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Jesse Mills, MD

Urology Blog


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Fitness Colorado Style

Monday May 12, 2014
May 12, 2014. What a deal. All of our blossoms are out, trees have leaved out for the spring and, in typical Colorado fashion, a low pressure system dumped 9 inches of snow on my house and all my trees. This morning, I wake up to a zone of destruction in my yard. After shaking off all of the trees, I had a daunting task in front of me. My beautiful mature cherry tree absorbed a boatload of snow and its biggest, tallest branch, a few hundred pounds of wood and leaf, cracked 25 feet off the ground. So what next? Call the tree guy? That's 500 bucks I'll never get back and I can only imagine the wait list given the devastation brought down by this monster May storm. Thankfully, I have a 16 foot ladder and an unwavering arrogance in my ability to climb a ladder, a tree and saw down branches. So I did. And I realized what had to go right to pull of this feat. I'm almost 44 years old but work out at least 5 days a week running and lifting weights. I'm in close to the best shape of my life. As a surgeon, I don't get to flex my blue collar muscle very often. But today is a great example of why men who sit behind a desk and use their brains over their brawn to make a living need to stay in shape. It felt great to climb that ladder and dispatch of that broken limb and save my tree without having to cave in and call the tree guy. So as men's health month approaches in June, look around your yard and your house and figure out how to turn your house projects into your gym. Stay in shape on a daily basis so you can rise to whatever the elements throw your way.

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.

Statins use may slow prostate cancer progression

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.

Resolve to Improve Your Bladder and Sexual Health in 2010

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.

Related Material

Male Sexual Dysfunction - How Common Is It?

Health risks of obesity: incontinence.

Fly Now, Urinate Later

Wednesday December 30, 2009

Walter Stamm, MD, Maverick in Urinary Tract Infections and Sexually Transmitted Disease Breakthroughs, Dies

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.

Related Information

Pelvic Inflammatory Disease video.

Do You Have A Urinary Tract Infection?

My Wish for Santa -A Pitchwoman for Urinary Incontinence

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?

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