The plastic menace

From the AUA Daily Scope

"BPA-exposed Chinese factory workers four times as likely to suffer from ED.



The Washington Post (11/11, Layton) reports, "Exposure to high levels of a controversial chemical found in thousands of everyday plastic products appears to cause erectile dysfunction and other sexual problems in men," according to a paper in Human Reproduction. The study of "634 [BPA-exposed] male workers at four factories in China," showed that participants "were four times as likely to suffer from erectile dysfunction and seven times as likely to have difficulty with ejaculation." What's more, "sexual dysfunction began in new workers after just months on the job."


Participants were also "about four times as likely to report low sex drive or low satisfaction with their sex lives," the AP (11/11, Ritter) reports. But, Steven Hentges, a BPA expert and official with the American Chemistry Council, commented that "the work is 'probably not very relevant for consumers," adding that "the workers inhaled BPA or got it on their skin," while "consumers get it through diet." "

This is another piece of evidence in the growing body of knowledge regarding environmental toxicants.  Plastics have become ubiquitous.  Just try to go one day without consuming anything that has not come into contact with plastic.  I bet you can't do it.

BPA has been shown to be linked to a host of human diseases, from cancer to infertility and is a compound in many of our plastics.  Until recently it was present in baby bottles. 

We think of plastics in our everyday materials as inert.  I drink from plastic bottles every day.  So do my three children.  Kind of scary isn't it. 

Dr Schoor

TESTOPEL: One Injection every 6 months

I have been using TESTOPEL for the treatment of my male patients with hypogonadism, or sexual dysfucntion that is the result of low blood levels of testerone. 

Testosterone is the male hormone.  It is produced in the testicle and circulates in the blood in a variety of active and inactive forms.  Testosterone, in its active form DHT, acts on the many organs in the body, such as the brain, liver, circulatory system, and penis, and allow men to function normally. 

Men with low testosterone levels complain of symptoms such as ED or erectile dysfunction, low sexual drive or decreased libido, irritability, difficulty with concentration at work, and insomnia.  Some men just have vague complaints and basically just don't feel well.

Hypogonadism is diagnosed with a history, physical examination, and a blood test.  Treatment depends on the situation, but typically involves medical replacement of the testosterone.  Testerone medicaltion comes in injection, gel, or patch format. 

Urologists most often prescribe gels to treat hypogonadism.  Men must apply the gels daily in order for them to work properly. 

Some urologists prescribe injections, like testosterone cypionate.   Testosterone cypionate must be given every 3 to 4 weeks due to the rapid rise and fall of the testosterone levels with this treatment plan.  For this reason, most men choose an different form of therapy.

TESTOPEL is the newest treatment for hypogonadism in men.  TESTOPEL is an dissolvable implant that I place under the skin of the buttock once every 4 to 6 months.   In my Smithtown Long Island urology office, I have now done many Testopels.  The procedure takes under 5 minutes and is painless. 

TESTOPEL patients have been thrilled with the results.  Men like the freedom of not having to apply medication daily and they feel "normal" again.

I think it is a great procedure.

Feel free to contact me if you have any questions:  Contact

Dr Schoor

Urologist, Smithtown NY
 

UTI Treatment and Birth Defects

The article in quotations has ben re-printed from the AUA Daily Scope.
"Study suggests UTI treatments may be associated with increased birth defect risk.


The Los Angeles Times (11/2, Dennis) "Booster Shots" blog reported, "Doctors assume antibiotics to be fairly safe during pregnancy." And, after analyzing "data on more than 13,000 women whose babies had birth defects, comparing their antibiotic use before and during pregnancy to that of almost 5,000 women whose babies didn't have birth defects," a team at the CDC found that the assumptions about safety were mostly accurate.

Specifically, "penicillins, erythromycins, and cephalosporins...were not associated with many birth defects," Medscape (11/2, Barclay) reported. On the other hand, two classes of drugs "were associated with several birth defects."

According to the paper in the Archives of Pediatrics and Adolescent Medicine, "mothers of babies with birth defects were more likely than mothers with healthy babies to report taking two types of antibiotics during pregnancy: sulfa drugs (brand names include Thiosulfil Forte and Bactrim) and urinary germicides called nitrofurantoins (brand names include Furadantin and Macrobid)," the AP (11/3, Johnson) reports. "Used for many decades, the antibiotics in question predate the Food and Drug Administration and its requirements for rigorous safety testing." Now, the agency "grades all drugs for safety to the fetus based on available research."

Such information, however, "is sorely lacking," HealthDay (11/2, Thomas) noted. "Much of that stems from the fact that ethical considerations preclude conducting drugs trials in pregnant women," explained lead investigator Krista Crider. Moreover, "resistant strains of bacteria are forcing doctors to use a wider array of antibiotics." As expected, the CDC team "found that about 30 percent of women took an antibiotic between the three months prior to conception and the end of the pregnancy."

MedPage Today (11/2, Peck) reported, "Sulfonamides were associated with six birth defects, more than any other class: anencephaly, two left-sided heart defects, hypoplastic left heart syndrome, and coarction of the aorta, choanal atresia, transverse limb deficiency, and diaphragmatic hernia." In addition, "four defects were associated with nitrofurantoin use: anophthalmia or microphthalmos, hypoplastic left heart syndrome, atrial septal defects, and cleft lip with cleft palate." "

I think this is a very important article.  Many doctors are either cavelier about giving antibiotics for presumed urinary tract infections or are unaware of the possibility that a positive urine culture or urine analysis might actually represent a contaminated urine specimen rather than a true urinary tract or bladder infection.  A contiminated specimen does not reauire treatment with an antibiotic while a true urinary infection in pregnancy does.
 
Urine specimens become contaminated due to improper collection technique.  In women, then urethra sits right next to the vagina and the labia.  When women void, the urine can touch the vagina, labia, and pubic hair that naturally contain bacteria and white blood cells (infection cells) and drag these cells into the specimen collection cup.  Often the result is a urine analysis that looks like an infection and a positive urine culture which in turn prompts the unsuspecting doctor to treat the the patient with antibiotics when in reality, the treatment was probably not necessary.
 
The better approach to the woman with a positive UA or urine culture is to simply ask her how she feels and is she has any urinary symptoms.  If she feels fine and has no symptoms, the doctor should suspect contamination and take further steps to prove that their is or is not an true urinary tract infection.  Further steps include either repeating the urine culture as either a clean catched mid-stream specimen or as a catheterized specimen. 
 
In a pregnant woman where the implications of antibiotic usage on the unborn baby are often unknown at best, I feel that the doctor has a special obligation to prove his or her choice to prescribe antibiotics.
 
Just think about this the next time the OB-Gyn prescribes an antibiotic for your "urinary infection."
 
Dr Schoor
 
Urologist Long Island

If viagra stopes working, try adding a statin

"Atorvastatin said to improve sildenafil response in men with high cholesterol, ED.


MedWire (10/29, Albert) reported, "Atorvastatin therapy improves the response to sildenafil of men with erectile dysfunction (ED) and hypercholesterolemia," according to a study appearing in the International Journal of Impotence Research. Researchers in Iran "investigated whether addition of atorvastatin therapy to sildenafil treatment would improve erectile function in 131 men, aged 62.9 years on average, with ED and high cholesterol who were previously unresponsive to sildenafil." They found that subjects "taking atorvastatin had significantly greater improvements in [International Index of Erectile Function (IIEF-5)] score by week six than those taking placebo. By the end of the study, the average IIEF-5 score was 13.9 for patients in the atorvastatin group and 10.5 for those in the placebo group." "

Reprinted from the AUA Daily Scope

This is new for me and I plan to try it study it further for my own erectile dysfunction patients here in Suffolk County Long Island Urology practice.  Another approach for when the PDE5 inhihitors like viagra or cialis stop working for patients is to evaluate the man for low testosterone.

Dr Schoor

The Semen Analysis: What it can and cannot tell us about male infertility.

For most men, the fertility evaluation starts with a semen analysis and most of these men will have normal semen analyses.  Does this mean that they are fine?  Does it mean that they don't have a male factor--a condition that is preventing their sperm from fertilizing an egg?

The answer is no it does not.

The semen analysis is a very crude indicator of a man's true fertility potential.  In other words it is very possibl to have a serious male infertility factor yet have a normal semen analysis.  How is this possible?

The semen analysis looks at a number of measures.   These features are:

• Seminal fluid volume
• Seminal fluid pH ( a measure of acidity)
• Seminal fluid viscosity (a measure of liguidity)
• Sperm concerntration
• Sperm motility
• Sperm morphology ( a measure of the sperm's shape)

While an abnormality in one or more of these measures indicates that a male factor may exist, an analysis in which all these features are normal does not mean that such a condition is absent.

So why do it at all?

Because it is the best we have and it is a good place to start.  It is a good, though imperfect, screening tool.   Used this way, if several semen analyses are normal, then it is less likely that the man will have a male factor condition.

Of course, as in everything in medical practice, there are exceptions.  Men who smoke or who are exposed to other environmental toxicants can have normal semen analyses yet have sperm that do not function properly.  I have this also in men with testis tumors and occult diabetes (undiagnosed diabetes).  I have also seen this in men with varicoceles.

So how, in my opinion, should we counsel a couple with infertility.  I think it is reasonable to start with several semen analyses rathe than just one.  If 2 or 3 are normal and the man has no urologic complaints, than the couple may proceed with assisted reproduction aimed at the women.  However, if after several attempts at the lower cost assisted reproductive procedures, like artificial insemination, the woman is still not pregnant and the  next option is for the couple to proceed to in-vitro or ICSI, then I think referral to a urologist is reasonable and beneficial.  Often it is the urologist who uncovers a treatable and reversible male factor that was probably contributing to the couple's infertility problem.  At best, after correction of the male factor the couple can enjoy a natural, unassisted pregnancy.  At worst, the couple proceeds with in-vitro after a brief and inexpensive delay. 

Thanks,

Dr Schoor

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Sperm may play major role in HIV transmission, research suggests.

Re-printed from the AUA Daily Scope.


"HealthDay (10/26, Dotinga) reported that a paper appearing in the Journal of Experimental Medicine indicates that "sperm, not just semen, can transmit the virus that causes AIDS to immune cells in the body." Researchers at the University of Buenos Aires explained that the "virus attaches to the surface of sperm and can be transmitted to immune cells" by "passing through tiny abrasions in the vagina or anus or perhaps through another method." What's more, the "slightly acid environment, which they likened to that in the vagina after sexual intercourse, boosts the likelihood of infection of these cells." "

HIV is still a major problem and transmission is not fully understood.  Avoiding high risk sexual behaviors can go a long away to prevent spread of the disease.
 
Dr Schoor

Another reminder that the male factors still matter.

Re-printed from the AUA Daily Scope Newsletter.

Sperm donor unknowingly passes potentially deadly genetic heart condition to offspring.


The AP (10/21, Tanner) reports that a paper appearing in the Journal of the American Medical Association reveals that a "sperm donor passed on a potentially deadly genetic heart condition" -- hypertrophic cardiomyopathy -- "to nine of his 24 children, including one who died at age two from heart failure." The story has spotlighted the "importance of thoroughly screening sperm donors." At present, "voluntary sperm bank guidelines say donors should be required to provide a complete medical history to rule out those with infectious diseases or a family history of inherited diseases."

A number of centers also provide genetic testing for conditions like "cystic fibrosis and sickle cell traits," according to MedPage Today (10/20, Fiore). However, those conditions are "much less common than hypertrophic cardiomyopathy in the general population." Therefore, the researchers at Abbott Northwestern Hospital "suggest that an echocardiogram may be a good way to determine which patients should be excluded from donating sperm." They also recommended "recording donor information in a national, searchable database to easily identify and notify any affected offspring if a genetic disorder is found."

Perhaps rather than an expensive echochardiogram, we just start with a detailed history and physical exam.  His condition could have been initially detected by history then confirmed with more expensive testing.

Dr Schoor