Archive for September, 2016

Urinary Tract Infections (UTIs) In Men

September 28, 2016

UTIs are just a problem for young women.  Although UTIs are more common in young women, men, too, are not immune to infections of the urinary tract.  One of the most common infections in middle age and older men are urinary tract infections.

Older men (such as, men 70 years and older) are at somewhat higher risk for UTIs because of problems going to the bathroom and/or emptying the bladder. Older post-menopausal women are also at a greater risk for UTIs due to lower amounts of vaginal estrogen, which can change the vaginal climate. The normal flora, ‘good bacteria,’ are looked at as ‘good’ because they kill off other types of bacteria that can cause UTIs. Good bacteria can only grow in slightly acidic vaginal climates and this needs some estrogen. Systemic estrogen replacement options like pills and skin patches do not help with this problem, but vaginal estrogen therapy can be helpful for certain individuals. Talk to your doctor to see if this is a choice for you.

Often, older adults can help stop UTIs by staying hydrated, using the bathroom and getting routine health exams to screen for health problems like high blood sugar that puts you at higher risk for getting a UTI. If you or a loved one wears adult diapers, it’s very important to keep the genital area clean and to change them often.

Other Groups at High-Risk for UTIs

People with high blood sugar and vesicoureteral reflux are at higher risk of getting a UTI. Vesicoureteral reflux is when urine goes backwards from the bladder toward the kidney. Over time, this reflux of infected urine may raise a person’s risk for kidney damage. Vesicoureteral reflux is usually seen in children with UTIs compared to adults. Additionally, some patients with kidney stones and indwelling catheters may also be a higher risk for getting a UTI. An indwelling catheter is a hollow tube that is placed into the bladder through the urethra and left inside your body. The catheter drains urine from your bladder into a bag outside of your body. A catheter-associated UTI happens when bacteria enter the urinary tract through the catheter and cause an infection.

How UTIs are Diagnosed

In most cases, if you think you have a UTI, you should visit a health care provider and give a urine sample for testing. A urinalysis is a test that looks for white blood cells, red blood cells, bacteria, and or other chemicals such as nitrites in your urine. A proper urinalysis can pinpoint an infection and a urine culture can help your health care provider choose the best antibiotic for treatment. It is vital to get a urinalysis and culture performed to make sure you have an infection and require care. Use of antibiotics when not needed, can be tricky, and can lead to greater rates of bacterial antibiotic resistance.

It should be noted that some individuals get a urinalysis result that shows bacteria, but the individuals are not having any symptoms of a UTI. This event is common in older adults. If the individual has bacteria in their urine, but has no symptoms, treatment is not right. Treatment should be given to individuals who have bacteria and associated UTI symptoms.

In closing, it should be noted that studies on cranberry juice and linked supplements are mixed. Some studies show that cranberry supplements can be helpful and other studies show that they don’t help stop UTIs before they happen. Be sure to read about the pros and cons of cranberry products, and decide if they’re right for you. For now, practice these tips to lower your risk of getting a UTI.

Tips for Preventing UTIs

  1. Drink plenty of water.
  2. Urinate often.
  3. Don’t hold it.
  4. Keep your genital area clean.
  5. Empty your bladder before and after sex

 

Bottom Line:  UTIs are common in men and women.  Men after age 70 are at a risk for UTIs.  The symptoms are burning on urination, frequency of urination, passing cloudy urine, and even blood in the urine.  The diagnosis is easily made with a physical examination, a urine exam, and occasionally other imaging studies.  Treatment with antibiotics is usually effective.

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PSA Testing for Prostate Cancer-To Screen or Not to Screen That is the Question

September 28, 2016

Today, nothing is more confusing for men than the concept of screening for prostate cancer.  Prostate cancer is the second most common cancer in men, following lung cancer, and there are 250,000 men each year diagnosed with prostate cancer and causes nearly 30,000 deaths a year.  About one in seven men will be diagnosed with prostate cancer during his lifetime.

But some prostate cancers develop slowly, and, as the disease is more common in elderly men, most men with prostate cancer die with it and not from it. Thus, screening, diagnosis and treatment of the disease are controversial.

There is no consensus about prostate cancer screening as early diagnosis can be associated with very bothersome side effects such as erectile dysfunction and urinary incontinence.  Also screening has not been universally shown to increase survival or decrease the death rate from prostate cancer.  This article will discuss the pros and cons of PSA screening for men.

Men who opt for screening undergo a digital rectal exam and a blood draw to measure a chemical called PSA or prostate specific antigen. This level of PSA can be increased in men with prostate cancer. Other conditions may cause the increase in the PSA such as benign enlargement of the prostate gland and prostate infections.

The best way to detect an early potentially deadly case is to collect yearly PSA tests over three to five years so trends can be assessed.

I like most other urologists are concerned about over treatment of prostate cancer — in other words, being too aggressive in using surgery or radiation when a small amount of potentially slow-growing cancer is found on a biopsy.

The federal government has also become concerned about this issue. A large medical research trial called the Prostate Lung Colorectal and Ovarian (PLCO) Cancer Screening Study released results from 2009 showing no benefit from screening for prostate cancer when comparing a large group of unscreened men to a large group of aggressively screened men.

Researchers across the country are assessing the effects of the USPSTF recommendations on prostate cancer mortality since 2012. In a recent study from Northwestern University in Chicago, researchers found a significant increase in the cases of advanced prostate cancer already spread to other parts of the body from 2004 to 2013. As a result we could be missing serious cancers because of decreased screening.

Prostate cancer also has a hereditary predilection and men with a father, brother, cousin, or uncle should consider having screening around age 40.  This also applies to African-American men who have a greater risk of prostate cancer than Caucasian men and should also have testing after age 40.

My best advice is to ask your doctor\urologist about the decision to undergo prostate cancer screening.

Turing On Your Laptop May Turn Off Your Sperm Count

September 28, 2016

Go onto any college campus or into any Starbucks and you see nearly every person pecking away on their computers.  Some men will balance their laptop computers on their laps.  As a result the heat from the laptop raise a man’s scrotal temperature a very small amount.  This small elevation of temperature, if done often enough, may decrease a man’s sperm count.

Elevated scrotal temperatures have been linked to poor sperm counts according to a study at New York University.  Other situations that can raise scrotal temperatures including hot baths, saunas, and the wearing of tight jockey shorts.

The study which was reported in the Journal of Human Reproduction measured the scrotal temperature every three minutes between men holding computers on their laps which were turned on and men holding computers which were left in the off position. Those men holding a working lap top computer had a 5 degrees Fahrenheit increase in scrotal temperature.  Also noted was that men with their thighs held close together had the greatest increase in scrotal temperature. The researchers concluded that “Working on laptop computers in a laptop position causes significant scrotal temperature elevation as a result of heat exposure and posture-related effects.”

The main question is the increase in temperature enough to impair male fertility? The researchers didn’t conclude the connection between laptop use and sperm counts. However, the authors noted that another study showed that sperm concentration dropped by 40% when median daytime scrotal temperature rose by 1 to 2 degrees Fahrenheit.

Bottom Line:  I know for sure that more heat to the scrotal area is going to be deleterious for sperm production.  Therefore, I suggest that young men or men in the fertility age group may want to limit their use of laptop computers on their laps.

UTIs-Natural Solutions For Prevention

September 6, 2016

UTIs affect millions of men and women impacting their quality of life and may even affect their kidneys. Fortunately, most of these infections are uncomfortable with symptoms of burning on urination, frequency of urination, and back and pelvic pain. This article will discuss the usefulness of cranberry juice which may serve as an effective treatment to prevent recurrent UTIs.

A recent study reported in American Journal of Obstetrics and Gynecology, Aug. 2015 showed that cranberry pills (two capsules twice daily, equivalent to two 8-ounce servings of cranberry juice daily) cut the rate of UTIs in half.

Also there is supplement, D-mannose, can also help to reduce recurrent UTIs. Another study found good results from a combination of cranberry and d-mannose.

D-mannose is filtered through your kidneys and concentrated in your bladder and coats the bacteria causing the infections and renders them unable to stay in your urinary tract.

More than 90 percent of all UTIs are caused by Escherichia coli (E. coli), which is normally found in your intestinal tract. Problems only arise when this ordinary bacterium is present in high numbers in places where it shouldn’t be—like your urinary system.

Although antibiotics are an effective means of eradicating bacteria within the urinary tract, antibiotics need to be used with caution. Antibiotics are not selective and they kill the pathogenic bacteria in the urinary tract but also kill the good bacteria within the gastrointestinal tract. As a result, the bacteria develop resistance to antibiotics and with the removal of bacteria from the gastrointestinal tract there is a risk of other infections such as vaginal infections, fungal infections and side effects like diarrhea.

Bottom Line: UTIs are so very common and affect millions of American men and women. Cranberry juice and D-mannose may be a solution to preventing recurrent infections. If you have any questions about recurrent UTIs, speak to your physician.

Urinary Tract Infections (UTIs) in Women

September 4, 2016

Perhaps one of the most common infections in all women and young girls are UTIs.  Nearly 50% of all women will experience a UTI during their lifetime.

Urinary tract infections (UTIs) are very common in the U.S. In fact, UTIs are the second most common type of infection in the body and are the reason for more than 8 million visits to the doctor each year. About 50% of all women will develop at UTI during their lifetime.

Most UTIs involve the bladder (cystitis) are not serious, but some can lead to serious problems like kidney infections. The most common care or treatment for a UTI is antibiotics. Signs of a UTI involve pain or burning when you pass urine, urine that looks cloudy or smells bad, pressure in your lower abdomen, and an urge to go to the bathroom often. You can get a UTI at any age, but there are peak times in life when they are more common.

Many women report UTIs following sexual activity. Another peak time for UTIs in women is after menopause. This is because of lower vaginal estrogen levels. Lower estrogen levels make it easier for bacteria to grow. A woman’s urethra or the tube from the bladder to the outside of the body is very short, about two inches in length compared to man’s urethra which is 8-10 inches long. This short length makes it easy for bacteria to enter a woman’s bladder. The opening of a woman’s urethra is near the rectum and vagina which happen to be two common places where bacteria dwell.

Prevention of UTIs in women may be as simple as instructing women to wipe from front to back following urination and bowel movements. This helps cut the chance of spreading bacteria from the anus to the urethra.

For women who notice more UTIs after sexual activity, I will often recommend that women take a low dose antibiotic shortly before or right after sexual activity.

Bottom Line: UTIs are common in women.  Most of these infections are not serious and can be treated with a short course of antibiotics.  For women with chronic or repeated infections, low dose antibiotics may be helpful.

Erectile Dysfunction and the Other “Bones” That Are Important

September 4, 2016

I would like men to think of erectile dysfunction as a harbinger of other chronic diseases like heart disease, diabetes, kidney failure, high blood pressure, elevated cholesterol levels and also bone disease or osteoporosis.

A recent study from Taiwan 4,460 men aged 40 years and older diagnosed with erectile dysfunction from 1996 to 2010 with 17,480 randomly selected age-matched patients without ED.  The research found that osteoporosis developed in nearly 6% with ED and 3.65% in men without ED.  Men who had ED had a 3 times more likelihood of developing osteoporosis when compared with men who did not have ED.

Osteoporosis is a metabolic bone disease in which the bones become brittle and porous escalating the rate of bone loss and increasing the chance of a fracture of the hips and spine.

The researchers think that the men with ED had a lower level of testosterone which is necessary for bone strength and development.  Another explanation offered by the authors is that chronic, low grade inflammation can damage the lining of the blood vessels and perhaps lead to a decrease in the blood supply to the penis which is necessary for an erection to occur.  The same inflammation can also cause the bones to fail in calcium rebuilding of bone and thus lead to osteoporosis.

Finally, there is the theory that there is alternation of the vitamin D with decreased levels in men with ED.  With less vitamin D there is a risk of alternations in the lining of the blood vessels especially those that supply the penis and lead to ED.  Decrease in vitamin D also alters bone metabolism and may result in osteoporosis.

Bottom Line: Men with ED should be check for the co-morbid conditions such as heart disease, diabetes, high blood pressure, hormone deficiency and also have tests to be certain that men do not have osteoporosis.

Statins, Cholesterol and Erectile Dysfunction

September 4, 2016

Statins are a group of medicines that can help lower the level of cholesterol in the blood.  Having a high level of cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD) such as coronary heart disease, chest pain, heart attacks,  strokes, and even erectile dysfunction\impotence.  Cholesterol that narrows the blood vessels can decrease the blood flow to the penis thus making it difficult to achieve and maintain an erection adequate for sexual intimacy.

Before taking statins, every man or woman should give strong consideration to lifestyle changes such as losing weight, exercising regularly, limiting alcohol consumption, and consider smoking cessation.  All of these actions can decrease the cholesterol levels.  All of these lifestyle changes can also improve sexual function.

Bottom Line:  Elevated cholesterol levels are deleterious to your health.  Consider lifestyle changes before starting statins.  Your erections and your partner will thank you!

Oh My Gosh, No More Hand Wash

September 3, 2016

Recently the FDA has demanded that certain hand washing products used in antibacterial soaps be removed from the store shelves in drug stores and food stores.  The FDA has shown that manufacturers failed to show they are safe and kill germs and that some of the hand washing products provide no benefits over regular soap.

The FDA has mandated that products containing triclosan and triclocarban must be removed from stores within a year which are present in 40% of the soaps on the market.

I might point out that hand sanitizers and wipes designed to be used without water and containing more than 50% alcohol are not affected by the new rules.

Numerous studies have shown that simple hand washing with plain soap and water is the most effective way to avoid getting sick and spreading germs to others.

It is important not to panic about the FDA ruling as the rule is intended for products that require use with water, and does not include hand sanitizers or wipes.

Bottom Line:  Handwashing before eating and after going to restroom is highly recommended as an effective means of reducing infections and transmission of disease.  Washing with plain soap and running water remains one of the most important steps consumers can take to avoid getting sick and to prevent spreading germs to others. If you choose to use a hand sanitizer instead, then I suggest using an alcohol-based hand sanitizer that contains at least 60 percent alcohol.  So wash up!