3 Effective Minimally Invasive Surgical Treatment For Kidney Stones

Over the last 15 years, kidney stone prevalence has doubled in United States. Today, roughly 1-in-10 Americans will have a kidney stone attack at some point during their lifetime. When they occur, kidney stones can cause agonizing and unbearable pain in the back and side, and may sometimes trigger nausea and vomiting. You can pass a stone by drinking plenty of water — taking pain medications to control the discomfort as you wait for the stone to pass. But if you have a large stone or one that’s causing complications, then a more extensive treatment may be necessary to remove the stone.

Minimally-invasive surgical treatments

At St Pete Urology, we offer surgical treatment for kidney stones, focusing on minimally-invasive procedures even for the largest stones. Most operations for smaller stones can be done as same-day surgeries, giving patients greater flexibility and a faster return to their work and other routine activities. For larger stones, the planning and execution of the procedures may take a little more time, but with the use of small incisions only large enough to allow insertion of thin tubes, fiber-optic lights, cameras and other tiny surgical tools, we are able to ensure significantly less pain, less scarring, shorter hospital stay, faster recovery and increased accuracy than with traditional open surgery for the stones.

There are three main minimally-invasive techniques for removal of kidney stones. The least invasive being extracorporeal shockwave lithotripsy, followed by ureteroscopy then lastly percutaneous nephrolithotomy. The choice of a surgical technique depends on multiple factors, including the type of stone, size and location, medications taken by the patient, other medical problems the patient may have, and patient preferences.

Extracorporeal Shockwave Lithotripsy (ESWL)

This is the most popular option for treating small and medium-sized stones. Performed in an outpatient setting with the patient placed under general anesthesia, ESWL is the least invasive and takes 20-30 minutes to be completed. During the surgical procedure, intense sound waves are focused on the kidney stone, shattering the stone with minimal effect on surrounding tissue. Smaller pieces of stones that are produced get washed out of the urinary system with the normal flow of urine, often with slight or no discomfort. ESWL is a highly effective treatment for most stones that form in the kidney or ureter.

Advantages of ESWL include:

  1. It’s an outpatient procedure so patients return home after a few hours.
  2. It offers excellent success rate with most small-sized and medium-sized stones.
  3. It doesn’t require incisions or invasive techniques.
  4. It has minimal postoperative discomfort.
  5. It has a fast and easy scheduling.

Limitations of ESWL include:

  1. It’s ineffective for stones that are very hard or resistant to breakage by shockwaves.
  2. It’s not appropriate for stones that are invisible on X-ray such as uric acid, monohydrate and cystine stones.
  3. It’s not ideal for larger stones or those located in the lower part of the urinary tract.
  4. It’s not appropriate for patients with certain conditions or using certain medications, such as pregnant women or patients on blood thinning medications.

Ureteroscopy

Ureteroscopy is another surgical procedure often used to treat small and medium-sized stones. The advantage it offers over ESWL is that it can treat kidney stones occurring in any part of the urinary tract. It’s a same-day procedure done after the patient is placed under general anesthesia. The procedure involves passing a small scope via the urinary opening and into the bladder then into the ureter. Once the stone is reached, it is targeted with laser so that it’s broken down into smaller pieces that are extracted out of the system or into pieces of dust left to wash out with normal urine.

Ureteroscopy is a little bit more invasive than ESWL, but it’s preferred in situations where kidney stones are too hard to respond to ESWL, or for stones that are invisible on X-ray. Ureteroscopy is also a better choice than ESWL when stones are located in the lower portion of the urinary tract, especially the region near the bladder. After the procedure, a small tube — a stent — is temporarily placed into the urinary system to help drain the kidney. The stent is totally internal, and is usually removed 3-10 days after the procedure. Stent removal is a quick and easy process done in the doctor’s office and without anesthesia.

Advantages of ureteroscopy are:

  1. Great results for small-sized and medium-sized stones.
  2. It’s an outpatient procedure.
  3. No incisions are necessary.
  4. Fast and easy scheduling.
  5. Done without stopping the use of blood-thinning medications.
  6. Effective for stones that are resistant to ESWL.

Limitations of ureteroscopy are:

  1. It’s not effective for very large stones.
  2. In some rare instances, scopes may not reach the stones.
  3. Many patients find the stents placed after the procedure a source of unease and discomfort.

Percutaneous Nephrolithotomy (PCNL)

For kidney stones that are exceptionally large, complex or several small stones bundled in one kidney, percutaneous nephrolithotomy (PCNL) is the most appropriate treatment. Conducted by a urologist, often assisted by an interventional radiologist, PCNL is typically an inpatient procedure requiring an overnight hospital stay. During the procedure, the urologist and radiologist collaborate to open a direct channel into the kidney’s drainage system via a small incision made in the back, often not larger than a dime.

After making the incision, the urologist uses a set of specialized tools to break the stones into pieces, which are then plucked out or vacuumed out of the kidney. With the procedure completed, a drainage stent or tube is left in place for temporary drainage of the kidney. For stones that are unusually large or complicated, the urologist may schedule a second “clean-up” surgery. In most cases, patients leave the hospital after PCNL within 24 hours of the procedure. And despite PCNL being a more invasive procedure than ureteroscopy and ESWL, it remains an effective and safe treatment that sees a high level of patient satisfaction.

Advantages of PCNL are:

  1. It is the gold standard treatment for very large or really complex stones.
  2. It is the most appropriate surgery for patients with a number of small stones bundled in one kidney.
  3. It clears most kidney stones fully in one procedure.
  4. It is highly safe and effective.

Limitations of PCNL are:

  1. A drainage tube or stent is necessary after the procedure, which may be uncomfortable for most patients.
  2. It is not appropriate for patients on blood-thinning medications.
  3. It is more invasive and so an overnight stay in hospital is a necessity.
  4. Though it clears most stones in one procedure, a repeat procedure may be necessary for the largest or most complex stones.

At St Pete Urology, we perform hundreds of minimally-invasive surgeries for kidney stones every year. We have several surgeons with extensive training, skill and experience in ESWL, ureteroscopy and PCNL, delivering excellent outcomes even for the most difficult kidney stones. Our collaborative, compassionate and patient-centered approach to care also means our patients enjoy utmost comfort and convenience throughout their procedures. So if you have symptoms of what you suspect to be kidney stones, don’t hesitate to come see us. We fix kidney stones safely and effectively. For more information on the prevention, diagnosis and treatment of kidney stones, visit the “St Pete Urology” site.

What are the risks of vasectomy?

You have all the children you want and have decided not to have any more. You can now enjoy a sex life with your partner without worrying about pregnancy if you opt for an effective method of contraception. There is no form of male contraception more reliable than a vasectomy, so is it the right decision for you?

Choosing a competent, experienced surgeon for your vasectomy procedure

If you’ve made the decision, what must you do to improve the success of your vasectomy and minimize the risk of complications? You must make sure it’s done by a qualified and experienced surgeon. When a vasectomy is performed correctly by a skilled and experienced physician, only about 1 in 1,000 vasectomies may fail to prevent sperm reaching the semen. But when done by a doctor who performs less than 50 vasectomies a year, the likelihood of failure is as high as 10-17 percent or more.

How are vasectomies done?

Your sperm is generated in the testes then stored in the epididymis, a sac adjacent to the testes. The sperm is driven through the shoestring-sized tube known as the vas deferens, about 15 inches long, by a whip-like motion of a tail. Because the vas deferens is connected to the prostate gland that produces semen and also with the seminal vesicles located near the bladder, sperm is able to find its way into the semen to reach the ova after an ejaculation, causing a pregnancy. Failure of sperm to reach the semen means a pregnancy won’t occur.

To conduct a vasectomy, a surgeon kneads the scrotum tenderly until the vas deferens are located — a process similar to a guy looking for a tie-string that has withdrawn into his sweatpants’ waistband. Once the doctor finds the vas, a needle is used to poke a hole in the scrotum before tiny clamps are applied to draw out a small portion of the vas. Then the surgeon cuts, closes or inactivates the two clipped ends of the tubes so sperm won’t get out of them.

There are a number of techniques for achieving this, but the best method currently is the intraluminal cauterization and fascial interposition, That is a technique involving the slicing of the vas in two, scarring the inside (lumina) of the vas using a heated needle, then pulling up the fascia (tissue that surrounds the tube) and clamping or suturing it over the vas end. With the procedure completed, you are ready to return home the same day and take a few days off work to recover.

Fascial interposition improves vasectomy success

During the vasectomy procedure, the doctor sews up the tubes to prevent “recanalization,” which may occur if microscopic channels develop between the tubes’ cut ends. And when recanalization happens, sperm may pass through micro-channels and get into semen, leading to a failure of vasectomy.

When the ends are only clipped but not cauterized up to 1-in-300 men can still get their mates pregnant after a vasectomy. In fact, according to one study of 14,000 men who had undergone a vasectomy, there were six pregnancies and up to 10 percent of men had significant numbers of sperm in semen months after their vasectomy.

However, with the fascial interposition technique, the surgeon puts tissue between the cut ends, which acts as a double zip and lock. The result is that pregnancy rates drop to 1-in-7,000 and only about one vasectomy may be redone per year. Nevertheless, the skill and experience of the urologist conducting the vasectomy still remains the most critical factor for success and minimal complications.

Improving vasectomy success

Three months following a vasectomy there will still be sperm swimming around “downstream” beyond the cut area. It is crucial to use another birth control method such as condoms to prevent pregnancy. At 12 weeks after the procedure, a follow-up test for the presence of sperm in semen is necessary — with a negative result confirming that the procedure was successful.

But even with the negative result, there is still a 1-in-2,000 chance that you can later regain your fertility. If a pregnancy does occur, you should assume that the body has healed and you’re again capable of making your mate pregnant.

Vasectomy pain

A significant number of men fear getting a vasectomy because of pain. But how bad is the vasectomy pain? While the procedure is almost painless when properly performed, it’s common to feel some soreness afterward. Studies show that somewhere between 1-50 percent of men have chronic testicular soreness, including epididymitis (blue balls) for up to a year after the procedure. And as many as 15 percent of men may experience a seriously aggravating pain after the procedure. The pain, however, is managed with painkillers and would rarely hamper your ability to engage in routine tasks.

Sexual intercourse should be postponed for at least a week after a vasectomy. Some men who have tried sex a day or two after the procedure have reported terrible pain and swelling of the scrotum. Again, it’s important to remember that the surgeon’s experience and technique will determine how much pain you experience after a vasectomy.

What of the link between prostate cancer and a vasectomy?

A few studies were published in early to middle 1990s that reported that prostate cancer is linked to a vasectomy. However, a more conclusive survey conducted in New Zealand disproved such a link. Another study by researchers from the University of Toronto and Mayo Clinic in Rochester examined results of 40 different studies with over 12 million participants and concluded that a vasectomy does not enhance the risk of a man developing prostate cancer. So as we now know it, there is no link between prostate cancer and a vasectomy.

Vasectomy and dementia

A 2006 study by researchers from Northwestern University appeared to relate vasectomy with dementia, causing some concern by highlighting a plausible, even if unlikely, mechanism through which vasectomy can result in brain damage. Triggered by a patient at an Alzheimer’s clinic complaining that his aphasia (speech problems) started soon after a vasectomy, the researchers surveyed 47 clinic patients with early-stage aphasia and found that 19 of them had undergone a vasectomy.

According to the study, sperm can leak into the body’s normal tissue after the vas deferens is cut resulting in the development of antibodies to sperm in the blood. This was observed in about two-thirds of vasectomized men (sperm doesn’t normally get into the bloodstream). From the observation, the Northwestern study theorized that if antibodies to sperm — which contain some proteins also found in brain cells — appear in blood, they may lead to an autoimmune attack of the brain cells resulting in dementia. Nevertheless, being a small study that hasn’t been replicated, it’s still quite early to draw much from it. And for now, dementia still remains only hypothetically linked to a vasectomy — though the association requires further research.

Effectiveness of vasectomy reversals

Vasectomies are reversible. That’s true. But when making the decision to undergo the procedure, it’s important to approach it as a permanent method of sterilization and not by expecting it to be undone. In fact, when done well, it can only be reversed successfully about 50 percent of the time and with no guarantees that you’ll have children. Only go for a vasectomy if you are sure you have had enough children or don’t want any children. Also make sure to ask all the questions and go for the procedure only when you are truly ready for it.

At St Pete Urology, we offer both vasectomy and vasectomy reversals using procedures that ensure maximum comfort and the least pain for our patients. We have assembled a team of skilled, knowledgeable and experienced urologists who perform hundreds of vasectomies every year. So you can be sure that your procedure will follow the right technique and have the highest chance of success. For more information on vasectomy and vasectomy reversals and their risks and benefits, visit the “St Pete Urology” site.

What treatments are available for erectile dysfunction?

Are you struggling to achieve or maintain an erection? Whether you are under 35 or over 65, you are certainly not alone. Erectile dysfunction (ED) is quite common in American men, affecting more than 20 million men. Statistically, 52 percent of men between 40 and 70 years old have some form of erectile dysfunction while 25 percent of men younger than 40 suffer from the problem on a regular basis. At St Pete Urology, we see a lot of cases of erectile dysfunction every month, administer treatments and achieve excellent results for our patients.

Types of ED treatments

There are a number of safe and effective treatments for erectile dysfunction which, when properly applied, help in achieving and maintaining an erection for satisfactory sexual intercourse. The main treatments include oral medications, penile injections, vacuum erection devices and surgery. The choice of treatment depends on factors such as underlying causes and severity of the dysfunction, and overall health and preferences of the patient.

Oral medications

Dr. Adam Oppenheim of Advanced Urology InstituteAt St Pete Urology, oral medications are typically our first line of treatment. The medications commonly given are vardenafil (Levitra, Staxyn), sildenafil (Viagra), avanafil (Stendra) and tadalafil (Cialis). All these medications work by improving the action and efficacy of nitric oxide, which is a natural chemical produced by the body and used to relax penile muscles. With increased activity of nitric oxide due to these drugs, there is increased relaxation of the smooth muscles, improved blood flow to and in the penis and greater likelihood of developing an erection when there is sexual stimulation.

Though the oral ED drugs are similar in their mechanism of action, they vary slightly in chemical makeup, timing of dosage and expected period of effectiveness, and potential side effects. For instance, sildenafil (Viagra) produces the best effect when taken without food about one hour before sex and its effect lasts six hours. Vardenafil (Levitra, Staxyn) can be taken with or without food one hour before sex and its effect lasts seven hours. Like vardenafil, avanafil (Stendra) can be taken with or without food, but 15-30 minutes before sex (depending on the dose) and its effects lasts six hours. Tadalafil (Cialis) should be taken in small daily doses or in a large dose (as needed) with or without food about 1-2 hours before sex and its effect lasts 36 hours. Doctors usually consider these differences before prescribing oral ED medications.

Penile injections

An effective alternative to oral medications is injectable ED medicine. The specific injectable medication may vary, but some of the most commonly used ones are papaverine hydrochloride, alprostadil, prostaglandin E-1 and phentolamine. An injection of one or a blend of these ingredients will relax arterial wall muscles, cause increased blood flow into the penis and result in an erection. A small, sharp needle is used for the injection and there is only minimal discomfort. At St Pete Urology, we teach patients how to do the injections and once they have mastered it, then drugs are ordered and sent to them to do the injections at home.

Vacuum constriction devices

A vacuum device is an external pump supplied with a band to help trigger an erection by driving blood into the penis. Vacuum constriction devices (VCDs) have three components: the plastic tube placed around the penis, the pump that draws out air from the tube and creates a vacuum, and the elastic ring that helps to maintain an erection during intercourse by preventing the flow of blood back into the body. The elastic ring should only remain in place for a maximum of 30 minutes and then should be removed to restore normal blood circulation and prevent potential skin irritation. Using a vacuum pump requires adjustment and practice — it may make the penis feel numb or cold, purple in color and bruised, although such effects are often painless and go away in a few days. The devices also may weaken ejaculation, but they do not affect orgasm (pleasure of climax).

Implant surgery

Surgery is often a last resort treatment for ED. At St Pete Urology, we speak with our patients about whether or not surgery is right for them. Surgery can be done either to implant a device into the penis that makes it erect or rebuild the arteries and veins around the penis to improve blood flow. Implanted devices (prostheses) are an effective treatment for ED with implant surgeries typically taking about one hour to complete and usually done in outpatient setting.

There are two types of penile implants: inflatable implants that make the penis wider and longer via a pump in the scrotum and malleable implants that are basically rods allowing for manual adjustment of the position of the penis. Patients leave the hospital the day after their implant surgery and are able to use the implant to achieve an erection 4-6 weeks after surgery. Possible challenges with the implants include infection and breakage, but they are generally effective in getting and maintaining an erection.

Vascular reconstructive surgery

Another option is the urologist can perform a vascular or arterial reconstruction surgery to improve blood flow to and in the penis. Vascular reconstructive surgery is a highly delicate procedure involving either the re-routing of arterial pathways leading to the penis to bypass blocked arteries that are restricting blood flow, or to unblock blood vessels causing an obstruction. An artery can be bypassed by moving an abdominal muscle artery to a penile artery. Alternatively, a penile vein can be modified to work like an artery.

Men who are younger than 45 are the ideal candidates for reconstructive surgery, especially those who have experienced trauma or injury that resulted in the damage to blood vessels at the base of the penis. The goal of the procedure is to remove or bypass any blockages that may impede blood flow to the penis. And with the obstruction removed, there is increased blood flow to the penis and greater likelihood of an erection.

If you have erectile dysfunction, the first step is to speak with a doctor. The right treatment for you will depend on your overall health and the underlying cause of your ED. At St Pete Urology, we see a lot of cases of erectile dysfunction and endeavor to achieve the best possible outcomes for our patients. For more information on treatment of erectile dysfunction, visit the “St Pete Urology” site.

How To Treat Kidney Stones?

When certain minerals are in excess in the body, they accumulate in urine. The urine becomes more concentrated as the levels of minerals and salts increase, particularly when the body is not well hydrated. As a result, hard masses of minerals and salts called kidney stones — often made of uric acid or calcium — form inside the kidney and can travel to other areas of the urinary tract. About 1-in-11 Americans will have a kidney stone at some point in their lifetime, but stones occur more often in men, people with diabetes and those who are obese.

Stones come in different sizes

Kidney stones vary in size. While some may be as small as a fraction of an inch and others only a few inches across, some stones can be very large and may take up the whole kidney. Smaller stones tend to remain in the kidney and rarely cause pain as they pass out of the body. In most cases they are not noticed until the kidney stones pass into the ureter. But larger stones may block urine flow, cause pain and result in urinary tract problems. Fortunately, the stones rarely cause permanent damage, and there are effective treatments for them.

Pain due to kidney stones

Pain is the most common characteristic and frequent symptom of kidney stones. Although the pain associated with stones varies from person to person, it can be quite intense and agonizing when it occurs — accounting for over 1 million visits to the emergency room every year. Many women who have had the condition attest that the pain is worse than the cramps and spasms of childbirth; others say it’s like being stabbed with a knife. The pain is felt along the side and back and below the ribs, though it may radiate to the belly and groin area with the movement of the stone along the urinary tract. It also generally occurs in waves, each wave lasting a few minutes, before disappearing and coming back.

Treatment of kidney stones

At St Pete Urology, we admit many patients in our emergency department because of painful kidney stones. Some patients also present with symptoms such as nausea, vomiting and hematuria (blood in urine). We determine how to manage kidney stone disease depending on the location and severity of the stones. For patients with small stones — several millimeters in size — we may allow time for the stones to pass without intervention. In that case, a patient is given pain medication, advised to drink plenty of water and waits for the stones to pass, under our close observation. But for large stones or complex ones causing problems such as severe pain, infection or kidney failure, we usually intervene to remove the stones.

Types of treatments

We often intervene to remove kidney stones that fail to pass spontaneously, are affecting kidney function, are accompanied by too much pain to wait for their passage, are blocking the flow of urine or are causing repeated infections. The interventions involve tiny or no incisions, minimal pain and a short time off work. At St Pete Urology, the treatments we commonly provide for kidney stones are extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and ureteroscopy.

1. Extracorporeal Shockwave Lithotripsy (ESWL)

ESWL (Extracorporeal Shockwave Lithotripsy) is the use of highly-focused sound waves released and focused from outside the body to crush kidney stones. The intense waves are able to reduce the stones into sand-like granules that can pass normally in urine over a few weeks. Before ESWL, patients are given a sedative or placed under regional or general anesthesia and ultrasound or X-rays used to pinpoint the location of the stones.

The procedure takes about 1 hour, but larger or more complex stones may need several ESWL treatments. Patients return home the same day and are able to resume normal activities in 2-3 days. Shockwave lithotripsy is not used for hard stones, such as cystine, struvite, and some types of calcium phosphate and calcium oxalate stones. It’s also not ideal for stones larger than 1 inch in diameter and for pregnant women.

2. Ureteroscopy (URS)

For some kidney stones, especially those located in the kidney and ureter, ureteroscopy is the preferred treatment. The treatment involves passing a small fiber-optic instrument called ureteroscope into the urethra and bladder, then into the ureter. The telescopic instrument enables the urologist to see the stone and to use a small, basket-like device to pull out a smaller stone. For larger stones that can’t be removed in one piece, the urologist uses laser or a similar stone-breaking tool to shatter the stone into smaller pieces.

Flexible ureteroscopes are used for stones located in the kidney and upper ureter while rigid ones are used when stones are located in the lower ureter near the bladder. During the procedure, you are placed under general anesthesia to keep you comfortable. A stent (or small tube) is left in the ureter to keep it open and drain urine from the kidney and into the bladder, but it’s completely within your body and doesn’t require an external urine collection bag. You can return home the same day and resume normal activities in 2-3 days, but the stent must be removed in 4-10 days to avoid infection and potential loss of kidney function.

3. Percutaneous nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is the most appropriate treatment for larger or more complex kidney stones. It’s also the best treatment if several small stones are bundled up in one kidney. During the procedure, the surgeon makes a half-inch incision in the side or back and then guides a nephroscope (rigid telescope) through the incision and into the area of the kidney where the stone is located. Using the nephroscope, the urologist reaches the stone with instruments that fragments it into pieces that are then suctioned out. The ability to suction tiny pieces of stone from the urinary tract makes PCNL the best treatment option for larger stones.

PCNL is performed with the patient under general anesthesia. The procedure requires hospitalization and you are discharged after 24 hours but resume normal activities after 1-2 weeks. Usually at the end of the procedure a tube is placed in the kidney to help drain urine into a bag outside the body. The tube remains for a few days or just overnight. Before you are discharged from hospital, the urologist may do X-rays to check if any pieces of stone remain. The nephroscope may be inserted again if any stone fragments are detected to remove the leftover fragments and to make sure you are completely free of the condition.

At St Pete Urology, we have experienced urologists, specialized equipment and highly-skilled support personnel to help us deliver excellent outcomes for patients with kidney stones. We use both surgical and non-surgical methods to tackle this painful condition, including the minimally-invasive procedures of shockwave lithotripsy, percutaneous nephrolithotomy and ureteroscopy, robotic surgical procedures, advanced imaging technology, medications and dietary changes. For us, the goal is not only to cure kidney stones but also to prevent a recurrence — striving to make your first stone surgery your last. So if you have symptoms of kidney stones or want advice on how to avoid this painful condition, come see us for help. For more information on prevention, diagnosis and treatment of kidney stones, visit the “St Pete Urology” site.

Meet Dr. Adam Oppenheim

Urology is a great blend of surgery and medicine and a specialty that provides an amazing work-life balance. It also brings profound satisfaction from the excellent outcomes with most cases. It is a wonderful opportunity to help people with embarrassing conditions and a chance to provide life-saving and life-extending treatments. Being passionate about making a difference in the lives of people, I found urology the perfect specialty for me.

Becoming a urologist

I was born and grew up in Yorktown, Va., and went to Virginia Tech for my Bachelor of Science in Biology. I went to the Nova Southeastern University, College of Osteopathic Medicine for my medical education. While a lot of factors were involved in choosing to become a doctor, my dad was a big influence. He was an ophthalmologist who spoke fondly about the joy of caring for patients — both in his office and in the operating room. My dad made medicine such a noble career that I was inspired to follow in his footsteps.

But it was when I was a third year medical student that I chose to become a urologist. My general surgery rotations allowed me to interact closely with many urologists. During those sessions I spent with them, I saw the enthusiasm the urologists brought to their work and it inspired me. They really appreciated their work and their passion and commitment translated into great care and excellent outcomes for their patients. They instilled that love for urology in me — a love that has continued to flourish ever since.

I completed my general surgery and urology residency at the Einstein Medical Center in Philadelphia. During those years in Philadelphia I also received urology oncology training at the Fox Chase Cancer Center — one of the nation’s top centers in cancer care. My urology training included working with the country’s leading doctors in penile implant surgery, enabling me to be solidly grounded in knowledge, skill and experience in penile prosthesis. Likewise, I took extra-curricular courses in mid-urethral sling insertion for stress incontinence in women, urologic prosthetics, GreenLight laser therapy and InterStim sacral neuromodulation for BPH.

What do we do as urologists?

We are specialists in treating medical problems of the urinary tract and the male reproductive system. The problems are found in organs such as kidneys, uterus, urethra, urinary bladder and male reproductive organs. When necessary, we perform surgeries to remove kidney stones, genital abnormalities present at birth, urinary tract obstructions, and other issues causing problems for patients. We diagnose and treat enlarged prostate, erectile dysfunction, urinary problems, urologic cancers, overactive bladder, urethritis, prostatitis and interstitial cystitis, among other conditions. We see patients of all ages, from babies and children to seniors.

Urology is a specialized field with a lot of things that I like. We do many procedures to improve the quality of life of our patients. For instance, we do prostate procedures to help patients pass urine, treat erectile dysfunction which is quite embarrassing to those who struggle with it, treat kidney stones that can cause agonizing pain, and tackle life-threatening conditions such as prostate cancer and kidney cancer. I practice every aspect of general urology but I have a special interest in erectile dysfunction, kidney stones, urinary problems, enlarged prostate, prosthetics and men’s health, spending the better part of each day doing exams on the male genitalia and performing a lot of surgeries on balls and penises.

Job Satisfaction

As a urologist, I always feel that I’m in a unique position. I am able to have a lasting relationship with my patients, which is something I find really gratifying. And after almost every successful diagnosis and treatment, my patients improve quickly and are able to enjoy life again — something that fills me with joy and satisfaction.

During our work, the most difficult part is usually for patients struggling with embarrassing and awkward conditions to walk in, sit down and discuss sensitive issues openly and honestly. With every encounter I try to provide a caring and compassionate environment that allows for frank and open conversations. The goal for me is to craft a personalized treatment plan that suits the goals and lifestyle of each patient. A plan may be as simple as changing medications or as complex as conducting surgery with sophisticated equipment.

Why St Pete Urology

St Pete Urology is a wonderful place with great professionals and state-of-the-art equipment. Working here always fills me with pride because of the excellent outcomes we achieve for our patients and the unwavering commitment to improving the standards of care through innovative and advanced techniques. It’s always buzzing with people sharing jokes and smiling, and that positive attitude is contagious. It also helps because we have to perform tests and procedures in an uncomfortable area of the body and there are often times we have to deliver news about diagnoses that patients may not want to hear. It has been an amazing time being here and I have only good things to say about urology — I would choose urology if I had to do so again.

For more information on our urologists and range of services, visit the “St Pete Urology” site.

How To Pass Kidney Stones?

Passing a kidney stone is an agonizing and traumatic experience. It’s something you wouldn’t wish for anyone, even your worst enemy. And you will want to do anything to avoid going through the ordeal again. Sadly, kidney stones are bound to recur in about 50 percent of people who have had them, often within 10-15 years if preventive measures are not taken. They occur more frequently in men than women and may lead to serious complications if not dealt with promptly, effectively and appropriately.

Triggers of kidney stones?

Kidney stones typically develop when the concentration of certain substances such as oxalate, uric acid and calcium are high enough in urine to form crystals. Once crystals are formed in the kidneys, they grow larger and solidify into “stones.” Most kidney stones (about 80-85 percent) are made of calcium while the others are uric acid stones occurring in people whose urine PH level is low.

Symptoms of kidney stones

Once they are formed, kidney stones can dislodge and move down the ureter, obstructing urine flow. As a stone moves through the ureter, it causes periods of severe, excruciating pain, including pain in the flank — pain occurring on one side of your body between the back and the stomach. In some cases, there may be nausea, vomiting and blood in urine. When the stones move beyond the ureter and toward the bladder, they are usually accompanied by bladder pressure, groin pain and frequent urination. If you have any of these symptoms, check with your primary care physician for help. The doctor most likely will do a urinalysis and an abdominal X-ray, renal ultrasound or CT scan to ascertain whether you have kidney stones and determine their number and size.

Allowing kidney stones to pass

It usually takes many weeks to a few months for kidney stones to pass spontaneously. The length of time to pass a stone depends on its size and location. As you wait for the stone to pass, you can use over-the-counter painkillers, such as acetaminophen (Tylenol), naproxen (Aleve) or ibuprofen (Motrin IB or Advil) to reduce the discomfort. Your doctor may prescribe an alpha blocker to help relax your ureter muscles and ensure the stone passes faster and with minimal pain.

For kidney stones that are too big to pass or are accompanied by very severe pain, surgical removal may be necessary. Your doctor may undertake a procedure called ureteroscopy, where a tiny endoscope (a device fitted with a small video camera and various tools fixed at the end of a long tube) is inserted into the bladder, then up the ureter to reach the stone. This is done while you’re under general anesthesia. Once the stone is reached, it’s broken down into smaller fragments and removed.

How can you prevent kidney stones?

Kidney stones are common and often recur in people who have had them. That’s why you should take the necessary steps to prevent them from forming. Some of the strategies to prevent kidney stones include:

1. Drink enough water: If you can produce 2 to 2.5 liters of urine every day, then you’re 50 percent less likely to have kidney stones than a person who produces less urine. To help you maintain such a level of urine production every day, you should drink about 8-10, eight-ounce glasses (roughly 2 liters total) of water every day.

2. Avoid high-oxalate foods: It is okay to eat foods with moderate to low quantities of oxalate, such as berries and chocolate. But you should avoid high-oxalate foods like almonds, beets and spinach, which will raise oxalate levels in your body.

3. Keep sodium in check: A diet with a lot of sodium can cause kidney stones because it increases the quantity of calcium that’s present in urine. Limit your total daily sodium intake to below 2,300 milligrams (mg). If you have had a previous incident of kidney stones due to the amount of sodium in your diet, then you need to reduce your daily sodium intake to about 1,500mg.

4. Take some lemons: Lemons provide citrate, a citric acid salt, which binds to calcium and prevents kidney stone formation. If you drink a cup of lemon juice concentrate that’s diluted in water each day, or just pure juice from two lemons, you will boost your urine citrate and reduce your risk of kidney stone.

5. Reduce your consumption of animal protein: If you’re prone to kidney stones, you should reduce your intake of animal proteins. Eating too much of eggs, meat and seafood, among other animal proteins, increases uric acid levels in the body and promotes the formation of stones. While you don’t have to avoid proteins altogether, you can opt for plant-based proteins instead.

Kidney stones are a painful and distressing condition that’s better prevented than treated. That’s why at St Pete Urology, we not only provide a variety of safe and effective kidney remedies, but also offer information to our patients so they can take action to prevent the stones from occurring. For those with stones, we offer extracorporeal shock-wave lithotripsy, ureteroscopy with either holmium or EHL Laser, ureteral stent and percutaneous nephrolithotomy, among other remedies. Don’t suffer in silence. If you suspect you have kidney stones, contact us so we can help you. For more information on the prevention, diagnosis and treatment of kidney stones, visit the “St Pete Urology” site.

What causes the prostate to enlarge?

Although the exact trigger of BPH (Benign Prostatic Hyperplasia) is not fully known and may vary from one man to another, there are risk factors that contribute to the condition. Benign prostate enlargement means your prostate grows in size without being cancerous. As the prostate swells and becomes bigger, it presses on your urethra and bladder and may cause a number of urinary and bladder function problems. The known contributing factors to prostate enlargement are age, hormones, stress levels and diet.

1. Age

Your age is a risk factor and not a cause of BPH. Prostate growth is considered a normal part of aging. In fact, the prostate usually goes through two major periods of growth as a man ages. During early puberty, the prostate doubles in size. Then from the age of 25 the gland enters a second phase of growth and continues to increase in size for the rest of his life. It’s typically during this second growth phase that benign prostatic hyperplasia occurs. About 50 percent of men over the age of 50 have BPH, while up to 90 percent of men over 80 years old have the condition.

2. Hormones

Hormones have a major role in triggering BPH. For instance, testosterone — the male sex hormone responsible for sexual development, muscle mass, deep male voice and libido — is converted to DHT (dihydrotestosterone) when it is in excess in the body. DHT is a useful hormone in adolescents because it ensures normal growth and development of sexual organs, including the prostate. But the production of excess quantities of DHT results in problems such as aggression and acne in adolescents. In older men, excess production of DHT causes the prostate to continue to grow and enlarge. If left unchecked, this could lead to an enlarged prostate and other problems associated with the gland.

3. Diet

Prostate enlargement is a more common problem in Western countries such as the U.S. and UK, but occurs in lower rates in Asian countries like Singapore and Japan because of dietary reasons. A typical Western diet contains simple carbohydrates, refined sugar, meat, dairy and unhealthy fats, while traditional Asian and Eastern diets are often richer in complex carbohydrates, vegetables and healthy soya-based proteins. The dietary differences are therefore critical for the varied incidences of BPH in the Western and Eastern countries.

The regular consumption of red meat escalates the risk of developing BPH by 38 percent, and regular dairy intake not only contributes to joint pain and hay fever through inflammation, but also inflames the prostate and accelerates the enlargement process. On the other hand, consuming 4 or more vegetable servings a day decreases the risk of BPH by 32 percent, and regular intake of soya reduces the chances of having an enlarged prostate. Likewise, zinc, commonly found in seeds and nuts and often missing in typical Western diets, is critical for a healthy prostate.

Poor diets lacking in fiber can cause constipation, which badly affects the prostate. The prostate is located very close to the bowels. If toxins remain in the bowels for a long time they start to leak into the surrounding tissues and into the prostate. When that happens, inflammation and pain may occur in the prostate. Similarly, the pressure caused by constipated bowels on both the bladder and prostate can worsen BPH symptoms.

4. Stress levels

Prolonged repeated exposure to stress, such as men who have high-pressure jobs, who commute frequently or who are rarely relaxed, can lead to or worsen BPH. For men already suffering the symptoms of an enlarged prostate, stress leads to inflammation of the prostate and worsens the symptoms. It also causes muscular tension, which results in further restriction of bladder function. Increased exposure to stress quickly depletes the body of nutrients and one of the most frequently stress exhausted nutrients is zinc, which is vital for prostate health. Repeated high stress levels also lead to increased secretion of testosterone and DHT hormones, which contribute to the growth of the prostate.

So what’s your role in preventing BPH?

You can’t do anything about your age, but you can do something about your lifestyle and diet to boost the health of your prostate. Start by avoiding or cutting down on dairy and meat, add lots of vegetables, fruits, nuts, seeds and whole grains to your nutrition regimen, and try including soya products like miso, tofu and tempeh in your diet. Initially that may be difficult if you are used to consuming meat and dairy-heavy meals. But by incorporating tasty, plant-based substitutes such as tofu, three-bean curry, mushroom risotto and vegetable satay, you can quickly get used to meals without meat and dairy. Take steps to reduce your stress levels by dealing with the underlying causes of your stress. Take a stress remedy, practice mindfulness or see a counselor — whatever works best for you.

For more information on prevention, diagnosis and treatment of BPH, visit the “St Pete Urology” site.

Foods That Can Cause Kidney Stones

You have a role in preventing kidney stones. By being cautious with what you eat and drink you can manage to stay free of the stones. One of the easiest ways to prevent kidney stones is to drink plenty of liquid, mainly water. In fact, unless you have trouble with your kidneys, drinking six to eight 8-ounce glasses of water every day is a proven way to prevent stones. Talk with your doctor about the quantity of liquid you should drink and begin right away. Another way to prevent kidney stones is to lose weight since being overweight increases the risk of the stones. Have your meals planned by a dietician and take the necessary steps to lose excess weight.

What if you have already had kidney stones?

You will need to talk to your doctor to find out which type of kidney stones you had. Depending on the type of stone, you’ll need to change your diet to prevent the recurrence of similar stones in the future. The most common types of kidney stones are calcium oxalate stones, calcium phosphate stones, uric acid stones and cystine stones. You can prevent them by making certain changes in how much calcium, oxalate, sodium and animal protein are in the foods you eat. Working with a dietician who is an expert in kidney stone management and prevention can help you greatly.

1. Dietary steps to prevent calcium oxalate stones

If you’ve had calcium oxalate stones, then you’ll need to reduce the amount of sodium, oxalate and animal protein in your diet while keeping your calcium consumption optimum. Speak with your doctor and also with a dietician about the food sources to avoid and how much of oxalate, sodium, calcium and animal protein you should take.

To reduce the amount of oxalate in your urine, avoid the following foods:

  • a. Spinach
  • b. Wheat bran
  • c. Nuts and nut products
  • d. Peanuts — which are legumes, but are rich in oxalate.
  • e. Rhubarb

To reduce the amount of sodium in your diet:

  • a. Reduce your salt intake
  • b. Avoid packaged, canned and fast foods, which often contain sodium
  • c. Avoid food condiments, seasonings and meats, which are often rich in sodium

To limit the amount of animal protein you eat, reduce the following in your diet:

  • a. Eggs
  • b. Chicken, beef, pork, particularly organ meats
  • c. Milk, cheese, and the other dairy products
  • d. Shellfish and fish

Remember, you’ll still need to get enough protein even as you limit the amount of animal protein. Just replace the meat and animal protein with other protein sources such as dried peas, lentils, white beans, which are plant-based and low in oxalate. Your doctor and dietician can guide you on the total protein you should eat and what portion of the protein should come from animal or plant-based sources.

Optimal calcium

To prevent calcium oxalate stones, you need to have enough calcium in your diet. While you may assume that increased calcium would increase your risk of kidney stones, that’s not true. Actually, in the right quantities, calcium combines with other substances in your digestive tract and prevents stone formation. You should check with your doctor about how much calcium you need to prevent a recurrence of calcium oxalate stones and to develop strong bones. Also find out from your dietician the best food sources of calcium for you. It’s often recommended that calcium be obtained from low-oxalate, plant-based sources like cereals, calcium-fortified juices, breads, some types of beans and some types of vegetables.

2. Dietary steps to prevent calcium phosphate stones

Just like calcium oxalate stones, the prevention of calcium phosphate stones requires that you reduce the amount of sodium and animal protein in your diet while ensuring that you get enough calcium. Talk to your doctor about the dietary changes you should make. A dietician who is expert in kidney stones can help you with exactly how much sodium, calcium and animal protein to include in your diet.

To reduce the amount of sodium in your diet:

  • a. Reduce your salt intake
  • b. Avoid packaged, canned and fast foods, which often contain sodium
  • c. Avoid food condiments, seasonings and meats, which are often rich in sodium

To limit the amount of animal protein you eat, reduce the following in your diet:

  • a. Eggs
  • b. Chicken, beef, pork, particularly organ meats
  • c. Milk, cheese, and the other dairy products
  • c. Shellfish and fish

Consider replacing the above sources of animal protein with plant-based ones such as:

  • a. Soy foods, like tofu, soy nut butter and soy milk
  • b. Legumes, such as dried peas, lentils, beans and peanuts
  • c. Sunflower seeds
  • d. Nuts and nut products, like cashews, cashew butter, almond butter, almonds, pistachios and walnuts.

Talk to your doctor and dietician about the total quantity of protein to eat and how much should be from animal foods or plant-based sources.

Optimal calcium

To prevent calcium phosphate stones, you’ll also need enough calcium in your diet. While it may seem that having calcium in your diet may cause calcium stones, taking the right amount of calcium helps eliminate various substances responsible for stone formation from your digestive tract. So talk to your doctor to find out how much calcium would help you maintain strong bones and prevent calcium phosphate stones. Also ask your doctor or dietician about the appropriate food sources for calcium. Getting calcium from plant-based sources such as cereals, breads, calcium-fortified juices, some types of beans and some types of vegetables will help you prevent the stone formation.

3. Dietary steps to prevent uric acid stones

For uric acid stones, increased intake of animal protein will increase your risk of developing the stones. The animal proteins to limit in your diet include:

  • a. Eggs
  • b. Chicken, beef, pork, especially organ meats
  • c. Shellfish and fish
  • d. Cheese, milk, and the other dairy products

In order to ensure that you get enough protein every day, replace the animal proteins with plant-based ones such as:

  • a. Legumes like beans, lentils, dried peas and peanuts
  • b. Soy foods like tofu, soy nut butter, soy milk
  • c. Sunflower seeds
  • d. Nuts and nut products like cashews, cashew butter, pistachios, walnuts, almonds, and almond butter

Speak with your doctor about how much total protein you should include in your diet every day and how much of that should come from plant-based or animal-based sources.

For uric acid stones, being overweight is also a major risk factor. So consider losing weight to prevent a recurrence of the stones.

4. Dietary steps to prevent cystine stones

The most important lifestyle change you’ll need to make to prevent cystine stones is drinking plenty of liquids, mainly water. Speak with your doctor about how much water you should drink, especially if you’ve had kidney failure.

Tips for limiting the amount of sodium in your diet

Most Americans take in too much sodium which increases their risk of kidney stones. An adult should consume not more than 2,300 mg of sodium a day — remember that one teaspoonful of table salt contains 2,325 mg of sodium. To prevent a recurrence of calcium phosphate or calcium oxalate stones, use the following guideline to limit the amount of sodium you consume:

  • a. Check the Percentage Daily Value (%DV) of sodium on the label of the food products you buy. A %DV of 20 percent or more is high while a %DV of 5 percent or less is low.
  • b. Write down the quantity of sodium you consume every day.
  • c. Always try to find out the sodium content of the food you eat.
  • d. Cook your meals from scratch — avoid canned vegetables and soups, fast and processed foods and lunch meats as they often contain a lot of sodium.
  • e. Buy foods labeled: salt free, sodium free, low sodium, very low sodium, light in sodium, less or reduced sodium, unsalted, no salt added, or lightly salted.
  • f. Check food labels for hidden sodium and sodium-rich ingredients such as sodium nitrate, sodium nitrite, sodium alginate, monosodium glutamate (MSG), disodium phosphate, sodium bicarbonate, and baking soda (contains sodium bicarbonate and other chemicals).

Looking for more information on prevention and treatment of kidney stones? At St Pete Urology, we treat ureteral and kidney stones as safely, painlessly and effectively as possible. We also equip our patients with the information they need to prevent the recurrence of the stones. Talk with us about your symptoms, fears or concerns and we can help find the best plan for you. For more information, visit the “St Pete Urology” site.

What are the symptoms of infertility in males?

Defined as inability of a couple to achieve pregnancy after at least one year of frequent, unprotected sexual intercourse, infertility affects women and men equally. Up to 15 percent of couples are unable to achieve pregnancy after one year of unprotected sex while 10 percent of couples are unable to have a successful pregnancy after two years. In couples suffering from infertility, about 35 percent of the cases are caused by male factors, 35 percent are caused by female factors, 20 percent are due to both female and male factors, and the remaining 10 percent are due to unexplained causes. These figures indicate that male infertility is a significant contributor to infertility of couples. To get his female partner pregnant, a man must:

1. Produce healthy sperm: That includes proper growth and development of reproductive organs during his puberty, with the testicles functioning properly, and his body must make enough testosterone and the other hormones necessary for sperm production.

2. His sperm must reach semen: After sperm production in the testicles, they must be transported in the tubes until they get into semen for ejaculation through the penis.

3. He must have enough sperm in semen: The sperm count (numbers of sperm found in semen) must be sufficient in order to increase the odds of fertilizing the ovum (egg). A lower-than-normal sperm count is having fewer than 39 million sperm per ejaculate or less than 15 million sperm in every milliliter of semen.

4. His sperm must be both functional and motile: If the function and movement (motility) of sperm is abnormal, the sperm may not reach or penetrate his partner’s ovum (egg).

Male infertility symptoms

The most obvious sign of infertility in men is inability to make a wife pregnant. But in most cases, male infertility occurs because of an underlying problem, such as low sperm production, a blockage preventing sperm delivery, abnormal sperm function, hormonal imbalance, inherited disorder, dilated veins in the testicles, illnesses and chronic health problems, lifestyle choices, injuries, and other factors. So even though most infertile men may not notice any symptoms apart from their inability to make their female partners pregnant, other male infertility symptoms do exist.

Symptoms of infertility include:

  1. A lump, swelling or pain in the testicular region.
  2. Sexual function problems, such as reduced sperm volume, difficulty with ejaculation, difficulty achieving and maintaining erections, or reduced sexual desire.
  3. Inability to smell.
  4. Recurrent respiratory infections.
  5. Decreased body or facial hair and other signs of hormonal or chromosomal abnormality.
  6. Gynecomastia (abnormal breast growth).
  7. A lower-than-normal sperm count (total sperm count below 39 million per ejaculate or less than 15 million sperm in each milliliter of semen).

Male Infertility Causes

Male infertility may be caused by a number of medical, environmental and lifestyle issues.

1. Medical causes

a. Varicocele: Refers to the swelling of veins draining the testicles. It’s the most frequent reversible factor in male infertility and it triggers infertility by hampering testicular temperature regulation, which in turn reduces sperm quality. When varicoceles are treated, sperm function and numbers improve, and the outcomes are better than opting for assisted reproductive techniques like in vitro fertilization.

b. Infections: Infections that interfere with sperm health and production or obstruct the passage of sperm, such as epididymitis (inflammation of epididymis), orchitis (inflammation of testicles) and certain sexually transmitted infections like HIV or gonorrhea, may contribute to male infertility. Though some infections may lead to permanent testicular damage, sperm is still often retrievable in most infections.

c. Sperm-attacking antibodies: Anti-sperm antibodies are typically immune system cells which mistakenly recognize sperm cells as harmful invaders and try to eliminate them.

d. Tumors: Cancers and non-malignant tumors of the male reproductive organs and the glands releasing reproductive hormones, like the pituitary gland, may lead to male infertility. In some instances, chemotherapy, radiation or surgery used to treat these tumors may affect male fertility.

e. Undescended testicles: During fetal development, one or both testicles may fail to move from the abdomen to the scrotum (sac that usually contains the testicles). Men who have had undescended testicles have a bigger risk of infertility.

f. Hormone imbalances: Disorders of the testicles and abnormalities of hormonal systems such as pituitary, hypothalamus, adrenal and thyroid glands can contribute to male infertility. Likewise, male hypogonadism (low testosterone) and other hormonal issues can affect fertility.

g. Defects of tubules transporting sperm: Tubes that carry sperm can be blocked through inadvertent injury during surgery, trauma, prior infections or abnormal development, including cystic fibrosis and similar inherited conditions. Blockage may occur at any level, such as within the testicle, in the epididymis, tubes draining the testicle, in the urethra, near ejaculatory ducts or in the vas deferens.

h. Ejaculation problems: During ejaculation, semen may occasionally enter the bladder instead of coming out through the tip of the penis. This is called retrograde ejaculation and it can be caused by various conditions, including spinal injuries, diabetes, medications, and bladder, urethra or prostate surgery. In men with spinal cord injuries or certain diseases, sperm is produced but semen can’t be ejaculated. In these cases, sperm can be retrieved and used in assisted reproductive techniques.

i. Chromosome defects: Abnormal development of male reproductive organs can be caused by inherited disorders like Klinefelter’s syndrome — whereby a male is born with two X and one Y chromosomes instead of the normal one X and one Y chromosomes. Other genetic syndromes related to infertility include Kartagener’s syndrome, Kallmann’s syndrome and cystic fibrosis.

j. Celiac disease: This is a digestive disorder resulting from sensitivity to gluten. It can cause infertility in men, but improves with adoption of a gluten-free diet.

k. Sexual intercourse issues: Problems such as premature ejaculation, erectile dysfunction, painful intercourse, relationship or psychological problems that interfere with sex, or anatomical abnormalities like hypospadias (having a urethral opening underneath the penis) can contribute to infertility.

l. Certain medications: Drugs such as cancer medications (chemotherapy), long-term anabolic steroid use, testosterone replacement therapy, some ulcer drugs, certain antifungal medications and various other medications can impair sperm secretion and reduce male infertility.

m. Prior surgeries: Inguinal hernia repairs, vasectomy, prostate surgeries, testicular or scrotal surgeries, and large abdominal operations performed for rectal and testicular cancers, among others, can reduce the chances of having sperm in the ejaculate. In most cases, the blockage can be reversed surgically or sperm can be retrieved directly from the testicles and epididymis.

2. Environmental causes

Excessive exposure to environmental elements like heat, chemicals and toxins can reduce sperm production and function. Specific environmental factors include:

a. Exposure to heavy metals such as lead.

b. Prolonged exposure to toluene, xylene, benzenes, herbicides, pesticides, painting materials, or organic solvents, which results in lower sperm counts.

c. Overheating the testicles: Elevated temperatures can impair the production and function of sperm. For instance, frequent use of hot bath tubs or saunas may temporarily lower your sperm count. Wearing tight clothing, long periods of sitting, or working for long stretches of time on a laptop may increase scrotum temperature and slightly decrease sperm production.

d. Exposure to X-rays or radiation can lower sperm production, though eventually it will return to normal. But exposure to high doses may reduce sperm production permanently.

3. Lifestyle, health and other male infertility causes

a. Alcohol use: Excessive consumption of alcohol can reduce testosterone levels, decreasing sperm production and causing erectile dysfunction. Liver disease due to excessive drinking also may cause fertility problems.

b. Drug use: Use of marijuana or cocaine may temporarily lower sperm numbers and viability. Anabolic steroids used to stimulate muscle growth and strength can reduce testicle size and decrease sperm production.

c. Tobacco smoking: In men who smoke, sperm counts are generally lower than in non-smokers. Likewise, male infertility may occur in men frequently exposed to secondhand smoke.

d. Weight: Obesity can directly impact sperm themselves or cause hormonal changes that may reduce male fertility.

e. Depression: In men with depression, sexual dysfunction and subsequent infertility can result from erectile dysfunction, reduced libido, or inhibited or delayed ejaculation. In fact, the likelihood of pregnancy is lower in couples where the male partner suffers from severe depression.

f. Emotional stress: Prolonged or severe stress can interfere with various hormones necessary for sperm production and affect sperm count.

So what are the infertility risk factors in men:

  1. Being overweight
  2. Being severely stressed or depressed
  3. Using alcohol
  4. Smoking tobacco
  5. Using certain drugs
  6. Trauma to the testicles
  7. Overheating the testicles
  8. History of undescended testicles
  9. Exposure to certain toxins
  10. Having certain present or past infections
  11. Prior pelvic surgery, major abdominal surgery or vasectomy
  12. Family history of a fertility disorder or being born with such a disorder
  13. Certain medical disorders, including chronic illnesses (like sickle cell disease) and tumors
  14. Undergoing medical treatments (like radiation or surgery for treating cancer) or taking certain medications.

How can you prevent infertility?

You can do so by avoiding some of the known causes of infertility. For instance:

  1. You should not smoke.
  2. You should abstain from or limit alcohol consumption.
  3. You should stop using illicit drugs.
  4. You should lose some weight.
  5. You should reduce stress.
  6. You should avoid exposure to heavy metals, pesticides and other toxins.
  7. You should avoid activities that result in prolonged heat to the testicles.

When should you see a doctor?

You should see a doctor if you’ve been unable to achieve pregnancy after 1 year of frequent, unprotected sexual intercourse. But you may need to see a doctor sooner than that if:

  1. You have ejaculation or erection problems.
  2. You have low sex drive or any other issues with sexual function.
  3. You have discomfort, pain, a swelling or lump in your testicles.
  4. You have a history of prostate, testicle or sexual problems.
  5. You have previously undergone a penis, groin, scrotum or testicle surgery.

For more information on male infertility and how to deal with it, visit the “St Pete Urology” site.

How do men deal with incontinence?

While a man with urinary incontinence needs to see a urologist for proper and timely treatment, there are certain things he can do on his own to manage the symptoms. In fact, taking these actions will not only prevent and relieve symptoms, but also will help overcome incontinence.Ways of managing urinary incontinence in men include:

1. Keeping a diary

Keeping track of how much fluid you drink, how frequently you have to go to the bathroom, when and how often you leak urine, and anything that triggers your symptoms, such as drinking a lot of coffee, coughing or bending your body in a certain way is an effective way of monitoring your incontinence. Using the diary, your doctor can get a better grip of your symptoms and how they affect your life, and find the right tests necessary for correct diagnosis.

2. Regular double-voiding

Double-voiding is a great way to minimize dribbling. So when you finish urinating, you should wait for a minute or so and then try voiding again. If you succeed to pass urine in the second attempt, you’ll seldom dribble afterward.

3. Cutting down on caffeine and alcohol

Caffeine and alcohol irritate the bladder and often worsen incontinence symptoms. By cutting down the amount of tea, sodas, coffee and alcohol you drink, you’ll make a massive difference with your urinary incontinence symptoms.

4. Quitting smoking

Smoking tobacco aggravates urinary incontinence in men. So the sooner you quit tobacco the better for you.

5. Spacing apart your drinks

Staggering your fluid intake can help to ease the symptoms. For instance, if you are having a lot of trouble at night, drinking less fluid before going to bed might help. And when you have problems during the day, it might help to drink less fluid many hours before you travel or leave home for an event.

6. Avoiding foods that trigger symptoms

Certain foods trigger urinary incontinence symptoms in men. For example, spicy foods and acidic foods such as tomatoes and citrus fruits are common culprits. Likewise, artificial sweeteners and chocolate may trigger incontinence. While everyone is different, it’s wise to identify the foods that worsen your symptoms and avoid them.

7. Training the bladder

Training your bladder can help you to control urinary incontinence. You can do this by starting to take scheduled bathroom breaks whether you are feeling the urge to go or not. Then gradually extend the time you take between your bathroom trips, making a conscious effort to tame your symptoms and push yourself to only pass urine every 3 or 4 hours. Bladder training may not give immediate results, but if you persist, you’ll get positive results within a few months.

8. Flexing your bladder muscles

Exercising the right muscles will help strengthen them and improve your bladder control. Because exercising the wrong muscles may increase pressure on your bladder, you should correctly identify the ones you exercise. The right muscles to focus on are those you would use to stop yourself from passing gas.

So how do you flex them? Apply tension on the muscles for 3 seconds, then allow them to relax for another 3 seconds. Build up gradually until you’re able to do three sets of ten repetitions. You can perform these exercises anywhere — at your desk, in bed or when watching TV, but don’t do them when urinating as that can lead to infections. You should do the exercises for 15 minutes per day. While it usually takes 3-6 weeks to achieve the desired effect, positive results may be noticed soon by men who are doing the right exercises frequently.

9. Lose weight and stay hydrated

Excess weight increases pressure on the abdomen and makes urinary incontinence worse. By shedding a few pounds, you can reduce symptoms. Likewise, while it seems a good idea to drink less water in order to prevent leaks, drinking less only makes urine more concentrated and increases bladder irritation, resulting in more urinary incontinence. Therefore, if you’re thirsty, drink some water.

10. Treat constipation

Constipation, together with the strain that comes with it, can negatively affect the nerves that control bladder function. By eating a high-fiber diet and taking the necessary actions to prevent constipation, you may help your incontinence.

11. Speak with your doctor about any medication adverse effects

Some medications and supplements can cause or worsen your incontinence. For instance, sedatives, antidepressants, diuretics and various allergy and cold medicines may elicit urinary problems. So make sure your doctor is aware of the medicines and supplements you’re using and of any adverse effects you’re experiencing.

12. Planning ahead

A lot of men with urinary incontinence are anxious whenever they have to travel, fearing accidental urine leaks. To ease your anxiety when going on a road trip, make sure to map out the route and identify the places you’ll stop at regular intervals to use the bathroom. Going out with a plan will make you confident and less prone to accidental urine leaks.

13. Get support

Urinary incontinence can be both stressful and embarrassing and you may even feel lonely and hopeless. So you should make an effort to remain connected with your family and friends. Joining a support group also may be beneficial. Your doctor can help you find any support groups in your area.

Applying these techniques may help relieve urinary incontinence symptoms. But because on their own these techniques are inadequate for managing urinary incontinence, you should work closely with your doctor to find the best solutions for your condition, particularly if the symptoms are adversely affecting your life. It’s also prudent to always speak with your doctor before you try any of these techniques for managing urinary incontinence. If you’re looking for a urologist near you, then you can always see one of our urologists at Florida’s St Pete Urology in St. Petersburg. For more information on the right treatment plan for urinary incontinence in men, visit the “St. Pete Urology” site.