Smoking While Pregnant Is Not a Joking Matter

November 28, 2015

Nearly everyone knows that smoking causes cancers of the lungs, digestive systems, liver and other organs.  It is worth nothing that tobacco poses many other threats especially to pregnant women.

Pregnant women who smoke place their babies at risk for complications such as premature delivery and increase neonatal mortality.

Nicotine and carbon monoxide from tobacco smoke inhaled by pregnant women are especially harmful to fetuses, constricting the flow of blood and choking off their oxygen supply.  Babies born to mothers who smoke have lower birth weights as a result of their undeveloped bodies, increasing the risk of heart defects, lung damage, and impaired brain development.  Finally, smoking while pregnant increases the changes of miscarriage and still birth.  Yet despite the severe consequences, studies by the U.S. Centers for Disease Control and Prevention indicate that less than half of smokers who become pregnant quite during pregnancy.

Bottom Line:  If you are pregnant and care about your unborn child, stop smoking.

Urinary Incontinence: Gotta Go, Gotta Go Right Now!

November 28, 2015

Urinary incontinence affects millions of Americans and causes havoc with their lives.  It I a source of embarrassment, shame and often depression.  Other medical consequences of incontinence include skin irritation, urinary tract infections, and pelvic pain.  This blog will discuss treatment options including medications and non-medical solutions.

Urinary incontinence means that the person suffering from it starts losing his/her control over the bladder. This leads to several kinds of problems of the urinary system including sudden urination, slow but steady leakage of urine, or dripping of urine when one undertakes a physically stressful exercise like lifting weight.  Those who have incontinence often lose urine with coughing, laughing, or sneezing.

Although this is a common medical problem, many suffers continue to suffer in silence, living a secluded and reclusive life.

While these causes cannot be controlled, it is important to take note of and control factors that can worsen the condition:


If you have a problem of urinary incontinence and the symptoms have gone from bad to worse, you need to check with your doctor about the medication or drugs you have been taking. For, chances are that some of these may be exacerbating the problem. Certain drugs to treat high blood pressure are linked to an increase in incontinence.

Alpha blockers dilate blood vessels to reduce blood pressure and they also often relax the muscles of the bladder, furthering urine flow. Some drugs to treat depression can contribute to worsening incontinence symptoms.

Anti-depressants work by relaxing the nerves of the mind and may also affect the ability of the bladder muscles to contract (side effects).

Diuretics are another set of drugs that are associated with increased

urination. In fact, these drugs are also called ‘water pills’, and are designed to flush out excess salt from your body to treat conditions like high blood pressure.


Caffeine is an important component of our daily lives as most of us consume it through coffee, tea and chocolates. Excessive consumption of caffeine is associated with the problem of increased urination. While mild consumption doesn’t have a negative effect, excess consumption can affect the renal system, as caffeine is a stimulant. It stimulates the cardiovascular system, increasing the heart rate as well as blood pressure. This increases the rate of blood to be filtered. It also relaxes the bladder’s detrusor muscles, causing them to feel fuller more frequently. So, limiting caffeine intake is healthy.

Type 2 diabetes

Type 2 diabetes is a major health concern of today as it affects the functioning of the entire body. It also increases the risk of urinary incontinence, as well as its severity. Efforts should be made to prevent and control diabetes by keeping your weight under control, exercising regularly and leading a healthy lifestyle.

Excessive weight also puts extra pressure on the pelvic muscles and weakens them. Therefore, it is also important to control body weight.


Besides controlling the aforementioned factors, it is important to take medical help to treat and manage urinary incontinence.

In some patients, adopting behavioral changes may help. For example, decreasing fluid intake to average levels, urinating more frequently to decrease the amount of urine that is held in the bladder and keeping regular bowel habits (as constipation can worsen the problem) may have a positive effect.

Pelvic muscle training exercises, aka Kegel exercises, can specifically help those who suffer from incontinence. The exercises help patients exercise better control of their detrusor muscles.

Weight loss has also been shown to help decrease symptoms in overweight people.

Bottom Line:  Urinary incontinence is a common condition affecting millions of American men and women.  Help is available and no one needs to “depend on Depends”!

Nothing Murky About Eating Turkey

November 25, 2015

We eat lots of turkey on Thanksgiving and Christmas.  Americans gobble up 46 million turkeys at Thanksgiving. That works out to almost 3 pounds of poultry per person who partakes in the feast, according to statistics from the National Turkey Federation. I’ve always wondered why turkeys are the bird of choice for our annual Thanksgiving dinner, and seeing as one of our most important national holidays will be celebrated tomorrow, I thought I’d satisfy my curiosity. I also discovered, to my surprise, that there are some terrific health benefits offered by a Thanksgiving turkey.

In case you are wondering about the history of Turkey on Thanksgiving, It’s actually debatable whether Turkey was served or not during the First Thanksgiving of 1621, because colonist Edward Winslow’s account of the harvest feast at Plymouth simply mentions that pilgrims gathered “wild fowl”, which means they were just as likely to have feasted on ducks or geese as turkeys.

More than 200 years passed before turkey gained traction as the staple Thanksgiving meal. It was the rediscovery in 1856 of colonist William Bradford’s lost journal that marked the beginning of turkey becoming the Thanksgiving meal of choice. In his journal, Bradford made references to wild turkey being hunted in the fall of 1621.

This was further enshrined in American culture when President Lincoln declared Thanksgiving a national holiday in 1863. So there you have it! That’s how we all came to eat turkeys with our families every fourth Thursday of November.

The good news is that although we may eat a little too much each Thanksgiving, eating turkey has numerous health benefits.

Here are just a few reasons to eat turkey tomorrow:

1. Keep Insulin Levels Stable

Turkey meat helps with stabilizing blood sugar levels because it is rich in protein. Protein also takes a relatively long time to digest, and this means that glucose absorption also slows down. That’s why some doctors recommend turkey as a good dietary choice for diabetics.

2. Strengthen Your Immune System

A recent study has shown that tryptophan metabolites contained in turkey are effective in reducing the symptoms of multiple sclerosis, an autoimmune disease. This means there’s tangible evidence for tryptophan’s important role in immune system health.


3. Boost Your Defense Against Cancer

Just as tryptophan helps the immune system fight off autoimmune diseases, it also stimulates T cell production. These cells are your immune system’s natural weapon for fighting off cancer. Furthermore, a trace element in the body called selenium has also been observed to kill cancer cells in various studies. While selenium takes on many different forms, the three main forms with anticarcinogenic properties are sodium selenite, L-selenomethionine, and selenium-methyl L-selenocysteine.

4. Take in Less Saturated Fat Than Other Meats

The form of cholesterol which isn’t good for your body is called low-density lipoprotein, or LDL. Consuming too much saturated fat triggers increased LDL production in the liver. It collects in your blood vessels when consumed in excess, leaving you at greater risk of heart disease. Turkey contains significantly less saturated fat in comparison to beef or pork.

5. Boost Your Metabolism

Turkey is a lean, complete protein ideal for building muscle and increasing metabolic function. Having a high metabolism is good for hair and nail growth and avoiding illness.

6. Enhance Your Mood

Eating turkey on a regular basis will have a positive effect on your mood, because tryptophan increases serotonin production in the brain. Serotonin is a neurotransmitter that contributes to feelings of well-being and happiness.  It is also the tryptophan that causes a tired feeling after consuming turkey.

7. Lose Weight

Lean protein, as found in turkey meat, contains important amino acids and helps you feel fuller for longer. Replacing other meats you eat with turkey will likely see you shedding a few pounds sooner rather than later.

8. Boost Your Energy

B vitamins are excellent for producing long-lasting energy, and turkey contains an extensive amount of them. Niacin is particularly good for converting carbohydrates, proteins and fats into efficient fuel for your body.

Bottom Line:  Turkey has been a staple of the holiday season.  Hope you enjoy your special day and stop and give a moment to be thankful for all the blessings we as Americans enjoy this and every day of the yeasr.

Prostate Biopsy Negative? What’s Next?

November 21, 2015

There are over 1 million men who have a prostate biopsy each year.  Many of the biopsies are negative.  What can a man do who has an elevated PSA level and a negative biopsy to be certain that he doesn’t have prostate cancer and avoid having a second biopsy?

Lots of controversy surrounds the standard PSA (prostate-specific antigen) screening test for prostate cancer, which is unreliable and not specific for the disease. This uncertainty has prompted many men to ask, “Is there a better test for PSA?” Fortunately, there are options which, while they don’t replace the current PSA test, can provide significantly more reliable, actionable information.

The PSA test involves a blood draw and measuring the level of the blood protein, prostate specific antigen. Currently, men whose PSA test levels are between 4 ng/mL and 10 ng/mL typically are told they should consider getting a prostate biopsy. However, an elevated PSA can be caused by many different benign conditions such as benign enlargement of the prostate gland, a prostate infection or simply lifestyle habits, which means a biopsy would be an unnecessary invasive procedure.

Why we need more accurate testing?

Approximately 1.3 million prostate biopsies are performed annually, and less than one third of them reveal cancer. While that sounds like good news on one hand, on the other hand it means that two thirds of those biopsies may not have been necessary and/or these men have negative biopsy results but other clinical risk factors for prostate cancer such as a family member who has prostate cancer or being an African-American man who have a slightly greater risk for prostate cancer than a Caucasian man.

If you have been in this situation, you probably know how frustrating and confusing it can be. What should you do? Have a repeat biopsy or choose to have more tests? The uncertainty of having a hidden prostate cancer can lead men to get repeat biopsies, which can be associated with an increased risk of infection, hospitalization, emotional trauma, and significant costs.

Fortunately, some progress is being made in the realm of better testing for prostate cancer and in determining whether a prostate biopsy is necessary. In this blog I will discuss the PCA3 test that may be helpful and prevent additional biopsies and additional psychological anxiety.

PCA3 Test

PCA3 is an acronym for Prostate CAncer gene 3. Prostate cells have PCA3 genes that are responsible for making this prostate cancer-specific protein. Prostate cancer cells produce higher levels of PCA3 than do healthy cells, and when the level of PCA3 protein is high, it leaks into the urine, where it can be measured. Unlike the PSA test, PCA3 is not affected by benign prostatic hyperplasia (enlarged prostate) or other noncancerous prostate conditions such as prostatitis.

To take the PCA3 test, you must first have a digital rectal examination (DRE), which stimulates the PCA3 to enter the urine. Then you must immediately provide a urine sample. Typically, it takes 1 to 2 weeks to obtain the results of the PCA3 test. For diagnostic purposes, the higher the PCA3 score, the more likely a man has prostate cancer. When the PCA3 score is used to help with treatment, the higher the score, the more aggressive the prostate cancer is likely to be.

The Food and Drug Administration approved the PCA3 test in 2012. Physicians can use the PCA3 score, in addition to DRE and PSA test, to help them make treatment decisions. For example, knowing a man’s PCA3 score can be helpful when:

  • Men have a family history of prostate cancer
  • Men have a positive biopsy, because their PCA3 score can provide additional information about how aggressive the cancer may be and therefore, be helpful in determining which treatment approach is best
  • Men have an elevated PSA or a suspicious DRE and are considering a prostate biopsy
  • Men have a negative result on their biopsy but the doctor is still uncertain about the presence of cancer
  • Men have a positive result on their biopsy and they and their doctor want to better understand how aggressive the cancer is
  • Men who have early, nonaggressive prostate cancer and have chosen active surveillance want to monitor any possible cancer progression

How effective is the PCA3 score in detecting prostate cancer? This question was addressed in a study involving 859 men who were scheduled to undergo a prostate biopsy. The authors found that use of the PCA3 test improved over-detection of low-grade prostate cancer and under-detection of high-grade cancer. Cost of the PCA3 test is about $450. The test is paid by most insurance companies including Medicare.

Bottom Line:  Prostate cancer is the most common cancer in men and the second most common cause of death in men.  The PSA test is a good screening test for men between the ages of 50 and 70.  However, there are false positive results with consequences of unnecessary prostate biopsies or may result in unnecessary repeat prostate biopsies.  The PCA3 test is helpful in identifying prostate cancer or helpful in reassuring a man that he doesn’t have prostate cancer and can avoid a repeat biopsy.  For more information, speak to your urologist.

Testosterone Deficiency: Male Menopause Which Is HARDly The Pause That Refreshes!

November 21, 2015

Everyone has heard about menopause for women.  This is due to a decrease in estrogen production from the ovaries.  Men also have a fall in their testosterone, the male hormone produced in the testicles, also decreases a small amount after age 30 but becomes symptomatic around age 50.  The problem affects millions of American men who have decreased sex drive, lethargy, loss of muscle mass, decrease in bone density, and even irritability\depression.  This blog will discuss the problem of male menopause or andropause.

Men losing testosterone is a steady decline, like a leak in a swimming pool you never refill. Over time, you empty out all your stores, creating a constellation of problems.

The constellation of problems compound each other, too. The apathy comes in part from the decline in hormones, which results in loss of lean muscle mass, depression, and forgetfulness. But it becomes a downward cycle, as the less lean muscle mass a person has, the faster he or she gains weight, which leads to more depression.

The seriousness of the problem of male depression tied to aging cannot be denied, as middle-aged and older men account for more than 20 percent of suicides, as compared to about 5 percent for women. Older white males represent 70 percent of suicides.  Before starting anti-depressants, doctors caring for older men with symptoms of depression should get a serum testosterone level and replace the hormone with testosterone replacement therapy before initiating anti-depressants.

Most of my physician referrals come from psychiatrists and neurologists, as men are seeing them because of depression and memory issues. Psychiatrists and neurologists know what a reduction in testosterone does to emotional well-being and brain function. These specialists want their patients to be tested for low testosterone before trying anti-depressants or other prescription therapies.

The reason more general physicians don’t think of, or want, to go the hormone testing route? Testosterone therapy got a bad rap a few years ago when there was a lot of misinformation with regard to testosterone being dangerous and possibly being linked to an increase in prostate cancer and heart disease.

There have been poorly designed studies, just as there were poorly designed studies with women’s hormone studies, such as the Women’s Health Initiative, indicating that it might be dangerous for women to take hormone replacement therapy. The result is that these defective studies resulted in a lot of men are not doing testosterone optimization correctly. There is a big difference between what is considered a normal level of hormones, which in America, is often abused to build super-normal muscle mass, and those levels at which men literally come back to life again.

Ideally men need to have their testosterone levels drawn in the morning when the testosterone levels are the highest. If the man has the symptoms described above and has a low testosterone level, they are candidates for hormone replacement therapy using injections of testosterone, topical gels containing testosterone, or testosterone pellets that are inserted under the skin every 4-6 months.

Many of these men come in saying they feel like half a man; well they are, because they are trying to live on half the amount of testosterone they had when they were younger. When they feel better, they make changes such as losing weight, or changing careers, because with the low level of testosterone, they didn’t care enough to do it before.

Bottom Line: If you don’t feel the same way about yourself or your partner, and you are in your 40s, 50s, or 60s, it may well be that one or both of you have hormonal issues. It makes sense to try and fix that with a brief history, physical exam and a testosterone blood test.

Options for Treating The Enlarged Prostate Gland

November 16, 2015

For reasons not entirely known, the prostate gland starts to increase in size around age 50 and causes symptoms of difficulty with urination. The prostate gland is a walnut sized organ at the base of the bladder and surrounds the tube, the urethra, which transports urine from the bladder to the outside of the body. When the prostate gland grows, it compresses the urethra making urination difficult.

By the time men are in their 40s or 50s, many are already experiencing symptoms, such as having to get up at night to urinate. Into their 60s and 70s, they may have to get up two or three times.

In addition, an enlarged prostate can also result in other urinary symptoms such as having to go frequently during the day, having a weak stream or having to go urgently.

The “gold standard” is called a transurethral resection of the prostate (TURP), where an instrument is inserted up the urethra to remove prostate tissue that is blocking urine flow. It is sometimes colloquially referred to as a “roto-rooter” procedure. The purpose of the TURP to carve out the inner portion of the prostate and leave just the shell. The procedure allows a much stronger stream and men who have it will have to urinate much less frequently.

However, the procedure requires general anesthesia and a hospital stay. While it does not usually interfere with the ability to have an erection, more than half of those who have it will experience “retrograde ejaculation,” meaning that no fluid comes out of the penis during orgasm. Instead, the fluid goes into the bladder where it is eliminated during urination. Men will also have to wear a catheter for a few days after the procedure and will require several months before they can resume all activities including sexual intimacy and heavy lifting.

Similar procedures known as GreenLight Laser Treatment, which uses a high-energy laser to vaporize prostate tissue, and holmium laser enucleation of the prostate (HoLEP), which also uses a laser to destroy prostate tissue, are also available. They are pretty much the same in terms of outcomes. They just use different energy sources.

Now there is a new treatment, the UroLift, that doesn’t remove any tissue but relieves the compression on the prostate gland making urnation easier and reducing the symptoms. The procedure can be done in the office setting, does not require any catheter, and does not cause any sexual side effects or retrograde ejaculation.

Bottom Line: Many middle aged men have sympotms related to the enlarged prostate gland. There are multiple treatment options and men can plan to resume their activities after treatment for benign prostate disease.

If you are 50 or older and you have any of these symptoms and they are bothersome, talk to your doctor.





Benign Enlargement of the Prostate Gland Affects Millions of U.S. Men-New Treatment With Prostate Urethral Lift

November 11, 2015

Benign enlargement of the prostate gland affects nearly millions American men. In the past the procedure of choice was a surgical procedure, transurethral resection of the prostate gland, which is often referrd to as the rotor router procedure. Now a first line treatment is the prostate urethral lift PUL, is a new alternative. This blog will discuss the PUL, how it works, and what are the risks and complications of the procedure.

Lack of awareness about a common health condition may be causing millions of men to suffer unnecessarily. Benign prostate enlargement (BPE), affects more than 37 million men in the United States alone. Unfortunately, many men postpone treatment for this disorder because of concerns about side effects such as problems with ejacualtion and impotence or erectile dysfunctihowever, their concerns may be alleviated with additional information.BPE occurs when the prostate gland that surrounds the male urethra becomes enlarged with advancing age and begins to obstruct the urinary system. Symptoms include sleepless nights and urinary problems, and can cause loss of productivity, depression and decreased quality of life.

About one in four men experience BPH-related symptoms by age 55 and, by age 70, over 80 percent of men suffer from BPH. Most men blame their symptoms on aging. They may not be aware of the high prevalence of BPH or the available medical or surgical treatment options. There is a high risk to delaying treatment and so men should proactively talk with their doctors.

The prostatic urethral lift is a minimally invasive procedures the risks are low compared to medications or other surgeries. BPE can have a significant impact on quality of life for men as well as their partners, and can place limitations on their activities. For example, the need for frequent urination may make travel, sleep and sports activities difficult. We hope that with greater awareness of symptoms and treatment options, men will take a more active role in treating BPE, and live life with greater vitality.

A recent U.S. survey of more than 1,000 men over the age of 50 demonstrated that concerns about the risk of side effects, such as loss of sexual function or urinary incontinence, would cause a majority to postpone or avoid treatment of BPH.

This is unfortunate because, not only is early treatment important to alleviate symptoms and stop the
disorder from worsening, but a new minimally invasive treatment option is available that does not require cutting, heating or removal of prostate tissue, and as such does not result in loss of sexual function or urinary incontinence.

The survey results mirror other research and anecdotal evidence from patients that show that men
rarely mention their BPE-like symptoms.

The more recent survey, which was completed in October 2015, demonstrated that:
• A majority of men (61 percent) would postpone treatment for BPH because of the risk of sexual
• side effects or urinary incontinence from traditional treatments
• Eighty-four percent of respondents indicated they would be more open to seeking treatment for
• BPE if the treatment options available held less of a risk of impotence or incontinence
• Nearly half of the men surveyed (44 percent) were not aware that BPH is more common than
• prostate cancer. In fact, BPE impacts more than 12 times as many men in the U.S. as prostate cancer
• Concerns over surgical treatments was high among respondents, with 83 percent stating they
• were interested in a treatment option that could improve BPE symptoms without cutting, heating or
• removing prostate tissue1

In the past,mMedication is often the first-line therapy for enlarged prostate, but relief can be inadequate and temporary. Side effects of medication treatment can include sexual dysfunction, dizziness and headaches, prompting many patients to quit using the drugs. For these patients, the classic alternative is surgery that cuts or ablates prostate tissue to open the blocked urethra. While current surgical options can be very effective in relieving symptoms, they can also leave patients with permanent side effects such as urinary incontinence, erectile dysfunction and retrograde ejaculation (dry orgasm).

About NeoTract
The PUL is a minimally invasive and clinically effective device that address unmet needs for men with BPE. The PUL is a minimally invasive permanent implant system that treats symptoms while preserving normal sexual function.

The UroLift System consists of a delivery device and tiny permanent implants. FDA cleared in 2013, this
unique technology works by directly opening the urethra with tiny implants that hold the enlarged tissue out of the way, like tiebacks on a window curtain. No cutting, heating, or ablating tissue is involved, making the UroLift System the first and only BPE treatment that does not remove prostate tissue and does not negatively impact a man’s sexual function.

4 pins in the prostate open the gland and allow improvement in urinary symptoms

4 pins in the prostate open the gland and allow improvement in urinary symptoms

I have done over 40 cases using the PUL and none of the men have experienced any sexual side effects from
the procedure. Most men can have the procedure in the office setting. They can leave the office without
a catheter and have marked improvement immediately or in a few days. The side effects are frequency of
urination and small amount of bleeding which only last for a short period of time. Research has demonstrated
that the procedure lasts for at least three years.

Most insurance companies, including Medicare, pay for the PUL procedure.

If you would like to more about the PUL, go to my website,, or go to YouTube and use the following URL:

Bottom Line: BPE is a common condition affects millions of American men. A first line treatment that is effect is the prostate urethral lift. Give my office a call if you have
any questions.

Cholesterol: the New Approach to Managing Your Cholesterol Levels

November 3, 2015

I am 72 years of age and have a family history of heart disease in both of my parents. I have been very concerned about heart health and my cholesterol level. This blog is intended to discuss the new numbers and what you need to know about using medication to lower your cholesterol levels.

More than a quarter of Americans older than 40 are taking a statin, a number that could rise to 46 percent of people aged 40 to 75 under the newest prescription guidelines, especially now that almost all statins are available as inexpensive generics. A recent study showed that prescribing statins under the new guidelines could cut in half the number of people who develop clinical evidence of cardiovascular disease.

Because statins are cheap, as well as effective and safe for most people, doctors often prescribe them for otherwise healthy patients with elevated cholesterol, even if they have no other cardiovascular risk factors. Yet many who could benefit — including people with established heart disease and serious risk factors like smoking, diabetes and high blood pressure — who are not on a statin for reasons that include reluctance to take daily medication, and concern about possible or actual side effects.

While best known for their ability to lower serum cholesterol, statins also reduce artery-damaging inflammation that can result in a life-threatening blood clot. By lowering cholesterol, statins also appear to stabilize plaque, artery deposits that can break loose and cause a heart attack or stroke. And they may cleanse arteries of plaque that has not yet become calcified.
Instead of striving for a target level of, say, under 200 for total cholesterol and under 100 for LDL, the new guidelines, put forth by the American College of Cardiology and American Heart Association, focus on four main groups who could be helped by statins.
1. People who have cardiovascular disease, including those who have had a heart attack, stroke, peripheral artery disease, transient ischemic attack or surgery to open or replace coronary arteries.
2. People with very high levels of LDL cholesterol, 190 milligrams or above.
3. People with an LDL level from 70 to 189 milligrams who also have diabetes, a serious cardiovascular risk.
4. People with an LDL level above 100 who, based on other risks like smoking, being overweight or high blood pressure, face a 7.5 percent or higher risk of having a heart attack within 10 years.
Gone are the recommended LDL(low density lipoprotein)- and non-HDL(high density lipoprogein)–cholesterol targets, specifically those that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL. According to the expert panel, there is simply no evidence from randomized, controlled clinical trials to support treatment to a specific target. As a result, the new guidelines make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of atherosclerotic cardiovascular disease.

Bottom Line: The new guidelines identify four groups of primary- and secondary-prevention patients in whom physicians should focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate dose of statin therapy in order to achieve relative reductions in LDL.

Your Bike May Cause Your Erections To Take a Hike

October 28, 2015

There are many cause of impotence or ED but one of the most common in younger men is bike riding. This blog will discuss the relationship of bike riding to ED and what can be done to prevent problems with bikers erections.

Bicycle seat neuropathy is one of the more common injuries reported by cyclists. The injuries and symptoms are due to the cyclist supporting his or her body weight on a narrow seat, and they are believed to be related to either vascular and\or neurologic injury to the pudendal nerve.

A wide frequency range has been reported for bicycle seat neuropathy, but it is believed to be underreported.

 A study of cyclists who ride for long period of time noted that 22% reported symptoms of either numbness or pain in the pudendal area. 21% reported penile numbness, with 6% cyclists reporting symptoms that lasted longer than 1 week. In addition, 13% reported symptoms of impotence, some men having experienced symptoms for longer than 1 week, and a smaller number reported impotence lasting longer than 1 month.

The cause of bicycle seat neuropathy has been attributed to several different events. One study hypothesized that compression of the pudendal nerve as it passes through the Alcock canal causes the condition. The Alcock canal is enclosed laterally by the ischial bone and medially by the fascial layer of the obturator internus muscle. The pudendal nerve exits the canal ventrally, below the symphysis pubis, and innervates the penis and perineal regions.

Long-distance cycling results in the indirect transmission of pressure onto the perineal nerve within the Alcock canal. Bicycle seat neuropathy is due to temporary and transient injury to the dorsal branch of the pudendal nerve secondary to compression of the nerve between the bicycle seat and the symphysis pubis.

Bicycle seat design (eg, shape) may be the major extrinsic factor for the development of bicycle seat neuropathy. Results of computer modeling showed that wider bicycle seats that support the ischial tuberosities or sit bones decrease pressure on the perineal area. Other studies have also demonstrated the effect bicycle seat design has on penile blood flow.

A recreational or elite cyclist who complains of numbness or impotence after cycling is the typical presentation of bicycle seat neuropathy. The amount of time the athlete spent cycling before the onset of symptoms is variable; however, studies have focused upon longer distance, multiday rides. Use of a stationary bicycle has also been reported as a cause of bicycle seat neuropathy.

Medical issues and complications include continued injury or insult to the area, resulting in continuation of the neuropathy and long-term sequelae such as impotence. Reevaluate the patient after making changes to the bicycle or riding style or after decreasing the training volume to ensure that improvement in symptoms is occurring. Continued symptoms despite changes in the bicycle seat position and training volume may indicate a different source of the symptoms and should warrant reevaluation by the physician.

The mainstay of treatment of bicycle seat neuropathy is the adjustment of the bike seat and bike position, such as tilting the nose of the seat down or lowering the seat height to relieve pressure off the perineum. Other recommendations include having the rider change the style of riding (eg, change positions more frequently or stop riding more frequently).

Newer bicycle seats with a split nose or a center cutout may also help to reduce the prevalence of neuropathy by limiting compression on the perineal area (see below). Some of the newer seats reduced perineal pressure by approximately 50%.

Bottom Line: Bike riding is a very popular form of exercise and recreation. However, long rides can affect a man’s potency and increase the risk of ED. I suggest that if you experience numbness after a long bike ride that you check your seat and speak to someone at the bike shop about a new seat that takes the pressure off of your sit bones so there is less compression of your nerves and blood supply to the penis.

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Nitrous Oxide for Outpatient Urologic Conditions

October 28, 2015

Today many procedures are being done in the office setting rather than in the hospital. By using nitrous oxide there is less pain and discomfort. This blog will discuss the use of nitrous oxide as a safe sedation for office procedures.

Nitrous oxide is commonly used in anesthesia; its use improves the quality and safety of induction of anesthesia, facilitates faster recovery and reduces costs compared to procedures performed in the office or the ambulatory treatment center.

Nitrous oxide or laughing gas as it is commonly known was first synthesized by Joseph Priestley in 1772. It was initially used as a dental analgesic forty years after this and has been used extensively in a wide range of surgical procedures for both sedation and analgesia.

The exact mechanism of action of nitrous oxide is unknown, but its effects take place within the pain centers of the brain and spinal cord. It is thought to have an effect on the Gamma Aminobutyric Acid (GABA) cells increasing inhibition of nerve cells causing drowsiness and sleep.  It also is related to the release of endogenous neurotransmitters such as opioid peptides and serotonin. The release of these neurotransmitters is thought to activate descending pain pathways that inhibit pain transmission.

Nitrous oxide has a role in some of the following procedures:

In dentistry, nitrous oxide is frequently used to decrease the pain and anxiety associated with procedures. It is commonly delivered by a nasal mask in combination with oxygen.

Other indications

Although not standard practice, additional described uses may include colonoscopy, sigmoidoscopy, laser procedures, obstetrical labor pain, ophthalmic procedures, emergency medical care of patients in accidents and during ambulance transport, and minor invasive medical procedures, including joint injections.


There are certain situations where the use of nitrous oxide is contra-indicated.  For example, in patients who have undergone recent eye surgery, involving gas bubble insertion (vitrectomy), as there is a risk that the nitrous oxide will diffuse into the bubble, causing the bubble to expand and cause injury to the eye.

Nitrous oxide can cause a rise in intra-cranial pressure, so it should not be used in cases of head injury and it must never be used if the patient has any conditions where air is trapped in the body and expansion would be dangerous, for example:

  • pneumothorax
  • abdominal distension
  • suspected intestinal obstruction
  • bullous emphysema
  • middle ear procedures
  • following a recent dive
  • maxillo-facial injuries,
  • impaired consciousness,
  • intoxication


When used properly, nitrous oxide is a very safe inhalational anesthetic gas. Complications up to and including death have been described. They are relatively uncommon with standard medical and dental use.

Adverse effects that may be associated with nitrous oxide include post procedure nausea and vomiting (PONV)

Short-term impairment in mental performance, manual dexterity, and audiovisual senses has been described with nitrous oxide use. This is not common and most patients can walk out of the office without assistance and even drive themselves home especially if they have not received any other sedatives like Valium or Ativan.

Bottom Line: Nitrous oxide is a very safe to provide sedation during office urologic procedures. It reduces the pain and anxiety of the procedure. For more information speak to your urologist.


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