Search for tag: "urology"

So your daughter comes to you and says, "It hurts to pee." Is it automatically a urinary tract infection? Not so fast. Girl parts are super-sensitive, especially between the ages of potty-training to puberty, and there could be a few things going on. So how do you know what the problem is?
Diagnosing UTIs in Children

First, your daughter would need to be seen. We cannot diagnose urinary tract infections in girls over the phone. We need them to actually come into the office and pee so we can do a urinalysis test. That will show if she has a UTI or if she's dehydrated and her burning with urination is due to concentrated urine.

It will also show if there is blood in the urine or any signs of diabetes as well, which doesn't cause burning with urination, but does cause frequent urination, which is another sign of a possible UTI.
Treatments for UTIs in Children

If your daughter does have a UTI, we can treat her with antibiotics while sending her urine off to get a culture at the lab and find out what type of bacteria is causing her UTI and make sure she's on the correct antibiotic.

If your daughter does not have a UTI, then we need to ask a few more questions, like is she drinking enough water? Does she take bubble baths? Is she wiping too hard? Is she wiping at all? Is she wiping in the right direction? Does she have any vaginal symptoms? And yes, we have to ask if anyone has touched her inappropriately down there.

Based on those answers, we can talk about treatments. Will drinking more water help? What about cranberry juice? Which may or may not help, depending on what's going on. Does she need any special creams for her private area? Does she need to work on better hygiene? If she is sexually active, do we need to test for chlamydia or gonorrhea? Is this not a urinary issue but more a vaginal issue?
What NOT to do for Your Child's UTI

Everything is in such a small space in that area that it can be hard to figure out what is going on and what the correct treatment is.

I've had parents ask me about certain home remedies that I can tell you, you should not do. Don't do the following. Don't have your daughter douche to clear out the UTI.

Similarly, I had one mom tell me that she was told to soak a tampon in probiotic kefir and insert it in her vagina to treat a UTI. Neither of those will help because a UTI is in the urinary system and inserting something into the genital system won't help. Just because they're in close proximity doesn't mean that they are treated the same.

Don't put random creams in or on your daughter's privates without finding out what the main cause of her symptoms are. Sometimes, that will make the problem worse.

And don't give antibiotics that were left over from a previous infection, because not all antibiotics will treat urinary tract infections.

So if your daughter has girl-part issues, please bring them in to be seen by their pediatrician. We can help you figure out exactly what is going on and what is best to help them feel better.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Troy: Do you ever tell clients to think about baseball?

Scot: I thought it was basketball.

Dr. Smith: I've never told someone to think baseball.

Dr: Madsen: Is it basketball? See basketball is interesting. You know, I've heard think about baseball. I don't know. Baseball is an incredibly boring game. Maybe soccer. Some people like soccer. It's pretty boring though.

Dr. Smith: Golf. I think of Austin Powers. It was Margaret Thatcher naked on a cold day.

Scot: Yeah, right.

Troy: Is that what it is?

Scot: Health is more than supplements, ripped abs, or crushing in athletics. It's a state of physical, mental, and social well-being and it's not an end. It's the means to an end. The currency that enables us to do all the thing we want to do, and the podcast is "Who Cares About Men's Health?" We like to give you inspiration, information, and a different interpretation to better understand and engage and feel better today and continue to be able to do those things we want to do today and in the future as well. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Smith: And I'm Dr. John Smith, a urologist at the University of Utah, and I care about men's health.

Scot: Dr. Smith is back. It's always great having Dr. Smith on the show. You know, one of our premises is here is that whenever you talk about men's health it seems like a lot of times it all comes back to our pieces and parts and we are more than our pieces and parts, but sometimes we are our pieces and parts and that's why you're here today, to help us with our pieces and parts, so thank you.

Dr. Smith: Thanks for having me.

Troy: Certain pieces and parts, yes.

Dr. Smith: I always appreciate being here.

Scot: Long way around the shed for that. Today it is ask a urologist. We like to bring in Dr. Smith to answer some of the questions that you have. A lot of different ways you can get them to us. Through our Facebook page, you can send a private message. You can put them on the wall. You can send us an email hello@thescoperadio.com. Troy's got the listener line. Sometimes we get calls on the voice mail listener line. What's that number?

Dr: Madsen: Yeah, that number is 601 55-SCOPE.

Scot: All right, and these questions sometimes you might be a little shy asking them, and if you do not want to use your real name, you can use an alias or a pseudonym, you know, like some sort of a generic name, like John Smith.

Dr. Smith: I love it.

Troy: I want people calling in to tell us it's Scot Singpiel.

Scot: I don't want that.

Troy: That's what I want. I want them to just start calling in and saying that . . .

Scot: That's funny. We've got three questions here. Question number one for Dr. John Smith is, strangely enough, from somebody named John Smith using a pseudonym there, we think. Do exercises for premature ejaculation work? So sometimes you might get mails, emails. You might hear people talking. Is that how you handle that issue or no?

Dr. Smith: It is definitely one of the ways that we handle premature ejaculation. There's behavioral, topical therapies, like behavioral, psychological, topical therapies and then oral therapies that we use. But I'll go over some of the behavioral therapies that actually I've seen patients utilize and actually find benefit from. So one of them is called the pause and squeeze or the squeeze technique. If you're someone who, you know, kind of struggles with this, the way you would do that is when you feel the sensation that ejaculation is imminent, you stop sexual intercourse and squeeze the head of the penis until the sensation to ejaculate goes away.

Scot: Physically?

Dr. Smith: Physically. And then once that urge is gone, then you can resume sexual activity and that can help you kind of elongate that sexual experience. There's also the stop-start technique. That's kind of exactly what it sounds like. You stop penile stimulation until the urge to ejaculate goes away. Again, when ejaculation feels like it's imminent, right on the doorstep, you just kind of cease, kind of just pull back, wait for that to go away, and then reintroduce yourself into the sexual encounter.

And the third one they call the quiet vagina, or that's the way it was described when I was in residency and fellowship. The female stops moving and the male stops moving and the . . . until the urge to ejaculate goes away. This one I found from most of my patients tell me that's less effective for them because there's still some stimulation there being in the sexual act still that makes it a little bit more difficult, but if that works for you, then that's another one.

And then another one is . . . they call it sensate focusing. You kind of . . . the best way to describe this would be to kind just start with non-sexual stimulation but stimulating yourself where you have sexual self-awareness by gradually progressing from non-sexual touching to sexual touching and then into the act of sexual intercourse itself to try to kind of ease things up and get the body more acclimated to a longer lasting sexual encounter. Some people would just call that foreplay, but if you wanted to get the $500-term for it, that's what we'd call it.

Scot: That was the medical term, medical school-issued term.

Dr. Smith: It's pretty much that. You know, those are the options that for most folks that we'll offer to them to kind of try and see if they work, and then beyond that there are some topical things that patients can use. I don't know if you wanted me to talk about any of that stuff, but we can go into any of that that you want to.

Scot: Yeah, I think just knowing that there's some stuff out there. So there's some things you can do in the moment it sounds like, and then there's some topical things that would make you less sensitive I'd imagine. Those things in the moment over time will then you'd be able to build up endurance if you do those or . . .

Dr. Smith: So it generally does help to continue those things, and once you kind of get your body acclimated to that, you have to do them less often, and sometimes hopefully not at all, but I've had a lot of patients who said they've had success when they've actually tried and performed those.

Scot: I've heard some guys say that just even talking about it to their partners helped because some of it can just be in the brain. It could be psychological, and once you kind of share that fear or whatever that it can just kind of go away. So I don't know if there's any validity to that. It's worked for a couple of guys I know, but . . .

Dr. Smith: I think it definitely can be. One of the things we always offer anybody who's having any sexual dysfunction one way or another is an opportunity to talk to a sex therapist because sometimes that can help. Having open, honest communication with your partner is also nice. I have a couple of patients who've also said that when their partner also talks to them kind of maybe a little dirty talk during sexual intercourse, that that can make the sexual encounter shorter for them. So they've asked their partner to kind of quiet down because they're very visual and audio stimulated person where that can make things worse too. So anything that you can do to try to help with that situation I think is worth a shot.

Scot: All right. What about, like, Kegel exercises? Do those work? Is that how do you pronounce that?

Dr. Smith: Yeah, Kegel, Kegel. I mean, I think you could say tomato tomato. It doesn't really matter. People understand what we're talking about, and at the end of the day any . . . you can try that. I don't know that that's as effective as the other things that we mentioned, but I think that's something that you can try, and again, if it's beneficial for you, then I would say continue it.

Troy: Yeah. I mean, it sounds like some of those are things where, you know, people may notice it. It may come and go, but other times . . . is more your takeaway if it's there all the time you probably need to do something about it where some of this stuff might come and go and not be an issue?

Dr. Smith: Exactly. If it's there and it's something that's there more often than not, come in and kind of be evaluated. If it's something that happens every once in a while, the majority of the time it's nothing. It's just that adhesion that goes away within a day or so and you may notice it once every so often. But when it becomes a more chronic issue, that it's happening more and more frequently, then you definitely want to come in and have it evaluated.

Scot: I had no idea there were so many reasons you might have two streams. I thought there was going to be one, but it sounds like yeah. That's interesting. All right question number three, and . . . well, I'll throw it out there. Question number three. Does wave therapy really work for erectile dysfunction? And it's from John Smith. Dr. Smith and I did a Scope piece on this. So we have a full link Scope piece where we talked about wave therapy and how to make that evaluation, whether or not that's something you want and how to ask the right questions. But let's just briefly cover it here on this podcast, and if you want more information, you could go to thescoperadio.com and do a search for it. So Dr. Smith.

Dr. Smith: Sure. So there's multiple different kinds of wave therapy. You may listen to the radio. You may see things on TV. There's an acoustic style wave therapy, and then there's a low intensity shockwave therapy. They're not equivalent. They're not the same. The low intensity shockwave does have research behind it that shows that it is beneficial for erectile function to help with the regrowth of blood vessels and help to improve erectile function.

Again, there are caveats to all of these things, but the acoustic waves don't have any data that shows that they're effective for erectile function. There are some other studies outside of urology that show that it can have some benefit there, but in the urologic sphere it's not been shown to be effective, and so the answer is yes but you got to be very honest with the patients and let them know because it's not for every patient. It's for someone with mild to moderate erectile dysfunction, not somebody who has a severe erectile dysfunction after they may have had like a prostatectomy or something like that. Those patients oftentimes don't see any benefit, but the folks with the mild to moderate erectile dysfunction there's some emerging literature and data that shows that it's very helpful.

Troy: By acoustic waves you're talking about just like ultrasound. Like, people are putting ultrasound on and saying this is helping?

Dr. Smith: Yeah, it's more of a sound wave. Sometimes it's called a gains wave or, you know, an acoustic wave. It's a very different waveform than a low intensity shockwave.

Troy: But bottom line is acoustic waves don't work. Shockwaves do.

Dr. Smith: They do. Again, you got to be judicious about the people that you do treat with it, and, you know, we have one at the university actually. We just obtained it a couple of months ago, and we've started using it on a few patients. We've had a few good outcomes so far, and so, you know, as we continue down that road, maybe we'll put out some more literature here in the future with how things are going.

Troy: Given some of the stuff I see in the ER, I'm going to add the caveat don't try it at home.

Dr. Smith: Right. That's always a very good lesson to learn is don't try this at home.

Troy: Electricity might help but don't try it at home.

Scot: The thing I learned from the conversation that I had that you could go listen to the whole thing with Dr. Smith is that there are kind of a lot of different reasons for . . . you know, different conditions of erectile dysfunction. There's a lot of different treatments and really you should have somebody that knows how to navigate that, like a urologist like Dr. Smith, to kind of work you through that sort of thing. That's what I ended up with, and if wave therapy is kind of where you end up, then that's great, but I think that discussion needs to happen, and I think Dr. Smith would agree with me on that.

Dr. Smith: I would agree 100%. It's something where if you do have issues or concerns, definitely following up with someone who does it on a regular basis and is reputable to take care of you.

Scot: All right, there you go. Three questions, man, Bam, bam, bam, and done. Nice work.

Troy: Done. We just need to tell our listeners there are other pseudonyms besides John Smith, Scot. So if we can get the word out there, try Scot Singpiel next time. It's a very common name. You could use that one.

Dr. Smith: Very common.

Scot: I think Troy Madsen, very common.

Troy: Very common. Scot Singpiel is just yeah . . . I know a lot of Scot Singpiels so . . .

Scot: Dr. Smith, thank you for being on the show and thank you for caring about men's health.

Dr. Smith: Hey, thanks, guys. Really appreciate it.

Scot: And thanks for checking out the podcast. If you enjoyed this particular episode, do us a favor, subscribe. Or if there's somebody in your life you think would find this episode useful, share the word with them.

On "Who Cares About Men's Health?" just to kind of give you a brief overview, we talk about the core four plus one more to stay healthy now and in the future, and we do episodes based on nutrition, activity, sleep, emotional health, and genetics. We also do shows like this, which are very specific to men, we call "Men's Health Essentials." So answering the questions that men would have about their health. Then we also have a show called "The Sideshow," which is just us having a little bit of fun.

So if you like this episode, check out some of the other "Men's Health Essentials" especially with Dr. Smith, or check out some of our other flavors as well so we can help you care about your health. Be sure to check the show links. We'll have links to anything that we talked about in the show in addition to links to contact us. Thanks for listening to the podcast and thanks for caring about men's health.

If you want to learn more about wave therapy for ED, Dr. John Smith goes into more detail in this Scope Radio interview: Does Wave Therapy for Erectile Disfunction Work

Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth

Interviewer: Frequent urination, the feeling that you always need to go to the bathroom, a weak stream dribbling, waking up in the night to go to the bathroom could all be the symptoms of an enlarged prostate. It's called benign prostatic hyperplasia, or an enlarged prostate, and it's more common than a lot of men realize.

Dr. Stephen Summers is a urologist at University of Utah Health and he's going to give us the information we need to help you if you're suffering from any of those symptoms.

So the first question that I do want to ask has nothing to do with the symptoms, but it has to do with a kind of a misconception. Is an enlarged prostate and prostate cancer the same?

Dr. Summers: No, they're not. It's interesting because I get this question frequently and a lot of men come to me with concern for possible prostate cancer with some of those urinary symptoms you were just talking about.

Certainly, you can have both conditions at the same time. You can have prostate cancer as well as an enlarged prostate causing urinary obstruction and the symptoms that we relate with that. But they're really two separate issues that both need to be addressed and handled often simultaneously. The age groups that are at risk for prostate cancer also happen to be the men that are most often suffering from lower urinary tract symptoms or the symptoms that we most commonly associated with BPH.

Interviewer: Just because I have those symptoms doesn't necessarily mean that it's prostate cancer. That sounds like it could be a fear that men have. Out of the men that come to you with those symptoms, how often is it prostate cancer versus just an enlarged prostate?

Dr. Summers: Yeah, prostate cancer is an extremely common cancer. That said, most of the men that I see with those symptoms do not have prostate cancer. And so, certainly, we ask questions to find out more history and evaluate them for prostate cancer, but we're also looking at other things. Aside from benign prostate enlargement, men can have infections that can cause similar symptoms. You can have a scar or a blockage in the urethra that causes similar symptoms.

BPH is the most common thing that causes all those symptoms and the most common thing I see with men, but it's important that you speak with your doctor and even see a urologist to evaluate for some of those other causes as well.

Interviewer: Sure. Is this true? Some men with those symptoms just figure that it's a part of getting older and there's really not anything that can be done about it. Does that happen a lot?

Dr. Summers: Yeah, so just as we were talking about the increased prevalence of it, a lot of men may not be bothered by the disease itself and their symptoms are very mild. And at that point, they may be right. It's a fact of getting older and their symptoms wouldn't lead to any long-standing problems.

The hard thing is there is a subset of men who have worsening symptoms and maybe have those symptoms younger. If those symptoms are left unchecked or untreated, it can lead to long-term problems.

For example, if a person has a prostate enlargement that obstructs the bladder from emptying, over time the bladder changes and the muscle itself gets thickened, it becomes stiff, it's less pliable, and ultimately the bladder fails and doesn't work. And so then a person is left without a functional bladder and they cannot urinate. Even if we were to go on and treat the prostate, they still cannot urinate and they may be dependent upon a catheter.

Interviewer: Wow, that is a reason to get that thing looked at, isn't it?

Dr. Summers: It certainly is. And I can't tell you how many times I've had men come in who have ignored the symptoms for a long time, thought it was no big deal. Maybe they have a work environment where they can use the bathroom as is out in the wild or whatever. And lo and behold, they have a pretty significant problem. And at some point, those changes become irreversible and no matter what I do, I can't change that.

The other step even further than that is if once the bladder fills, then the urine backs up and you start having kidney problems as a result. And I've seen men with kidney failure that need to go on and have dialysis or even a kidney transplant all because of their prostate problems and their urinary problems that they've neglected for so long.

Interviewer: The symptoms that we talked about, the frequent urination, feeling that you always need to go to the bathroom, a weak stream, dribbling, waking up in the middle of the night, do these all kind of come on at once, or is this more of a gradual thing, so much so that maybe some men don't even notice that there's an issue right away?

Dr. Summers: That's a great question, Scot. It's that gradual, insidious onset that I think can be deceiving to a lot of men. Symptoms may start out very mild and they're so slow changing that you get used to it. You adapt to it. And it may be that you don't even notice that you're having those symptoms, and it's a loved one often that will point out and say, "Boy, you're going the bathroom a lot more frequent than you used to," or, "It's taking you a lot longer," or, "It seems like we can't go through the store without you looking for a restroom." And it's those kinds of comments that I think are very important to hone in on and remind people that there may be a problem that needs to be evaluated.

Interviewer: So it can oftentimes be just kind of this slow onset, so much so that you don't even notice. Then when it becomes to the point where it's critical, does that kind of generally hit just all at once? How does that play out? Do you get what I'm asking?

Dr. Summers: I get what you're asking. Yeah, it can go both ways. So sometimes men may not have . . . they may have symptoms that they ignore for any number of years, and then there's an inciting event that triggers a major problem. So that event can be in a urinary infection, it can be surgery, it can be the start of a new medication, and all of a sudden, they get to the point where they may go into what we call urinary retention, where they cannot urinate at all. And that becomes an emergency and one where we see patients in the emergency room in extreme discomfort.

Other patients, it's very slow and they get to the point where they're getting up four or six times a night. And that's when they come in kind of seeking help because the symptoms have just gone on for so long that it's interfering with their sleep.

So it goes both ways. Certainly, I think the earlier that you can address the problems, the much easier it is to fix. And more importantly, you can avoid some of those long-term effects that we talked about on the bladder and the kidney function.

Interviewer: I was reading some stuff online that some men that get this that it kind of just all of a sudden hits, then you're using a catheter to help drain the bladder, and that doesn't sound like a whole lot of fun. And it sounds like if you kind of get in early enough, not only can you avoid some of the potential downsides you talked about earlier, but maybe a lot of pain in a particular moment if you get to it early enough. Is that true?

Dr. Summers: That's certainly true.

Interviewer: Yeah. Okay. It doesn't sound like a lot of fun.

So it sounds like one of the major risk factors is just, as you get older, the prostate just naturally starts growing. So I saw something . . . I think you said, what, 60% of all men over 60 tend to get it, and then the older you get, it goes up and up and up, right?

Dr. Summers: It does.

Interviewer: So, other than that, are there any risk factors that might cause a man to get this?

Dr. Summers: The prostate continues to grow as we age, and it's highly influenced by androgen levels. And that is, in large part, influenced by genetics. And so, if a person has a higher genetic predisposition or family history of prostate disease, they're much more likely to have similar type symptoms.

Interviewer: Lifestyle too can impact it, right? Because I know that that is one of the treatment options, which we'll get to in a second briefly, because we do have a special podcast we're going to do just on treatment options. But like obesity or diabetes or not enough exercise, those types of things can contribute as well. Is that a major contributor or not so much?

Dr. Summers: Yeah, it certainly can be. Take obesity for example. So obesity, it's unfortunately very common in our society. And with that, you get increased pressure that's put on the bladder, which is only going to make those symptoms worse. And so, if a person can lose weight, then you can markedly reduce some of the frequency and urgency symptoms.

Similarly, different diets. Caffeine is a common culprit for many of us. And the more caffeine that you consume, it has both a diuretic effect as well as an irritant to the bladder and will only cause increased frequency. And so, if you're already having some baseline urinary frequency and difficulty with those symptoms, you add any of these lifestyle components onto that, things are only going to get worse.

Interviewer: And some of those lifestyle changes you have seen make a difference for some men.

Dr. Summers: Yes. So weight loss, exercise helps, limiting caffeine, limiting alcohol. Spicy foods can wreak havoc on the bladder.

Interviewer: So everything but the spicy foods is just stuff that should be doing anyway, right?

Dr. Summers: Yeah. I mean, it's interesting. Healthy living really translates into so many different things across the spectrum of our health.

Interviewer: So lifestyle changes, is that generally the first thing you do, or what's that hierarchy in general look like?

Dr. Summers: Yeah, you're exactly right. So oftentimes we'll talk about lifestyle modification, losing weight, changing diet. Exercise is our first-line therapy because it's low risk, and it has other benefits. When that fails or your symptom improvement isn't where you would like, then we talk about medications. Once you start getting into medications, it's a balance of dealing with side effects with the benefit of the medication. And there are several different classes of medications we use to treat prostate disease. And then we move on toward office-based procedures and surgical treatments for the prostate.

Interviewer: So, when it comes to an enlarged prostate, it's something that all guys are going to get. Maybe some will start showing the symptoms we talked about and some will go on affected. It sounds like you want to go to somebody as soon as you start noticing those symptoms. The quicker, the better. I would imagine you run some tests just to verify that that's actually what's going on, and then you would discuss some treatment options. So it sounds like it's not a one-size-fits-all sort of a treatment.

Would you recommend going to a urologist first if you're noticing these symptoms, or start out with your general practitioner or family doctor?

Dr. Summers: I think you can certainly start with your general family doctor or general practitioner and at least raise the question about your urinary symptoms. Some of the early interventions, the medication and the lifestyle modification, can certainly be prescribed by your general practitioner. I think when your symptoms are more severe a urologist is more ideally suited to treat your disease at that point.

Interviewer: We're here with Dr. Jeremy Myers. He is a specialist of urological surgery. So, Dr. Myers, what exactly is a urethral stricture?

Dr. Myers: Well, a urethral stricture is, quite simply, a scar in the urethra, which is the pee channel running from the bladder and out the penis. And it almost exclusively happens in men. It's very rare that it occurs in women. And so that's where we deal with it most.

Interviewer: And what can cause some of these scars?

Dr. Myers: Most of the scars are what we call idiopathic, which means they just come up. And they come up in a particular area of the urethra, below the scrotum. But you can also get the scars from a bad infection, such as a sexually transmitted disease, which is very rare. And you can also get it from trauma. The classic trauma that can cause it is when a man lands on the perineum, like on a rail skateboarding or snowboarding.

Interviewer: Yeah, and the saddle injury, I think, is something I read too, right? Horseback riding?

Dr. Myers: That's exactly right. In the West, we see this from horseback riding and sometimes from ATVs. And, sometimes, it's accompanied by a pelvic fracture when it arises from trauma, but this is a small portion of the strictures. Almost all of them just arise for no known reason.

Interviewer: Since these structures are kind of internal, and it's not something you necessarily see, how does a person or a man, kind of . . . How do . . . What are some of the symptoms of having a stricture?

Dr. Myers: The strictures are pretty rare, and so it's very often that they're misdiagnosed or not recognized for some time. I remember talking to an internist once, and they said, "Oh, I didn't even realize that could happen." So they're not really on the radar a lot for the medical community as a whole. So patients are often diagnosed as having a prostate infection or a voiding dysfunction or a urinary tract infection, and then their symptoms don't get better, and then they're sent to a urologist who can diagnose the stricture.

Interviewer: So, essentially, they have difficulty passing urine and other complications because the urethra is actually smaller or not flexible, is that what happens?

Dr. Myers: That's exactly right. The urethra narrows down in a lot of cases just to a pinpoint, and so, the most obvious symptom of that is a very slow flow. And most guys will tolerate a slow flow alone. But there's a lot of other symptoms that come up. Men can have urinary tract infections. And then also, their bladder stiffens because it's squeezing so hard against the scar and so they have to urinate more frequently and may have urgency of urination. And so, a guy might be up four or five times a night urinating, and it may just be due to the blockage.

Interviewer: So, if it's commonly misdiagnosed, what does it take to actually diagnose a proper stricture?

Dr. Myers: Well, the suspicion is increased for a urologist in a younger man, who really should be voiding very well. In older men, the symptoms may be attributed to a large prostate. That's really common. But in a younger man, we can diagnose it or suspect it based upon their flow. And so, when someone comes to a urologist, we typically have them pee in a special toilet that allows us to measure their flow, and if they have a very slow flow and they're a younger man, then it's suspicious. They might have a scar. And where we go from there is pretty variable. The strictures can be diagnosed with a special x-ray of the urethra, or more commonly, a urologist has a scope that's flexible just like a catheter, and he'll pass, or she'll pass the scope up the urethra and then be able to visualize a scar. And that's a very easy way of diagnosing the scar.

Interviewer: So after it's been diagnosed, what are some of the options available to treat and kind of give some relief to these people?

Dr. Myers: The options basically fall into a couple categories. One is using a scope to either break open or to cut the scar, and that's the . . . the medical term for that is a dilation or urethrotomy, and they work about the same. Essentially, a urologist passes the scope up to the area of the scar and then uses dilators to sequentially stretch the scar and break it open, or they'll take a tiny knife that comes out of the scope that they can visualize and they'll kind of cut the scar almost like a Mercedes sign.

Typically, after this, a patient will have a catheter for a few days, and then the catheter is removed. And the hope was stretching or cutting the scar is that the urethra will heal over the catheter and will heal to a reasonable size where the patient is not having any symptoms. The unfortunate part of dilation or internal cutting is that it's rarely successful, and it probably only works in maybe 20% to 30% of cases. The studies on it are pretty mixed about its success rate. And so it's minimally invasive in the sense you'll only have a catheter for a short time, and it just uses a scope in the urethra. But, unfortunately, it's rarely a long-term solution for men.

So the other way that we treat urethral strictures is to do an actual surgery, where we cut into the body, and that's called a urethroplasty surgery. And that's what we specialize at the University of Utah in. Essentially, the idea of a urethroplasty is we cut over the scar in the body, which is mostly in the perineum, which is the area between the anus and the scrotum, and then we very carefully find the area of scarring by just passing a catheter down the penis and feeling where the catheter stops within the urethra. And then we cut out the area of the scar, and we create a very fine connection or anastomosis between the two ends of the urethra that are freed up and stretch. And that cures the stricture.

So that's a surgery that can take anywhere from two to four hours depending on how the surgery is done and what's required. And the catheter has to be in a longer time, and you can imagine an incision below the scrotum can be pretty tender. So it's much more invasive, but it's also much more successful. And the success rates of those surgeries are about 80% to 90%, just depending on the types of surgeries.

Interviewer: Well, that's significantly better results then. And how long of a healing process is that?

Dr. Myers: So, usually, the catheters are in for anywhere from two to four weeks, just depending on the nature of the stricture and what has to be done to fix it. And so, during that time, the catheter is really pretty uncomfortable, and most men will be off work during that time, or if they do non-physical work, they can maybe go back to work after a couple of weeks. The recovery is not like a hernia, so you can't tear open the repair but, usually, when a catheter is in, guys don't want to be doing anything too physical at all because of the discomfort of the catheter. So I'd say the realistic recovery where men are really feeling quite a bit better is about a month or so, and that's why it's much more invasive than the internal cutting, where the recovery really is just five or seven days.

Interviewer: So it, you know, it's an invasive procedure, and it sounds like there's going to be a bit of a recovery, but, you know, when it's all said and done, you know, what are some of the satisfaction rates of some of your patients?

Dr. Myers: We've actually studied this really well at Utah in conjunction with a number of other centers in the country, and if you look at satisfaction with a surgery, men rate themselves as satisfied or very satisfied with the surgery in about 87%. And, most of the time, when they're not satisfied with surgery, they have some side effects, such as a sexual side effect, which is, fortunately, pretty rare or the surgery fails them and, obviously, you wouldn't be satisfied with the result. So that's a very . . . a powerful number to give men when they're considering a pretty invasive surgery is that 85% or more are satisfied or are very satisfied with the results.

Another thing that men experience is their urinary symptoms, and then some men also have a lot of anxiety and depression related to the stricture. And this can be anxiety about not being able to urinate, not having the normal function that men have or anxiety about being in a public bathroom or needing to find the bathroom urgently. And the rates of depression and anxiety are much higher in men with strictures. And we did a study where we showed that these rates normalize and get much better after a stricture surgery. So, overall, a lot of things get better. The urinary symptoms get better after the surgery. So it's a good surgery even though no man would ever want to think about undergoing a surgery like that. It's a very personal and private spot, but it really fixes the problem with a pretty good certainty.

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: A vasectomy is one of the most effective forms of birth control available. But there can naturally be some apprehension about a procedure that's been nicknamed "getting snipped." Joining us is urologist and male fertility specialist, Dr. Alex Pastuszak from University of Utah Health. And in order to help make this a little less scarier procedure, Doctor, I'd like you to give us an overview from preparation to procedure what to expect during and what recovery looks like. But first of all, let's talk about the procedure itself first. So where does it happen? Where does it all start?

Dr. Pastuszak: Yeah, great question, Scott. So a vasectomy is one of the easiest procedures that anybody can undergo. We either do it in the clinic or in an operating room as a day surgery. So it's very simple.

Interviewer: All right, a very simple operation, which is fantastic. What exactly happens? Now, again, there's that getting snipped thing, which brings up visuals that I don't want to talk about. But it's nothing like that actually. It's very non-invasive.

Dr. Pastuszak: No, exactly. I mean, we make one or two very small holes in your scrotal skin, and we just pluck your vas up. We'll clip it. We'll cut it, make sure the two ends don't come back together, and then we'll put it right back. All of that takes anywhere from 15 to 40 minutes.

Interviewer: So actually, probably preparing for and recovering from it takes a lot longer than the surgery. I mean . . .

Dr. Pastuszak: That's right.

Interviewer: You'll probably spend more time in the waiting room than you will actually getting the procedure done.

Dr. Pastuszak: Absolutely. I actually tell guys to budget about an hour, an hour and a half. And as I just told you, a minority of that is actually spent doing the procedure.

Interviewer: A lot of guys think it's kind of painful. So it does use local anesthetic, which is another advantage, right? You're not completely going under. It's just in the area, like if you went to the dentist, for example, and had a tooth extracted.

Dr. Pastuszak: That's right, and that's part of what makes it really safe. And a lot of guys come in very anxious about it. But we give them some medication to relax ahead of time. And like you already said, they get some local anesthetic. At the end of it, most of them ask me, "Why was I so anxious? I shouldn't have."

Interviewer: Yeah, I got you. And so I guess I'm a little anxious about the fact I'd be awake during this procedure, right? So should I be concerned about that, or how do you kind of alleviate, you know, that stress?

Dr. Pastuszak: Not at all. Well, usually, guys are actually pretty relaxed by that point.

Interviewer: From the medication. Okay.

Dr. Pastuszak: From the medication. But if they're not, please bring your iPad, bring your iPod, bring your iPhone or your Android, listen to some music. And, you know, you should expect to have very professional, courteous staff. They'll help laugh you up during the procedure, too, if you're anxious. We're good at that.

Interviewer: Okay. So the actual procedure, pretty painless. How do you prepare for the operation? So, you know, it only takes 15 minutes there. But what do I need to do before I come in?

Dr. Pastuszak: Well, so you should bring some tight-fitting underwear or a jockstrap because you're going to leave with your scrotum supported and you're going to want to have that for the following week just to sort of prevent your boys from jumping up and down and causing any undue discomfort. You should come in with a clean genital area. We don't necessarily require that you shave. But if you'd like to, you can do that the day of, and we'll do any sort of trimming that we need to in the clinic. And you definitely need to bring someone to drive you home because, like I said, these relaxing medications will basically be like drinking two or three martinis.

Interviewer: Okay. So I got you. What about any sort of medications or anything like that? Do I need to worry about that before surgery?

Dr. Pastuszak: Yeah. We don't want you to be on any anticoagulants. So if you take aspirin regularly, I would stay off of it for about a week. If you take any other prescription medications that would thin your blood, you should also make sure that the doctor who prescribed that is okay that you're off that. But I would be off that for a week. And also fish oil. A lot of guys don't realize that fish oil is an anticoagulant. So I would not take that for at least a few days to a week before the procedure.

Interviewer: What about after the procedure?

Dr. Pastuszak: So these are going to be the best couple of days of your life because . . .

Interviewer: That's what I hear. Pick something to binge-watch.

Dr. Pastuszak: Exactly. No, we don't want you being a complete couch potato, but you kind of have, hopefully, free reign in the house depending your partner. We do want you to rest. No real strenuous activity for three to five days. It's a great idea to buy a bag of frozen peas. In fact, some of my colleagues have branded ones that you put on your scrotum and keep them there not enough to freeze your boys, but just enough to kind of keep the discomfort at bay.

It really only takes a few days to heal from this. The discomfort is transitory. It'll be there for a few days to a week, but it's very minor, and you'll be back up and running before you know it. Point of note, you do want to get up and walk around while you're resting. You don't want to be a complete couch potato because you don't want blood clots in your legs. But sack out for a little bit.

Interviewer: All right. And how long until I'm back to work? So I get the procedure. I go home on, like, say, a Monday. When can I expect to go back to work?

Dr. Pastuszak: Yeah, that's a great question. So, basically, we don't want you lifting anything heavy for three to five days. So depending on what you do, just be aware of that, you know. If you're a guy at a factory who lifts 50-pound boxes every day, desk duty for a few days.

Interviewer: Got you.

Dr. Pastuszak: If you're, you know, a corporate executive, lawyer, doctor who just kind of pushes pencils or stands and does surgery, a day or two should be fine.

Interviewer: All right. And when will the patient know that the procedure was actually effective because it's not immediate?

Dr. Pastuszak: Right. So it takes your body three months to make sperm. So we only know that that tube is occluded with no sperm coming out three or more months after your vasectomy. Also, keep in mind that you need to ejaculate 10 to 20 times to clear the pipes between when you have your vasectomy and when you go in three or more months later to get your semen analysis.

Interviewer: All right, and the great thing about that is this is one of the . . . it might be the only birth control procedure you can test for effectiveness, that's not somebody getting pregnant.

Dr. Pastuszak: That's right. That's right. And, you know, just talking about birth control, you should use a second form of birth control while you're waiting for that three-month period to be over.

Interviewer: Got you. Are there any risks I should be aware of?

Dr. Pastuszak: Yeah. So any procedure comes with risks, but the risks for vasectomy are very minor. And the three main risks include infection, bleeding, and pain in the testicles that is present after the vasectomy itself, or develops weeks to months after the vasectomy itself. All of those risks are less than 1% to 2% of all patients who have a vasectomy.

Interviewer: Wow. So that is about as safe as it gets when you're talking about a surgical procedure, it sounds like.

Dr. Pastuszak: Absolutely. If you want to have a great sex life without worrying about getting your partner pregnant, vasectomy is the way to go.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: It never used to happen but now you have to get up and go to the bathroom once or maybe even more times every night. Dr. Gary Faerber is a urologist. What could be going on with that? Could it be one thing or is it a lot of things?

Dr. Faerber: Well, it could be a number of things. Probably the most common along these lines comes from older men who can . . . you know, who are worried that these might be the signs of prostate cancer. That's the most sinister, you know, thing that they can think about.

Interviewer: So we're talking older, how old, 50?

Dr. Faerber: Oh, yeah, men in their 50's, 60's, 70's, yeah.

Interviewer: So like up until this point, they could sleep through the night and not need to go to the bathroom and all of a sudden now . . .

Dr. Faerber: Right.

Interviewer: Does it just kind of happen all of a sudden or is it just kind of over time like . . .

Dr. Faerber: Oftentimes, it's a gradual thing, you know. Initially, they may get up once a night and then it's two times and three times and . . .

Interviewer: So if that starts happening, then there could be something going on?

Dr. Faerber: Absolutely, yeah.

Interviewer: Could it just be that they've started drinking water late at night?

Dr. Faerber: That's . . .

Interviewer: Is that the first thing you look at?

Dr. Faerber: Sure. We certainly do keep track of how much fluid they take and when they take it in just to get a sense of whether this is a normal thing just because the amount of fluids that they drink, or is this, you know, not quite so normal.

Interviewer: All right. So if it turns out to be not quite so normal, let's talk about what some of the possibilities could be.

Dr. Faerber: It's probably related to their prostate. And it's not because they have prostate cancer but in most cases, it's because they have benign or normal enlargement of the prostate gland. And when that happens, it causes some changes in how the bladder functions. And they may not be emptying all the way. The bladder may become a little bit more overactive and therefore, they can't hold the urine as much as they used to when they were younger. And all of those reasons may result in them having to get up at night.

Interviewer: So an enlarging prostate's just part of life. As you age, it's going to happen, if I understand correctly.

Dr. Faerber: Yes.

Interviewer: So nothing to be concerned about really?

Dr. Faerber: That is exactly right. If you're 80 years old, 100% of you men will have benign enlargement of the prostate. So it is a normal aging process.

Interviewer: All right. So that's kind of the most common thing. What do you for that then?

Dr. Faerber: It depends on how bad it is. For example, if it's not too bad, you can do some behavioral changes. For example, just don't have that big glass of water before you go to bed or don't have a lot to drink in the evening. And to be honest with you, most men try that initially. You know, they experiment a little bit and they said, "Yes, I've done that."

Interviewer: Yeah, by the time they get to you, right?

Dr. Faerber: Right, exactly. And then, I'll do an exam on a gentleman and see how big his prostate gland is. And then, we then also look to see how well he empties. So we'll have a gentleman void and then we can do an ultrasound of the bladder to see how much urine is left in because we want to see whether or not they're emptying all the way or whether they're just sort of emptying a little bit but most of the urine is left in the bladder. And if that's the case, then you can understand that it doesn't take very long for the bladder to refill and then they feel the urge that they have to go again and . . .

Interviewer: All right. And that is caused by the . . . not emptying all the way is caused by the enlarged prostate?

Dr. Faerber: That's exactly right.

Interviewer: So if they're not emptying all the way, is there anything you can do?

Dr. Faerber: I tell men that enlarging prostate is sort of like, you're sort of pinching off a garden hose where the prostate, as it enlarges, it narrows the channel where the urine comes out of the bladder. And there are different ways of managing that and there are different types of medications that are available nowadays.

Interviewer: Do some men choose to do nothing and just continue to get up at night?

Dr. Faerber: Yes.

Interviewer: And that's completely acceptable as well?

Dr. Faerber: Yes. You know, if we find that they're actually emptying their bladder, then that's perfectly fine. And I would assume there are a lot of men out there who are very comfortable at getting up once or twice a night, and it's really not affecting them physically or emotionally or socially.

Interviewer: So that need to get up and go to the bathroom once or more each night could be an enlarged prostate. What are some of the other things? Let's not go too in-depth but I just kind of want to do a quick of what else it could be.

Dr. Faerber: Right. We do know that as we all get older, and this has to do with not only with men, but with women too, is that the bladder becomes overactive. We all know, myself included, that when I was 18 years old, I didn't have to pay attention to my bladder when my bladder told me it was full.

Interviewer: Right. Twelve-hour road trip, 8 hours in, you could still go another 4 hours, yeah.

Dr. Faerber: Right. It was no big deal. And I was always that, you know, chuckling at my mom and dad who had to make these more frequent bathroom breaks.

Interviewer: You chuckle no more.

Dr. Faerber: Right. Exactly. I do not chuckle anymore. I understand completely. So as we get older, our functional bladder capacity goes down. And that's a normal aging process. There are some medications which can help with some of those patients where it's really a problem. But in most cases, we don't need to really do anything about it. Oftentimes, if I can just reassure patients that, "If it's not bothering you, it's not bothering me so we don't need to do anything about that." So normal aging process is one.

Two is could there be something within the bladder which makes the bladder more irritable, for example, bladder tumor or a bladder stone or something else like that, that may need to be checked. Oftentimes, if that's the case, it's associated not just with having to get up at night but there may be blood in the urine or they may have frequent urinary tract infections, or something else like that which would tell us that there may be something more going on than just an overactive bladder.

Interviewer: Yeah. And of course, if the bladder symptoms accompany any other symptoms like you said, that's when, probably . . .

Dr. Faerber: . . . you really need to get concerned. Yes, absolutely.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 1, 2019
originally published: April 12, 2017

Dr. Jones: Multiple sclerosis is a disease that's more common in women than men. It's a complicated disease, it's a neurologic disease, but it affects many parts of the body and today we're going to talk about the bladder, and MS, and your health, on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones, on The Scope.

Dr. Jones: Today in The Scope studio, we have Dr. Sara Lenherr, who is a specialist in neurology, she's trained as an urologist, but she's pretty clearly interested in the way the brain talks to the bladder. And today we're talking with her about MS, patients with MS, and problems they might have with their bladder, and what might be done. So talk a little about the brain talking to the bladder and multiple sclerosis.

Dr. Lenherr: In normal patients that don't have neurological problems, the brain is designed to tell the bladder to store urine for as long as is reasonable, and then when you're near a bathroom, then you volitionally go ahead and void out your urine. Unfortunately in multiple sclerosis and a lot of different types of neurological disorders, the communication between the brain and the bladder is disrupted by the nervous system problems that happen in MS.

And so specifically, sometimes that bladder becomes over-active and receives too many signals from the brain, and then it also, the sphincter that's supposed to keep you from leaking doesn't necessarily relax when you want to go ahead and pee.

Dr. Jones: So what happens? So a woman who has MS and has neurologic symptoms in her bladder, what would she experience?

Dr. Lenherr: So usually they'll present with urinary frequency and urgency, but sometimes they just don't empty their bladder at all, so they'll feel like they have to go, they try to go, and then they can't empty out their bladder completely. Either just a little bit comes out or none comes out at all, and interestingly, sometimes we catch these cases of multiple sclerosis before they're even diagnosed by a neurologist, because women will present when they're a little bit younger, and they have no reason to be in urinary retention to not empty their urine.

Dr. Jones: So let's back up, so urinary retention. You mean if they go a little bit, then their bladder gets fuller, and fuller? I see a balloon in my head.

Dr. Lenherr: Exactly.

Dr. Jones: How full is too full and what happens?

Dr. Lenherr: Well, if you have too much urine in your bladder, especially for women, usually when you have too much in your bladder and you're a female, you have what's called overflow incontinence, where the urine just comes out even though the sphincter is nice and tight. And so those women will notice that they just leak, and they can't empty out all the way. They feel full.

Dr. Jones: Well, so a lot of women leak, so how would you know that it's overflow? What test would you do?

Dr. Lenherr: So we can do either a catheterized volume to see if there's urine left over after you pee. Or we can just do a little bed side ultrasound to evaluate whether or not there's any urine leftover in your bladder.

Dr. Jones: So a urologist might actually pick up MS before the patient shows the other neurologic signs of MS.

Dr. Lenherr: That's correct.

Dr. Jones: And these are young women.

And young women being wet all the time is devastating, well it's what, it's devastating for any woman of any age, but for young women in particular, they don't want to be wearing pads, and Depends. So what kinds of things do you have to offer for women with MS?

Dr. Lenherr: So once we identify the problem, then we need to discuss with the patient what drives their quality of life, and what is a safety issue. So safety issues would be if your bladder doesn't empty all the way, and it ultimately causes the bladder to stretch out and cause damage, and sometimes could impact kidney function.

Dr. Jones: Oh, so it backs up and backs up?

Dr. Lenherr: It can back up all the way and it could cause the kidneys to have damage which is a bigger issue. The other thing that can happen with the urine sitting in the bladder for a long time, it can lead you to get urinary tract infections. So there's multiple things that we can address with a safety issue, and then we need to look at quality of life, so quality of life is impacted by leaking all the time, or having to go to the bathroom all the time.

Dr. Jones: So do women have to empty their own bladder with a tube? I mean do you give them medication to make their bladder squeeze a little harder?

Dr. Lenherr: So depending on how their bladder works when we evaluate it, we frequently have to have these patients go use a small catheter to empty their bladder on a timed basis. And that generally treats them very well because it empties the urine when they want to, and they're able to control risks of urinary tract infections and kidney damage, and then they also don't have the overflow incontinence that we discussed before.

That's one good strategy, sometimes if the over-activity is really bothersome, and they still have irritation even though there's a small amount of urine in their bladder, we put them on other types of medication and we also can offer them chemodenervation, which is called botox, which is similar to the botox that you put on your forehead for wrinkles, we can inject that in the bladder to relax it.

And we can also put in nerve stimulators that help act like a bladder pacemaker. So there are multiple different options we can offer women with multiple sclerosis to help them manage their bladders better.

Dr. Jones: Well that's great news, because for MS it's a condition that waxes and wanes through a life time. It often begins in women's early 20s, or 30s. So giving somebody the qualify of life so they can be the persons that they want to be, is a really important service that you guys can offer.

And I think for many women with MS, they feel like their life and their agency has been taken away, and empowering them to have a little more control.

Dr. Lenherr: Exactly, and also considering that we follow them for the rest of their lives, and sometimes their bladder conditions change, so we need to adjust the strategies that were working five years ago.

Dr. Jones: And here at the University of Utah, we have a medical record that helps our doctors talk to each other so you're not doing this just in the urology clinic. You talk to their other MS doctors.

Dr. Lenherr: Exactly.

Dr. Jones: Because often they're on a lot of meds.

Dr. Lenherr: We coordinate all their care and make sure that we're all working together to improve the quality of life and keep them safe.

Dr. Jones: That's great to know because I've had a lot of patients over the years with MS. It's very discouraging. Knowing that there's things that they can do is very helpful, and Sara thank you for joining us on The Scope.

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