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.
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
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.
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.
Thursday February 25, 2010
A recent study published in the journal Cancer Epidemiology, Biomarkers & Prevention
found men who took statins to lower their cholesterol before prostate cancer surgery had significantly lower inflammation within prostate tumors. Inflammation within tumors has been associated with cancer progression and more aggressive tumor growth, researchers said.
"We found that preoperative statin use was associated with a 69 percent lower risk of intra-tumoral inflammation," said Dr. Lionel Bañez, an assistant professor of surgery and urology at Duke and the lead author of the study. "We also discovered a trend suggesting greater risk-reduction with higher doses of the drugs."
The Duke researchers examined tissue samples of tumors from 236 men undergoing surgery for prostate cancer
at the Durham VA Medical Center. Researchers identified the samples as coming from statin-users or non-users, tracked the dose and frequency among the users, and graded the degree of inflammation in the tissue samples as absent, mild, or marked.
They found that 37 patients (16 percent) took statins
during the year prior to their prostate surgeries. Most of the statin users (92 percent) were on simvastatin (Zocor®). Among all patients, 82 percent had inflammatory cells in their prostate tumors, with roughly one-third registering marked tumor inflammation.
After taking into consideration factors such as age, race, body mass index and other clinical variables, investigators found that statin use was associated with reduced inflammation within the tumors. Older patients with more advanced cancers were most likely to have tumor inflammation and have the longest times from biopsy to surgery.
Sunday January 3, 2010
2010 could be a year where you improve your bladder and sexual health. Say you are getting older and your bladder and sexual health is not what it used to be. You may not want to take another pill or undergo a procedure. Maybe, you would gain a lot if you vented less at the pharmaceutical industry and invested in some self care.
Are you bothered by urinary incontinence? Try to get yourself to go to the bathroom at regular times. Learn how to identify your pelvic muscles and strengthen them through pelvic floor (Kegel exercises) . This will help you hold your urine.
Are you sad that you have erectile dysfunction and you don't know what to do about it? How about resolving to lose some weight, getting your glucose in control if you have diabetes, and eating a heart-healthy diet this year?
Scientific evidence shows that obesity, diabetes, and vascular problems are primary risk factors for erectile dysfunction. Obesity also puts pressure on your bladder.
Taking the initiative to take care of yourself can make you feel far better than any magic bullet you imagine that your doctor could provide. At the same time, be open with your doctor if you are demoralized by changes in your bladder and sexual health. Level with your doctor. Self care, when it works, is great, but you should also consult with your doctor if you notice changes in bladder and sexual function. Treatment could also make a substantial difference in your bladder and sexual quality of life.
Male Sexual Dysfunction - How Common Is It?
Health risks of obesity: incontinence.
Wednesday December 30, 2009
Sunday December 27, 2009
Until Dr. Walter Stamm, MD, pursued his meticulous research into urinary tract infections (UTIs) and sexually transmitted diseases in the 1970s, women were put on long treatment courses of antibiotics. Chlamydia trachomatis,-- then unknown-- was a cause of pelvic inflammatory disease and female infertility. But Dr. Stamm changed all that, altering the standards of care for UTIs and chlamydia. It was with great sadness that I learned of Dr. Stamm's death last week.
In an obituary in the New York Times, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, called Dr. Stamm "a giant in the field of infectious diseases in general who made many seminal clinical research contributions over decades that have transformed the diagnosis and treatment of urinary tract infections and pelvic inflammatory disease."
The obituary shows Dr. Stamm's wide range of accomplishments, including the discovery of pathogens causing urinary tract infections, minimizing antibiotic resistance through shorter, less aggressive antibiotic regimens, sparing women from becoming infertile, launching worldwide chlamydia disease screening and control programs, and working on HIV vaccine research trials.
Pelvic Inflammatory Disease video.
Do You Have A Urinary Tract Infection?
Monday December 21, 2009
As 2009 comes to a close, I find myself writing about urinary incontinence in older women. Millions of women suffer with it in shame and silence.
I have this wish for Santa: In 2010, could women finally get their pitchwoman for urinary incontinence? Women need to have someone serve like Bob Dole did for erectile dysfunction, Lance Armstrong does for testicular cancer, or First Lady Betty Ford did for breast cancer.
Can you suggest any endearing women celebs for this position? What kind of woman would you like to see bring this common health problem out of the closet?
Wednesday December 16, 2009
Years in the making, the National Institutes of Health is recruiting for the Testosterone Trial, or T Trial. It is a great sign that the mistakes made with hormone replacement therapy in women--may not be repeated in men.
"This is a very important study and it should be supported," said H. Ballentine Carter, MD, professor of urology at Johns Hopkins Medical Institution, who consulted on designing the trial. Dr. Carter has underscored the importance of clinical trials before making a medication like this more widely available.
Peter Snyder, MD, principal investigator at the T Trial Coordinating Center, and professor of endocrinology at the University of Pennsylvania, Philadelphia, explained the background and rationale for the trial. "As men get older, there is a very slow decrease in their testosterone levels. With it, men develop abnormalities in physical functioning, sexual function, and cognition. Some men become diabetic, and may become anemic."
"One important question is whether decreasing testosterone levels are part of normal aging--not pathologic, a normal consequence and even adaptive," said Dr. Snyder. Another possibility is that low testosterone levels result in frank hypogonadism, fatigue, and loss of physical function. The hypothesis that we are working with is whether men who are 65 years or older and have low serum testosterone concentrations will improve their physical function, sexual function, vitality, cognitive function, and low hemoglobin concentration, as well as decrease risk factors for cardiovascular disease and diabetes."
According to Dr. Snyder, men who are age 65 and older and have low blood testosterone, may be eligible for the trial if they also have one or more of the following: difficulty walking a quarter of a mile, less interest in sex, or less vitality than they used to have. However, there are important exclusion criteria as well.
If you are accepted into the trial, you will be randomly assigned to receive a testosterone gel (AndroGel®, Solvay Pharmaceuticals) or a placebo that will be applied daily. You will be followed for a year. Over the course of the year, men will be tested by questionnaires and blood tests to determine if their walking, interest in sex, energy, memory and blood count are getting better.
Testing Efficacy First
The T trial follows recommendations from an Institute of Medicine Panel calling for "first establishing clear benefit before assessing long-term risks" and to testing testosterone as a therapeutic intervention in men most likely to benefit."
In other words, if efficacy remains unproven, there will not be a large-scale trial like the Women's Health Initiative, which followed thousands of women for years and was extremely costly. That trial would be moot, according to Dr. Snyder, if testosterone does not prove efficacious.
Up Against Testosterone Proponents
The trial comes on the heels of intense promoting of testosterone as a miracle vitality drug for men--both as a preventative and treatment drug. Books and articles have targeted the men's consumer press. Testosterone replacement therapy has been taken up frequently at large medical meetings and Continuing Medical Education programs. Perhaps, a short, well-controlled trial with clear results will put the issue of efficacy to rest.
A total of 800 men at 12 sites around the United States will be enrolled in the trial. To see if there is a study center to contact in your area, check the T Trial site.