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Men

Enlarged Prostate (BPH)
Epididymitis
Hydrocele
Impotence/Erectile Dysfunction
Penile Warts/Condyloma
Peyronie's Disease
Prostate
Prostate Specific Antigen (PSA)
Prostatitis
Testicular Self Examination (TSE)
Varicocele
Vasectomy

Enlarged Prostate (BPH)

1. What is Benign Prostatic Hyperplasia (BPH)?

As men get older, the prostate gland commonly enlarges. This enlargement is called Benign Prostatic Hyperplasia (BPH). Occasionally, this enlargement may represent cancer but usually is related to a benign, non-cancerous growth. BPH is the most common benign tumor in men and is responsible for some urinary symptoms in most men over the age of 50.

2. What are the symptoms of BPH?

  • Hesitancy upon the start of urination
  • Weak stream while urinating
  • The sensation of not completely emptying the bladder
  • Stopping and starting while urinating
  • Frequent urination
  • Frequent nighttime urination
  • Urgency to urinate
  • In extreme cases, the inability to urinate at all

3. What are the causes of BPH?

As men get older, the prostate gland routinely enlarges and therefore can constrict the passage of urine coming out of the bladder to the penis. This may cause difficulty voiding and the other symptoms of BPH.

4. How is BPH diagnosed?

Your physician may ask you questions about how you void or to fill out a questionnaire to help evaluate the severity of your symptoms. Some additional tests may be ordered to see if you have an obstruction. A rectal examination and a blood test to check for prostate cancer will most likely be done on the initial visit to the urologist.

5. How is BPH treated?

The urologist will consider the best option for the individual patient. Medications can be prescribed to help alleviate the symptoms of BPH. However, there are surgical options for BPH.

The "standard" treatment is the Transurethral Resection of the Prostate (TURP). This procedure has been done for years. It involves inserting a scope into the urethra (the tube inside of the penis) and surgically removing a portion of the obstructing prostate tissue.

In recent years, several alternative surgical techniques have been developed which employ lasers, special tools, or microwave therapies. The laser procedure, although effective in certain cases, is still not covered by several insurance companies. With the laser therapy, the physician uses a cystoscope to view the prostate. Then the laser tip is inserted into the prostate to destroy a precise area of the enlarged gland. The tissue that is destroyed is absorbed naturally by the body, decreasing the symptoms of BPH. The microwave therapy is a less effective alternative, but most insurance companies are starting to pay for this therapy. It works about the same as the laser, by increasing the temperature of the prostate to destroy the enlarged gland. It is not as precise.

Individuals should not suffer with BPH. There are many options available, and certainly each patient's needs may be met in choosing one of the alternatives. It is important to be evaluated by an urologist in order to make the right choice.

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Epididymitis

1. What is Epididymitis?

Epididymitis is an inflammation or infection of the epididymis. The epididymis is the structure of tubes that transport sperm from the testicle. These tubes merge to form the vas deferens. The vas deferens is the tube that is cut during a vasectomy to prevent pregnancy.

2. What are the symptoms of Epididymitis?

  • Discomfort in the region of the testicle.
  • Swelling
  • Firmness

3. How do you diagnosed Epididymitis?

The physician will do a testicular exam, and possibly a scrotal ultrasound.

4. How do you treat Epididymitis?

Treatments for epididymitis include antibiotic therapy, anti-inflammatories and scrotal support. In the cases of acute epididymitis, cold therapy is recommended.

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Hydrocele

1. What is a Hydrocele?

A hydrocele occurs when fluid fills the membrane covering the front and sides of the testicle and epididymis in the scrotum. This is usually not painful but is often uncomfortable due to the increased size of the scrotum. A hydrocele commonly affects one side of the scrotum, but in some instances both sides may be affected.

2. What are the symptoms and causes of a Hydrocele?

As mentioned, a swollen scrotum is the first sign of a hydrocele, but it is seldom associated with pain. Possible causes of a hydrocele are: trauma to the scrotal area or inflammation or infection of the epididymis.

3. How do you treat a Hydrocele?

Some hydroceles do not need to be treated, as they will correct themselves or remain unchanged. Indications for hydrocele repair include pain and discomfort due to the size and/or location of the hydrocele. The most common procedure is a surgical procedure under anesthesia to correct the hydrocele. If surgery is not the best choice due to health or other reasons, the hydrocele can be aspirated. Hydroceles that are aspirated often re-occur.

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Impotence/Erectile Dysfunction

1. How does an erection occur?

An erection is an involuntary reaction in response to sexual, psychological sensory, and nerve stimulation. This stimulation causes a rapid increase in the amount of blood flowing into the penis. An erection occurs when blood becomes trapped. As the shaft of the penis rapidly fills with blood, the penis becomes firm and elongated, resulting in a successful erection.

2. What is Impotence/Sexual Dysfunction?

Impotence/Sexual Dysfunction refers to the inability to have or maintain satisfactory erections, or the inability to achieve successful sexual intercourse. Impotence can be total or partial and it can affect men of different age groups. Some of the symptoms of impotence are:

  • Decreased sexual drive
  • Early loss of erection
  • Inability to have a full erection
  • Premature ejaculation

3. What can cause Impotence/Sexual Dysfunction?

Impotence/Sexual Dysfunction can be the result of medical, surgical, or psychological factors. The medical problems include illnesses like:

  • Alcohol or substance abuse
  • Arteriosclerosis (hardening of the arteries)
  • Diabetes
  • Hormonal Imbalances
  • Kidney Disease
  • Neurological Diseases
  • Injuries or Pelvic Fractures

Some medications can cause impotence/sexual dysfunction. These drugs include:

  • High Blood Pressure Medications
  • Depression Medications

The surgical procedures that contribute to impotence/sexual dysfunction are:

  • Removal of the Prostate for cancer
  • Colon surgeries
  • Blood vessel surgery

The psychological causes may include:

  • Marital Problems
  • Mental Problems

4. How is Impotence/Sexual Dysfunction evaluated?

The urologist will need to obtain a complete history of the patient's problem and information about previous operations, illnesses, injuries, and medications. It is important to understand the patient's development and social history. There may be some aspects of a person's life that would be affecting their impotence/sexual dysfunction. The physical examination of the penis and scrotal area may help find physical underlying problems. In some cases, blood tests, ultrasounds, and x-rays may be ordered.

5. How is Impotence/Sexual Dysfunction treated?

The good news is that most men with impotence/sexual dysfunction can have their sexual function restored with proper treatment. There are many different treatments for impotence/sexual dysfunction. They are as follows:

  • Pills taken orally to help achieve an erection.
  • Directly injected medication into the penis - The patient can use a self-injection treatment to achieve an erection. These require the patient to inject the drug directly into the penis. It is surprisingly almost pain-free and well tolerated by patients.
  • Inserted medication into the penis - Medical urethral suppository is a newly developed treatment that consists of a very small medicine pellet inserted into the urethra (tube inside the penis).
  • Hormone replacement therapies - if the blood tests indicate there is a decrease in testosterone, then hormone treatment may help.
  • Vacuum erection device (VED) – this is a mechanical device that allows for the expansion of the penis using an external vacuum pump and then when an erection is achieved, placement of a rubber ring at the base of the penis to sustain the erection.
  • Surgical procedure – this would include the use of implants that offer predictable erections using mechanical methods. It requires a brief stay in the hospital.

Sexual and Marital counseling – this is important for those individuals and couples where an underlying emotional or relationship problem is a major contributor to sexual problems.

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Penile Warts/Condyloma

1. What is Condyloma?

Condyloma is commonly called genital warts. It is a sexually transmitted disease (STD). It is spread by skin to skin contact. Condylomas can be found on the external or internal genital areas of men and women. Some condylomas can be pre-cancerous or even cancerous, so it is important to see a physician.

2. What are the signs and symptoms of Condyloma?

Condyloma may not be apparent for 2-3 months or even longer after being infected by the virus. Condyloma usually starts out as small bumps either singularly or in a group and may have a "cauliflower" look. Most of the time the individual will have no symptoms unless the virus has been active without treatment for some time. The most common symptoms if present are:

  • Pain
  • Itching
  • Burning with intercourse

If the condyloma is in the anal area, there may be rectal bleeding and itching.

3. How is Condyloma treated?

Condyloma can only be treated, not cured. There are treatments that destroy the majority of contaminated cells and decreases the rate of recurrence. Some common treatments are as follows:

  • Topical Solutions - these are often used on external condyloma as the first line of treatment.
  • Surgical Procedures – this can be used if the area failed to respond to the topical solutions or if the warts are large. The condyloma can be removed by burning or freezing the infected area, and is done as an outpatient procedure.

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Peyronie's Disease

1. What is Peyronie's disease?

Peyronie's disease is an unnatural curvature in the penis, most noticeable during an erection. The disease may prevent a complete erection due to the plaque or scar tissue that develops in the penis. The curvature can cause painful erections and may be so severe that intercourse is impossible.

2. What are the signs and symptoms of Peyronie's disease?

The cause of the plaque is unknown but may develop due to a trauma to the penis or in the groin area. Some of the symptoms of Peyronie's disease are:

  • Painful Erections
  • Soft Erections
  • Curvature in the Penis
  • Fibrous area under the Skin of the Penis

Peyronie's disease is not cancerous and is not sexually transmitted.

3. How is Peyronie's disease treated?

There are many options in treating Peyronie's disease depending on the severity of the disease. In some cases, there is no need for treatment. However, if the curvature becomes much worse, treatment may be indicated. There are non-surgical and surgical treatments.

Non-surgical

  • Oral medication used to decrease the pain, soften and reduce the plaque.
  • Medication is injected directly into the plaque to soften and dissolve the plaque.

Surgical

  • Excision of the plaque with repair by graft.
  • Surgically shorten the unaffected side of the penis, to straighten the penis.
  • Penile prosthesis may be implanted to straighten the penis and provides enough rigidity for intercourse.

After treatment, Peyronie's disease may return and may be a chronic problem. All of the risks and complications should be taken into consideration before a treatment is selected.

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Prostate

1. What is the Prostate?

The prostate is a male sex gland that is important for reproduction, as it produces the majority of ejaculate fluid. It is a small walnut-shaped gland that is located above the rectum and at the bottom of the bladder. The prostate surrounds the urethra (the tube that carries urine from the bladder) like a doughnut, at the point where the urethra connects to the bladder.

2. How can Prostate abnormalities be detected?

A rectal examination should be considered as part of the annual physical checkup for men beginning at age 50. Rectal exams should begin at age 40 if you are exposed to increased risk-factors, such as having Afro-American heritage or a family history of prostate cancer.

Next, men should also have a Prostate Specific Antigen (PSA) test. The PSA is an effective tool available to physicians to help monitor the prostate gland.

3. What are some common Prostate abnormalities?

  • Prostate Cancer
  • BPH
  • Prostatitis

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Prostate Specific Antigen (PSA)

The PSA test has revolutionized the detection of prostate cancer and the monitoring of the effects of treatment. It has enabled the medical community to allow early detection of prostate cancer. However, prostate cancer may be present in a person with a normal PSA. Therefore, it should not be used as the sole method of prostate examination but should be performed in combination with the digital rectal examination.

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Prostatitis

1. What is Prostatitis?

Prostatitis is the inflammatory condition of the prostate gland.

2. What are the symptoms of Prostatitis?

The patient may show a variety of symptoms. They often include:

  • Low back pain
  • Burning upon urination
  • Frequent urination
  • Urgent urination
  • Pain deep in the rectum or scrotal areas.

At times the symptoms may also include joint and muscle aches, fever or pain almost anywhere within the pelvis and scrotum. The symptoms may be mild or may be overwhelming.

3. How is Prostatitis diagnosed?

The urologist will perform a digital rectal exam. This may reveal a very tender prostate gland. Urine and/or prostate secretions may be examined.

4. How is Prostatitis treated?

Prostatitis is most commonly treated with antibiotics. Anti-inflammatory drugs and sitz baths are often helpful. In very rare cases, surgery can be done to remove part of the prostatic tissue.

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Testicular Self Examination (TSE)

Testicular self-exam is an important part of routine, health maintenance for men and should be done once a month.

  • Start by holding your scrotum in the palm of your hands. Then feel one testicle. Apply a small amount of pressure. Slowly roll it between your fingers. Try to find hard, painless lumps.
  • Now examine your epididymis. This comma-shaped cord is found behind your testicles. Its job is to store and transport sperm. Tender when touched, it is the location of most non-cancerous problems.
  • Continue by examining the vas deferens, the sperm-carrying tube that runs up from your epididymis. Normally, the vas deferens feels like a firm, movable, smooth tube. Now repeat the exam on the other side.

Most scrotal or testicular masses are not cancer but if one feels an abnormality, a consultation with a urologist should be made as soon as possible.

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Varicocele

1. What is a Varicocele?

A varicocele is the enlargement of the veins that drain the testicles. A left varicocele is more common. A varicocele affects fertility due to the decrease in circulation of blood in the testicular area.

2. What are the signs and symptoms of a Varicocele?

Some varicoceles may cause pain and/or the decrease in size of the testicle.

3. How is a Varicocele diagnosed?

A varicocele is usually diagnosed during an infertility work up.

4. How is a Varicocele treated?

Once diagnosed, a surgical procedure can be done to correct the problem. The procedure may be needed because of the decreased size of the testicle, infertility, or because of the size and discomfort related to the varicocele. If the varicocele is the cause of infertility, in many cases fertility will improve in a few months.

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Vasectomy

1. What is a Vasectomy?

A vasectomy is the most effective means of permanent birth control. A vasectomy does not affect the production of male hormones nor does it alter sexual function. The vasectomy involves surgically cutting and closing off or blocking the vas deferens (the tube that carries sperm from the testicle). After the vasectomy, the testes continue to produce sperm cells that are simply absorbed by the body.

2. What to expect during surgery?

The urologist will make one or two small openings into the scrotum. The vas deferens will be cut and a section of the tube will be removed. Even with the local anesthesia, the patient will experience a tugging or pulling sensation in the scrotum or groin area. The two ends of the vas deferens will be tied or cauterized; the opening(s) will be closed with small sutures which will dissolve on their own; and a surgical dressing will be applied to the incision.

An athletic supporter or a brief type underwear should be worn following surgery to immobilize the scrotum and minimize discomfort.

3. What to expect after surgery?

The patient should make arrangements to have a family member drive him home following surgery. The patient may experience some discomfort within the first 24 hours. If necessary, the urologist will prescribe pain medication. The patient should avoid any heavy lifting or vigorous exercise for 24-48 hours following surgery. To protect the incision, do not bath or shower for the first 24 hours following surgery. Sexual activity with birth control protection can be resumed within one week.

After the vasectomy, it is necessary to continue to use some form of birth control until all stored sperm are cleared from your system. This usually takes at least 8-10 weeks. Two separate semen specimens should be taken to the urologist's office to confirm that the specimens are free from sperm.

4. What are the possible complications?

No surgical procedure is without risk. However, the majority of complications associated with vasectomy are minor.

  • Up to one week following surgery: Internal bleeding in the scrotum which may cause pain and swelling. There is always the risk of infection after a surgical procedure. Swelling, redness, pus, or pain are symptoms of a possible infection.
  • Up to several months following surgery: Sperm granuloma- which is a lump at the site where the vas deferens is tied off. This will usually disappear in time.
  • Congestion: This is caused by sperm within the epididymis which may cause aching. This symptom usually disappears without treatment.
  • Spontaneous regrowth: Although rare, spontaneous formation of a new vas deferens through the scar tissue can occur. This is usually detected by a post-operative semen test.

5. Can a reversal of the Vasectomy be performed?

Although a vasectomy should be considered a permanent surgical procedure, there is a surgical procedure that can reverse a vasectomy. It is called a "Vasovasostomy." A vasovasostomy involves surgical reconnection of the vas deferens to re-establish the flow of sperm. Patients are cautioned that fertility is not guaranteed.

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