Urology Blog

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.

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.

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.

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.

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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.

Related Information

Pelvic Inflammatory Disease video.

Do You Have A Urinary Tract Infection?

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?

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.

Recruitment Information

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.

Thanks to Jacob Goldstein at the Wall Street Journal Health Blog for a heads up on Sciele Pharma's efforts to build buzz, AKA "awareness" of its new premature ejaculation drug, PSD502, which is not yet available for market.

Sciele's PSD502 is a spray that contains 7.5mg of lidocaine and 2.5mg of prilocaine, and it is used 5 minutes before intercourse. Sciele expects to file for FDA approval in the spring.

Goldstein met them when they visited with the WSJ Health Blog and reports that they are presenting at meetings globally, talking to journalists at newspapers and magazines, and have created a website for bloggers.

Sciele's press release states that approximately "one-third of men ages 18-59 suffer from premature ejaculation, making it more prevalent than erectile dysfunction." Wow.

Also discussed in Sciele's press release is an evidence-based definition of premature ejaculation established by the International Society for Sexual Medicine (ISSM). In 2008, the ISSM characterized the condition as "ejaculation which occurs prior to or within one minute of vaginal penetration; and inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy."

Could this be the next blockbuster sexual dysfunction drug? I wonder.

People with urology problems, such as an enlarged prostate, interstitial cystitis, or urinary incontinence often don't feel comfortable hitting the road for holiday travel. Panic sets in about where that next bathroom will be.

Here's a link that the National Association for Continence has on its website that shows you where you can find a public bathroom and a more detailed guide from About's irritable bowel syndrome guide, covering not just US travel, but elsewhere. It just might give you the confidence to take the trip that you thought you might not be able to make.