News!!! If you read nothing else, please read this segment.

In this segment I offer my latest thoughts in Urology and Sexual Medicine.

• The screening PSA for prostate cancer upper limit of normal should be 2.5 ng/ml in certain healthy men. If you know your current PSA value you may use the Prostate Cancer Risk Calculator, http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp or ask your doctor do this for you  to report your current risk for having prostate cancer. Although there has been recent differences of opinion about prostate cancer screening, the American Urologic Association, www.aua.org,  recommend that men 40 years of age should begin screening for prostate cancer. In 2009 the youngest man that I diagnosed prostate cancer in was 37 years old. Recent evidence based studies suggest that to better interpret a PSA true value, your serum Testosterone level should also be obtained. A low Testosterone can falsely lower your PSA value leading to a missed diagnosis of prostate cancer.


• Testosterone, progesterone and Estradiol levels must be balanced in women with sexual dysfunction to achieve improvement in sexual performance. Ask your doctor to use bio-identical medications and not synthetic products. Bio-identical means that the medicine that you use is the molecular compound that your body naturally makes and your receptors are genetically designed to recognize. The vagina must be kept healthy and local bio-identical replacement is very helpful to achieve this goal, improve vaginal lubrication during sexual arousal, increase orgasmic experience and decrease pain that may be associated with intercourse. And yes, in certain situations PDE5's (Viagra, Cialis and Levitra) are helpful to be used off label in women. We can apply the diagnostic tools of identification, education and modification to help improve your sexual function.


• Overactive Bladder (OAB) is a condition of urinary frequency, urgency to void, urge urinary incontinence and nocturia, awaking at night with an urge to void. Although we do not have the perfect medication for OAB, we do have several good approaches, medication and behavioral changes, that are easy to administer and non-surgical. Urinary incontinence, leaking, is the most distressing complaint of overactive bladder. 80% of those undergoing management can expect to experience symptom improvement.


• Most women with urinary incontinence and men with prostate problems report sexual dysfunction. This situation can be readily improved with medication and life-style modifications.


• Nocturia, getting up at night to void, can be the most difficult symptom of overactive bladder to improve. Nocturia can be caused by conditions other than OAB, such as congestive heart failure, diabetes or even sleep apnea. I can help you understand your nocturia cause.


• In some men PDE5's (Viagra, Cialis or Levitra) do not work satisfactorily, either because of side effects or they just do not give the necessary erection for intercourse. Just remember that there are other medications to be offered, such as injection treatment, when Viagra, Cialis and Levitra fail. I teach several men and partners each year injection treatment. All men before experiencing injection treatment are fearful of this approach. It is usually well received for those who are willing to just try this approach once or twice. Vacuum erection devices (VED) often leave the couple disappointed. Please consider all of your options before getting a penile prosthesis. But when all other methods fail then 90% of men who have a surgical prosthesis are afterwards glad they did he surgery and would do it again if needed.


• If a radical prostatectomy for prostate cancer has been recommended, be sure to ask if a more minimally invasive surgical approach is appropriate for you. Laparoscopic Prostatectomy offers shorter hospital stay and less post-operative pain. In some cases your hospital stay is as little as 23 hours. The need for a blood transfusion is much reduced with laparoscopic surgery. It is also important for you to consider your future sexual health as you go into prostate surgery and recover. Ask how you can best protect from impotency after surgery.


• Feel tired, gained weight, loss of energy at the end of the day, fall asleep while sitting on the couch or lost interest in sex? You could have a low Testosterone. You can take the quiz and score yourself at www.seekwellness.com/andropause/adam_quiz.htm. You should be considered for low Testosterone if you are over the age of 50, diabetic, obese, have the metabolic syndrome, have any chronic illness such HIV-AIDS or suffer from renal failure. If you take narcotic pain medication for only a few days 75% of men have been found to have low Testosterone. It is not enough for your doctor just to check your serum testosterone. If you are being evaluated for Testosterone deficiency, be sure that your Sex Hormone Binding Globulin is checked as well. If your values are put into the Androgen Deficiency Risk Calculator, www.testim.com, and your calculated free Testosterone is less than 50 ng/dl, you likely have Male Androgen Deficiency and may be a candidate for a trial of testosterone replacement.
  
• The glans penis, head, in certain men do not become erect with sexual stimulation in some men, particularly there has been surgery. This is often due to scar tissue in the glans penis and a variation of Peyronie’s disease. Please go to my tab on Peyronie’s disease to explore this further.