladder emptying can give rise to frequent urination since the bladder is already starting out on the bias of being partially filled.  Incomplete emptying is often seen with prostate enlargement, scar tissue in the urethra, neurologic issues, and bladder prolapse.

How is nocturia diagnosed?

The key diagnostic tool for nocturia is the frequency-volume chart (FVC), a simple test that can effectively guide diagnosis and treatment. This is a 24-hour record of the time of urination and volume of urination, requiring a clock, pencil, paper and measuring cup. Typical bladder capacity is 10–12 ounces with 4–6 urinations per day.

How is nocturia treated?

Lifestyle modifications to improve nocturia include:

  1. Preemptive voiding before bedtime
  2. Intentional nocturnal and late afternoon dehydration
  3. Salt restriction
  4. Dietary restriction of caffeine and alcohol
  5. Adjustment of medication timing
  6. Use of compression stockings with afternoon and evening leg elevation
  7. Sleep medications

Urological issues may need to be managed with medications that relax or shrink the prostate when the issue is prostate obstruction, and bladder relaxants for overactive bladder. For nocturnal polyuria, synthetic ADH can be highly effective.

Bottom Line: Nocturia should be investigated to determine its cause, which may often in fact be related to conditions other than urinary tract issues. Nighttime urination is not only bothersome, but may also pose real health risks. Chronically disturbed sleep can lead to a host of collateral wellness issues.

Written by Dr. Andrew Siegel 

How to Naturally Boost Your Testosterone Levels

15 Jul 2019 Blog

Testosterone has become a very in-vogue term. Many patients come into the office specifically asking for their testosterone levels to be checked.  The pharma industry has aggressively pursued direct-to-consumer advertising of testosterone replacement products, which has promoted a grass-roots awareness of testosterone issues, a topic that was previously the domain of urologists and endocrinologists.

So what is testosterone?

Testosterone (or T) is that all-important male hormone that goes way beyond male sexuality and is now regarded as a key factor in men’s health. Aside from contributing to libido, masculinity and sexual function, T is responsible for the physical changes that begin at puberty, including pubic, underarm and facial hair, deepening voice, prominent Adam’s apple and increased bone and muscle mass. Additionally, T contributes to your mood, bone and muscle strength, red blood cell count, energy, and general mojo.

What are the symptoms of low testosterone?

Most testosterone is manufactured in the testicles, although a small percentage is made by the adrenal glands.  There is a gradual decline in T that occurs with the aging process—approximately a 1% decline each year after age 30. This will occur in most men, but will not always be symptomatic. 40% of American men aged 45 or older have low or low range T.

Low T is associated with diabetes, bone mineral loss, and altered sexual function. Specifically, symptoms of low T may include one or more of the following:

  • fatigue
  • irritability
  • depression
  • decreased libido
  • erectile dysfunction
  • impaired orgasmic function
  • decreased energy and sense of well being
  • loss of muscle and bone mass
  • increased body fat
  • abnormal lipid profiles.

How obesity and lifestyle choices can affect testosterone levels

Obesity plays a pivotal role in the process leading to low T. Fat is not just fat—it is a metabolically active endocrine organ that does way more than just protrude from your abdomen. Fat has an abundance of the hormone aromatase, which functions to convert testosterone to the female sex hormone estrogen. The consequence of too much conversion of testosterone to estrogen is the potential for gynecomastia, (a.k.a. man boobs). Too much estrogen slows testosterone production, and with less testosterone, more abdominal obesity occurs and even more estrogen is made, a vicious cycle of emasculation.

The good news is that by losing abdominal fat, the unfortunate consequences of low T can often be reversed.

How to naturally boost your testosterone levels

  • A healthy lifestyle, including good eating habits, maintaining a healthy weight, engaging in exercise, obtaining adequate sleep, moderation with respect to alcohol intake, avoiding tobacco, and stress reduction are the initial approaches to treating low T. Insufficient sleep can lower T, and excessive alcohol increases the conversion of testosterone to estrogen. Maintaining an active sex life can help maintain T.
  • Lose the abdominal fat, with the caveat that a sufficient caloric intake of quality food and nutrients is necessary to prevent the body going into “starvation mode,” which can substantially decrease T production.
  • In terms of exercise, a healthy balance of aerobic, resistance, and core training is best. In particular, vigorous resistance exercise is crucial. This will help the flabby abdomen disappear and build lean muscle mass, which in turn will increase your metabolic rate.

Other treatment options for low testosterone

If lifestyle modifications fail to improve the symptoms of low T and levels remain measurably low via a simple blood test, a trial of T replacement under the supervision of your doctor can provide a meaningful improvement of your quality of life.

Written by Dr. Andrew Siegel

Kidney Disease: Symptoms, Treatment and Prevention

8 Jul 2019 Blog

Kidney disease is a very common cause of serious illness, affecting more than 25 million Americans. Each year approximately 110,000 new patients start dialysis treatments in the US, and kidney disease is responsible for nearly 100,000 American deaths annually.

How do the kidneys work under normal circumstances?

Our kidneys are a pair of bean-shaped, fist-sized organs that work diligently and silently behind the scenes constantly, filtering our blood free of toxins and waste products so that we can maintain a healthy existence. When they are working well, they are often taken for granted. The renal arteries bring blood to the kidneys, the kidneys do their magic, and the cleansed and purified blood is returned into the renal veins, with the liquid waste—urine—excreted into the ureters that drain into the urinary bladder.

If the kidneys stop working properly, excessive fluid and toxic waste builds up rapidly, resulting in death within a matter of days to weeks. Death by kidney failure is described as “euphoric” because of the very abnormal blood chemistries and electrolyte disturbances that occur…not that death is something to be “giddy” about, but kidney failure just happens to be an easier, more peaceful way to exit the planet than many others.

Because of their critical importance to our healthy existence, we should take great care of these prized possessions which nature gave us in duplicate. This “spare tire” is capable of sustaining life in the event of trauma, cancer requiring surgical removal, donating a kidney or other issues resulting in loss of one kidney.

The kidneys are multifunctional, not only filtering our blood to remove waste products, but also responsible for regulating fluid, electrolyte, acid-base balance and blood pressure. They are in charge of maintaining the proper fluid volume within our blood stream. They regulate the levels of our electrolytes including sodium, potassium, chloride, etc. They keep our blood pH (indicator of acidity) at a precise level to maintain optimal function. They are key players in the regulation of blood pressure. Furthermore—and unbeknownst to many—they are responsible for the production of several important hormones: calcitrol (calcium regulation), erythropoietin (red blood cell production), and renin (blood pressure regulation).

What is kidney disease?

Under normal circumstances, the kidneys filter the blood, removing waste products and excessive fluid, returning into circulation the body’s important chemicals and constituents. When the filtration system is not working properly, one’s system is not cleared of the bad (waste products), resulting in electrolyte disturbances and proteinuria, a condition in which what is good for the body (protein) ends up being filtered out into the urine.

When the kidneys fail (end stage renal disease), the options are peritoneal dialysis, hemodialysis, kidney transplantation, or death. Peritoneal dialysis uses the peritoneal membrane that lines the abdomen as a filter to clear wastes and extra fluid from the body. Hemodialysis involves being hooked up to a machine that mimics the function of the kidneys; it requires three sessions weekly that take about 3-4 hours per session.

What are the symptoms of kidney disease?

The unfortunate thing about kidney disease is that it typically causes few symptoms until it is advanced; however, simple tests are capable of detecting it. Symptoms of kidney disease are non-specific and may include the following:

  • fatigue
  • decreased energy
  • poor appetite
  • difficulty concentrating
  • insomnia
  • swollen ankles and feet
  • nighttime muscle cramping
  • puffiness around one’s eyes
  • dry and itchy skin
  • frequent urination, particularly at night

How is kidney disease diagnosed?

A definitive sign of kidney disease is the presence of protein in the urine, which is easily detectable on a urinalysis. Additionally, uncontrolled high blood pressure is highly suggestive of kidney disease, as is an elevated serum creatinine, detectable by a simple blood test. Early detection is critical as it can help prevent kidney disease from progressing to kidney failure. The bottom line is that three simple tests can detect kidney disease: blood pressure; serum creatinine; urine albumin (protein).

What are the risk factors for kidney disease?

Risk factors for kidney disease include:

  • African-American race
  • diabetes
  • high blood pressure
  • family history of kidney disease

The two leading causes of chronic kidney disease are hypertension and diabetes, responsible for about two thirds of cases.

How is kidney disease treated?

Urologists are the specialists who deal with surgical kidney issues whereas nephrologists are the specialists who deal with medical kidney tissues including hypertension and impaired kidney function. If kidney disease is diagnosed, one will typically be referred to a nephrologist for further evaluation and management. Nephrologists will typically measure the serum creatinine, and do blood and urine tests to assess the glomerular filtration rate, a quantitative test of kidney function. Often a renal ultrasound is performed and in some cases it is necessary to do a renal biopsy to find the root cause of the kidney dysfunction.

Treatment for progressive kidney disease includes interventions such as blood pressure control, often with the use of ACE inhibitors and angiotensin receptor blockers, and control of diabetes.

Nutritional interventions include dietary protein restriction that may slow the progression of chronic kidney disease. High-protein intake can worsen the proteinuria and result in the accumulation of various protein breakdown products as a result of decreasing kidney function, which can cause toxic effects.

How to prevent kidney disease

So how do we care for our kidneys? The prescription for healthy kidneys is to maintain a healthy lifestyle and, if you have been neglectful in this department, to do a lifestyle remake through the following: good eating habits; maintaining a healthy weight; engaging in exercise; obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction.

Additionally, being proactive by seeing a physician on a regular basis for “scheduled maintenance” is very important in order to detect kidney disease—or any other disease—as early as possible.

Written by Dr. Andrew Siegel

9 Ways to Overcome Premature Ejaculation

24 Jun 2019 Blog

What is Premature Ejaculation?

Premature ejaculation (PE) is a condition in which sexual climax occurs before, upon, or shortly after vaginal penetration, prior to one’s desire to do so, with minimal voluntary control. It is the most common form of male sexual dysfunction. “Rapid” ejaculation may be a kinder term than “premature” ejaculation.

The key features are:

  • Brief time to ejaculation (often less than one minute)
  • Lack of control over ejaculation
  • Sexual dissatisfaction, distress and frustration of partner

How Long Should it Take to Climax?

In a study of more than 1,500 men, The Journal of Sexual Medicine reported that the average time between penetration and ejaculation for a premature ejaculator was 1.8 minutes, compared to 7.3 minutes for non-premature ejaculators.

Another study of 500 couples across five countries reported results ranging from 33 seconds to 44 minutes with the median being 5.4 minutes.

What Causes Premature Ejaculation?

PE can be psychological and/or biological and can occur because of over-sensitive genital skin, hyperactive reflexes, extreme arousal or infrequent sexual activity. Other factors are genetics, guilt, fear, performance anxiety, inflammation and/or infection of the prostate or urethra and also can be related to the use of alcohol or other substances.

PE occurs in up to 30% of men, involving all ages, ethnicities, and socio-economic groups. PE can cause embarrassment, frustration and loss of self-confidence and can be devastating to a relationship. It is very typical among men during their earliest sexual experiences.

PE can be lifelong or acquired and sometimes occurs on a situational basis. Lifelong PE is thought to have a strong biological component. Acquired PE can be biological, based on inflammation/infection of the reproductive tract or psychological, based upon situational stressors. PE can sometimes be related to Erectile Dysfunction (ED), with the rapid ejaculation brought on by the desire to climax before losing the erection.

Emphasis on ejaculation as the focal point of sexual intercourse tends to increase the performance anxiety that can initiate the problem. Once PE has occurred and established itself, fear of and mental preoccupation with the issue can actually induce the unwanted rapid ejaculation, creating a vicious cycle.

How to Overcome Premature Ejaculation

  1. Diversionary Thoughts: Non-erotic mental diversionary tactics (concentrating on thoughts other than ejaculating) may prevent PE. Baseball, work, counting backwards, etc., are examples of such thoughts, but these are rarely effective and diminish the pleasure of sexual intimacy.
  2. Down Tempo: This requires one to develop a mindfulness of the sensation immediately before ejaculation. By slowing the pace of pelvic thrusting and varying the angle and depth of penetration before the “point of no return” has passed, the feeling of imminent ejaculation may dissipate.
  3. Pause-Start Method: If slowing the tempo is not sufficient to prevent the PE, one may need to stop thrusting completely while maintaining penetration in order for the ejaculatory “urgency” to go away. Once the sensation to ejaculate subsides, pelvic thrusting may be resumed.
  4. Squeeze Technique: Originated by Masters and Johnson, as imminent ejaculation approaches, the penis is withdrawn and the head of the penis is squeezed until the feeling of ejaculation passes, after which intercourse is resumed. Although effective, it requires sexual interruption, is cumbersome and demands a very cooperative partner.
  5. Pelvic Floor Muscle Training: Contracting one’s pelvic floor muscles is a less cumbersome alternative to the Master and Johnson technique. Instead of the clunky and obvious squeeze technique, a more subtle and discreet method is to slow the pace of intercourse, pause the pelvic thrusting and do a sustained pelvic muscle contraction. This is an internal “squeeze” without the external hand squeeze and can achieve the same goal, short-circuiting the premature ejaculation. With sufficient practice and the achievement of “muscle memory,” this process can become easier and the problem of PE improved, particularly with commitment to a pelvic floor muscle training program.
  6. Decreasing Sensitivity: One method of doing so is by using thick condoms. Alternatively, local anesthetics in the form of topical creams, gels, and sprays can desensitize the penis. These include Lidocaine cream or gel, Lidocaine and Prilocaine (EMLA cream) or Lidocaine spray (Promescent) that are applied before intercourse. Another desensitization technique is increasing the frequency of ejaculation since PE tends to be more pronounced after longer periods of sexual abstinence. By masturbating prior to engaging in sexual intercourse, the PE may be controlled.
  7. Erection Pills: Viagra, Levitra, Cialis and Stendra, which are commonly used for ED, can have a role in the treatment of men with acquired PE that is due to ED.
  8. SSRI Antidepressants: These selective serotonin reuptake inhibitors can substantially delay ejaculation. One is generally started on a low dose, with an increase in dosage as necessary. Once an effective dosage is achieved, the medication can be used on a situational basis, several hours prior to sexual intercourse.
  9. Counseling: Since PE can be on a psychological basis, it may be beneficial to seek the counsel of a sexual therapist. This can be done in conjunction with some of the aforementioned techniques to hasten the resolution of the PE.

Although not life-threatening, PE is a common and distressing quality of life problem that is sometimes relationship-threatening. The good news is that there are a number of effective treatment options available, so one need not suffer with the problem.

Written by Dr. Andrew Siegel 

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