2020 Men’s Health Month
This Men’s Health Month, we teamed up with Dr. Hadley Wood, Urologist from Cleveland Clinic, to get you expert answers to your most pressing men’s health questions. Here’s what you asked:
What is the best fertility advice for a male in late 20s who may want to start a family with their partner?
If you smoke or use anabolic steroids or hormones that are not being managed by a medical doctor, discontinue them. Likewise, general health recommendations, like controlling weight, managing blood pressure, and getting daily exercise, can all have an impact on fertility. If you can ejaculate, a semen analysis (ordered by your doctor) will tell you if it’s possible to impregnate your partner. If you cannot ejaculate, I recommend you see a male fertility specialist to discuss procedures that may assist with fertility. Men and women with Spina Bifida who are attempting conception are recommended to take supplemental folic acid (4 mg daily, beginning 1-3 months prior to attempting conception).
Are all men with Spina Bifida sterile?
The fertility potential of a man with Spina Bifida is roughly correlated with the level of lesion. Higher spinal lesions are more likely to have infertility and lower lesions are less likely to have infertility. However, “natural” fertility (meaning being able to establish a pregnancy with intercourse) requires many factors (erection, ejaculation, sperm quality), all of which can be altered by the condition of Spina Bifida. In general, if a patient can ejaculate, he should assume he has fertility potential (see the question above) and a semen analysis will help sort that out. If he cannot, then he may require assistance with fertility or in vitro fertilization (also known as IVF).
Is there an increased risk of Prostate cancer or what are the recommendations for a prostate check-up for people with Spina Bifida?
There is no known increased risk of prostate cancer in men with Spina Bifida. The problem is that our current screening recommendations, which include a digital rectal exam and blood test (PSA), have not been validated in men with neurogenic bladder. Men with neurogenic bladder (particularly those who are catheterizing) are at higher risk for recurrent UTIs and this may falsely elevate PSA. It is recommended that patients talk to their urologist about this. Advanced testing, like prostate MRI, may be considered for men with elevated PSA. Please note, men with neurogenic bladder may be at elevated risk of urosepsis with a prostate biopsy.
People with Spina Bifida and undescended testes have a higher chance of testicular cancer. Does that risk ever go down, or is that high risk for life?
Testicular cancer is a disease of young men. Men over forty (almost) never get diagnosed with testicular (germ cell) cancer. Older men can get cancers of the testicles that are not associated with undescended testicles (like lymphomas). If you have concerns, I would recommend you see a urologist who can examine your testicles and help advise you about testicular self-examination (TSE). If you are unable to perform TSE, your urologist can advise you about other ways to monitor the situation and your risk based on age and other risk factors. If you are approaching or older than 40 and without any evidence of cancer, your risk is very, very low.
I had the ACE procedure done when I was 10 years old. Should I have it revised since I am now in my 30s? It bleeds sometimes when I put the catheter in and sometimes the water backs up in the catheter.
It may need revision, but sometimes small procedures, or changing up your irrigation routine, can help trouble-shoot the problem and avoid surgery. I would recommend you see a urologist with experience building and revising ACEs.
As a catheter user, what can I do to stay dry in between? I cath every four hours.
This requires a special evaluation to determine the cause of leakage. For example, some people leak between cathing because the sphincter isn’t tight enough, while others leak because the bladder is spastic. Typically urologists may perform a test called urodynamics to sort this out. If the leakage is related to insufficient sphincter function, treatment may be to tighten the bladder neck, place an artificial sphincter, or place a sling. If it is related to bladder spasticity, we typically treat first with caffeine and alcohol avoidance, constipation management, medications, and Botox injections to the bladder.
Last year my urologist tried to do a scope to check for problems in my urinary tract. It was done as a precautionary thing due to my age, not because I have had problems. The doctor had trouble getting the scope in, so the test couldn’t be completed. My doctor mentioned a surgery to “clean out” my urethra, but I know that once it’s done, that in itself can cause more scar tissue to grow. I’m hesitant to risk getting myself into a viscous cycle. Is there any other way to check for problems? What is the smallest size scope that can be used?
Scopes come in all sizes, with some as small as 7 French. However, not all urologists have access to flexible scopes of all sizes, particularly urologists who care for adult patients only. You are correct that cutting or stretching scar tissue can propagate more scar tissue. It is difficult to make a recommendation about how aggressive to pursue this without more background on the rationale for doing so. If your bladder is incompletely emptying (particularly if you are getting infections), the urethral stricture could be potentiating the problem by preventing drainage of the urine completely. I would recommend you express your concerns to your doctor and ask if he/she has a smaller scope, and if he/she does not, what the risk would be of putting the procedure off, or seeing someone who has more access to smaller scopes.
SEXUAL HEALTH & FUNCTION
Is it normal to have a hypersensitive penis with a damaged spine?
That can happen. I would recommend talking with a urologist to see a specialist for this problem. Sometimes topical anesthetics or other techniques (condoms) can help with this.
Aside from pills, what other options are available for erectile dysfunction?
If pills don’t work or you cannot tolerate them, the next step is learning how to inject a drug directly into the penis (like an insulin injection, with a small needle). This requires medical oversight and “titration” to minimize the risk of complications. There is a drug that can be inserted into the urethra to help with erections too, but is more difficult to obtain and costly. Finally, if all else fails, penile prosthetics can be surgically inserted into the penis, hooked up to a pump in the scrotum. This is the last step in treatment of erectile dysfunction.
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