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Urologist
A urologist
is a medical doctor who has completed an additional five years of
surgical training and has chosen to specialize in the branch of medicine
called urology. Urology involves the diagnosis and treatment of diseases
and disorders of the male reproductive organs and the urinary tract of
both men and women. The urinary tract consists of the kidneys, the
bladder, the ureters and the urethra.
Men and women may consult
a urologist about urinary tract problems, such as kidney stones, bladder
infections and difficult or painful urination. Men who have problems
with the prostate
gland may be referred by their general practitioners to urologists
for more sophisticated diagnosis and treatment, possibly including
prostate biopsy and transurethral resection of the prostate (TURP).
Some urologists have a
subspecialty in male reproductive and sexual health. These specialists
deal with male infertility problems, such as low sperm count and sperm
abnormalities. They perform vasectomies and diagnose and treat erectile
and ejaculatory dysfunction. Urologists who specialize in sexual health
also have an awareness of psychological factors that may contribute to
or be responsible for erectile and ejaculatory problems. Often they have
a collaborative relationship with certified sex therapists, and may
refer patients to therapists when no organic causes of sexual
dysfunction can be found. It is important for a male with sexual or
reproductive concerns to seek a urologist who identifies himself as
specializing in sexual health.
One of the most common
male sexual problems a urologist treats is erectile dysfunction, or impotence
. Erectile dysfunction is the consistent failure to obtain or maintain
an erection rigid enough to achieve penetration. An initial visit to a
urologist for a sexual concern, including impotence, typically begins
with a detailed medical and sexual history, followed by a complete
physical exam. Additional tests may or may not be necessary, depending
on the information obtained from the initial evaluation. Such tests may
include blood tests for hormone levels and cholesterol and lipid levels,
penile blood flow studies, or sleep monitoring. Penile blood flow is
assessed by means of an ultrasound examination whereby the actual
condition of the blood vessels and blood flow within the penis can
easily and painlessly be checked. For sleep monitoring, a simple,
non-invasive device called a snap gauge is worn on the penis during
sleep for two to three nights. The purpose of the snap gauge is to
determine if erections are occurring throughout the night, as is
normally expected. Research has shown that during a phase of sleep known
as rapid eye movement (rem sleep), men without erectile difficulties
become partially or fully erect approximately every 88 minutes. These
data can help in diagnosing the underlying cause of the impotence.
Additional studies are occasionally recommended to measure nerve
impulses and pressure changes within the penis, items that are
instrumental to erectile functioning.
Urologists treat
impotence according to the information obtained through these diagnostic
tests. Medical treatments include hormone replacement therapy for cases
of hormone deficiency, and oral medications in cases of mild to moderate
erectile dysfunction. If these treatments fail to produce desired
results, alternative therapies may be offered. One such treatment is
penile self-injection. A single drug (Prostaglandin) or a combination of
three drugs (Prostaglandin, Papaverine and Phentolamine) is injected
into the chambers of the penis to produce an adequate erection within
minutes. This method works in approximately 75 pecent of patients, but
the drugs are only effective when used in injection form. The injections
are given at the base of the penis, with an extremely fine needle for
minimal discomfort. Penile self-injection is the most prevalent form of
treatment because of its relative simplicity, effectiveness, and patient
satisfaction. Complications are rare and usually preventable.
Another urological
treatment for erectile dysfunction is known as a Vacuum Erection Device
(VED). This external device pulls blood into the penis by means of
negative pressure, or suction. The blood is then trapped in the penis by
a rubber compression ring at the base of the penile shaft. If not
properly used, complications can arise. Some patients use the VED
satisfactorily; many, however, discontinue its use, reporting diminished
sensation along the penile shaft, difficulty with ejaculation, or the
experience of the penis "flopping" at its base.
Urologists can also treat
impotence by means of penile implants. Implants are a surgical procedure
in which a hydraulic penile prosthesis is inserted completely within the
body, allowing patients the flexibility to have an erection at any time
and for any length of time simply by inflating the prosthesis. This
Federal Drug Administration (FDA) approved procedure has received high
marks for reliability and patient satisfaction.
As with the choosing of
any medical doctor, the patient should choose a urologist who is board
certified and with whom he feels comfortable. If seeking help for a
sexual dysfunction or infertility, be sure to ask if your urologist
specializes in this area. If he does not, seek a second opinion from
someone who does before proceeding with any treatment.
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Sex
