The use of cannabis is on the rise, as it has become legal for both medical and recreational use in several states across the country.This comes with its own unique challenges. One of those challenges is the negative effect that marijuana can have on male fertility.

There is a body of evidence today that supports this finding and studies now suggest that the impact is multi-factorial. The use of marijuana can lead to:

• Reduced sperm count
• Reduced sperm concentration
• Changes in sperm motility and morphology
• Hormone changes
• Reduction in libido and sexual performance
• Reduced sperm viability

Unfortunately, many of these effects can linger for weeks and even months after discontinuing the use of marijuana. Dr. Daniel Mazur at Urology Associates has been involved in researching and reporting the effects of marijuana use on male fertility. Let’s take a closer look at some of the things he and the team discovered.

For many years, studies have shown that sperm have cannabinoid receptors on them, which suggests that cannabis has the ability to disrupt sperm function.  Additionally, studies have shown a high correlation of men using marijuana who have reduced sperm counts and concentration. In fact, men who use marijuana more than once a week have nearly a 30% reduction in sperm count and sperm concentration, and this has been shown to last five to six weeks even after they stop using marijuana.

In studies across both the US and the UK, research shows that men who have used marijuana three months prior to giving a semen sample also have abnormal sperm shape, also known as morphology.  This is even the case in younger men – those who were 30 years old or less.  Use of cannabis at both therapeutic and recreational dosages also showed a reduction in sperm motility, the ability for sperm to move efficiently, as well as viability, how long the sperm live.

In addition to the changes in sperm quality, counts, and viability, marijuana also impacts the reproductive hormones, such as the luteinizing hormone (LH). This hormone plays an important role in fertility, especially through its role in regulating testosterone levels. Research has shown that the recent use has a more detrimental impact than the frequency of use when looking at testosterone levels in men.

Another effect of cannabis use is that men who have prolonged and consistent exposure can experience testicular atrophy, a condition where the testes diminish in size and can even lead to the loss of function. This is due to direct damage to the seminiferous tubules (the tubes where the sperm is produced). While this condition can often be reversible, it is a factor to consider when evaluating male fertility in those individuals who have a long history of frequent marijuana use.

Lastly, there is strong evidence that erectile dysfunction, known as ED, is also a side effect for men who use marijuana. Long considered an aphrodisiac in past cultures, research today actually shows that it has a negative impact on sexual performance. In fact, in one study 78% of men who reportedly experienced ED were frequent marijuana users vs only 3% who did not.  It is believed that cannabis induces ED by causing damage to the endothelial cells, those cells that live on the interior surface of the blood vessels and help to maintain an erection.

If you are thinking of having a family in the near future, it’s important to know the impact that marijuana use may have on fertility. If you are interested in talking to a doctor or getting tested, please contact the Center for Male Fertility and Reproductive Medicine at Urology Associates.  Our team works with the regional fertility experts and stands ready to help you.

In some cases, a kidney stone diet may be enough to prevent stones from occurring and giving you kidney stone pain. While it is not complicated, it may take some dedication.

If you have ever had a kidney stone before, I am sure you remember the pain. According to the National Kidney Foundation 1 in 10 people will develop kidney stones in their lifetime. For most people, kidney stones are not a one-time occurrence and another will appear within seven years – without preventive measures.

Kidney stones form when certain chemicals become concentrated in the urine-forming crystals. Those crystals turn into stones that can make their way through the urinary tract. If they get stuck along the way they can block the flow of urine and cause unique kidney stone pain.

Learn more about kidney stones
The good news is that there are multiple natural ways to prevent kidney stones from occurring. In some cases, dietary changes may be enough to prevent stones from occurring again. But in other cases, additional medication or surgery may be needed.

If you have passed a stone before, it is helpful to get it tested to learn what type of stones you have and what prevention tips may work best for you.

Below are the seven most common kidney stone diet tips to stay stone free.

Staying hydrated helps prevent kidney stones

The number one natural way to prevent kidney stones is to drink more water. If you are not hydrated, you will not produce enough urine. This can increase the chances of kidney stones because low urine output means the urine is concentrated and less likely to dissolve urine salts that cause kidney stone.

I recommend that you drink around eight glasses of water each day. If you sweat a lot, exercise or have a history of stones, you may benefit from additional fluids.

A good way to tell if you are drinking enough water is to look at the color of your urine

Orange juice and lemonade are also good options to drink because they contain citrate, which prevents stones from forming.

Get enough calcium from a balanced diet

By increasing the amount of calcium-rich foods you eat, you may reduce your chance of the most common type of kidney stone, a calcium-oxalate stone. Good calcium-rich options include low-fat cheese, low-fat milk and low-fat yogurt.

If you already have an adequate calcium intake, this may not be helpful to reduce your chances of stones. The amount of calcium you need depends on your age and gender. Check with your primary care provider or urologist on what is right for you. Also, make sure you have vitamin D in your diet to help the body absorb the calcium.

While you may think it would be helpful, taking calcium supplements does the opposite and may increase the risk. If you need to take supplements, be sure to take them with a meal to try to reduce that increased possibility of stones.

Limit oxalate-rich foods

Oxalate is a natural compound found in food that binds with calcium in the urine and can lead to kidney stones forming. By limiting these types of foods, you can help prevent kidney stones from forming.

Oxalate and calcium bind together in the digestive tract before reaching the kidneys. If you would like to eat foods that contain oxalate or the mineral calcium, it is best to consume them at different times.

Foods to reduce or stay away from that are high in oxalates include:

• Chocolate.
• Coffee.
• Spinach.
• Sweet potatoes.
• Rhubarb.
• Peanuts.
• Beets.
• Wheat bran.
• Almonds.
• Soy products.

Reduce sodium intake

Sodium is a natural mineral found in some foods and also makes up 40% of table salt, with chloride making up 60%. We get most of our sodium from table salt. A person with a history of kidney stones should consume less sodium/salt, because the salt in urine does not allow the calcium to be reabsorbed into the blood. This can lead to urine with high levels of calcium, which may lead to stones.

For someone whose sodium consumption has contributed to their stones in the past, I recommend reducing your sodium intake to 1,500 mg each day (one teaspoon of salt contains 2,325 mg of sodium).

When trying to have a low-sodium diet, it’s important to read food labels. Foods that you should stay away from include:

• Canned soups.
• Canned vegetables.
• Chips, crackers, pretzels and other processed foods.
• Lunch meat.
• Hotdogs, bratwurst and sausages.
• Cheese.
• Condiments.
• Pickles and olives.
• Foods that contain monosodium glutamate, sodium bicarbonate (baking soda) and sodium nitrate.

The Centers for Disease Control and Prevention has a good guide on how to reduce sodium.

Eat less animal protein

Animal protein can be high in acidity and lead to increased urine acid. This can lead to both calcium-oxalate and uric-acid kidney stones.

Foods you should aim to limit or avoid are:

• Poultry.
• Beef.
• Pork.
• Fish.

Eat plenty of fruits and vegetables

I recommend that all people who form kidney stones should have at least five servings of fruits and vegetables daily. This will help by providing fiber, potassium, magnesium, phytate, antioxidants and citrate, all of which can help keep stones from forming.

If you are worried about knowing how to eat the right amounts of fruits and vegetables, talk to your doctor about what will be best for you.

Don’t take vitamin C supplements

Vitamin C supplements, also known as ascorbic acid, have been linked to kidney stones especially in men. A 2013 study out of Sweden followed men for 11 years and found that those who took higher doses of vitamin C supplements doubled their risk of kidney stones.

Foods that are high in vitamin C do not seem to carry the same risk.

What to do when a kidney stones diet doesn’t work

Dietary choices may not be enough to stop kidney stones from forming for all people. If you have recurrent stones, we recommended you talk to your urologist about what role medication can play to prevent them in the future.

Each type of kidney stone has a different type of medication that can help reduce the amount of that material present in the urine causing the stone.

For example if you get calcium stones, a urologist may prescribe phosphate or thiazide diuretic. A person who gets uric acid stones may benefit from allopurinol (Zyloprim) to reduce the acid in the blood or urine. Those with struvite stones may be prescribed a long-term antibiotic to reduce the bacteria in the urine. Lastly, a doctor treating someone with cysteine stones may prescribe capoten (Captopril) to reduce the level of cysteine in the urine.

Some prescriptions or over-the-counter medications you are taking could lead to kidney stones. Those include:

• Diuretics.
• Decongestants.
• Anticonvulsants.
• Protease inhibitors.
• Steroids.
• Chemotherapy drugs.
• Uricosuric drugs.

If you are taking any of the medications listed above, you should talk to your doctor about alternatives. Do not stop any medically prescribed medications without discussing it with your doctor first.

I do not recommend my patients use herbal remedies that are not well-researched or well-regulated for the prevention and treatment of kidney stones. It is best to head to a doctor to discuss your options.

Stones still forming

Even with medication and a proper diet a person may still get kidney stones. People may be able to pass smaller stones on their own. For other cases, medication such as tamsulosin (Flomax) may be prescribed to relax the ureter, making it easier to pass the stone. For large or painful stones, surgery may be needed to remove the stone from the ureter or kidney.

At Urology Associates we go over with each patient the risks of surgery and find the best option for those who need to have a stone surgically removed.

Pay attention before you flush: know how to translate the message your urine color is sending you – especially if it is red, pink or brown.

It may be surprising for some to learn that urine can come in a spectrum of colors – and they can all mean different things. The changes in color could be caused by foods, medications or food dyes. But in other cases, these changes could be caused by a health problem you don’t want to ignore like a liver condition, urinary infection or kidney stones.

Urine is your body’s liquid waste. It is mostly made up of water but also includes salt and chemicals (urea and uric acid). In most situations, the color depends on how diluted the urochrome pigment is. This pigment is made when it breaks down hemoglobin.

The color is not the only telling feature. It is also important to pay attention to changes in consistency and frequency.

You should not be afraid to pee in a cup when asked to at your doctor’s office. It tells your doctor a lot about your body functioning and could be very beneficial for your health.

The meaning behind urine color

We hope you will find this blog as a translator helping you learn what your trip to the bathroom is trying to tell you. Each color of urine can mean multiple things so we want to make sure you do not panic. But if you are experiencing an unhealthy looking color, make an appointment with your doctor.

Our color categories are approximate. Each person’s liquid waste will look slightly different than someone else’s, but this guide will provide you with a good frame of reference.

No color or transparent urine

Clear or transparent means you are drinking a lot of water. While it is rare to drink too much water, I recommend that if you see this shade, you cut back a bit. Cutting back your fluid intake will also reduce the number of trips to the bathroom.

Cloudy or foamy urine

Changes in the consistency of the liquid, including if it is cloudy or foamy, can be a sign of a urinary tract infection, an overabundance of certain minerals, a symptom of a chronic disease or sign of a kidney condition. If the discharge is cloudy with foam or bubbles, it could be a symptom of Chron’s disease or diverticulitis. In some cases, it is also a sign of dehydration. Another cause could be that you love steak and eat a lot of red meat or are on a ketogenic diet (high-fat and low-carb).

Pale yellow or gold urine

When everything is healthy and normal, your urine should be pale yellow to gold. It is helpful to regularly pay attention to your urination to see what your normal color is, so that you can tell when it is different.

Amber urine

Amber urined your bright yellow or neon liquid. Bright yellow urine is harmless, and is just a sign that you are taking more vitamins than your body needs. You may want to check with your doctor on what vitamins your body does not need as much of so you can cut back.

Bright yellow urine

If your morning routine includes popping a handful of vitamins and supplements, this could be the culprit behind your bright yellow or neon liquid. Bright yellow urine is harmless, and is just a sign that you are taking more vitamins than your body needs. You may want to check with your doctor on what vitamins your body does not need as much of so you can cut back.

Brown urine

Brown color in urination could mean you have severe dehydration or a liver condition. If you have melanoma skin cancer, your body may be adding skin pigment in circulation that’s winding up in the liquid waste. Brown urine could be misinterpreted as a very dark red, which could be caused by blood. Brown coloration could also be caused by large consumption of fava beans, aloe or rhubarb. Medications that cause your discharge to appear brown include metronidazole (treats infections) or chloroquine (prevent malaria).

Red and pink urine

Red or pink urine can range in a variety of colors. This may mean you have blood in your urine (hematuria) or it could be a sign of kidney disease, urinary tracts infection, tumors or a prostate problem. This could also be caused by recently eating blueberries, beets or rhubarb, or if you recently did strenuous activities.

Orange urine

Orange urine may mean you are dehydrated and need water. It could also mean you could have a liver or bile duct condition. Another meaning could be you ate large amounts of carrots or carrot juice, or you ate something with food dye. Many medications can also turn the urine orange, including phenazopyridine (for urinary relief), sulfasalazine (anti-inflammatory drug), isoniazid (tuberculosis treatment), high doses of riboflavin, some laxatives and certain chemotherapy drugs.

Blue and green urine

A green or blue color in the urine is not very common. It could be caused by a rare genetic disease or a bacteria causing a urinary tract infection. But most likely it is caused by medication or food dye in something you ate (watch out for those green eggs and ham). The medications most known to turn your liquid discharge blue are the pain reliever indomethacin, the antidepressant amitriptyline, the stomach acid drug cimetidine, and the anesthetic propofol. Asparagus could also add a greenish tinge but it is more known for adding an odor.

Purple

Purple is the only color that has a syndrome named after it, purple urine bag syndrome. This occurs in rare cases when using a urinary catheter where the patient also has a co-existing urinary tract infection.

When to bring in the professionals for urine color

Sometimes changes to a person’s urine are temporary and harmless, such as the result of eating certain foods, taking medications or vitamins. But changes can also be a sign of a more serious underlying medical condition.

Anytime you see blood in your urine or notice it is brown or orange, it is time to seek medical attention and make an appointment with your primary care provider. This is especially true if the change lasts more than a day, or if it comes with back or side pain, fever, burning with urinating, vomiting, discharge or thirst.

Blood in the urine is a common sign of a urinary tract infection, kidney stones or urinary tract cancer. Brown or orange urine may be caused by a malfunctioning liver especially if it is partnered with pale stools and yellow eyes and skin.

Smelly urine

On top of your urine color, I also recommend paying attention to the smell while going to the bathroom. Changes in smell could be caused by a range of underlying conditions but also could be because of your latest meal. If diet is suspected (as is common with asparagus), try eliminating the culprit. Contact your primary care physician if the odor persists.

Here if you need us

A urologist does not need to be the first line of care for most urinary color problems. Make an appointment with your primary care provider, who will refer you to a specialist like the providers at Urology Associates if it is needed.

When should a boy or young man wear an athletic cup? Always when playing a sport that could cause a genital injury & testicular pain.

We all have experienced a time when a boy or man was injured in the genital area during a sporting event and we hear the crowd gasp. This is because most men know how much pain it can cause. Even women have an idea from movies, TV shows and conversations with men in their life–and from the afflicted athlete holding the area and obviously suffering.

But it can trigger more than testicular pain, it can also cause a significant genital injury. This can include internal bleeding, severe bruises, fracture of a testicle and more. The most serious injuries are testicular rupture, when the testicle smashes against the pubic bone and bleeds internally, and testicular torsion, which cuts off the flow of blood and requires immediate medical care.

A new school year has begun and that means the start of football, soccer and wrestling, three sports that can cause genital injuries and testicular pain. But it is not just fall sports; lacrosse and baseball also account for a high number of testicular injuries. In fact, it may come as a surprise that the sports in order of the highest to lowest rate of testicular injury are lacrosse, wrestling, baseball and football.

While sports-related genital injuries are not very common, they can cause more than testicular pain including some significant injuries, especially if not treated. The ideal situation is to avoid testicular injuries to begin with. Genital injuries are seen in higher numbers in those who play a contact sport without the proper protective gear.

A Geisinger Health System 2016 study published in the Journal of Urology found that only 12.9 percent of athletes wore an athletic cup. That same study showed that 18 percent of athletes have experienced a testicular injury. There are more reported injuries than those who are trying to protect themselves. I am here to try to educate male athletes and their parents of the importance of the right protection and what can result from that genital injury.

Finding the right athletic cup to avoid possible testicular pain

An athletic cup should be worn if a male is involved with any kind of activity that can cause a groin injury, regardless of his age. The cup is made of metal or plastic and has padding on the inside. A cup should be worn as soon as a young athlete’s testicles and penis are big enough to fit in one. The cup might have holes in it for airflow.

Boys and men usually wear an athletic supporter, or jockstrap, to hold the cup in place. This will keep the testicles stationary and close to the body. Younger boys can order a smaller size cup than what stores might usually stock, and they can wear briefs instead of boxers to have a tighter fit.

In addition to holding a cup in place, wearing a jockstrap or compression shorts can help keep the testicles pressed against the body. While they are not as protective as a cup, they are better than no support for use in contact sports. They can also be used to prevent jostling around of the testicles in sports like running, basketball and skating. For contact sports, I always recommend taking the extra step of the full security of a cup.

Over the years, manufacturers of genital cups have made many improvements, and now there are many options that are cushioned making a cup more comfortable to wear. Many athletes don’t wear a protective cup because it is uncomfortable or because they feel it restricts their movement. But that’s not a good reason to refuse sensible protection.

Types of genital injuries in sports and treatments

Testicular injuries can be very serious and in worse case scenarios can result in the loss of a testicle if not treated correctly. The types of genital injuries that can occur in sports include:

• Epididymitis – causing the epididymis, the tube that holds the sperm after leaving the testicles, to become inflamed or infected.
• Hematoma – a blood clot that can cause bruising on the surface or within the testicle.
• Scrotal or testicular contusion – injury in the blood vessels that causes internal bleeding in the respective area.
• Testicular rupture – blood and other contents leak into the scrotum from the testicles after contact causes one or both to smash against the pubic bone.
• Dislocation – pushing the testicle out of the scrotum.
• Degloving – The scrotum is torn away.
• Testicular torsion – at least one testicle gets twisted inside the scrotum, cutting off the flow of blood. This requires emergency treatment.

Treating testicular trauma

At home treatments for testicular trauma include icing the scrotum, resting, over-the-counter pain medication, and wearing supportive underwear. Surgery is needed at times especially in testicular torsion and dislocation cases.

But if your son experiences any of the following symptoms, it is time to visit a urologist:

• Bruising.
• Swelling.
• Nausea.
• Blood in the urine.
• Fever.
• Trouble urinating.

Some problems can cause serious complications. Seeing your doctor promptly can reduce the chances of serious complications. Some complications include the need for the testicle to be removed, the testicle shrinking or infertility.

Our urologists can handle these issues without referring to another provider if advance treatments are necessary.

Make an Appointment Now

Unfortunately, there is not a one-treatment-fixes-all answer to overactive bladder, but there are multiple options, some you can do, some we can do.

Overactive bladder (OAB) affects 33 million Americans, but this number could be much larger because many people living with OAB do not ask for help. OAB is a problem with bladder function that causes the sudden need to urinate and can lead to the involuntary loss of urine.

It can affect both men and women but is more common in women, with about 40 percent of women affected by it at some time. These symptoms do not need to upset anyone’s life.

Oral medication is a common treatment for overactive bladder. These include oxybutynin (brand names Ditropan, Ditropan XL or Urotrol), tolterodine (Detrol) and fesoterodine (Toviaz). But most people do not stick with the pills long term. Around 75 percent of patients who start these prescription medications stop taking them within a year.

Some patients mention they stop taking the pills because they feel the medication is ineffective or has bad side effects, including dry eyes, dry mouth and constipation.

Overactive bladder medication is only one treatment option for the suffering. If medication is not working for you, come talk with one of the doctors at Urology Associates. We have many other options for you to explore, listed below.

When a patient is showing signs of overactive bladder, we start with an initial evaluation where one of our doctors will ask about urgency, frequency and retention as well as rule out infections, diabetes, prolapse and obstruction. Then we will discuss many lifestyle changes mentioned below, focusing on physical therapy.

If the patient has not seen an improvement with physical therapy or medication, we will perform a urodynamic studies to see how well the bladder, urethra and sphincter hold and release urine. These tests will give us a clearer picture to determine the best treatment option.

Lifestyle changes

Lifestyle changes, also known as behavioral therapy, are often the first step when looking to manage overactive bladder. If you did not try any lifestyle changes before you started taking medication, they could be good options. Lifestyle changes can include the following.

• Limiting drinks and food that irritate your bladder.
• Maintaining a healthy weight.
• Trying to empty your bladder twice each time you go to the bathroom, by taking a 30-second break and trying again.
• Delaying going to the bathroom and training your bladder to be able to wait longer between trips to the toilet.
• Scheduling when you will use the restroom.
• Don’t forget to do your Kegels, which will build up the bladder muscles.
• Pelvic floor physical therapy is also an early option to strengthen the muscles.
• Practicing quick flicks when you need to go to the bathroom. These are quick squeezes that contract and relax the muscles in your bladder, sending a message to the nervous system to stop squeezing the bladder muscles.

Pessary

Only an option for women, a vaginal pessary is a small, removable device that is inserted into the vagina to reduce OAB symptoms caused by bladder prolapse.

There are many different shapes and sizes; a doctor can go over the differences to find the pessary that best fits each patient’s lifestyle. If fitted correctly, the woman will not feel when the pessary is in place.

Botox for your bladder

Another possible treatment option for OAB is injections of Botox into the bladder muscle. Similar to when Botox is used to smooth wrinkles, when injected into the bladder it reduces the frequency of the muscle contracting. This treatment needs to be repeated two or three times a year, depending on when a patient notices that the effects are wearing off.

Stimulating nerves

Stimulating the bladder nerves, or neuromodulation therapy, delivers electrical pulses to the nerves to change how they work. There are two types of nerve stimulation treatments, InterStim and percutaneous tibial nerve stimulation.

Both treatment options target the sacral nerve located at the bottom of the spine that regulates and controls the pelvic floor and bladder muscles.

InterStim Therapy

InterStim Therapy uses an implantable device to send mild electrical pulses to the sacral nerve. The device is controlled with a separate handheld control. Prior to implantation of the device, we have a trial period to confirm the nerve stimulation works for the patient.

After that 1-3 week trial period and if there is an improvement, an in-office procedure will be completed to permanently implant the device in the upper part of the buttock. I like to call this device the pacemaker for your bladder.

Percutaneous tibial nerve stimulation

Percutaneous tibial nerve stimulation (PTNS) is a nonsurgical treatment that is completed with multiple office visits. PTNS provides an electrical stimulation through the tibial nerve, located on the inner ankle, which passes to the sacral nerve.

The therapy consists of 12 treatments administered once a week. After the initial 12-week treatment session, there may need to be occasional treatments to maintain the muscle control. It can take a month or more of the 30-minute treatments before a patient will see initial improvements.

Surgery

Surgery to treat OAB is only for those who have tried other alternative treatments without seeing an improvement. If surgery is needed, the goal is to reduce the pressure on the bladder and improve the bladder’s ability to store urine.

Discuss Treatment Options

Three new studies support the use of PSA testing for prostate cancer, putting to rest the idea that the test does not save lives.

I want to make sure that all men know about new reports that contradict previous studies about the use of the prostate-specific antigen (PSA) tests for prostate cancer. Two were presented in March 2018 at the European Association of Urologists Congress and one was released in September 2017 by the Annals of Internal Medicine.

That earlier report of September 2017 found that men between 55 and 70 benefit from getting the PSA test, which can result in a longer life. The two March 2018 reports by researchers at the University of California, Irvine found an increase in more serious prostate cancer cases since the 2012 recommendation by the U.S. Preventive Services Task Force (USPSTF) that men between the ages of 55 to 69 not be screened for PSA unless they were at elevated risk for prostate cancer.

The September 2017 study, which was completed by Dr. Alexender Tsodikov and his colleagues, reviewed data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial. These trials have been reviewed in the past, but this analysis found important differences in the studies. Once they accounted for the dissimilarities, a conclusion was made that PSA testing can lower a man’s risk of prostate cancer death by 25 to 32 percent.

In one of the CU, Irvine studies, Dr. Thomas Ahlering and colleagues analyzed 19,602 men at nine high-volume referral centers in the United States. They compared prostate cancer patients with a Gleason grade 8 or higher and who had seminal vesicle and lymph node involvement before the 2012 USPSTF recommendations were issued with such patients after the recommendations were issued. They noted a 22.6 percent decrease in surgical volume after the recommendations, as well as an increase in median PSA level from 5. ng/mL prior to the recommendations to a median of 5.8 ng/mL after the USPSTF non-screening recommendations.

“Treating high-risk disease has its limitations, because you are not going to cure the majority of patients no matter what you do, so the better answer is to diagnose prostate cancer earlier,” Ahlering told Medscape Medical News. “If our data are correct, the most important thing to do is to start screening more intensely again.”

A related UC, Irvine study by Linda Huynh analyzed data from 1,380,219 men who had undergone radical prostatectomy in one of three time periods assessed, two before and one after the USPSTF 2012 recommendation to reduce screening. The study found that after the 2012 recommendations, the risk in absolute numbers of high-risk prostate tumors with Gleason scores of 8-10 increased in stepwise fashion, while each year saw more cases of high-grade disease.

These studies are welcome news for all of us at Urology Associates, because we have been unflagging champions of PSA testing throughout a long period of controversy.

The history of PSA testing

Doctors have been suggesting men be tested annually for prostate cancer with the use of the PSA test since the 1980s. Testing for prostate cancer is complicated since the tumor tends to grow slowly. Because of this, testing is much different than for diseases like breast cancer where you can easily find the tumor. The PSA blood test has been found the most effective way to detect early signs of prostate cancer.

Once a PSA test is complete, a biopsy might be needed to confirm the findings of the blood test. While this is a comparatively safe procedure, it still carries possible complications like infection. Due to the possible complications and because for most men prostate cancer is not fatal, some doctors in the United States started to view the PSA test as unnecessary.

In 2012, the U.S. Preventive Services Task Force (USPSTF) announced its recommendation that men between the ages of 55 and 69 not get a PSA test unless they have a family history of the disease or are at heightened risk of prostate cancer.

The task force made its conclusions based on two studies published in 2009 from the PLCO in the U.S. and the ERSPC. The U.S. study did not find a difference in deaths caused by prostate cancer in men who were screened with a PSA and those who were not. The European study discovered that PSA tests led to a 21 percent lower risk of prostate cancer being the cause of death during the study compared with those who did not get screened.

Given the uncertainty with these two studies, one finding a reduction in deaths and one seeing no change, the USPSTF stated the data was not convincing enough to recommend men receive a PSA test.

New review, new findings

In Dr. Tsodikov’s September 2017 study, a new team looked at the same data from the PLCO and ERSPC and found that PSA testing does, in fact, reduce the deaths from prostate cancer. Their findings were different from the previous analysis because they found the studies had major differences that made comparing the two like comparing apples and oranges. Once you set up parameters to account for the differences, it was clear that getting a PSA test was the correct recommendation for men between 55 and 70.

When looking at the two studies, you could find that the doctors in the U.S. trial were using a greater threshold for PSA levels for completing a biopsy compared with the European trial. This could have led to men in Europe getting treated sooner, which one could tie to a reduction in prostate-related deaths.

Another jarring difference was that the PLCO study was screening men every year, while the men in the ERSPC were only screened every two to four years.

A final major difference to point out is that prior to the U.S. study, PSA screenings were seen as the norm and many of the men in the control group had a PSA test at least once before. This caused the nontested group to be an inaccurate group to compare the data against.

Taking these differences into consideration, the September 2017 study found that men who get the test can see a 20 to 32 percent decrease in prostate cancer deaths compared with men who are not screened. The two more recent UC, Irvine studies corroborate the earlier one and add more detail and import to the argument for more, not less, PSA screening.

In 2017 the USPSTF updated its recommendations for men to make an individual decision on getting the test. Since these studies have been released the USPSTF has not revised their guidelines for screening for prostate cancer, but I feel that the change will be coming soon.

In the meantime, hopefully these latest studies give men the clarity and confidence needed to ask for a PSA test annually. We are more than happy to oblige.

Leaking urine isn’t a female-only problem, as millions of American men know, though they are likely not forthright in talking about it with their buddies, or their urologist.

I frequently see men with incontinence or bladder control problems who are not aware of the many options to stop the plumbing problems keeping them from the activities they love. Colorado is an active state, and I would like to keep men hiking, biking, fishing, playing with kids or grandkids, camping, throwing around the football or whatever activity they like best. I am here to share some options for male incontinence so you can get back to your favorite activity.

According to the Urology Care Foundation, women are about three times more likely than men to experience urinary incontinence, but about 25 percent of men have it, too. Understanding the problem and taking steps to relieve it, either on one’s own or with my urologic care, can help men overcome this bothersome obstacle that often carries emotional worries as well.

For instance, the psychological aspect can affect social life, preventing men from pursuing their normal activities. They might pass on going fishing or playing golf because they know they can’t be that far away from a bathroom for that long. Not many men want to go to a Rockies game with their friends if they know they might have to make a run (literally) for the bathroom when the bases are loaded with two outs.

Men can experience three general kinds of urinary incontinence.

Overflow incontinence is dribbling urine regularly. This is due to the bladder not emptying all the way when urinating.

Stress urinary incontinence (SUI) is when a cough, sneeze, lifting a heavy object or other activity causes the man to leak urine.

Overactive bladder (OAB) is the sudden, often strong urge to urinate. In this case, men can leak urine before making it to the bathroom in time.

Men may also experience OAB and SUI together. In addition, a man can have total incontinence, which means he leaks urine all the time due to failure of the sphincter muscle.

These kinds of issues can often be efficiently addressed. And most men’s urinary incontinence can be reduced significantly or cured altogether.

Interestingly, men are quicker than women to seek care once they start having bladder control problems. On average, women wait 6.5 years before seeing a healthcare provider; men wait 4.2 years. Perhaps women are much more used to hearing about or experiencing leakages, which causes them to wait longer to go to the doctor. I wish both would seek help sooner, but it is, of course, a touchy subject for anyone.

The mechanics of male incontinence

Each type of bladder control issue is caused by different factors. Bladder control problems can be short-term or long-term. Most cases of short-term male incontinence result from a specific health issue or recent treatment. For example, taking certain medications, such as those for colds, depression, sedatives, narcotics and diuretics, can cause short-term bladder control problems.

Chronic male incontinence is a long-term condition, and thus of greater concern to the man who has it and to his urologist as well. ­Chronic male incontinence issues are often related to prostate problems or treatments for them.

A lot of men I see think urinary incontinence is another of those things that always happens with age. While it is more prevalent at older ages – and more than 10 percent of men over 65 have bladder control problems – it is not a normal condition.

Let’s address why each type of chronic bladder control issue is likely to occur.

Cause of overflow incontinence. Two things can happen: you make more urine than the bladder can hold or the bladder can’t empty when it is full. Maybe the bladder muscle can’t contract as it should to squeeze the bladder, or there could be something blocking the flow. The result is urine dribbling (a constant drip) or only urinating a small amount, but having to do so frequently. An enlarged prostate gland or benign prostate hyperplasia (BPH) can cause overflow, as can a urethra that is too narrow.

Cause of SUI. This happens when the pelvic floor muscles have been stretched, causing them to weaken. That results in reduced support for the lower part of the bladder, leaving all the work of retaining urine in the bladder to the sphincter muscle. And when physical activity (or a sneeze or cough) pressures the bladder, urine leaks out. SUI is more common in women, but that does not put men in the clear. Heavy lifting can increase the chance for SUI, which is an activity many men participate in whether for their job or while working out.

Cause of OAB. The brain signals your bladder to empty, even though it may not be full, and the bladder muscles contract, squeezing out urine. This can also be caused by malfunctioning bladder muscles that contract on their own, squeezing out urine when the bladder isn’t full. These both result in a sudden, often strong need to urinate. One of the more common causes of male OAB symptoms is the prostate getting larger. This can be caused by aging or prostate cancer.

What can we do about it?

First off, go see a urologist. I’ll do a physical exam, talk to you about your symptoms and how long they’ve been going on, and run a test on your urine. If these don’t give us a solid diagnosis of the problem, we may do other tests.

How we treat male incontinence is based on what we find out as the cause, and also on how much the control problems are affecting your life. At Urology Associates, we generally like to start with what you can do on your own and go from there.

If lifestyle changes (listed below) don’t solve your problems, we may move to medications. Some cases may require surgery, but not that many do.

Deciding factors on pursuing surgery include severity of symptoms, recurring blood in the urine, recurring urinary tract infections and the need to remove blockages that may harm kidney functions. Sometimes surgery has to be done to correct ongoing incontinence after the prostate gland has been previously removed. We can perform the following surgical procedures for male incontinence.

• Nerve stimulation for OAB. Also called neuromodulation therapy, this involves implanting a small device under the skin near the tailbone that sends electrical impulses to the nerves going to the bladder. It acts like a heart pacemaker by controlling bladder contractions. Other neuromodulation therapies may also help.
• Sling surgery for severe urinary incontinence. A bulbourethal sling goes under the bulb part of the urethra and is secured to bone or muscle. This lifts up and compresses the urethra, helping it resist pressure from the abdomen.
• Urethral bulking. To prevent urine leakage, we close a hole in the urethra or thicken its wall by adding material to it.
• Adding an artificial sphincter. This is an inflatable silicone device we place around the urethra that acts like the sphincter muscle.

In persistent cases of male incontinence in which treatment options above aren’t sufficient or desired, you may need to consider wearable absorbent products. Another management option is surgical insertion of an indwelling catheter that drains urine into a holding bag.

What you can do about it

Hopefully, your bladder control issue can be taken care of primarily by your own actions. Here are things you can do.

• To strengthen your pelvic floor muscles, do exercises like Kegels, the ones women do that are essentially tightening your muscles like you’re trying to hold back urine.
• Maintain a healthy weight, as carrying too many pounds means more pressure on the bladder.
• Reduce caffeine consumption because it’s a diuretic that increases urination.
• Don’t have more than one alcoholic drink a day.
• Also limit carbonated beverages.
• Avoid constipation, which adds stress to the bladder, by eating a high-fiber diet.
• Don’t smoke (you’d be surprised at all the urologic trouble smoking can cause).
• Practice the double void: urinate as much as you can, relax, urinate again.
• Try to modify your bladder’s behavior by scheduling bathroom trips at set times during the day.

Those tips on lifestyle can often be very effective. If they don’t work, you really should see me or another urologist – at Urology Associates, of course.

Do yourself a favor. Don’t be the average guy with male incontinence and wait 4.2 years to make an appointment. Start taking control of that bladder today.

The first line of defense against these troubling and pervasive bacterial infections is you, then your primary care doctor, then a urologic specialist like me.

I understand how alarming it can be when the first symptoms of a urinary tract infection (UTI) appear. The frequent and painful urge to urinate, an achy abdomen, pain during urination and an unsightly color in the toilet bowl can be petrifying. It may even have you cringing as the phrase “Not again,” crosses your lips.

We’ve prepared some tips to help prevent UTIs. I’ll also share treatment options and insight into when to see your primary care doctor, and when to see me for a UTI. Some basics first.

Urinary tract infections occur when bacteria enter the urinary tract, typically through the urethra, the passage where urine is released from the body. After entering the urethra, troublesome bacteria begin to multiply and spread through the system that processes and removes urine from the body. These bacterial infections often occur within the lower urinary tract – the bladder and urethra. If left untreated in its early stages, the infection can spread to the ureters and kidneys.

A majority of UTIs are caused by E.coli (Escherichia coli), a type of bacteria commonly found in the digestive system, which breaks down and absorbs nutrients from your food and also expels solid waste from the body. Other bacterium like Klebsiella, Proteus mirabilis and Staphylococcus saprophyticus are also common culprits. The type of bacterial infection will influence how a doctor treats your UTI.

UTI’s account for more than 8.1 million healthcare visits in the United States each year. Despite how common they are, most UTIs do not require care and treatment from a urologist. Understanding how to prevent a UTI, their symptoms, what symptom severity means, and potential treatment options can help you make the right move in caring for it.

Where do you stand when it comes to UTI risk?

It’s normal for a woman to experience one or two urinary tract infections each year. Due to their anatomy, women are much more likely to develop a UTI than men. Women have shorter urethras than men, and a woman’s rectum is much closer to the urethra than a man’s, leaving a much shorter distance for E. coli bacteria from the digestive tract to travel. Additional risk factors for UTIs in women include:

• Sexual activity, new sexual partners
• Certain types of birth control such as diaphragms
• Diabetes or other diseases that suppress the immune system
• Urinary tract abnormalities or blockages (kidney stones)
• Catheters
• Being postmenopausal.

Urinary tract infections don’t always cause symptoms, or the symptoms may be so minor you might not notice them. The most common symptoms of UTIs are:

• Strong urge to urinate
• Frequently passing small amounts of urine
• Painful, burning sensation while urinating
• Pain in the lower abdomen or pelvis
• Urine that is cloudy, dark or bloody (may appear slightly pink or brown in color)
• Urine with a strong odor.

Once a urinary tract infection has spread to the kidneys it can cause irreversible damage. Go to an urgent care facility or emergency room if you have a UTI and are experiencing nausea, vomiting, fever and chills, or pain in your lower back or ribs.

Diagnosis and treatment

Urinary tract infections can typically be diagnosed in a short office visit involving urine analysis or culture to identify signs of infection. Doctors typically prescribe antibiotics to treat UTIs. The type and duration of treatment depends on the severity of the infection and where it has occurred in the urinary tract. Medication has to be taken for at least two to three days, but treatment can last as long as several weeks.

There’s power in prevention

There are some steps you can take to avoid the pain and discomfort a UTI can present. Since urinary tract infections occur when bacteria enter the urinary tract, common sense says that the best way to avoid that is to prevent bacteria from entering the urinary tract, multiplying and spreading infection. You can do this by maintaining proper hygiene and making certain lifestyle and habit changes.

Drink more water

Many health professionals recommend drinking at least eight cups of water daily. Water is always a good idea. A recent study shows that increased water intake in women who only drink about six cups of water daily can prevent the occurrence of UTIs and reduce the need for antibiotics. Drinking more water dilutes urine, which decreases the concentration of bacteria and increases the frequency of urination, helping to flush your urinary system of bacteria.

Go cranberry crazy … or not

The efficacy of cranberry products in preventing and treating urinary tract infections has been researched very l, and the results are mixed. Some researchers believe the antioxidants in cranberries make it harder for bacteria to grow within the body, others believe that the increased fluid intake from cranberry juices works similarly to the flushing properties of water. As long as you are not allergic or taking blood thinning medications, consuming cranberries and cranberry products hasn’t proven to do any harm. If consuming 100% cranberry juice helps you to feel better, enjoy your cranberry juice.

Give probiotics a go

Not all bacteria are bad. Though research in the area is still evolving, we do know that naturally occurring bacteria can help the body fight infection. Probiotics, which occur naturally in the body, notably in the digestive tract, have been shown to help prevent UTIs. Probiotic supplements are readily available, and you can also get probiotics by drinking kombucha or Kefir, eating yogurt or other fermented foods like kimchi, sauerkraut and tempeh.

Change those bathroom habits

With increased water intake comes an increased need to urinate. Holding urine for long periods of time exposes the body to the harmful bacteria that can cause a urinary tract infection. Voiding the bladder as needed helps eliminate that risk. Wiping from front to back can also decrease the risk of spreading bacteria from the rectum and vagina to the urethra.

Bedroom habits, too

Urinary tract infections are not sexually transmitted, but are a result of bacteria that builds up and is pushed into the urethra during intercourse. Urinating prior to and promptly after intercourse can help remove unwanted bacteria from the urinary tract. Be mindful that your birth control may also be contributing to the spread of bacteria: diaphragms or spermicidal agents can increase your risk of developing a UTI. Women can wash their genital area before and after intercourse to also reduce bacteria buildup, which leads me to our next order of business.

Be conscious of hygiene products

Feminine products and treatments such as douches, powders and deodorants should be avoided, as they can irritate the skin and cause bacteria growth in the pelvic area. Washing with mild, unscented soaps and rinsing thoroughly is more than sufficient.

Don’t DIY your UTI: When to see a doctor

If you’ve had a UTI in the past, you may be able to recognize the symptoms more easily and much earlier. If you’re concerned that you’re getting a UTI, you can start a course of treatment in the comfort of your own home. The rest should be left to a healthcare professional.

1. Start drinking water immediately after noticing potential symptoms. This will help dilute the urine and flush out infection-causing bacteria.
2. Urinate frequently. The constant, painful urge to urinate is a symptom, but increased water intake will also require you to urinate more. The more you urinate the more difficult it is for bacteria to build up in the bladder.
3. Visit your doctor. While increasing the amount of water you’re drinking may stave off the infection and improve your symptoms, it cannot cure a UTI. Your primary care provider or local clinic can provide you with a diagnosis and medication. If needed, your doctor may then refer you to a urologist for specialty care.

There are a lot of steps you can take to prevent getting a urinary tract infection. Should those prove unsuccessful and you find yourself struggling with a bacterial infection in your renal system, it can likely be treated without a trip to your friendly neighborhood urologist, me.