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A New Year and Your First Visit To A Urologist

How to find the urologist for your urology problems, how to prepare for your visit, and get the most out of it.

Urology Spotlight10

Beware the broken penis

Monday April 14, 2014
"Dr. Mills, this is the ER. We have a guy here who thinks he broke his penis." "Broke his penis? What's it look like?," I answer in my best just took a page at 2 AM voice. "Well, it's completely purple and looks like an eggplant," the ER physician responds. "Yep," I say slightly more awake, "that's a broken penis." O.K., back up. How can you break a penis if it's not a bone? Every time I get this call and have to go in to surgically repair the deformity, I get this question from doctors and nurses alike. So it's time to educate everyone on the broken penis. First, the penis, despite its erect nickname, is not truly a bone. The penis is made up of a couple of cylinders of blood called the corpora cavernosa, or the erectile bodies, and a urethra, encased in the corpora spongiosum. These three tubes are encased in a thick fascial coating called the tunica albuginea. This coating is a thick fibrous layer that keeps the cylinders in place and helps keep the shape of the penis as it turns into an erection. Blood pressure in an erect penis is twice the normal body blood pressure at around 300 millimeters of mercury. So an erection is trapped blood in a thick fascia structure. When a man is having vigorous intercourse (either with himself or someone else, I've seen both), and accidentally slams his penis into something, usually the pubic bone of his partner, or forcibly bends the penis mid shaft, it applies a whole lot of force to the fascia coating and can cause this coating to tear. The pressure is so high in the penis that when the fascia tears, the man (and partner, if applicable,) hears a pop that sounds just like Joe Thiesman's Monday Night Football femur snap; that's a fracture. Penile fractures are a big deal because they usually happen in the middle of the night when folks are going at it which means the ER is calling me in the middle of the night. These fractures are surgical emergencies. If I don't get up and go and to fix them, guys with penile fractures have a 50% chance of impotence. How do you know if you or someone you are loving has a penile fracture? The classic signs are hearing a loud pop during vigorous intercourse, immediate loss of the erection and rapid bruising that causes the penis to assume the shape and color of an eggplant. If any of these things happen during a session of merry making, seek emergent urologic care. Risk factors for penile fractures are classically excessive alcohol intake causing loss of judgment, depth perception and pain sensation and sex in funky places. A study out of Washington University in Saint Louis a few years ago demonstrated that penile fractures are more common when people are having sex in cars, elevators and other public places. Lest one think this article, being published in April, is a spoof, let me rather proclaim April to be penis awareness month and let men know that penile fractures are a real event, they occur commonly enough to warrant attention and a public knowledge on how to prevent. Easy on the booze, be wary of too much strain on that tough but delicate penile fascia and all should be good.

Testosterone and the heart

Thursday March 13, 2014
There is quite the debate raging in the healthcare world about testosterone therapy and heart disease. Let's break down what's hype and what's fact. Recent studies have demonstrated a link between testosterone therapy and increasing a man's risk of heart attack and stroke. For years, many prospective studies have demonstrated testosterone replacement decreases risk of metabolic syndrome, obesity, glucose intolerance--all major risks for heart disease. Now a couple of studies refute this. These studies were retrospective and not controlled. The FDA has issued a statement that more studies are required before we can establish a link between testosterone and heart disease. In the meantime, men are encouraged to discuss the findings with their physicians but not necessarily alter their treatment. I'm telling my patients what I always tell them; exercise daily, follow a heart healthy diet and don't let the testosterone therapy replace common sense of a fit lifestyle

ED may predict cardiac events, earlier death

Wednesday March 17, 2010
A recent study published in the journal Circulation found patients with erectile dysfunction (ED) who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications. "The present data clearly show that ED is closely associated with an increased risk for all-cause deaths, as well as the primary composite outcome of cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure," wrote Michael Böhm, MD, of the University of the Saarland, Saarbrücken, Germany, and colleagues. For the study, the researchers looked at a subgroup of 1,549 men who had participated in either the ONTARGET study, which looked at the effectiveness of a ramipril/telmisartan combination in patients with cardiovascular disease, or the TRANSCEND sudy, which examined the effects of telmisartan in patients who were intolerant of ACE inhibitors. Of those enrolled in the ONTARGET study, 400 had been randomly assigned to ramipril, 395 to telmisartan, and 381 to combination therapy. Among those in teh TRANSCEND study, 202 patients had been randomized to placebo and 171 to telmisartan. Of the 1,519 men included in the final analysis, 842 had moderate to severe ED at baseline and 677 had mild ED or functioned normally.

FDA approves generic version of Flomax

Thursday March 4, 2010
Men with benign prostatic hyperplasia (BPH) will soon have a cheaper option for treating the condition.

The FDA has approved the first generic version of Flomax (tamsulosin). The generic drug works the same as the brand name, and has similar potential side effects, such as kidney problems, decreased libido, diarrhea, and more.

Remember, the symptoms of BPH can sometimes resemble those of prostate cancer, so if you are experiencing any of these signs, schedule an appointment with your doctor.

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