Search for tag: "urology"

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Scot: Welcome to a very special Valentine's edition of "Who Cares About Men's Health." Did you hear that, Troy? Did you hear what . . .

Troy: That wasn't me. That was Mitch.

Dr. Smith: That was Mitch 100%.

Mitch: All of our very special episodes give me such anxiety. What is the topic today, Scot? Let us hear. What's Valentine's Day going to be about?

Scot: Yeah, you guess what our topic for Valentine's episode is going to be?

Mitch: I don't know. Emotional openness or . . . I don't know. What is it?

Scot: Vasectomies.

Mitch: You know what? I'll give it a solid B-plus. I think this is a good thing. Yeah, love this. Okay, great.

Troy: It works for Valentine's Day.

Scot: Does it? Did you get the tie-in? I was afraid you wouldn't get the tie-in.

Mitch: No, I feel it.

Troy: V-Day has a whole new meaning.

Scot: Actually, a vasectomy could be an amazing gift because women have traditionally borne the responsibility of birth control, right? And sometimes it impacts their hormones, and some of it is uncomfortable, and some of it is a daily grind, it's a responsibility, or all of the above, right? So what if you could take that weight off of your wife and put it on you?

From what I understand, a vasectomy is one of the most effective forms of birth control, and it can remove a lot of stress when you're having sex. But there are some crazy things on the internet about vasectomy side effects, and there are also some legit concerns. And we're going to find out what's legit, what's not, plus also how to figure out if vasectomy is right for you and your partner and what to expect.

This is a Men's Health Essentials episode about vasectomy for the vasectomy curious of "Who Cares About Men's Health," providing information, inspiration, and a different interpretation of men's health.

My name is Scot Singpiel. I bring the BS and I'm on Team V. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I just want to know did you give your wife a vasectomy for Valentine's Day? Is that how this kind of all came up?

Scot: No, I got it a couple of years ago.

Troy: But not on Valentine's Day.

Scot: But not on Valentine's Day.

Troy: I just wanted to know how many men have actually done that.

Mitch: What do you put in a box or card for that?

Troy: Yeah, exactly.

Scot: Always with his unique perspective, Mitch Sears.

Mitch: Hey. Hello. I'm not concerned about this, but I am curious to learn more about it.

Scot: All right. And the most manly guy on the planet because, get this, he performed his own vasectomy on himself.

Troy: This is amazing. This actually blew my mind when I heard this, so I hope you're going to describe this in detail for us.

Scot: It's urologist Dr. John Smith on the show.

Dr. Smith: Man, I thought my wife was the only person who loved to start conversations with that story.

Troy: That is seriously the manliest thing I've heard.

Scot: I know.

Troy: I have sutured myself up and I tell people that, and they're like, "Whoa, are you serious?" But to tell someone I did my own vasectomy, that would just be next level. I've never heard of that before.

Scot: Yeah, on a scale of one to awesome, how do you feel about that, Mitch? That John did . . .

Mitch: I just can't even imagine. Did you have to? Were you in an emergency vasectomy situation, or what was going on?

Dr. Smith: I mean, all of that is up for interpretation. My wife and I had surprise twins during the beginning of the pandemic, and that was a shocker. And so once we had the twins, she literally looked at me and said, "When are you getting your vasectomy?"

Scot: And going to another provider never was something you considered?

Dr. Smith: I mean, I considered it. I probably should have done it. I mean, probably not the brightest move I've ever made in my life, but it's worked out just fine. I mean, it was one of those where someone no-showed their vasectomy. I wasn't going to throw that stuff away, so I made the executive decision to just do it.

Mitch: You just sat down and did it?

Dr. Smith: Yeah.

Troy: And just to clarify for any listeners who are thinking of doing this, this is a . . .

Dr. Smith: Don't.

Troy: . . . procedure you do on a regular basis.

Dr. Smith: Oh, yeah. I mean, volume-wise, I'm one of the highest-volume vasectomy folks at the University of Utah.

Troy: So this is not an unfamiliar procedure. But you did it on yourself. That's amazing.

Scot: This is a "don't do it at home" sort of . . .

Troy:Yeah, don't do this at home.

Dr. Smith: I would not take what I did and make it something that's the smartest thing I've ever done.

Scot: So, as a guy who had the procedure, I had a misconception. I thought that I was going to show up and there was going to be an operating room full of people, right? I thought there was going to be just a ton of people, but there wasn't. There was one guy. That's one of the things we're going to talk about, one of the misconceptions people have.

But before we get into that, John, what are some of the crazy things that men hear about vasectomy on the internet that they ask you about?

Dr. Smith: I mean, a lot of them will come in and they'll be like, "I'm going to be able to have an erection? I'm going to be able to . . . I'll still ejaculate? This won't impact my testosterone levels? I'll still feel and have testosterone?" Pretty much anything that you can think of when it comes to your genitals being in the crosshairs. There's a lot of misconception out there.

Scot: And it's not true. All those things you said . . . I'm not going to all of a sudden have the desire to start watching Hallmark Channel movies or something, right? My voice isn't going to get higher.

Dr. Smith: No, not at all. And so yeah, a lot of the misconceptions are there. It doesn't change erectile quality. It doesn't even change the amount of ejaculate. The sperm themselves make up about 5% of the ejaculate. And so there's not even a really noticeable decrease in the amount of ejaculation. Your testicles make the testosterone and sperm. They don't stop making testosterone because you got a vasectomy. All those things are all misconceptions.

Scot: Mitch, Troy, have you heard about any kind of crazy things about vasectomy that you've wondered about? I've got one here that I saw on the internet.

Mitch: Yeah. The big one that I've ever heard and when I've talked to people before, they're like, "Ew, no, I'm not going to do that," is the sexual dysfunction stuff. It's the, "I won't be able to ejaculate again," or, "It won't be the same," or, "I won't have . . ."

Scot: Or the pleasure, right? It's going to be less pleasurable.

Mitch: Yeah. And I guess none of that is true.

Dr. Smith: It'll be less pleasurable if you had another kid that was screaming in the background. I'm just kidding. That was terrible of me. But consequence-less intercourse does have its appeal.

Scot: Yeah. And on the other hand, it's really almost freeing. It can make sex better because it's one of the most effective forms of birth control, if I understand correctly, right?

Dr. Smith: Yeah. It's very effective. The pregnancy risk after a vasectomy is 1 in 2,000. And that's not 1 in 2,000 ejaculations, by the way.

Scot: Sure. Okay. I mean, it kind of just makes things freer. And then knowing that I took the responsibility on and my wife doesn't have to go through the stuff she used to have to go through anymore, I think it's cool. I mean, that's my take.

I've seen on the internet that sperm will build up and that could be a problem. Is that true?

Dr. Smith: Very rarely is that a problem. There's a 1% risk of chronic testicular pain after the procedure, which that is one of the possible reasons you could have the chronic testicular pain. But oftentimes, that is not the case. The sperm have a life cycle, they die, and then they're absorbed by the body, so it doesn't really hold true.

But some people do notice chronic testicular pain and they get a vasectomy reversal and the pain goes away. So there is some thought that there may be some truth to that, but it's not a common thing.

Scot: I will admit that was the one potential side effect that I was concerned about, because that could impact your life for the rest of your life. But it's a very, very low chance.

Dr. Smith: You've got a 1% chance of chronic testicular pain is what most of the literature will say. That chronic testicular pain, often there are ways to mitigate that. It sometimes will involve another procedure or another surgical intervention to get rid of that pain. It is a rare occurrence. But when it happens, it's definitely not something that you're going to be like, "Man, I'm so glad that happened to me."

Scot: Troy, any misconceptions you want to clear up?

Troy: I don't know if it's a misconception. I know some people have talked about some of the pain they've experienced after a vasectomy and . . .

Scot: Like just procedural pain? Pain from the procedure itself?

Troy: Yeah, procedural pain. And I know it's a common procedure to have around the Super Bowl. I think some places make a big push then because the idea being that you're going to just sit on the couch all weekend and have an ice pack on your groin to ease the pain.

Scot: Or March Madness, right? You've got an excuse to sit around and do nothing.

Dr. Smith: We've done a Vas Madness a few years.

Troy: Vas madness, yeah.

Dr. Smith: Where you get them in and do it before the tournament.

Troy: And is that common? Are people typically saying, "Hey, I'm just going to have to sit on the couch for two or three days because it hurts too much to walk"? Or is that more of an excuse to watch a lot of basketball?

Dr. Smith: I'm not going to sell anybody out here. Most of the time, we recommend after the procedure to take it easy for a couple of days, about 48 hours after the procedure. Some folks are a little bit more aggressive. Some folks are a little bit more conservative as far as telling you to take it easy for four or five days.

I usually tell my patients ice 20 minutes on, 20 minutes off, for the first couple days and then get back to your routine as it feels okay. No heavy lifting for about five days after the procedure. You can't get in a pool or hot tub or submerge it in water for about 10 to 14 days while the small incision heals. Other than that . . .

I mean, some people will tell you that you can have sex within a couple of days. Some people say wait a week to have sex. It varies between who does your procedure.

Some people will say you can shower the night of the procedure. Some people say to wait to shower a couple of days after the procedure. Again, there's not a huge variety of people that are getting infections or anything from this.

Troy: No running?

Dr. Smith: I usually tell people they can go running when things feel better. I can tell you that I know a couple folks who went golfing the day after they did their vasectomy. Not that they did their own, but after they had their vasectomy done. And they said they were fine. There were no problems.

The big thing that you worry about when you are too active too soon is a small blood clot in the scrotum. Not the kind that goes to your heart or lungs, but a hematoma is what they'll call it. Just a collection of blood in the scrotum. And it makes things a lot more sensitive and painful during the recovery and makes the recovery a little bit more miserable for a couple of weeks.

Scot: Also, I've read that some people are concerned it can cause prostate cancer or it's been linked to cardiovascular disease. Talk about that. That's not true, though, is it?

Dr. Smith: No. A lot of that has been debunked. I mean, there's a lot of literature out there about other things as well that say that. But there's no clear link to getting a vasectomy and then having prostate cancer. There were some articles that came out and most of that has all been debunked, and it's not true.

Scot: And then I didn't know this. There's a no-scalpel vasectomy. Is that kind of the common way now, or what?

Dr. Smith: Well, it's all a gimmick, right? You've got to open up the scrotum to get where you've got to get to start. So it's one of those where you've got to make a hole in the scrotum at some point, whether you poke a hole with a sharp instrument, whether you use a scalpel, you've got to open it up anyway. There's no magic to just the vas deferens just coming out without making some kind of an opening in the skin.

Scot: Do I need to be concerned about, first of all, the way they're making the hole? I mean, is one way any better than the other really?

Dr. Smith: Honestly, no. I mean, the scrotum is very robust as far as its healing capacity it's going to be fine. In three to four weeks, you're not even going to know that somebody was there regardless of how they got in.

Scot: All right. And then as far as how they're actually going to . . . if they're tying or if they're cauterizing the vas deferens, does that make a difference? Should you request one over the other?

Dr. Smith: Well, most people will cauterize and then do something else, or just cauterize. And so the cautery is the one thing that the American Urologic Association says is best practice, is to have mucosal cautery of the lumen of the vas deferens. And so that's something that I'm pretty sure everybody does.

And then on top of that, some people will put clips. Some people will do something called fascial interposition. And that's pretty much where there's an opening in the fascia of the scrotum, and sometimes you'll tuck one end of the vas deferens underneath and put a clip or a stitch over the top of it.

So it's kind of like putting one of them in the basement and one of them in the upstairs so that they can never meet again, is kind of a way to think of it. They call it fascial interposition.

Some people will just tie a ligation stitch around both ends. I mean, there are different variations. You could talk to 50 different urologists and have 50 different ways to do it.

Mitch: What's the thinking behind that? Is it just if the two somehow accidentally meet up again it will heal?

Dr. Smith: Right. So the thought is that you can have someone who's . . . I call them super healers because I don't know of any other way that this happens. But where you can have those mucosal ends grow back together and just recanulate and make a tube again.

I mean, that happens. Very rarely does it happen. I have a friend of mine who actually had it happen where he had a vasectomy done, and he told me he actually had a second vasectomy done. I haven't confirmed that in his medical records, and he still says he has active sperm.

Mitch: Is he Wolverine?

Dr. Smith: He has to be, man. I checked for adamantium, but I did not see any on first glance. I'm not sure.

Troy: Did he know it had reconnected because he had another kid, or what? How did he find out?

Dr. Smith: Usually, we have folks get a semen analysis in 8 to 10 weeks. Some people say six to eight weeks. Again, it varies between folks that are doing this. You get to a semen analysis that looks to see if there are any mobile sperm, how much sperm there are if there are any, and if they're moving. And that gives you a good idea of whether you should lose the protection or not.

Troy: Well, speaking of reconnecting . . . I'm going to put this out there as a misconception, and maybe it's not. But the misconception being that it's very easy to reverse a vasectomy. If you get it done and you want to have it reversed in five years, it's a simple thing to do and you can go on and feel confident you're going to have kids at that point. Is that a misconception?

Dr. Smith: So a lot of it depends on time. The vasectomy reversal can be done. The longer that things are scarred down, the less successful the reversal is. But the reversals are pretty successful. I mean, a high number, we're talking three-quarters or more of them, are able to have sperm there after the reversal procedure. Also, individual doctors have different kinds of success rates that they'll quote you.

The thing that you've got to realize with that, though, is insurance is not going to cover that. So you're going to hit that on your own. It's going to cost you $6,000, $8,000, $10,000, depending on where you get it done, cash to do that.

Obviously, insurance paid for you to get a vasectomy so that they wouldn't have to pay for another kid. And so a lot of that becomes out-of-pocket expense for the person who gets the reversal.

Scot: So I think a lot of guys want to know what the procedure is like. It was almost a non-event. I was a little intimidated going into it. Like I said, I thought it was going to be this big procedure. I think it was done in like 15 minutes. The pain wasn't super bad. I went and bought a couple bags of peas and iced like I was told to and took it easy for two or three days, and everything was great.

I'd read some of the crazy stuff, that it was going to decrease your sexual pleasure, and yadda, yadda, yadda, and none of that happened. And it just feels great not having to worry about it. Is that pretty accurate? Did I describe the procedure pretty well? I mean, just kind of the overview, John?

Dr. Smith: Yeah. I mean, it's a simple procedure that's done in the office. And I don't want to simplify anything because surgery is never a big deal until it's on you. And then obviously, when it's on your genitals, it's an even bigger deal. But it's a very commonly done procedure. It takes 15 to 20 minutes, maybe 30 minutes, in the office. It's minimally invasive. I do mine through a single incision that's about a centimeter to a centimeter and a half long. Numb things up with lidocaine and just take care of it.

Scot: Don't even feel it. Don't even know. It is kind of weird though because you're sitting there in a chair, and you're kind of watching the doctor do it, but you're not seeing what the doctor is doing, because you've got some blankets or something up there. So you know something is going on and you're actually kind of seeing that something is going on, but I didn't feel a thing.

Dr. Smith: Yeah, once you're numb . . . I mean, the worst part is the numbing. When I did mine, that was the worst part, was getting numb. And most men when they're done, they're like, "Oh, the numbing was the worst part. After I realized I was numb, I could just relax and hang out."

Scot: I don't even think the numbing was that bad, really. I don't remember it.

Dr. Smith: Listen to this guy. What a tough guy. "It didn't even bother me, man. My name is Scot."

Scot: I still don't measure up to you, but . . .

Troy: Yeah, I think you're trying to outdo John on this one, Scot.

Dr. Smith: It hurt, man. I did not like numbing it up. I'm not going to lie to you. That was the worst part by far. But again, once it's done, that is the part that people say is the worst.

And then you had a great recovery. Most people do have a good recovery like that. I was very similar to that. I had some minimal discomfort for a few days. Bruising for 7 to 10 days in and around the scrotum.

I did not get a hematoma, thank goodness. I mean, they happen about 1 in 20 to 1 in 30 vasectomies. So they're not super common, but they're the most common "complication" that you have after the procedure. If you do get one of those, your recovery is not quite as fun. I tell you guys it gives you the man flu for a couple of weeks. You're not going to want to do much. But that's kind of what to expect for it.

A lot of guys come in they're like, "Man, I was really worried and scared about this and it wasn't as bad as I thought." I hear that quite a bit.

Troy: And you mentioned insurance coverage earlier too, John. It sounds like this is covered by insurance.

Dr. Smith: So a lot of insurances will consider this preventative care. You need to check, obviously, with your insurance company. But if you think about it, it makes sense for them to pay for a vasectomy. Then you don't have to worry about taking care of another kid on the insurance for 18 years, or 26 years. And so a lot of them will have that.

So we'll have a mad rush at the end of the year where people think that they've met their deductible and they need to go get their vasectomy. But then a lot of times, if you look at your insurance coverage, you could have done it into March, April, May, it didn't matter because it was considered preventative care.

Now, not every insurance is that way, but a lot of them are because it's advantageous for them to obviously have that done to decrease another kid coming on to the policy.

Troy: Yeah, a calculated decision on their part.

Dr. Smith: Yeah, exactly.

Scot: As we get ready to wrap this up, what type of guy would be a good candidate for a vasectomy? Are there some people that are better candidates than others?

Dr. Smith: Almost everybody is a good candidate. Oftentimes, if there is a difficult exam or something where we think it needs to be done in the operating room, it can be. Most everyone is able to be done in the office.

Obviously, a good candidate would be someone who's not interested in fertility any longer and does not want to have any more children. And so those folks would want to come in.

We have them have a consultation to go over all the risks/benefits before they have the actual procedure, and then come back for a second visit for the actual procedure. That way, they have the ability to do that.

Also of note, when we talked about insurances, government insurance makes you wait 30 days from a consultation to have the procedure done so that you have time to think about it.

I was told when I did my training that that was because some places were doing the vasectomies on people who were in mental hospitals, things like that, without consent. And so the government changed it to where they had to have consent and wait 30 days, and yadda, yadda, yadda.

But all of the government insurance does require a 30-day wait period and a form to be filled out. So Medicaid and other government insurance, you have to do that.

Scot: Something I remember, I had my consult and they asked me the same thing. They asked me how many kids I have. Zero. "Are you positive that you don't want to have kids?" Well, I'm to the age and my wife's to the age where that's probably not even a smart thing from a health standpoint, and we've decided that that's the case. And they did ask if I talked to my wife about it. You would recommend that as well? This is a conversation that should be had between both partners. You shouldn't just go out and surprise . . . do the Valentine's Day vasectomy surprise.

Dr. Smith: Right. If you've already had that conversation with your partner, and you guys have decided that's not what you're going to do, then I think you're pretty safe. But I think it is a wise thing to talk to your partner. If you don't have a partner, then obviously it doesn't apply.

Troy: And I have to ask this too, John. Let's say someone out there is thinking they're not married, but they don't want to worry about the issues with possible pregnancy with partners, and so they decide to have a vasectomy. How effective is a vasectomy at preventing STDs?

Dr. Smith: It's not at all.

Troy: So you're still using a condom for those guys.

Dr. Smith: Yeah, absolutely. I mean, that's not going to stop an STD in their tracks at all. That's just going to make it so you're not going to get someone pregnant, but it's not going to stop transmission of any of that stuff.

Scot: By the way, I think Troy knew the answer to that question.

Troy: I had to ask it.

Dr. Smith: Was Troy baiting me in?

Troy: I was baiting you. I had to ask it. I think that maybe potentially that could be a misconception, that you think, "Hey, I had a vasectomy. Great. I don't have to worry about pregnancy."

Scot:Yeah. Woohoo.

Troy:You're right. Not a big concern. Far more effective at preventing pregnancy than condoms or oral contraceptives, but doesn't do anything for STDs.

Dr. Smith:Absolutely.

Scot: Yeah. You might forget that. I could definitely see that.

Well, if you're considering having a vasectomy, of course, if you have any concerns or questions, if you've seen something crazy on the internet that we didn't address today, then definitely talk to a urologist.

If you have other concerns, like what it's like, for some reason other guys that have had them, it's been my experience, love to talk about them. I don't have any qualms about it.

I don't know if there are some people that think it makes you less manly or anything like that, but from my personal experience, I'm really glad that I got one.

I will admit it was a little strange thinking that this is it. I've made the decision that under no circumstance . . .

You do consult men that this is not a reversible procedure, even though there is potential to reverse it if you've got the cash and if you do it soon enough?

Dr. Smith: Correct. I usually tell people that this is reversible, but I don't do it to be reversible.

Scot: Yeah. Right. Your job is to do it so it works and those things don't grow back together. But beyond that, I mean, it's been great. So I would highly recommend it if you are done having children and you don't want to have to worry about birth control anymore.

Dr. Smith: I concur.

Scot: If you have any questions, you can email us. The email address is hello@thescoperadio.com. And we've just given you a Valentine's Day gift idea, so you're welcome. Just don't make it a last-minute gift. Have that conversation.

Troy: Last-minute gift. Yeah, it sounds like maybe the gift would be proposing the idea rather than coming home and showing the incision on your scrotum.

Scot: Yeah, that's a good idea. Thank you for listening, and thank you for caring about men's health.
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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.

Scot: They say kidney stones are more painful than childbirth, if you can believe that. I suppose people who have had kidney stones would think that. This is "Who Cares About Men's Health," a Men's Health Essentials. We're talking about kidney stones today. Is there anything you can do to prevent them?

And we've got the cast and crew here today. My name is Scot Singpiel. I bring the BS. We've got Dr. Troy Madsen. He is the MD to my BS.

Troy: Hey, Scot. I've never given birth to a child, but I imagine it's painful and I imagine kidney stones are much more painful.

Scot: Producer Mitch is also on the show.

Mitch: Hey. So I'm looking at this pain scale, not to derail too far, but out of 50, a kidney stone says it's 42, and childbirth is a 32, and a really bad tooth break is a 19.

Scot: Oh, wow.

Mitch: I'm excited to hear more.

Scot: Dr. John Smith is a urologist. He's going to help sort us through the kidney stones. How are you doing today?

Dr. Smith: Oh, living the dream, gentlemen. Thanks for having me.

Scot: You ever have kidney stones?

Dr. Smith: I have not, but I've seen enough patients that have that I drink four liters of water a day to make sure I don't have one.

Scot: It's one of those things where when you see somebody that has it, you start doing the things that are going to prevent you from getting them. Is that actually one of the good things to do? Is it caused by not drinking enough water, or can you prevent them by drinking more water?

Dr. Smith: Absolutely. So the old Chinese proverb of the solution to pollution is dilution is correct.

Mitch: I love that.

Scot: Is that a Chinese proverb?

Dr. Smith: I don't know. It was told to me when I was training by one of my mentors and he said it was a Chinese proverb, but it doesn't sound like one to me. It just sounds like good advice.

Scot: Yeah, sure.

Troy: That's funny. So you've heard that in your urologic training, and then I hear it all the time with toxicology, with overdoses. "The secret to pollution is dilution." So, anyway, it crosses multiple specialties

Dr. Smith: And the orthopedic colleagues will say, when they're rinsing out a joint that's infected, that that's the solution.

Troy: Yeah. There you go.

Scot: So, with kidney stones, what's causing those things? Is it because of something I've eaten or something I'm doing, or are they more hereditary? What's the story on that?

Dr. Smith: Yes.

Mitch: Well, no. That's a really good question. I've got a buddy, he's a listener, and I don't want to go too far into it, but I've seen him go through kidney stones. It seems like he gets them every single year. And I know he does a lot to drink all his water, he's done some things to change his diet, but he still gets them. So what could be causing them other than lifestyle, I guess?

Dr. Smith: So I don't know. Troy, do you want to jump in here? I'm happy to go over my spiel that I give my patients who are the chronic kidney stone guys and even the ones who are first-timers.

Scot: I think we want to hear that, don't we, Troy? I mean, I could listen to Troy anytime. I don't always get to listen to Dr. Smith.

Troy: Scot gets tired of listening to me, so please go on.

Dr. Smith: Man, that was some shade, Scot. Wow.

So when I have folks that come in and we talk about kidney stones, there are a couple of different reasons that people get them. And usually, for folks that are first-timers who've never had a kidney stone before, they meet . . .

The other day I had a patient in his mid-40s who came in, never had a kidney stone, and we started discussing stones. Most commonly for folks who aren't predisposed genetically or have some kind of a metabolic issue, it's usually a hydration issue. And so dehydration will put you at risk for stones.

I usually use the analogy of if you ever made those salt crystals or sugar crystal things as a kid where you had that pot of tons of salt or sugar and you dipped a string in and you made those crystal things. You guys ever do that?

Mitch: Yeah.

Scot: Yeah.

Troy: Yep.

Scot: That's what's going on?

Dr. Smith: It's similar to that, because the more concentrated your urine is, the more stuff that's in there that could form a stone. And all a stone is, is a crystal that forms and it's made of different material. The most common ones are calcium-based. A dilute urine will not form a stone the way that a concentrated urine would. So that's the first thing I tell people to do. To drink plenty of fluids is going to keep them from having a concentrated urine. That's number one.

And I usually say there are four things that you can do to prevent a kidney stone regardless of the kind of stone you make, regardless of why you get them.

Number one is hydration. And I usually tell people you want to make at least two to two and a half liters of urine per day. Now, that's a hard one to do because nobody just measures their urine every day. And so that generally means . . .

Scot: Let alone in liters. I mean, what are we doing with the metric system here? We're in America. Come on.

Dr. Smith: Well, but in medicine we use the metric system, unfortunately. But I usually tell folks if you go get those big packs of water at Costco or the supermarket, those are a half a liter each. Those 16.9-ounce bottles are a half a liter each. So you should be drinking four to six of those a day.

Scot: Yeah, or one of those big sodas. Those are two-liter bottles of soda. Now you're talking.

Dr. Smith: Sure. See, now we're talking things. So if you drink at least 6 of those a day, your body uses between 500 and 750 milliliters of fluid a day for metabolic purposes, and so you're not making urine out of that. That's just what you need to be alive. And so anything above and beyond that gets turned into urine. That's why I say you need to drink two to three liters of water per day. To make two liters of urine, you've got to drink around three liters.

Troy: Now, Scot just mentioned he's going to go start drinking those two-liter bottles to measure it. What about drinking soda? Is that going to increase your risk?

Dr. Smith: So it can, depending on the type of stones you make. Obviously, the more stuff you have in your body that your body has to metabolize and break down and put into the urine, the more stuff is in your urine, the more likely you are to make a stone.

And so, for some folks, they're really predisposed to that, so it can make a difference for them. And for other people, it may not make a huge difference. That's something where when we get to the diet-related stuff I usually mention, but the first thing is just drinking plenty of fluids.

The second thing that anybody can do would be to decrease the amount of salt in your diet. And so that means soda. Oftentimes diet soda in particular has a ton of salt in it, as well as other processed foods. Pre-made stuff that you buy at the supermarket has a ton of salt in it.

Your body gets rid of excess salt in the urine and oftentimes the other solutes, the things that are going to help make stones, will follow that salt out into the kidneys and make urine. So that's another thing that you can avoid.

The third thing you can do is avoid animal protein. Now, that doesn't mean beef. It means any kind of animal protein -- fish, pork, chicken. Those create a high acid load in your system and decrease the pH of your urine. And when your urine pH is decreased, that increases your risk of stones. Stone formation increases when you have a low pH in your urine.

And that leads into the fourth thing that I usually tell people. Alkalinizing your urine in some way with lemon, lime, fresh fruit, berries, things that have citrate in them will cause a base to form in the urine and increase the pH.

So those are the four things you can do. Without knowing what kind of kidney stone you have if you've never had it analyzed and you have chronic stones, those are the four things you can do to decrease your risk of stones.

Scot: So coming back to our core four, kidney stones are caused by the types of foods that we're eating and drinking. It's totally diet based, right?

Dr. Smith: So not necessarily. Obviously, the dehydration thing is huge, but someone who has . . . So Mitch's buddy probably has a metabolic issue where his urine makeup predisposes him to having stones.

And so oftentimes, for folks in that situation, we'll do a 24-hour urine test and look at what's in the urine and what's spilling into the urine to see what's high level. If there are high levels of calcium or high levels of certain chemicals, high levels of nitrogen from animal protein, high levels of just salt, and different things that can predispose you to having stones, we definitely look at those.

Scot: How much does genetics play into whether somebody develops kidney stones or not? I would imagine that there are plenty of people that aren't drinking water and eating high salty foods and never get stones, or is that not true?

Dr. Smith: No, I think there is definitely a genetic component. How strong it is, is very difficult to kind of put your finger on. The literature shows that there can be some predisposition for folks who have family history.

And I've seen that anecdotally in my practice. Folks who come in at a younger age with stones oftentimes have family members who have chronic kidney stones. So I definitely think there's a correlation for those folks. Absolutely.

Scot: And you talked about the different kinds of stones. What's that about?

Dr. Smith: Well, there are a few different kinds of stone. The most common are calcium-based. There are calcium stones, multiple different kinds of calcium stones, but the important part is they're made with calcium.

Now, that doesn't mean don't drink milk, don't eat calcium. You actually want to have a normal amount of calcium, but not overdo it and not underdo it, which has been a misnomer for people. They're like, "Oh, I'll just stop drinking milk, I'll stop eating calcium, and it'll fix my stone problems." And it actually has been shown to make it worse in some of the literature. So you don't want to cut that out completely, but you also want to make sure that you're not eating other foods that may be problematic.

So calcium oxalate is the most common types of stones. And when you have a high oxalate diet . . . So coffee has oxalate, tea, spinach. Dark green, leafy vegetables have oxalate in them. There are other foods that have oxalate. Some people will say, "Oh, you've got to go on an oxalate-free diet," when in reality if you have calcium and oxalate in your gut, your gut can bind those things and it actually gets put out in the stool instead of going into the system. That's why you don't want to cut out calcium completely.

I mean, there are a lot of dynamics to kidney stones that kind of make it difficult, and knowing what type of stone you have can be helpful. So the calcium stones, we can kind of base things on diet.

The other type of stone that we see in folks is uric acid. Those are probably the second most common that I see. Those ones can actually be "melted" with medication and alkalinizing the urine, making the pH of the urine go up. So that's one where if we know that someone makes those and we keep their urine pH up, we can decrease the size and the amount of the stones that they make with the pH of the urine.

Scot: Which stones are the prettiest stones?

Troy: Calcium, of course.

Dr. Smith: They're all beautiful. They're all terrible.

Troy: Well, the calciums are kind of nice and shiny and it almost looks like a pearl.

Scot: Are you serious, Troy? Do they really?

Troy: I don't know.

Scot: I thought maybe you knew.

Troy: I just know they show up really well on an X-ray.

Dr. Smith: They do. That's the calcium.

Troy: Yeah. I don't know how they look when they come out exactly. But I can say hearing this, though, it sounds like the key is, like you said, John, drink lots of water, try to avoid eating too much meat, avoid salt, fruits and vegetables. Those are the keys. I mean, that just kind of gets back to a lot of what we talk about. Just healthy diet in general.

But hearing this, we talked just a little bit about the pain with kidney stones, but I can tell you when I see someone in the ER with a kidney stone, I don't know that I ever see anyone on a regular basis in the ER who has more pain than a person who's there with a kidney stone. You can tell. You walk in the room, they're writhing. They're pacing around the room, kind of holding their side. It's just incredible pain.

Every time I see them, I kind of have the same feeling you do. It's just like, "Hey, I want to do everything I can to avoid this." And if it means drinking tons of water and just watching my diet, it's well worth it just because that looks absolutely miserable.

Mitch: So what are some of the symptoms, I guess? I mean, we're talking about the pain itself and how to prevent them, but what are the actual symptoms? Is it just, "I've got pain in my stomach"? Or where do we feel it and things?

Dr. Smith: Well, I think Troy could probably answer that because he has them come in, but usually it's a pain in the flank, which is kind of the upper outer portion of your back on either side. And as the stone kind of travels down the ureter, that pain can migrate to the low back, even into the groin.

And I usually tell folks when stones are sitting in the kidney, they don't usually cause pain because they're not obstructing. They're not bothering you. But when they start blocking the flow of urine and they get into the ureter, the small tube, your body tries to get rid of that by peristalsing, just the way it does when it moves food through your intestines.

And so at that time, the stone, once it gets into the tube is where you start to have the pain and it usually starts in the flank and then moves down.

Troy: Yeah, and that's exactly what I see. People are kind of holding their sides. So if you were to kind of reach around, hold your sides of your abdomen, that's typically where they're feeling the pain. I push on their stomach, their belly doesn't hurt, they're not really tender, but it's just a deep, severe pain. And they'll tell me it comes and goes, it's sharp, sometimes it's better, sometimes it's worse. John, it's exactly like you mentioned, that spasm where that ureter is spasming. That's when they really seem to have severe pain.

Scot: And then is the treatment painful too? I mean, is this the double whammy of not only does the thing hurt, but the treatment is going to hurt bad as well?

Dr. Smith: Well, what Troy does for people doesn't hurt. They really love Troy. They don't like it when they come and see me after they've seen Troy.

Scot: Okay. Because Troy gives them . . .

Troy: I just give them pain meds.

Scot: And then you send them to John.

Troy: Exactly. But it's great, though, because there is a non-narcotic and non-steroidal anti-inflammatory medication that we give intravenously. And it just works beautifully for kidney stones. So it's not like we're just knocking people out with narcotics. Some people need narcotics, but so many people, I give that medication and they're just like, "Wow. I feel better."

Scot: What's the treatment then, Dr. Smith?

Dr. Smith: So there are a couple of different treatments depending on where the stone is at and different things. I mean, there's a little bit more to it here, some nuance. But if it's moving down and it's relatively small, oftentimes we'll offer people to pass it on their own. We call it medical expulsive therapy. It's not pretty, but it gets rid of the stone.

And so we give them some medication to help the stone pass. And after we do that, we let them kind of do their thing and pass the stone on their own for a couple of weeks. And if it doesn't pass, well, then we bring them back and we offer them surgery. Stones can be . . .

Scot: Ugh.

Dr. Smith: Go ahead.

Scot: No. I just went, "Ugh."

Mitch: Yeah, ugh.

Troy: Two weeks of that. Yeah.

Scot: Yeah. I don't have to say anything other than ugh.

Dr. Smith: I mean, I'll give them a little bit more than two weeks if they're really confident that they're passing it and they're not wanting to do anything surgically.

But the other options that we have are if the stone is visible on an X-ray, just like Troy alluded to earlier, sometimes we can do what's called an extracorporeal shock wave lithotripsy. Some people just refer to it as lithotripsy, where we use an external shock wave beam to break up the stone, and then you still have to pass the fragments. And that's only if we can see it on an X-ray to target and hit it.

Scot: So those are my two options? Either give birth to that stone myself or . . .

Dr. Smith: No, there are other options. I'm just saying those are the two . . .

Scot: Oh, okay.

Dr. Smith: I'm going from least invasive to most invasive here.

Scot: All right. Get them busted into shards or have surgery. Yeah, that's more reasons why to drink more water, I guess.

Dr. Smith: Exactly. So the third option that I offer folks is called a ureteroscopy laser lithotripsy, where we go up with a small, thin, flexible camera and we find the stone and we blast it with a laser.

Scot: Oh, that sounds badass.

Dr. Smith: It's pretty cool.

Mitch: It's all pretty cool, but miserable.

Dr. Smith: Yeah. And usually, with that, they have to put what's called a stent, which is a small, thin, flexible plastic tube from the kidney to the bladder. And they are miserable. I always tell patients, "It's miserable. You keep it in for about a week to let things heal and then you take it out in the office."

Troy: And I think Scot, when he thought that was really cool, I think it's probably worth telling him how you get the laser up to the stone.

Scot: Oh, no.

Mitch: Oh!

Scot: No, I'm good.

Troy: You're good? Okay.

Dr. Smith: Well, there's no cutting, Scot, so you can use your imagination.

Scot: Yeah. Just thread that thing right up there, huh?

Dr. Smith: Yep. Just like throwing darts.

And then the last thing that we do for stones if they've gotten too large to pass and they're in the actual kidney, we can do what's called a percutaneous nephrolithotomy. They use the term PCNL because it's way easier to say. And that's where we make a small incision in the back and we go into the kidney and we actually are able to remove the stone in larger pieces that way.

That's obviously the most invasive way to do it, and we do that for much larger stones. You've got to have a stone that's a centimeter and a half or larger, or at least that much volume of stone in the kidney before we would contemplate doing that.

Scot: Troy, can these stones get so bad that you're going to see somebody in the emergency room that has to have an emergency surgery because they just can't urinate anymore?

Troy: I can't say I see them where they can't urinate, because usually it's just in one of the ureters and so the other kidney is working, although you could have it, I guess. I've rarely seen it where it's so bad that you can really see it's impacted their overall kidney function.

The more concerning thing I see is when you get an infection along with the stone, and those are the cases where they're definitely admitted to the hospital.

But yeah, if it's a really large stone, like John mentioned . . . Usually the cutoff we use is six millimeters, but even there, I think sometimes our urologists will say, "Give it a little time. Let's see what happens." But if they've got a big, centimeter and a half stone just lodged in there, yeah, those are cases where the urologists will admit them and do something sooner rather than later.

Dr. Smith: Good point, Troy. When you have an infection above the stone blockage, those folks can get real sick real quick. And those are the people that emergently get surgery. And oftentimes we don't treat the stone immediately. We treat the infection. We put a stent in and give them antibiotics and come back another day to take the stone out. They're just so fragile as far as their health goes at that point that oftentimes they need antibiotics to clear out that infection before we're able to treat the stone.

But Troy is right. Anything 5 millimeters and under have a 75% to 80% chance of passing on their own. Now, that to be said, I have folks who come in with two-millimeter stones who are unable to pass them and folks with seven-millimeter stones that pass them and they said it wasn't a big deal. So, again, it's all relative to the patient. But once you get these larger stones, definitely surgery is much more frequent for those folks with larger stones.

Scot: Hey, Mitch, we're wrapping this up. Do you have anything you'd like to share?

Mitch: I'm just very uncomfortable and trying to drink my water off camera. That's what I'm doing right here right now.

Scot: You went and got some more water.

Mitch: I did. And I'm saving everyone from the sipping noises, but yeah, a refill was necessary.

Scot: These lifestyle changes that we make, Dr. Smith, is there a percentage of reduction of risk that they will do that we know about?

Dr. Smith: That's a tough one. I don't know that there's an actual percentage of risk. I would say when you do it, if you are a chronic kidney stone patient, we usually follow your 24-hour urines to check your risk assessment. But folks who have a stone and pass a stone and then hydrate themselves can really reduce their risks just by doing those things.

The numbers that I know and usually quote people is if you have a kidney stone that requires surgery, 50% of folks who have that issue will have another episode of a kidney stone within a year. And so that's why I usually tell folks the more you can do to drink and keep them away, the better off you are.

Scot: Well, it was a fun topic. I still don't know which stones are the prettiest stones, which makes me a little bit sad, but that's okay.

Dr. Smith, thank you so much for being on the show, and educating us on kidney stones, and telling us what to do. Would you like to summarize, Mitch? What are you going to do? You're going to drink water. What else?

Mitch: I'm going to just drink all the water and I'm going to make sure that I'm not having too much salt in my diet.

Scot: Watch the processed foods.

Mitch: And watch the processed foods. I need to eat less taquitos.

Scot: And maybe a little lime in your water, it sounds like. Is that right, Dr. Smith?

Dr. Smith: Yeah.

Scot: Get that pH down. Is that what that . . .

Dr. Smith: It won't hurt you.

Scot: No, that's getting that pH up, isn't it?

Dr. Smith: Yeah, pH up. Correct.

Scot: Yeah.

Mitch: Okay. So preventing scurvy and rocks in places I don't want rocks. Got you.

Scot: Dr. Smith, thanks for being on the podcast. Thanks for caring about men's health.

Dr. Smith: Troy, Scot, Mitch, it's always a pleasure. Thanks for having me.

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.

Scot: Welcome to "Who Cares About Men's Health." It's a Men's Health Essentials episode. A weak stream, is that something that you should have a doctor look at? That's what we're going to talk about.

My name is Scot Singpiel. I am the manager of thescoperadio.com. I provide the BS. That's what I do. The MD to my BS is Dr. Troy Madsen.

Troy: Hey, Scot. It's me, and I have to say I am so excited to be joining you today on the number two rated podcast in the world.

Scot: What?

Troy: Men's health podcast. Let me clarify that. The number two rated men's health podcast in the world. It's my honor to be here.

Scot: Tell me about that. We're number two?

Troy: We are number two. I did a search. I just searched on Google "top men's health podcast." The first site that came up ranks them by multiple factors. We are number two, behind "Men's Health" magazine's podcast. It's pretty cool.

Scot: All right. Wow.

Troy: We'll take it.

Scot: Yeah, I don't know if . . .

Mitch: We will take it.

Scot: . . . that's cool or that's more pressure. And joining us as always, Producer Mitch is in the mix.

Mitch: Hey, there.

Scot: And going to help us with our weak streams if any of us have weak streams . . . I think I might have a weak stream. I don't know. We're going to find out. Urologist Dr. John Smith, welcome.

Dr. Smith: Hey, thank you.

Scot: So weak stream. Hey, Troy or Mitch, how is your stream? Everything okay with the stream? You feeling pretty good about it?

Troy: The problem with a question about the stream, Scot, is I don't know what to compare it to. Should I be looking at guys in the airport in the urinals without the barrier there and just look at their stream? I don't know. I think my stream is good.

Scot: Yeah, or sometimes you listen, and it's like, "Oh, my gosh, what's that? About a gallon a minute coming out of there?"

Troy: Oh, yeah. Some guys are just like, "Wow." Yeah, it's something else. I feel like I've got a good strong stream, but I don't know.

Scot: All right. Mitch, do you want to comment or do you want to abstain?

Mitch: No. I know for a fact that I have an average or above-average stream because I've actually talked to a urologist.

Scot: Oh, you have?

Mitch: Yes, I have, about this very concern.

Troy: And you've measured it?

Mitch: They measured it. It's not like I measured it myself. There was a science to it that I'm sure Dr. Smith will be able to tell us all about.

Dr. Smith: So you objectively know you've got a good stream, it sounds like.

Mitch: I'm going to see if I can't pull up the graph. You guys might find that interesting, or gross. I don't know. Hold on. Keep going.

Scot: Dr. Smith, that's what we're here to talk about. I feel like perhaps as I've aged, maybe I've lost a little stream power. Maybe. I don't know. It varies. Some days I'm like, "Huh, this isn't coming out very fast." And then other days, things seem to be fine. So we're going to get into all of that. First of all, is stream something that we should be worried about as guys?

Dr. Smith: I think you should be at some point. I usually ask gentlemen about their stream and I ask them, "Do you hit the back of the bowl, the middle of the bowl, the front of the bowl, or your shoes?" But I think if you're a front of the bowl or shoes guy, we definitely should be having a conversation.

Scot: Okay. Has that been proven by research, that little method that you just told us about?

Dr. Smith: It's anecdotal, but it gives me a lot of information right up front without having to put them on a machine like Mitch.

Scot: Okay. All right.

Troy: So you're saying that for some men, full force, they're hitting their shoes?

Dr. Smith: Well, they shouldn't hit their shoes. That usually means they've got a problem.

Troy: Yeah.

Scot: And is this they're trying to actually actively push out, or should the urine just be coming out? Is that how you would measure the ideal stream measurement?

Dr. Smith: I'll answer that with talking about Mitch's machine. So we do have a machine. It's called the uroflowtometer. It sounds really, really cool. We shorten it to uroflow just to make things easier.

And they actually have one of these that you can get at home now. There's a company where you can get one of these at home. It's called the Stream Dx, and your doctor could actually send one home with you.

What this machine does is when you urinate, it takes the amount of urine that you're putting out over time, and then it'll also show us if you're actually straining to urinate and you're using your abdominal muscles to urinate, because you really shouldn't need to do that. You should be able to just open things up and let things go.

And some men notice as they age, they have to push a little bit more. The urine stream is not as strong as it used to be. Some younger men may notice that they had an abrupt change in their stream. And those can both be issues that need a little bit of attention.

Scot: Is it normally an abrupt change, or is it over time, or is it both really?

Dr. Smith: So, depending on what's going on, the thing that is the problem depends on whether it's more of a sudden thing.

So an abrupt change in stream is something where you want to get it checked out because it could be a narrowing of the urine channel or the urethra, anywhere from the bladder all the way down. That usually happens in a rather quick fashion, and that's something that can cause a problem.

A urethral stricture is usually the most common thing that we see in younger men who come in with an abrupt change in their stream. And that's a narrowing in the urine channel as a result of a traumatic event, or even just sometimes what we call idiopathic, meaning it happened and we have no idea why.

Troy: You talked about the abrupt change, suddenly something happens, but it sounds like probably what you see more commonly would be stuff that just gradually decreases over time.

Dr. Smith: Yeah. So the decrease over time thing generally happens with men as they age, and that tends to be more of a prostate-related issue. And that's the slowing down of the stream where you go to the restroom in the airport, or you go to the Jazz game, or you go somewhere and you're standing next to somebody and you go, "Man, that doesn't sound like what I've got over here."

And so that can be due to age-related changes in the prostate. The prostate is like your ears and your nose. It continues to grow until the day that you die.

Scot: I feel like this is a stupid question. What about kidney stones? Could that result in a reduced stream?

Dr. Smith: It can if it's lodged within the urethra. Usually, kidney stones that are in the tubes coming down the ureters from the kidney to the bladder don't usually slow your flow down. They just cause pain and make you miserable.

Mitch: You'll know if you have a kidney stone, and that's what's blocking things, right?

Dr. Smith: Usually, if you know you're passing a kidney stone and then you have a urinary flow change, you could have it stuck in the urethra, but it's less likely to happen because the tube coming from the kidney down to the bladder is very, very small. And compared to the urethra, that's very, very large in comparison. It'd be like taking a coffee straw and then a Boba straw.

Scot: Good reference.

Mitch: All right. Okay.

Scot: You're very topical, aren't you? So is it really only two things that might cause a weak stream, the narrowing of the urethra or a prostate issue?

Dr. Smith: No. There are other things too, but those are the most common things that I see in younger and older age groups.

Another thing that I see commonly across all age groups is something called pelvic floor dysfunction. There's also dietary things that can make urination more difficult. The big three that I always talk to folks about are caffeine, alcohol, and spicy foods, three things that can definitely make urination more difficult or problematic.

Scot: Back to that machine that measures stream pressure, do I have to stand up when I do that, or is that a sit-down deal?

Dr. Smith: Either one. So usually, you can stand up to do it if you're comfortable that way, but you can also sit down.

It's kind of a crude measurement. It pretty much measures the urine as far as a volume . . . actually, excuse me, as a weight of urine as it comes out. It measures how much weight is being added to this scale over time. And so initially, you're going to be adding less weight, the weight of the urine to this flowtometer. And as you build up speed and you reach your maximum flow, you're putting that weight in at a rate and then it graphs that in a curve.

And the normal curve looks like a bell curve that you would have in school when they would grade you and give half the kids Fs that are on that one end, and the other kids get As and everybody else is in the middle. That's what the uroflow, a normal one, would look like.

Scot: Hey, in the chat, click on . . . Mitch sent us this. Is this what we're talking about here?

Mitch: Yeah. Those are two examples of the machines.

Scot: The very first one?

Dr. Smith: I don't know how to get into the chat. Let me check and see.

Mitch: Yeah. I had something similar to the first one.

Dr. Smith: Yeah. That's exactly what it is. Did you order one of those on Alibaba?

Mitch: We are $500 away from knowing exactly how everyone's flow is going.

Scot: I know.

Dr. Smith: It's less than that if you just get your doctor to prescribe you a Stream Dx.

Mitch: You could probably DIY this. It looks like you could maybe do a bucket, a funnel, and . . .

Dr. Smith: One hundred percent you could DIY this.

Troy: It's just a funnel and some sort of measuring . . . Yeah.

Mitch: A scale.

Troy: A scale. That's right.

Dr. Smith: It really is. Then you've just got to be able to graph it over time and have that amount of stuff come in. But yeah, those are the normal graphs. If you look at that flow curve, you'll see what we see. That normal bell curve is pretty normal. And then the guy that has multiple different curves, they have an interrupted flow, that start, stop, start, stop that a lot of guys will talk about that have a slow flow.

Scot: What's up with this dysfunctional voiding curve? It goes way up and way down.

Dr. Smith: So usually, that's due . . . When they say a detrusor overactivity, the detrusor is the muscle that's in the bladder wall. And when that muscle is overactive, it has a spasm and just pushes with a high amount of pressure, and that's why you see the flow and the pressure go up.

Troy: Interesting.

Mitch: So you completely void the bladder in the first few seconds. That's why we're seeing such a high curve. I'm trying to make sure for listeners who can't see graphs . . .

Dr. Smith: Yes.

Mitch: Yes. Okay. Interesting.

Troy: I guess as I'm hearing this, though . . . I don't know if I have a weak stream. Maybe you go to a Jazz game or a sporting event or something, you hear other guys and it sounds like they just opened up a garden hose over there or something. I don't know. But the question is, does it matter? Do I need to buy the uroflowmeter and check out my flow, or what's the downside of having a weak stream?

Dr. Smith: So to a certain extent, it's not an issue. It can be and it is as people age. The big thing you want to make sure of is that you're emptying your bladder.

Now, the thing I always tell my patients is the urinary system, the bladder on out, is meant to be a low-pressure system. The sphincter that keeps the urine in your bladder and out of your pants opens up, your bladder squeezes, the urine goes out into the toilet, and nobody is the wiser. And that's supposed to be done in a low-pressure setting.

As we age, the prostate gets bigger and closes down the opening of the prostatic portion of the urethra, making it a higher-pressure system. Now, that's not a problem until it becomes a problem.

I know that's very specific, and so what I usually tell people is there's a certain point where that pressure builds up and the bladder can't keep up with it and you start to have residual amounts of urine where your body is not emptying the bladder completely. That can cause a problem, increase your risk for infection.

But also, as your bladder increases the pressure, it can also push pressure back up the ureters towards the kidneys, and long-term can cause kidney damage. And so that's the reason where if you think there's a problem, you should probably have somebody take a peek at it.

Troy: Would you have other signs also that would maybe suggest that there was an issue there?

Dr. Smith: Yeah. So normally, we call these lower urinary tract symptoms. Some doctors will just say LUTS. That's the lazy way to say it. But it's pretty much a non-specific group of things like going to the bathroom more frequently, having increased urgency to get to the bathroom. When you have to go, you have to go now. I call it the "gotta-gos." You can have urinary hesitancy, difficulty getting things started. You can have nocturia, which is waking up multiple times at night to go to the restroom.

Those are all considered lower urinary tract symptoms. And there are a few others that are involved there that make the rounds.

And so again, those are the things that you may also experience in addition to a slowed urinary flow. People may also say, "I don't feel like I'm emptying. I just feel like after I'm done, there's more there."

Scot: You probably already explained this, but I just want to be clear. So first of all, I thought a weak stream was indicative of maybe some health problem. But other than the fact that you might not be getting all the urine out and over time that can cause an issue, a weak stream in of itself isn't necessarily a bad thing.

Dr. Smith: Not necessarily. It does depend on how weak the stream is and what's going on upstream. Some people have intermittent weak stream, like you were saying. Some days, it seems like it's weaker than others. Usually, that's due to caffeine, alcohol, spicy foods, things like that, where people notice, "Oh, if I drink four cups of coffee, I tend to go more frequently and have urgency and may not feel like I empty well," or whatnot that way.

Mitch: So the reason I got tested was I was urinating a lot more frequently last year, and it was enough that I was worried to go to the doctor. They had me use the uroflow, test everything out, and then come to find out I was just drinking a pot of coffee a day because of the two jobs I was working. So it was a whole thing.

Dr. Smith: Yeah, you're not uncommon. A lot of times when people come in, I usually check for lifestyle things. Guys that go to Buffalo Wild Wings and they have a couple of beers and then they go home and they notice that their urinary system or their urinary function is more frequent, less frequent, those types of things, I tell them, "If you know that's happening to you, then it's self-inflicted and you know how to change it."

Or the guy that drinks a pot of coffee and I say, "Hey, you just need to drink less caffeine or no caffeine to make your life easier and make your urinary system better."

Troy: I guess hearing this, too, it makes me wonder, and hearing Mitch's experience, do you find that people think their stream is too weak and they overreact and so you see a lot of these cases where, "Hey, your stream is fine"? Or do you find that a lot of guys just put this off and ignore it and then come in when they have a really weak stream?

Dr. Mitch: So I see both ends of that spectrum. I have the guys who when something seems to go wrong from the waist to the knees, they immediately are in your office, and the other guys that don't think it's a problem and come in once their bladder is no longer functioning and they have a liter and a half of urine in their bladder and don't know it.

So those are kind of the extremes, but I do see both angles where people are very worried about their current urinary flow, and then others that are like, "Oh, yeah. It's been like this for 15 years," and they don't do anything about it.

Troy: Yeah. See, John, I'm just worried I'm going to be the guy with a liter and a half in my bladder. I'm going to finally show up and be like, "Something is wrong here."

But again, it's hard to tell. Now that we're talking about all this stuff, I'm thinking, "Yeah, I do get up two or three times a night," and, "Yeah, sometimes I really have to go." So it makes me wonder. I don't know. Maybe I need to get checked out.

Dr. Smith: Well, Troy, I'm not going to age you at all, but I'll just give what I tell people. Over the age of 50 to 55, everybody, both men and women, gets up once a night. It's pretty normal. So once a night is not a huge issue.

When you start getting up two and three times a night, that tends to be a little bit more pathological where you may want to even just get it checked out.

Troy: I might need to. I do drink a lot of water. We've talked about that before. So I don't know if that's part of it. Hearing Mitch's experience, it sounds like there was a lot of coffee consumption going on and a lot of caffeine. I just drink a ton of water. So I've always chalked it up to that, but I don't know. Yeah, it sounds like maybe I should get checked out.

Dr. Smith: Well, some homework you could do too is if you cut the liquids off a couple hours before you go to bed and then you notice that you don't wake up as much.

I have plenty of patients who come in and they're like, "Yeah, I drink two glasses of water before I go to bed and I wake up two or three times." I said, "Yeah, go figure."

Mitch: That's how I felt after we had done all this testing and everything and he's like, "You're drinking how much coffee a day?" And I'm like, "Yeah, it's about a pot of coffee a day. Of course, I'm urinating more. No duh."

Troy: Exactly.

Dr. Smith: You're putting eight cups of a diuretic into your system and then drinking a liter and a half water. You're going to be going to the bathroom. And the same thing, if you drink 32 ounces of water before you go to bed, you're going to wake up to go to the bathroom.

Troy: Yeah. That is true.

Scot: I feel like this conversation has expanded beyond weak stream. We're talking about going often or going in the middle of the night. Is it all really related?

Dr. Smith: Yes. When it comes down to a lot of that, a lot of times people come in and once you ask them those more probing questions, "Do you have increased frequency, urgency, your stream is weak? Do you feel like you're emptying well? Do you have hesitancy? Do you start and stop your flow?" those types of things, usually it's not just, "Oh, I thought my flow was weak," and that's it. There's usually a yes to multiple of those other questions.

Scot: Okay. And then how do you avoid being the person that's in your office when anything goes wrong between the pelvis and the knees, you said?

Dr. Smith: Yeah, the waist and the knees.

Scot: Yeah, and being the person that should have been there two years ago. How does a guy that's listening figure that out? I think a lot of us guys don't go to the doctor because we're like, "Oh, it's probably nothing," or we don't want to be a bother, or it can be a hassle, or whatever. So how does a guy figure that out?

Dr. Smith: I think you use your best judgment if you think it's slowed down enough that you want to get it checked out. But other things you can do are just lifestyle modifications. Mitch could have probably cut the coffee down before he went into the urologist and seen if there was a difference. Troy can cut water off before he goes to bed, and see if that makes a difference.

You can do lifestyle modifications where you decrease the amount of caffeine you intake, alcohol, spicy foods, see if there's anything dietary related. Then you can also watch your intake before bed. Make sure that you're putting yourself in the best position possible to see how your urinary system functions without any of those additives that may make your life worse.

Troy: And what about the person who's listening right now, just like me listening to this, and just thinking, "I've wondered if there's an issue"? Would it be a simple test to just say, "Okay. I've got to go urinate right now"? You go and you urinate, and your stream is hitting the back of the bowl without a lot of effort. Are you good?

Dr. Smith: That's the reason that I ask that question, because it lets me know how worried I should be about those folks.

The other thing is to go ask those questions to . . . If you've got a significant other, that's my favorite when the patient comes in with their spouse.

Scot: Oh, no.

Dr. Smith: I go, "Is your stream weak?" He's like, "No. It's good." And you just look over their shoulder and their significant other that's with them is just shaking their head like, "He's totally lying."

Scot: Is that because they're the one that cleans the toilet? Is that what's going on there?

Dr. Smith: Guaranteed. Yeah. Or washes the shoes.

Troy: You're just a poor aim, or what?

Dr. Smith: But you'll see a lot of them like, "Oh, do you wake up much at night to go to the bathroom?" They're like, "No. I maybe wake up once," and their partner looks over at them like, "No, he wakes up like four times at night." So they'll keep you honest a lot of times.

Scot: Yeah. It sounds like that's something to watch out for as a guy, is just that sometimes maybe we disillusion ourselves a little bit. We need to take an honest look at these types of things.

Dr. Smith: Absolutely.

Troy: Again, just for my own peace of mind, it sounds like if you do go to the bathroom and you are hitting the back of the bowl without a lot of effort, you're probably okay.

Dr. Smith: Yes. I would say that's a pretty good idea. If you're not forcing the urine out and your flow is coming out pretty robustly, you're okay.

Now, if you have any questions, Troy, you just give me a buzz. We'll get you into the office.

Troy: Okay. I'm a little nervous now because the whole night thing, that's got me thinking, "Maybe I need to get things checked out." Anyway, I'm feeling okay about things.

Scot: But there are not other symptoms, though, really. Are there?

Troy: Sometimes, like John said, the whole gotta-gos things, sometimes I'm just like, "I've got to go." But again, I've always just attributed it to I drink a lot of water. So maybe I'll cut back on the water a little and see what happens.

Scot: Hey, if you guys want . . . Hey, Dr. Smith, can you write us a prescription for that thing? Do you guys want to have a little competition?

Mitch: There's no need to make this a competition.

Dr. Smith: I'm sure we could figure that out. Not that we need to make this a competition, but I think we could probably figure that out.

Mitch: I'm worried this is going to be like the pushup competition where it's going to be a recorded thing and John is going to be the referee watching and like, "Okay. Go for it, Mitch. Let's see what you can score."

Dr. Smith: Well, I don't have to watch. I have the machine give me a printout, so it makes it much less awkward.

Troy: That's good.

Scot: And then that's a little souvenir for all of us. We can each have our own little printout when we're done. So that'll be fun. Put that up in the office next to the diploma or whatever.

Mitch: Man.

Troy: Yeah. Exactly.

Dr. Smith: You can do that live on . . . not a podcast. You can make a vlog and throw that up.

Troy: Yeah, just like, "Here we go." This is University of Utah Health at its finest.

Scot: Any final thoughts, Dr. Smith? Anything that you feel compelled to say? Anything we should have hit or should have mentioned, or a wrap-up that you'd like to give a guy?

Dr. Smith: No. I think if you're worried about your stream and you do have any questions or concerns, getting in sooner rather than later is definitely better for you. So if you do have concerns, just pick up the phone, make a phone call. It's a pretty easy visit. It's nothing to be overly concerned about. You can check things out pretty quick and get some good objective answers and give yourself a lot of peace of mind.

Scot: And is that a urologist you're going to go to, or would your primary care physician have this equipment to do this?

Dr. Smith: If your primary care has this equipment, I would be very, very surprised. You want to call a specialist like a urologist, yeah.

Scot: Okay. Great. Well, Dr. Smith, as always, it's great having you on the show. Thanks for being a part of it, and thanks for caring about men's health.

Dr. Smith: Hey, pleasure is mine, guys. Thanks for having me. It's always great to be with you.

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: Erectile dysfunction can cause stress, self-confidence, and relationship problems, but making sure that you get the right treatment specific to your situation is important as well.

And that's why we've got Dr. John Smith, he's a urologist at University of Utah Health, on The Scope with us today. I wanted to talk to Dr. Smith about if a patient comes in with erectile dysfunction, what are some of the things that you do, what are some of the things you look at? But I think the first thing, Dr. Smith, that I do want to talk to you about is it seems like there's kind of this thought that maybe men are still embarrassed to go talk to their doctor about erectile dysfunction and any tips for overcoming that.

Dr. Smith: You know what, just it's okay. It happens. If you really look at it, I would say, in my practice doing men's health at the university, that's a majority of what I see. So you're in a majority, not a minority when you come to my clinic.

Interviewer: Yeah. I think another thing to keep in mind too is it's a lot of things that could cause erectile dysfunction, I mean, from physical to mental. So it's not necessarily like any sort of personal thing. It's not about you. It's a system. It's a complicated system, and that's one of the things that I want to get to today. So what are some of the causes?

Dr. Smith: So there's quite a few things. Some medical conditions can cause it. Diabetes is one that's well known. Gentlemen who've had prostate cancer and had treatment for that is another common one. Another probably less commonly known one is, you know, having stress in your life, whether it be at work, at home, relationship issues. The complexity of life can kind of get at you sometimes and wreak havoc on your body's libido and erections.

And sometimes its underlying medical conditions we don't know about. So we mentioned diabetes and prostate cancer that's been treated, but some folks with underlying, you know, cardiovascular problems that they don't know that they're there may also have a sudden onset of erectile dysfunction that could be kind of a harbinger of other things.

Interviewer: Yeah, that's interesting. So erectile dysfunction could be a symptom of, like you said, a lot of other just physical conditions we've all heard about before. So if somebody is experiencing erectile dysfunction and they come into your clinic, what does that visit look like? How do you try to figure out the best treatment for that individual?

Dr. Smith: So I bring folks in and we sit down and we start to have a conversation. I like to get a nice history of, you know, what's gone on, if they have past medical problems, and kind of also get kind of their social situation, what's going on relationship-wise and other things in their life, you know, work-wise, see and look at the whole individual and see, you know, kind of what could be causing this issue. And if we can put our finger on something specific, like they've been a diabetic for quite some time and this has been a long time coming, you know, that's one thing, or if they come in and it's just kind of a sudden onset thing, where stress, you know, went up in their life and they just noticed kind of a more sudden onset and kind of get a real feel for what brings them in and what kind of things we can do to help them. I like to get a testosterone on folks that come in to make sure that there isn't some kind of an endocrine issue going on as well as make sure, with my history and physical exam, that there may not be some other underlying condition that may be, you know, more problematic.

Interviewer: What's the next step in treatment? Obviously, if there's an underlying condition, the first goal would be to treat those underlying conditions. I'd imagine you want to make sure that those are taken care of. But what's the next step at that point?

Dr. Smith: For a lot of folks, you know, exercise can increase erections. You know, diet and exercise can be a great improvement for some folks who may have a few extra pounds and who may not be as active as they once were. That can help boost testosterone levels and also just kind of help them in general. If that's something that, you know, they're not really keen on or they're already doing and they're still having erectile dysfunction, you know, sometimes we'll trial medication to see how that can help them to have maybe a little bit more confidence or help their erections to be of a higher caliber or quality.

Interviewer: What types of medications are available? I mean, we've all heard of the one, right? Are there other types that do something different?

Dr. Smith: So in the class of drugs like the little blue pill that we've heard of so much, many of them have gone generic now. So the Viagra now is generic as sildenafil and Cialis is now generic as tadalafil. There's also Levitra, which was hot on the market for some time. That's also known as vardenafil. Those have all gone generic and have become quite inexpensive as treatment options. And there is some differences between those medications that we kind of go over with patients to make sure that we're getting them the right medication if that's the course that we go to.

Interviewer: Other than pills, are there things that you do for treatment options before you think surgery?

Dr. Smith: Of course, of course. There's multiple of different things we can do up until surgery. There's constrictive devices. The layman's term would be a cock ring. That can help people who are able to get an erection, but have difficulty maintaining it because that's part of the erectile pathway as well. If they have what we call venous leak, where their penis is letting out more blood than is coming in, you can lose that erection. And so sometimes those constrictive rings can really help during sexual intercourse. You can't leave that on for an elongated period of time. You use it during your sexual encounter, and then it's got to come off so it doesn't damage the tissue surrounding it because of the pressure. But that's one thing that we can do if we suspect a venous leak. That's why a thorough history and physical and understanding what's going on with a patient's erections, when they come in, can kind of lead us down a path to treat them with that rather than medicine.

Interviewer: What if the problem that is causing the erectile dysfunction is more of a mental issue? First of all, what types of mental issues kind of get in the way of that? And then what would you do to help somebody with that?

Dr. Smith: So one of the things is we call it psychogenic erectile dysfunction, where physiologically there's absolutely nothing wrong with the patient, but they're having difficulty with an erection. And I've seen this quite a bit with a few different types of patients. Someone who's been in a new relationship or had something like that, where they've had difficulty with their performance say, that can kind of ruin their psyche and kind of gets you down and then they have problems continuing. Another one that's fairly common is once people have started to try to conceive children, when sex kind of becomes a job at that point, sometimes I've seen men who kind of have difficulty with an erection because now it's not a spontaneous thing or it wasn't as fun as it used to be. Then I'll see them come in and say, "You know, I've had some trouble. We've been trying to have a kid for six months. It's been difficult, and I'm just, you know, a little short on the confidence thing, where this has kind of become more of a job than anything else."

Interviewer: And then ultimately, when a patient leaves, will they be coming back at some point then?

Dr. Smith: I generally say, "Here's the medication. We'll start with a dose." And I usually let them titrate the dose up or down depending on if they need additional medication within safe limits. And then I bring them back within, you know, a few months to make sure that that medication is effective, because if it's a not, I want them to know that we can look at other avenues and options to make sure that we can take care of their erectile dysfunction.

Interviewer: So the ultimate message is that if somebody is experiencing ED, that there is a solution for it. You can help in most cases.

Dr. Smith: Seven out of ten men will do well with just pills alone and, you know, beyond that, we can help them with other avenues as need be. So there is hope we can definitely help folks to get to their goals.

Interviewer: Are there times that you decide with a patient not to treat it because it just ultimately doesn't matter? Like they come there because they think that it is a problem, but ultimately, they're just kind of like, "Well, I really don't care."

Dr. Smith: Yeah. I've seen that, not too often. I mean, it's mostly older patients who may be like post-prostatectomy, who come in and they're not partnered anymore. They're, you know, either a widower or they're divorced. They don't have a partner. And it's like, "Why am I going to give you pills that may give you a headache or flushing, or, you know, those types of things when I don't really need an erection at this point?"

Interviewer: Yeah. Got you.

Dr. Smith: So those aren't as common. But I think some guys, when they come in, the younger guys as well, but they usually want a pill as kind of the ace in the hole to have in their back pocket so that it gives them a little confidence, to be honest.

Interviewer: Well, yeah. I mean, there's something to be said for that, right? They might not even never need to take it.

Dr. Smith: Oh, I've had tons of guys come in that are psychogenic erectile dysfunction, who come in, you know, in their 20s and 30s, who there's not a darn thing physiologically wrong with them. They have no underlying medical conditions. They go to the gym all the time. They're otherwise healthy. It's just they had that one sexual encounter and it didn't work, and now it's never going to work again.

Interviewer: But then you've got that pill. At least, you know that if worse comes to worse and that pill and you might not even need it.

Dr. Smith: Yeah. Well, and that pill potentiates things. I mean, once you get an erection, that pill will help you keep it. And that's the whole point of the pill. And so those guys totally, you know, it's total placebo, but not at the same time, if that makes sense.

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.

Scot: Nobody's got any questions? Good.

Dr. Smith: I thought you brought the questions.

Scot: I do. I've got the questions.

Troy: That's Scot's job.

Scot: That's right. I have two jobs. One is to provide everybody with microphones, although you bought your own, so I feel pretty . . .

Dr. Smith: I did. I brought the heat today.

Scot: Yeah, Troy, Dr. Smith bought his own mic.

Troy: Exactly. Why buy it when you're getting it for free? You gave me mine, so I'm like, "I'm not spending money on this thing."

Dr. Smith: Well played.

Scot: It's "Who Cares About Men's Health." That's the name of the podcast. What do we do here? We provide information, inspiration, and motivation to understand and engage in your health so you can feel better today and in the future. My name is Scot Singpiel. 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 John Smith. I'm a non-surgical urologist at the University of Utah and I care about men's health.

Scot: All right. Dr. Smith, Dr. John . . . can I call you John, Dr. Smith? Is that okay?

Dr. Smith: You can surely call me John.

Scot: It's John's first time on the show. Welcome. This is exciting.

Dr. Smith: Thank you.

Troy: Welcome, John. Thanks for joining us.

Scot: I noticed Troy is not clapping. He's not nearly as excited as I am, but that's okay.

Troy: I'm very excited.

Scot: He's tough to win over sometimes, so . . .

Troy: Thanks, Scot.

Scot: We'll see how you do.

Troy: We'll see how you do. I'm still warming up to you, so . . .

Dr. Smith: We'll see if I can get him to clap by the end of the show.

Troy: We'll try.

Scot: Dr. Smith, thank you for being on the show. We're going to do some listener questions today. We're going to get to those in just a couple of seconds. But first, Troy, I'm curious, as an emergency room physician, what is the general take in the medical field on urologists? Like, when I said, "We're going to have a urologist on," what goes through your mind?

Troy: What goes through my mind? Well, we very regularly talk to our urologist. We see all sorts of urologic emergencies in the emergency department, whether it's trauma related or other issues we're seeing. They're people we talk to frequently. So, it's someone we rely on in the emergency department and we're very grateful always to have their assistance.

Scot: All right. So, it's great to have their assistance. But, I mean, what do you really think about urologists in general?

Troy: Scot, what are you getting at here?

Scot: I mean, in all fields of medicine, isn't there a little friendly competition between you all and there's some . . .

Troy: I'm jealous of urologists. It's a great field. It's a really great field. It's a very competitive specialty. It's a great field. It's one of those things where the people I knew who went into urology in med school were great people, like good friends of mine. I think it's a very well-respected specialty.

Scot: Dr. Smith, are there some urology stereotypes out there?

Dr. Smith: Oh, of course.

Scot: Yeah? What are some of these urologist stereotypes? Because I think I've noticed some patterns when I've met a few urologists.

Dr. Smith: I guess, on the other side, I . . .

Troy: Are you just trying to get him to cracks and dirty jokes? Is that where we're going, Scot?

Scot: Anything for ratings.

Dr. Smith: There are a few urologist jokes out there that are semi-family-friendly.

Scot: Well, hold on that because, actually, at the end of the show, I'm going to ask you to end with a urologist joke. So, hold on to that, okay?

Dr. Smith: Well, I'll save my favorite for then.

Scot: All right. But are there kind of some stereotypes in the medical field when it comes to urologists? It seems like urologists tend to have a better sense of humor than some of the other specialties. They're cracking jokes a lot. Is that fair or . . .

Dr. Smith: I would agree with that, I think. Most of them are good-natured, fun-loving guys and gals that they like to have a good time, but they also are very intelligent, like to work hard, and take care of folks.

Scot: All right. Sounds good. I can't wait for the joke at the end though. I'm really looking forward to that. That's going to be great, a good urologist joke.

Troy: Yeah. Stick around for the joke. For no other reason. We've got a good joke on the way.

Scot: These questions for our urologist, Dr. John Smith, came from a few different sources. First of all, we have a listener line. You can call and leave a message, and that is 601-557-2673, or easy way to remember it, 601-55SCOPE. You could also email hello@thescoperadio.com, and we also got a few Facebook direct messages. So, if you have a question for a urologist, those are the channels that you can get those to us.

Troy: Sure, it's our bodies, but it's something that's obviously very personal and people crack jokes about their genitalia, and so I think it's one of those things where, yeah, it's something that . . . And it really gets at the essence of our manhood. If you're talking about erectile dysfunction, sure, it's a medical issue, but it really gets at the essence of your virility and your manliness. So, I think it's tough to bring up and it's tough to really be willing to address it, for sure.

Dr. Smith: I think that's true. And then you also have the society stereotypes. It does get to the heart of manliness. A lot of people feel like, "Well, if I can't perform, I'm not a certain one way or another." I mean, I've heard it all from different guys who have different perceptions of things.

Scot: If you want to ask a question and you are a little embarrassed or hesitant, we're going to make this as simple as possible. So, you can say that you're asking for a friend if that makes you feel better. We'll totally believe that. You don't have to use your real name. You can make up a name. You can even use a fake name that's obviously fake, like John Smith, for example. We're just trying to make it super safe. And as a matter of fact, we're making it so safe that we have a urologist who's obviously also using a fake name. So, this is about as anonymous as it gets.

Dr. Smith: Witness protection has been good to me through the years.

Troy: There you go. Nice.

Scot: All right. Here we go. Question number one.

John: Hi. My name is John Smith and I'm calling in the urology line to ask the question "Can guys really get urinary tract infections?" I thought that was more of a woman thing. Anyway, just asking for a friend. Thank you.

Scot: Okay. So, yeah, great question. I guess I am in the same camp. I guess I figured that urinary tract infections, mainly women get them. Can men get them?

Dr. Smith: So, a couple of different reasons why a man would get a urinary tract infection. As men age, their prostates continue to grow. Your nose, your ears, and your prostate continue to grow, but they only told you the first two in school growing up. But when your prostate gets larger, it can obstruct your urinary flow and predispose you to urinary tract infections. That's one of the most common things that we'll see. A gentleman has urinary tract infection and he's older, prostate is generally the cause.

Scot: What if you have to pee and oftentimes find yourself in a situation where you have to pee but you don't have the ability to do so? Can that cause urinary tract infections? If you're a long-haul truck driver or something like that and you're not going to the bathroom as often as you should . . .

Dr. Smith: You can predispose yourself to that. It's less likely. If there's not an obstruction . . . so I tell my patients, "You're either a pond or you're a river." And what that means is if you've ever been around a pond of stagnant water, you know what happens to it. A river generally doesn't look like that.

Scot: All right. And what does that urinary tract infection feel like? I mean, I've heard about it a lot from men and women in my life, but . . .

Dr. Smith: So, it depends on . . .

Scot: And rightly so, it's painful.

Dr. Smith: It sounds awful, yeah. It's miserable.

Scot: I can get myself in trouble here.

Troy: You are going to get yourself in trouble, Scot.

Dr. Smith: Asking for a friend, right, Scot?

Scot: Yes. Friends have told me they've heard this.

Troy: Yeah. Women in your life have said things . . .

Dr. Smith: "I've heard . . ." So, generally, folks will end up with dysuria or burning with urination. Some people go to the bathroom more frequently. Some guys will get kind of groin pain, flank pain. Testicular pain can also occur. Those are signs that you could have that. Fever and chills can also be a sign.

Scot: Yeah. The good news about all those symptoms you mentioned, if any of that stuff start happening on a regular basis, I think I'm going to go visit a doctor.

Troy: Yeah.

Dr. Smith: You probably should.

Troy: Those aren't subtle things. Once you start seeing blood in your urine and burning, you're going to get checked out.

Scot: Question number two, this one is one that came in through Facebook Messenger. No shock here. It's from John Smith and asking for a friend. "Is there any legitimacy to exercises that promise more size, girth, stamina, those sorts of things?" You know those emails you get that say, "Do these exercises and all these good things will happen."

Troy: Now, you're referring to bicep girth, or what's the gist here, Scot?

Scot: These emails are generally in your junk folder and they're promising . . .

Troy: And referring to your junk. Okay, right. Got it.

Scot: Yes, exactly

Dr. Smith: That's why it's a junk mailbox.

Troy: That's right. Got it.

Scot: Yes, because that's all that's in there. Dr. Smith, is there any legitimacy to any of those exercises?

Dr. Smith: I can't confirm that there's any legitimacy there to any of that stuff. The one thing we do know is that diet and exercise can help the quality of your erection for men with kind of mild erectile dysfunction. But there are no exercises or stretches or anything that has been shown to be super effective in that category.

Scot: All right. And even those ones that are for medical use, I'd imagine, if you were experiencing something like that, probably best to visit a physician first and use those under the guidance of a physician, not just kind of a do-it-yourself thing. Or is that okay?

Dr. Smith: Absolutely. You want to be evaluated to make sure that you're a candidate for a lot of those devices. It's always smart to go see a doctor. When in doubt, you should probably go and see a physician about things. It just makes sense and it's safer that way to kind of be under the guidance of someone who's done this before.

Troy: Any downside to using those devices? Have you ever seen things go wrong with those sorts of things?

Dr. Smith: So, I've seen some folks come in with certain cultural injections that they've had put into the penis and things that have promised to give increased size or girth, where they've had an infection from that, and had to have some things taken care of that way. I've also seen people who have tried to inject caulk or silicone.

Scot: What?

Dr. Smith: Oh, yeah.

Scot: What? How? Where?

Troy: Just like something from Home Depot, like some silicone caulk or something?

Dr. Smith: Exactly.

Scot: The way I'm imagining that they would inject it, I mean, there's like one way that I'm thinking that gets in there.

Dr. Smith: And you're probably thinking of it the right way.

Scot: Okay. Wow.

Dr. Smith: I've also had people who've come in with urinary retention who've placed things like that inside their urethra to try to help with rigidity of their erection, so . . .

Troy: Wow.

Scot: Wow. There's a do-it-yourselfer right there.

Troy: So, when you say inject, you're not talking . . . they don't have a needle. They're just going in the urethra, right in the hole there, with the silicone.

Dr. Smith: Oh, no, both ways.

Troy: Both ways? Wow.

Dr. Smith: Oh, yeah. A lot of them will get an infection under the skin because they've injected some of those things at times.

Troy: So, they've injected with a needle under the skin and then just shot it directly in the urethra? Wow. That sounds like a recipe for disaster.

Scot: You haven't had any of those come through the emergency room ever, huh, Troy?

Troy: I have never seen that. After 15 years of doing this, you think you've seen just about everything, but that is one thing . . . I mean, I've seen some crazy things and some crazy things people have put in their urethra, but I've never seen silicone shot in the urethra. That sounds awful.

Dr. Smith: You must not work nights, Troy.

Troy: I worked plenty of nights, yeah. That's just one thing I haven't seen. It's crazy. I haven't seen it, so . . .

Scot: Wow. All right.

Troy: Interesting.

Scot: So, question number two, is there any legitimacy to exercise to promote more size, girth, or stamina? According to what Dr. Smith says, there's no real good research that says that there is. So, don't spend your money on that stuff, I suppose, and don't be injecting either.

Troy: But he did say, though, and it's worth noting, it sounds like . . . John, you did mention that exercise and diet can improve the quality of erections. Maybe not necessarily just the size of a man's penis, but it sounds like there is potentially benefit from diet and exercise.

Scot: And it comes back to that core four that we talk about here. To stay healthy now and feel good now and in the future, you want to work on your nutrition, your activity, your sleep, your stress management, and, of course, know your genetics as well and manage those addictive behaviors and those nagging health issues. So, diet and exercise, it seems like it always comes back to that.

John: Hi. This is John Smith here and I'm calling about the "Who Cares About Men's Health" podcast. I was just wondering if I found a lump on my testicle, is it cancer? Just curious.

Troy: So, Scot, were these guys all planted? Did you tell them just to make up the name and call themselves John Smith?

Scot: On the Facebook page . . .

Troy: What are the odds?

Scot: Here's the thing. On the Facebook page, I said, "If you don't want to use your real name, use an alias like John Smith. You could also say you're asking for a friend." I'm trying to . . .

Dr. Smith: So, you set all these guys up then. Okay.

Scot: Dr. Smith, lump on testicle, does that mean cancer?

Dr. Smith: It does not mean cancer. It can mean cancer, but it quite often does not mean cancer. The other thing is a lot of men like to say, "I have a lump on my testicle," and then I'll do an examination and it's not even on the testicle. There's something that's very common called an epididymal head cyst or an epididymal cyst. Sometimes people will call it a spermatocele. It's kind of a cystic little area of the epididymis, which they can continue to grow, get larger. And a lot of times, men will notice those and they think that there's something going on. I see quite a bit of those, especially younger and middle-aged men.

Troy: So, John, I guess that raises the question as well, as a young man going through sex education in fifth grade, I was taught I should be examining myself every month in the shower to feel for lumps and bumps, get it checked out, and then from my understanding, it's kind of gone out of vogue. Is that something we should be continuing to do, that men should do?

Dr. Smith: So, I think self-examination is important. The biggest thing is just knowing your body, knowing yourself. I don't know that marking the calendar for the 24th of every month to check your scrotum is the way to go. But, you know . . .

Troy: So, you're saying I've been doing it wrong?

Dr. Smith: No, I'm saying you're probably doing it just fine.

Scot: That's so weird. I was over at Troy's house and saw the calendar on his kitchen refrigerator. I'm like, "Well, that's weird, but okay." But now I understand.

Troy: Scot's like, "What's TSE?" "Scot . . ."

Dr. Smith: But yeah, I think to know yourself . . . I mean, most guys, if you have the opportunity to just check things every once in a while and make sure that things are normal. And if anything feels abnormal, it's worth coming in and having someone take a peek at it.

Scot: Yeah, and . . .

Troy: It sounds like . . . oh, sorry, Scot.

Scot: Go ahead.

Troy: It sounds like from what you're saying, though, you don't have to feel like you've got cancer. It's worth checking out. What percentage of these cases that you see actually end up being cancer, people that come in for lumps and bumps they're concerned about?

Dr. Smith: So, for me, it's a lower percentage that I would see that are cancer. Most of them are these very small little lumps that end up being epididymal head cysts or things like that. Testicle cancer, or testis cancer, you tend to have your testicle . . . it feels like a rock. It changes its consistency more so than just a teeny little lump or bump. Those teeny little lumps and bumps are often benign. However, you will find some of those that are cancer, and so it's good to just get it checked out.

Scot: You know what? This is a podcast about understanding your health, and here I am, not going to be as educated as I'd like to be, I discovered a lump about 10 years ago, went in, and it was . . . help me out here. It was benign. They did an ultrasound on it and it was on the spermicidal cord. That's not right, because spermicidal is some . . .

Dr. Smith: Yeah, the spermatic cord.

Scot: Spermatic cord, yeah. It was just something on the spermatic cord and they just said, "Watch it." And if it ever starts hurting, that's when I need to come back. Otherwise, don't worry about it too much. Did I get good information?

Dr. Smith: You did. That's in a similar family to those epididymal cysts. It's in a different location. But those cystic structures, they just end up . . . it just turns into a little sac of fluid, a little sac of water.

Troy: John, getting to your point here, this is kind of what I see too in the ER. We do occasionally see people who come in for this and they find a lump. They're concerned. They don't want to wait to try and get in to see a urologist. But it's a small percentage of the time it's cancer. But like you said, it's worth getting checked out, get an ultrasound just to make sure everything's okay.

Dr. Smith: And ultrasounds are relatively inexpensive, too. There's no reason not to get one, really.

Scot: And probably not go to the ER for it.

Troy: Yeah, not necessarily.

Scot: Unless Troy's on at night.

Troy: Yeah, unless it's 3:00 a.m. on a Friday night, because I have nothing better to do then. Please come in.

Dr. Smith: Well, a lot of times, a good primary care doctor will order an ultrasound for you and get you a referral to the urologist's office where you can get some peace of mind. Because specialists can be difficult to get into at times, but . . .

Scot: All right. Well, that was a good session. How are we feeling about that? Dr. Smith, how do you feel about your first experience on the "Who Cares about Men's Health" podcast?

Dr. Smith: I like it. It's a lot of fun. I think I feel a little ill-prepared at times because there's always more. I mean, in medicine, it's never just as simple as the wham-bam, as Troy will tell you. But I think this is great. I appreciate you guys having me on. It's a lot of fun.

Scot: It's been a lot of fun having you on. And now, the moment you've all been waiting for. Oh, boy. I tell you what. I'm sure that everybody woke up this morning thinking . . .

Troy: I thought it was this, Scot. I thought it was me clapping.

Dr. Smith: Is that Troy clapping?

Troy: I'm clapping.

Dr. Smith: Wow.

Troy: I'm clapping for John. He did a great job. I've warmed up to him now. I'm going to give him some applause. So, it's great having you on here, John.

Dr. Smith: Hey, I appreciate you guys having me. This has been a lot of fun.

Scot: All right. Time to end with a good urologist joke. Dr. Smith, go ahead.

Dr. Smith: All right. What does the urologist say before he starts the procedure?

Scot: What does a urologist say before he starts the procedure? Troy?

Troy: I don't know.

Scot: I know what a urologist says if he or she has a breakthrough. They say, "Urethra!" But I don't know what the urologist says when they start the procedure.

Dr. Smith: "It won't be long now." That's my dad joke/urologist joke. It works for both.

Troy: Yeah. That's good.

Scot: Fine work. Thank you so much for being on the podcast, Dr. Smith, and thank you for caring about men's health.

Troy: So, Scot, I'm just going to leave this here. The silver lining in the pandemic, I think, for a lot of us . . . I know you've talked about some different things you've done. But one thing for us is I've gained a greater appreciation of getting takeout. We have now done where we're regularly getting takeout at least once a week from a local place. We like to try different places out. We really had some pleasant surprises in trying out new places where we'd never eaten before.

Scot: So the takeout always goes home.

Troy: The takeout always goes home because, otherwise, the dogs are leaning over the takeout and drooling in it. That never goes well.

Scot: Maybe you could take the takeout to a park sometime, though.

Troy: We could.

Scot: They could watch squirrels and . . .

Troy: They could watch squirrels and then try and jump up on the picnic table and eat our takeout.

Scot: Just going to leave this here. So, last week, we had "windmaggedon." I don't know what people are calling it. They called it the inland hurricane here in Utah, in the Salt Lake area, in the valley where we had these category two hurricane winds. Now, the difference being that we didn't have water, and the other difference being that category two hurricane winds are constant and these were just the gusts would be up to category two.

Troy: But talk about that feeling of the haves and the have-nots. It was 7:00, 8:00 at night. The sun is going down. I look across the street, and all the houses on the other side of the street, their lights are on.

Scot: That was us, too.

Troy: Like, "Wait a second. This is not fair. I'm over here . . ."

Scot: I know.

Troy: Yeah. "I have nothing here." I am here in my 50-degree house with no heat and my neighbors all are just enjoying it and their heat is on, and their lights are . . . I'm like, "Wait, this isn't right."

Scot: That's when you find an outdoor outlet at your neighbor's and run an extension cord across the street.

Troy: Exactly. That's a good thought. I did not do that. I should have.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. As always, thanks for listening. Please subscribe if you like the podcast so we can be sure to be in your podcast player of choice every single week, and we're on all of them. And if you want to reach out, Troy's got the details on that.

Troy: Yeah. You can reach out to us. Drop us an email at hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Website is whocaresmenshealth.com. We actually have a listener line as well. You can call in and ask questions, and I'm hoping Scot has the number for that line.

Scot: 601-55SCOPE. Go ahead and write that down, Troy, and write that down, everybody else. 601-55SCOPE. If you have any questions, comments, you just leave your message right there. Thanks for listening and thanks for caring about men's health.

Interviewer: Three reasons guys should go see their urologist immediately. Dr. John Smith is a urologist at University of Utah Health, and today wanted to talk about three different things from your perspective, Dr. Smith, that if a man is experiencing, they should probably go see their urologist sooner than later. Let's go ahead and start with number one.

Dr. Smith: As men age, they tend to have a little bit of a decrease in their urinary stream, and sometimes this can be a sign that something may be going on that long term could be damaging to their urinary tract.

Interviewer: All right. So if you are experiencing any sort of urinary problems like the stream isn't as strong, are there other symptoms that would indicate that that might be an issue to get to your urologist?

Dr. Smith: Absolutely. I tend to be very frank with my patients, and I ask them, "How's your stream? Do you hit the back of the bowl, the middle, the front, or your shoes?" And if they're hitting their shoes, then they probably needed to be here a little bit sooner than they are.

Other things that I generally ask is are they going to the bathroom more frequently. If they're on the golf course with their buddies and they golf 18 holes, do they go to the bathroom way more than their friends, or do they have an urgency, the gotta-gos?

Another thing that I'll ask them is, "How much are you waking up at night to go to the bathroom?" Those are good indications that there is likely something going on, and it's usually an enlarged prostate causing an outlet obstruction.

Interviewer: I always thought that was just part of getting older, but it's not, huh?

Dr. Smith: Well, to an extent. So if we lined up 100 people, both male and female, over the age of 60, all of them will get up to go to the bathroom once, possibly twice, and that's within the normal limits. But the gentlemen who come in and I say, "How much are you getting up?" and they're like, "I'm up five or six times a night," that's abnormal and doesn't normally happen.

Interviewer: All right. And if you don't take care of that right away, what's the detriment?

Dr. Smith: So the detriment is your urinary system is a low-pressure system. Your bladder likes to fill. It likes to empty. It likes to be like Maxwell House, good to the last drop. And when you have this outlet obstruction, generally you hold a little bit of urine back and your bladder has to push harder to empty. And that, long term, can cause damage to the bladder. It makes it so it's not as elastic, meaning that it can't fill and empty the way that it would like to, and it can cause an issue. And long term, with higher urine leftover, kind of a glass half full kind of guy, you can have damage long term to the bladder as well as to the kidneys.

Interviewer: All right. So three reasons guys should see the urologist right away, number two.

Dr. Smith: So number two is guys with a family history of prostate cancer. I've seen quite a few guys who kind of put that off coming in and having a PSA test done.

Prostate cancer is a slow-growing disease that we can treat very well these days. We're very good at it. And there are also some new technologies for identifying possible prostate cancer to make sure we get early treatment.

So starting early, getting a PSA at age 50, 55, depending on your family history, and having that discussion with a urologist can really be beneficial to make sure that we get you in the loop, and take care of you, and make sure that there's not a problem down the road.

Interviewer: So to you, as a clinician, that family history is a pretty good indicator that a man is likely going to have prostate cancer issues in their future?

Dr. Smith: Absolutely, especially men who have a family history of their father or a first-degree relative, like a brother, who has had prostate cancer at an early age. Those are the ones that we definitely want to watch a little bit closer.

Interviewer: Getting in sooner than later is definitely a good plan. All right. Three reasons guys should see their urologist sooner than later. What is number three?

Dr. Smith: Number three is one that everybody wants to talk about all the time -- erectile dysfunction. And I'm joking.

Interviewer: Yeah. I was going to say I don't think we want to talk about that all the time.

Dr. Smith: And that's one where we have great treatments. We can generally treat men rather easily with few side effects. Seven out of 10 men generally do very well on medication to help their erections. And so there's no reason to have a subpar sexual life when there is great treatment out there and all you have to do is come in and say the word, "Hey, I need a little help."

Interviewer: Yeah, and it's okay to think about it as a health issue because having a satisfying sex life is very much a part of emotional and mental health, something that us guys don't normally think about, right? We think about the physical part of it more than the emotional part.

Dr. Smith: That's true. Another thing too that we keep in mind is sudden onset erectile dysfunction can sometimes kind of clue us into something that could be going on, underlying vascular problem that may need some attention that you just thought was an erectile issue. So, again, there are some other things there that can really be beneficial.

Interviewer: It's a symptom of maybe something else going wrong in your body that's just manifesting itself through your ED?

Dr. Smith: Absolutely. One of the most common is a cardiovascular problem for men who kind of have a sudden onset of erectile dysfunction and are otherwise healthy that may not think . . . Maybe they have a few extra pounds and they just thought, "Oh, well, I just figured with age my erection would go away." Well, when it was there on Saturday and it's not there on Monday, that's not usually something that is normal and may need a closer look by your primary doctor.

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.

Dr. Jones: The problem with feeling like you have to pee all the time or peeing your pants as a grown-up is that it's embarrassing and it's such a 2-year-old thing to do. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health. And this is "The Seven Domains Of Women's 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: Back to the 2-year-old problem of peeing your pants or being afraid that you will. This is a very common problem for older adults men and women, but you may not know that it's common because your friends and family don't talk about it. Many of us quietly have urgency. But what can we do about it? Today we're going to talk about this as grown-ups. Here in The Scope studio is Dr. Sara Lenherr. She's a urologist at the University of Utah with a special interest in continence in adults, meaning not peeing your pants. Thanks for joining us, Dr. Lenherr. Well, how common is this problem? Is it more common for older people or men or for women or? Tell me about your patients.

Dr. Lenherr: So really overactive bladder or OAB really impacts millions and millions of women and men in the United States. And many patients are tried on medications, but then stop them because they're ineffective or cause bothersome side effects. There are other treatments that are not without side effects, but with appropriate counseling can be very effective at improving their symptoms and quality of life.

Dr. Jones: How common is this problem? Is it more common for older people or for men or for women? Tell me about who comes to see you.

Dr. Lenherr: There are people of all different ages that come to see me about having to pee all the time. They're men, they're women, people that have had this all of their lives or just have it as they get older. We treat so many different people that have to go to the bathroom urgently, frequently, they either lose their urine with incontinence, or they don't have any incontinence. All these different types of people come in for evaluation.

Dr. Jones: Okay. You've used the word overactive bladder, and I really like that term because it sounds so medical rather than peeing your pants or something. So overactive bladder and that's really the umbrella term for the kinds of problems that you specialize in?

Dr. Lenherr: So it basically means that you can't delay the urge to go and pee when all of a sudden you need to go. And then most people also have the frequency that they need to go to the bathroom quite often. So they're having to go every 20 minutes or every one hour as opposed to being able to hold their urine for a reasonable amount of time, like four or five hours.

Dr. Jones: Right. So tell me a story, the common kinds of things. You mentioned that sometimes people try to treat this by not drinking, but sometimes people maybe drink so much.

Dr. Lenherr: Some people drink a lot more fluid than they realize their body really needs or really can handle. And they also sometimes drink fluids that can be very irritating for the bladder, like a lot of coffee, tea, things with artificial sweeteners, sodas with caffeine. All those things can irritate the bladder, and they just don't realize that it's impacting their bladder health.

Dr. Jones: Right. The Big Gulp is the big pee. Right?

Dr. Lenherr: Exactly.

Dr. Jones: Oh, yeah, yeah. So how do people come to you? They've been in trouble for a couple of years or they had it once or they have to be referred by their doctor?

Dr. Lenherr: Many people decide they've had enough and they come and seek an evaluation with a urologist right off the bat. But some people have been struggling this for their entire lives and they just haven't had the time to tackle it on their own or their primary care physician hasn't been successful with helping them just yet.

Dr. Jones: Yeah, yeah. Well, what kinds of things begin? I just want to retrain my brain and my bladder the way I did my 2-year-old. So I just like to say, "Stop. I want to start over." Because I train my 2-year . . . well, actually, it was my mother-in-law trained my 2-year-old in a weekend. I want to retrain my bladder to behave. So what kinds of things can be done?

Dr. Lenherr: So, first, I always start off with evaluating an individual's risk factors or reasons that they have an overactive bladder. Is it because of their fluid intake or the types of fluids that they're drinking, or are they delaying urination and they just don't realize that they should have gone a while ago and then they're bothered by having that all of a sudden urgency that they need to go?

The other thing that can really contribute to overactive bladder or that sensation that you need to go pee more often is chronic constipation, so having difficulties with bowel movements, and it basically becomes a space issue in the pelvis. And so if your pelvis is full of poop, you don't necessarily have enough room to store the urine down there in your bladder.

Dr. Jones: Right. And then for women, sometimes they have a fibroid or a big uterus that's leaning on the bladder, or for men, they might have a big prostate.

Dr. Lenherr: Exactly.

Dr. Jones: So people don't know that there are many kinds of things. So the evaluation process is for each person. That's something that not all primary care docs or even some urologists can do. So I was worried because we know that 2-year-olds have problems holding their urine and we try to train them out of it. But we also know that 80 and 90-year-olds as they kind of get demented, their brain isn't as good at calling it quits and say, "I'm holding this for another half an hour." So, as you get older, is your brain just not so good?

Dr. Lenherr: Oftentimes the sensation and the awareness that you need to go is a little bit more unclear in the older population. And so sometimes they just need prompting to be reminded to go to the bathroom on a pretty regular basis.

Dr. Jones: Right.

Dr. Lenherr: The other thing that's really common in that older population is constipation that no one identifies. So, again, it just makes the bladder always feel like it's partially full.

Dr. Jones: Right. Well, I think that this is common.

Dr. Lenherr: Very common.

Dr. Jones: In fact, if you bring it up and I won't say you, I brought it up to my family, my sister and I found out that she was struggling with the same problems that my mother had struggled with it, that I had struggled with it, and then I talked to my friends and we're all occasionally struggling with it. And so this is a common problem and some people manage to putter along and do okay, but for people whom it really interferes with their life having to know every single potty in every single store and every single rest stop between here and your cabin, that can get old.

Dr. Lenherr: It's very exhausting. It definitely impacts quality of life. And that's one of the main things that I assess with my patients is, how much is this really running their lives? And if they're not that bothered by it and they can accommodate on the weekend or so, then they're okay. But sometimes people have special events that they want to go to, and so we come up with a tailored plan to help them when they want to go to a wedding or they have a road trip that they want to do with a friend and they have been avoiding doing such activities because they're afraid they're going to have to go and pee all the time.

Dr. Jones: Well, it's great that (a) you can talk like a grown-up to a grown-up, we can talk grown-up to grown-up about this kid's issue. And the takeaway here is that there are many causes of overactive bladder and many treatments, not just medication that you might see on the TV, and we're grateful to have Dr. Lenherr to help us hold it. And thanks for joining us on The Scope.

Dr. Lenherr: Thank you for having me.

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.