http://theurologygroup.cc/blog/Thoughts, expertise and musings about today’s health-related issues, by the physicians at The Urology Grouphttp://theurologygroup.cc/blog/2013/05/22/some-lesser-known-causes-of-male-infertility Every year, one in six couples will struggle with infertility. At The Urology Group, we define infertility as being unable to conceive after one year of regular, unprotected intercourse. The good news is only 1 to 2 percent of couples deemed infertile are actually sterile, and half of those who seek help can eventually bear a child. Male-related problems account for 30 to 50 percent of infertility cases. Though most commonly caused by sperm disorders such as low sperm count, male infertility can also result from several diseases, lifestyle choices and environmental factors. Some of the least-talked about causes of male infertility are often some of the most avoidable. Here are some examples: Mumps One side effect of mumps, seen in roughly 20 percent of patients with the virus, is inflamed testes. The swelling can lead to fertility issues if damage to sperm-producing cells occurs. Infertility from mumps is preventable with responsible vaccination. Marijuana Studies have shown that repeated use of the recreational drug can deplete sperm count and might also negatively affect sperm quality, both of which can cause infertility. Smoking cigarettes can also lead to decreased fertility. Stress Severe emotional stress can wreak havoc on sperm count not to mention one’s overall health. Elevated stress levels have been shown to interfere with certain hormones needed to produce sperm. Celiac disease Undiagnosed, the digestive disorder characterized by gluten sensitivity can negatively affect male fertility. Studies have shown that sperm characteristics and hormone levels improved after men adopted gluten-free diets. Couples concerned about their ability to conceive should visit their physicians. I recommend that the male partner of the infertile couple be evaluated first because testing is often less invasive and easier for men than women. One in six may sound like a fairly high number, but even if you are diagnosed as infertile, it does not mean you must face a life without children. There are several treatments, from medicine to surgery, that can help in adding a little one to your life. Your doctor can advise on the best options for you. http://theurologygroup.cc/blog/2013/04/24/awakening-to-better-treatment-highlights-from-our-clinical-research-labs In the 1990 movie “Awakenings,” a neurologist played by Robin Williams performs clinical research using a test drug to rouse patients from a catatonic state. The drug, L-Dopa, did not prove effective in that case, but its promise was further explored and it continues to be used successfully today on a wide range of conditions, including Parkinson’s. The point of this story is that without the clinical trials, the power of a treatment would never have been known. Every day, the medical community is seeking new, more effective approaches to curing patients, and clinical research is crucial to that. This is a fact at the Cleveland Clinic as much as it is at The Urology Group. For instance, we recently concluded research that involved the use of Botox as a viable treatment option for adults with overactive bladder. By participating in a clinical trial, patients play a more active role in their own health care by accessing new treatments, and they help others by contributing to medical research. At the Urology Group, several trials are scheduled and underway. There is never a charge for being in one of our studies. In fact, many of our studies include a stipend. Are you interested? See below: The Urology Group is performing multiple studies for new therapies for advancing prostate cancer. We are conducting a study to evaluate the effects of a recently approved medication for erectile dysfunction (ED) on sperm production. Healthy men (ages 18-45) and men with mild ED are eligible for this study. We routinely do multiple studies for people with overactive bladder (those who find themselves going to the bathroom too frequently and having trouble with urinary leakage). There will be several trials, evaluating various medications, to hopefully control this problem. Shortly, we will be participating in several studies for interstitial cystitis (IC). We are seeking women with this condition to participate in the trials. The movie “Awakenings” has a melancholy ending – the drug did not work, but the surgeon involved learned a lesson in the value of living life to its fullest. By offering and participating in trials, we all strive to do the same. If you think you may be interested in one of these studies, please call 513-841-7550. http://theurologygroup.cc/blog/2013/04/09/for-vip-treatment-free-prostate-screenings-can-be-life-saving What do Robert De Niro, Colin Powell, Nelson Mandela and Arnold Palmer have in common? Hint: It’s not a good golf game. Turns out, the four well-known men all suffered from prostate cancer at one point in their lives. They all have since recovered and, reportedly, Arnold Palmer was even able to play golf just eight weeks after his surgery. These famous men are not alone in their prostate cancer survivorships. In fact, one in six American men over the age of 50 will be diagnosed with prostate cancer, but with early detection and proper treatment, most of those men will not suffer from this disease. At The Urology Group, we feel so strongly about the benefits to preventative prostate care that we’ve partnered with local organizations to offer free screenings and examinations. Tomorrow, April 11, a number of our physicians will be at the Sharonville Convention Center to assist with the first of many free prostate exams and PSA screenings this year. I urge men over 40 who haven’t had their prostate checked recently to attend and be examined. Because prostate cancer usually causes no symptoms unless it has spread outside the prostate, preventative care is particularly important. Urologists typically diagnose prostate cancer using a combination of patient history and physical exams including PSA tests. Early testing such as the PSA test has contributed to the decline in prostate cancer death rates by nearly 40 percent over the last two decades. For more information about tomorrow’s free screening and future screenings please visit www.freeprostatecincy.com. http://theurologygroup.cc/blog/2013/03/28/the-prostate-and-the-pill To many people, BPH may sound like the name of a new fuel station chain. But to millions of men, the initials BPH represent a different kind of pain at the pump. BPH stands for benign prostatic hyperplasia, or enlarged prostate, and to many men, it signals the beginning of a prolonged and often unpleasant medication regime, due to allergies and side effects. We’re not talking a slight inconvenience for a small number of men here. More than half of American men in their sixties and as many as 90 percent in their seventies have symptoms of enlarged prostate. As the condition worsens, the tissue surrounding the gland restricts its expansion, causing it to press against the urethra and impede urination. Not surprisingly, this results in discomfort and pain, so learning your options beforehand will put you at an advantage of a faster recovery.     Several drugs can treat BPH by relaxing the prostate and bladder muscles, improving urine flow. Other drugs inhibit production of the hormone DHT, which is involved in prostate enlargement. But a lot of drugs do have known side effects, including lightheadedness, vomiting, swelling and irregular heart beat. For some patients, these side effects can interfere with work, family and daily tasks. So it is important to know that medications, while common, are not the only course of treatment. Just like you have choices at the fuel station, you do have other options to treat BHP. One of them, transurethral microwave thermotherapy, is a common outpatient treatment during which the excess tissue is burned away using microwave heat applied by a tiny, urethral catheter. Other services include: Transurethral resection of the prostate: In this procedure, a small electrical loop inserted through the penis cuts away at obstructing tissue while sealing blood vessels. Transurethral vaporization of the prostate: Here, a tiny instrument with an electrode or laser fiber is passed through the urethra and vaporizes the obstructing tissue. Open surgery: In cases when the prostate is very large, a surgical incision will be required to remove obstructing prostate tissue. Holmium Laser Enucleation of Prostate (HoLEP): This newer treatment involves the removal of the entire obstruction using a vaporizing laser, so no incision is required. HoLEP treatment is reserved for larger prostates and is limited in availability, but it is offered as at The Urology Group. The old line goes that an informed consumer is a better customer. This goes for personal health care as well as for food or gas. By learning today what you may need to know tomorrow, you will be halfway to putting your health care decisions in the rearview mirror. http://theurologygroup.cc/blog/2013/03/06/vasmadness-doctor-s-note-for-watching-games Vasectomies are one of the most common procedures performed by urologists at The Urology Group. Yet, there are still a lot of questions, uncertainty and misperceptions concerning this procedure. The number one thing you should know? It’s a quick, virtually painless and highly successful office procedure. The benefits are clear for any man considering a vasectomy. It is the most effective form of birth control, which can simply improve intimacy with partners by reducing worry of unplanned pregnancies. Also, it’s easy. This quick (about 20 minutes) outpatient procedure is non-invasive. Most insurance companies cover vasectomies, as it is considerably more cost effective when compared to alternative birth control methods. Even without insurance, a typical vasectomy costs only about $700. Finally, the biggest thing men want to know is what happens after the procedure. The procedure does not alter hormone levels such as testosterone, and therefore will not affect your libido, sex drive or ability to get an erection. Men perform just as they did before their vasectomies, but without the stress of an unplanned pregnancy! Recovery is minimal, only requiring one or two days off work, which is why VasMadness is the perfect time to schedule a vasectomy. Men can get the procedure done and take a day or two off work to watch the NCAA basketball tournament. The Urology Group is dedicating several doctors’ schedules on Wednesday afternoon, March 20 and Thursday morning, March 21 for vasectomies, with games tipping off that day. We are partnering with WEBN-FM and Alamo Electronics to offer a grand prize giveaway of a 42” TV during the month of March. We’ll also have special goodie bags for men who get the procedure March 20-21. Click here for details.  To schedule an appointment or to learn more, just visit our website or call (513) 841-7500. We’re here to walk you though this simple procedure, and are happy to sign your doctor’s note for work. Happy basketball watching (and whatever else happens after the tournament)! http://theurologygroup.cc/blog/2013/02/19/more-than-skin-deep-botox-treatment-option-offered-at-the-urology-group Overactive bladder is a condition that affects an estimated 33 million Americans, including a large percentage of my patients. It’s always great to have another treatment option, particularly one that offers a simple procedure in place of medications or a more invasive surgery. So, after participating in a clinical trials program we are thrilled here at The Urology Group that BOTOX®, the widely used wrinkle-removing injection, is actually adding overactive bladder to its growing list of medical condition treatments. The U.S. Food and Drug Administration (FDA) has officially expanded its approval of BOTOX® (onabotulinumtoxinA) as a viable treatment option for adults with overactive bladder who cannot use or do not adequately respond to traditional medications. (Until a couple of weeks ago, Botox was only approved for patients with neurological conditions such as spinal cord injury and multiple sclerosis.) Overactive bladder is a condition that affects both men and women. Symptoms include frequency of urination, a feeling of urgency to urinate, accidents or leakage from inability to reach the restroom in time and waking up at least twice a night to use the bathroom. Normal bladder function involves communication between the nervous system and the muscles that make up the bladder wall. The nerves send signals to the bladder muscles, telling them to contract when the bladder is full. In patients with overactive bladder, those nerve signals occur more suddenly and frequently — even when the bladder is not full. This is where the BOTOX® treatment is most effective. It’s a relatively simple procedure that requires injecting the drug into the bladder during cystoscopy (a medical procedure that lets a doctor see inside the bladder.) It sometimes requires general anesthesia. BOTOX® works by relaxing the bladder, thus allowing it to store more urine. The effects can last from four to six months. The upside for patients is the technique may be repeated, with at least 12 weeks between each treatment. As with most treatments, there are possible side effects, including urinary tract infections, painful urination and incomplete emptying of the bladder. However, this new treatment is promising for patients with chronic bladder control issues. http://theurologygroup.cc/blog/2013/01/31/the-urology-group-stands-behind-importance-of-life-saving-psa-cancer-screenings The physicians at The Urology Group are big supporters of vigorous debate, especially when it comes to patients’ health and the choices they make. But recent reports that question the necessity of prostate-specific antigen (PSA) tests for prostate cancer force us to get out in front of the issue and defend the importance of the screenings.   Data continues to confirm that early testing for prostate cancer, in particular the use of the PSA test, has contributed to the decline in prostate cancer deaths by nearly 40 percent over the last 20 years. Indeed, The Urology Group alone has treated thousands of patients with prostate cancer and we know for a fact that the early detection the PSA makes possible is the key to recovery and survival. This is particularly the case among high-risk groups such as men with a history of prostate cancer and African American men. But we also know that it is always the patient’s decision regarding the course of treatment, whether to watch and wait or have surgery. Here are some prostate cancer facts for patients and families to consider: Prostate cancer is the second leading cause of death in American men, second only to lung cancer. One in six men will get prostate cancer at some point and nearly 30,000 men will die from the disease this year. One in 12,000 men under age 40 will be diagnosed. African American men carry the highest rate of prostate cancer in the U.S. with an incidence rate 60 percent higher. They are two-and-a-half times more likely to die from the disease than men of any other ethnic group. The PSA debate is not a new one; we have made our case before and will continue to do so as long as we believe that PSA screenings save lives. Like any physician, we are in the field because we want to provide advanced care and improve the health of our patients. To support that mission, The Urology Group has invested in an active clinical trials program researching new treatments for a variety of urologic conditions, including prostate cancer (www.urologygroup.cc/clinical-trials).  Knowledge empowers you with choice. My advice to all men 50 and older, or to men who are 40 and are African American or have a family history of prostate cancer, is to make a prostate exam a part of your annual checkup. We know screening works and will continue to be an advocate. http://theurologygroup.cc/blog/2013/01/29/treatments-for-pelvic-prolapse-offer-women-hope Once rarely discussed or recognized, pelvic prolapse or pelvic floor weakness has now become a priority in women’s health. The problem is so prevalent that by age 80, more than one in every 10 women will have undergone surgery for prolapse. Today, many primary care physicians and gynecologists routinely screen patients for the symptoms, but urologists are the true experts in treating prolapse conditions and the urinary incontinence that often results. Women with mild prolapse discovered during a routine pelvic exam may have no symptoms at all. But others experience considerable discomfort and a range of symptoms, including: Pressure and pain. The most common complaints are a feeling of pelvic pressure, or bearing down, leg fatigue and low back pain. Urinary symptoms. Cystocele (bladder) and uterine prolapse can cause stress incontinence and difficulty in starting to urinate. Bowel symptoms. A rectocele (rectum prolapse) may cause problems with defecation by forming a pocket just above the anal sphincter. Stool can become trapped, causing pain, pressure and constipation. Sexual problems. A prolapse can cause irritated vaginal tissues or pain during intercourse, as well as psychological stress. If you think you have a pelvic prolapse condition, a traditional pelvic examination is the only way to diagnose it. Treating Pelvic Prolapse Women with very mild symptoms may not need treatment, although they should avoid anything that might worsen the prolapse. It is often a good idea to lose weight if necessary, avoid lifting heavy objects, and quit smoking to prevent prolapses from progressing. Prolapse doesn’t necessarily worsen over time, so there’s no need to seek aggressive treatments, unless symptoms get worse. Nonsurgical treatments include: Activity modification: The physician may recommend activity modification such as avoiding heavy lifting or straining. Pessary: This is a small plastic or silicone medical device similar to a diaphragm or cervical cap that’s inserted in the vagina to help support the pelvic area. Kegel exercises: Simple strengthening exercises that can tighten the muscles of the pelvic floor. Estrogen replacement therapy. Estrogen helps strengthen and maintain muscles in the vagina. Practicing Kegel exercises help to strengthen the pelvic floor and reduce the chance that mild condition will progress. Kegel exercises are a series of contractions that strengthen the pelvic floor. You squeeze two sets of pelvic floor muscles at the same time: those you would use to prevent yourself from passing gas and those you would tighten to stop urinating. Surgical options: For women who are experiencing major discomfort or inconvenience, surgery is the only definitive way to relieve symptoms and improve quality of life. Vaginal surgery with mesh: The physician uses a mesh “kit” to pull the vagina up to the sacrospinous ligament (near the sacrum, the triangular bone just above the tailbone). The FDA recently warned that mesh could introduce risks that are not present in traditional non-mesh surgery, including: mesh erosion (exposure of the mesh in the vagina); mesh contracture (shrinkage); pelvic pain; pain with intercourse; bleeding; and infection. Robotic surgery using mesh (sacrocolpopexy): For treatment of prolapse for women who have had a hysterectomy. In the procedure, the surgeon connects the prolapsed vagina to the sacrum (the triangular bone just above the tailbone) using an artificial tissue material called a mesh. The Urology Group uses the da Vinci Surgical System for these procedures, which is similar to laparoscopy with small incisions, but with the more precise movements of the robot. Considered the “gold standard” for prolapse surgery, this procedure can only be done in women who have had a hysterectomy or it can be done in conjunction with a hysterectomy. The FDA warning about mesh does not apply to this procedure. Vaginal surgery without mesh: This treatment involves repair with either a suture or with biological material, such as pigskin. However, the repair may not have the longevity of robotic sacrocolpopexy. http://theurologygroup.cc/blog/2013/01/16/everyone-pees Adult Americans who have celebrated the experience of raising toddlers at any point in the last 40 years likely are familiar with Everyone Poops, the children’s classic from Taro Gomi about one of life’s more salient biological facts. A book geared to an entirely different stage in life might well be titled, Everyone Pees. Upon opening that book, the question becomes, for some of us, how much do we pee? Or more to the point, how much is too much? Perhaps it’s best to illustrate the signs that a person is peeing too often by using a  selection of everyday references. You’re peeing too often if: You know the location of every bathroom in the city…just in case You wake up tired because of so many night time trips to the bathroom You can't get through a movie without several trips to the toilet You're buying pads, but it's not that time of the month and you're too old for diapers These experiences may seem familiar, and even a bit funny. But it’s wise to take bladder control issues – our own or those of our loved ones – seriously. Here’s another set of signals, expressed in doctor-speak. It’s time to see a urologist: If a person regularly voids more frequently than once every two hours If frequent urges to void are interfering with daily life, work or sleep If a person is bothered by wearing pads for urinary protection Sometimes friends or family notice before the patient does. Patients will tell their urologist, “My friends or co-workers make fun of how often I go to the bathroom,” or, “My spouse can't sleep anymore because I’m getting up so often and I keep her (or him) awake.” Here’s a word to the wise for anyone challenged by bladder control issues – Interstim. Interstim therapy is a treatment option that uses mild electrical impulses to modulate the nerves that control the bladder and nerves that control the muscles related to urination. A patient is a candidate for Interstim therapy if he or she has frequent, sometimes uncontrollable urges to void that are not responsive to conservative therapy such as medication or behavioral changes.  Interstim therapy also is indicated for urinary retention in the absence of obstruction. Additionally, Interstim is indicated for bowel control in patients with fecal incontinence that has not been responsive to conservative management with medication, diet and behavioral changes. The good news is that Interstim can improve incontinence symptoms, frequency and urgency, by greater than 50 percent without the side effects of medication. http://theurologygroup.cc/blog/2013/01/02/new-year-s-resolution-for-better-urinary-health-in-six-steps The famed Roman poet Virgil said more than 2,000 years ago, “The greatest wealth is health.” As another year passes between his time and ours, the substance of these sage words has not diminished a speck. Yet everyday, I am sure most of us catch ourselves doing something that is not in the best interest of our health. We cannot always help that – the demands of our workday lives often force us to sit too long, to rush too much, and to feel a bit of stress. Fortunately, there are a few practices we can adopt to help offset these unhealthy situations. I’d like to share my resolutions for one more year of better urinary health: Drink water when you feel thirsty: One of the best and most affordable preventative measures against kidney stones and urinary tract infections is water. Medical evidence suggests that drinking too few fluids can exacerbate a chemical oversaturation of the urine, causing stones to form. Further, increased water will dilute the urinary stream and enable the body to flush bacteria before an infection can begin. Learn how to perform self-examinations: Not every event that occurs beneath our skin requires an X-ray for detection. Scrotal masses are relatively easy to catch during a self-examination, which is recommended on a monthly basis. A scrotal mass is a lump or bulge that may indicate enlarged veins, inflammation, or cancerous or non-cancerous growths. Early detection means better chances of recovery. Have a regular PSA screening: All men over the age of 50 should commit to annual PSA (prostate-specific antigen) screenings, a blood test that measures the level of proteins produced by cells of the prostate. A man is 35 percent more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer, according to the Prostate Cancer Foundation. Yet if detected early, prostate cancer is nearly 100 percent treatable. Monitor your use of pain medication: I'd like to use another quote here, by Benjamin Franklin: “The best doctor gives the least medicines.” True enough, the prolonged uses of pain medications, both prescription and over the counter, have been shown to increase the risk of kidney cancer. A 2011 study found that regular use of non-aspirin anti-inflammatory painkillers – by both men and women – raised the likelihood of kidney cancer by more than 50 percent. Don't smoke: The chances of contracting or dying from bladder, kidneys or prostate cancer are significantly elevated if you smoke. For example, the risk of bladder and kidney cancer is twice as high among cigarette smokers than nonsmokers. And recent research shows smokers diagnosed with prostate cancer are more likely than nonsmokers to die of the disease or experience a recurrence. Perform Kegel exercises: Many people wrongly assume that Kegels are strictly for women, but men can benefit as well. The exercise, which involves strongly contracting the pelvic muscles used to hold back urine, reinforces those muscles and can tighten and strengthen the pelvic floor. Kegels may be prescribed for both men and women with incontinence and for women with pelvic floor prolapse. The poet Virgil died in 21 BC, at the ripe old age of 51. We are fortunate to have much longer lifelines, but our extended time also exposes us to health issues unheard of in Virgil’s day. The onus is on us to keep healthy bodies because, as another sage man once said, “It’s the only place you have to live.”