Gregory A. Lewis, M.D.

Q: What are the 3 drugs now available for treatment of erectile dysfunction and how do they differ?

A: Sildenafil (Viagra), vardenafil (Levitra), and tadalofil (Cialis) are the 3 drugs currently available for the treatment of erectile dysfunction. Although all 3 oral drugs show a high degree of safety and similar efficiency, the pharmacokenetics of each compound are unique, allowing patients and physicians to choose the drug that best fits with the patient's health needs and lifestyle. The primary differences among these 3 drugs are related to their food interactions, duration of action, and potential side effects.

Q: I have an enlarged prostate ...and have heard saw palmetto may help. Is this true?

A: Saw palmetto berry extract (serenoa repens) is the most popular of the many phytotherapeutic agents which have become more common in the treatment of the enlarged prostate (BPH) in recent years. Though current evidence suggests a possible benefit of saw palmetto berry in the treatment of lower urinary tract symptoms caused by an enlarged prostate, the mechanism of action is not known, there is no standard dose, and the time efficacy has never been conclusively proven in double-blind randomized, placebo-controlled trials.

Q: Should I drink a lot of fluids to keep my kidneys healthy...or will that overwork them?

A: Yes and no. To keep healthy, proper hydration is important to replace the amounts of fluid we lose daily through excretion, perspiration, and other bodily functions. This amount varies widely from person to person, based on a variety of factors such as age, physical size and condition, activity level and climate, The conventional recommendation of "8 to 10 glasses of water per day" is only a rule of thumb, not an absolute minimum, not based on scientific study, and not all of our water intake need come in the form of drinking water. The current infatuation with water as an all-purpose health potion is a blend of fashion and fiction and very little science.

Q: Can any man use Viagra...or can it be harmful for some men? If I don't have erectile dysfunction, can I use it anyway?

A: Viagra is the #1 prescribed medicine for erectile dysfunction (ED) and has been used by over ten million men in the U.S. It is important to remember that no medicine is for everyone. Men who have various types of heart disease or use nitrate drugs which are often used to control chest pain should not use Viagra as the combination can cause the lowering of blood pressure to unsafe or even life-threatening levels. Though Viagra is generally a very safe and effective medication for the treatment of ED, it should not be used as or considered a "performance-enhancer" for those men who do not have ED.

Q: My urine smells funny after I eat asparagus. Why?

A: Asparagus contains a sulfur compound called mercaptan which is also found in rotten eggs, onions, garlic and in the secretions of skunks. During digestion, mercaptan is broken down into by-products which impart a unique smell to urine as they are excreted. Interestingly, only about half the population is able to notice this pungent smell after the ingestion of asparagus. This is because only about half of us have the gene that enables us to smell these odoriferous chemicals.

Q: After working outside in extreme heat, my urine was very dark colored. Why?

A: The color of urine is dependent on the state of one's hydration, foods eaten, dyes added to foods, disease states, and drugs. Urochrome is the name of the pigment that gives urine its characteristic color. Normal urine may vary from a very pale yellow to a dark amber color depending on the concentration of this pigment. Inadequate fluid intake or excessive fluid losses such as occurs in extreme heat lead to dehydration and a concentrated, deeply colored urine.

Q: My physician has suggested I void at a certain time. Will that help my urine leakage?

A: Bladder techniques for both the overactive bladder and urinary stress incontinence include fluid and dietary modifications, pelvic floor, muscle exercises, and scheduled voiding regimens. Voiding at certain times or at regular intervals is one such technique that can be effective in helping one gain better control over their urinary leakage problem. After one's baseline incontinence and voiding frequency is first established by keeping a bladder voiding diary for several days, one can best determine at what fixed interval to begin their "timed voiding" routine.

Q: I leak urine when I laugh or sneeze. Should I be worried this is something major?

A: Stress incontinence is the most common cause of the involuntary loss of urine in women and is defined as the leakage of urine that occurs with lifting, straining, laughing, or coughing. It is caused by weakness of either the urethral sphincter and/or of the anatomic muscle support of the bladder such as occurs with aging and childbearing. The medical, psychological, hygienic, economic and social consequences of urinary incontinence can be immense and should not be underestimated. There are a variety of successful medical and surgical treatment options available for the condition.

Tom Burns, M.D.

Q: My doctor put me on medication for my enlarged prostate. I don't want to take the medication for the rest of my life. Are there any other treatments available other than surgery?

A: Over the last several years, there have been significant improvements in treatment of men with enlarged prostates (BPH). The most effective treatment for men with severe symptoms remains surgical resection of the interior of the prostate. There are, however, other office-based treatments that are very effective. These are typically "minimally invasive" treatments. Microwave therapy (TUMT) is one such treatment that is performed in the office under local anesthesia. The treatment takes only 30 minutes, and patients go home the same day. Patients usually get significant improvement in their symptoms and most patients do not require a tube in the bladder after treatment. For more information about microwave therapy or other treatment options, you should contact your urologist.

Q: My uncle has been a heavy drinker all his life and now he has bladder cancer. Could there be a connection?

A: Bladder cancer can occur at any age, but it is much more common in the middle-aged and elderly. Bladder cancer is typically diagnosed during evaluation for blood in the urine. There are many risk factors including alkaline dyes, radiation therapy to the pelvis and chronic bladder irritation from catheters or stones. There is no known association between drinking alcohol and bladder cancer. Smokers are four times more likely to develop bladder cancer than nonsmokers. If your uncle is a smoker, stopping smoking now may improve his chances and decrease his risk of developing more tumors in the future.

Q: Where does the fluid come from that builds up in the scrotum? If surgery was done, where would the fluid go? Can it cause cancer?

A: Scrotal swelling can be caused by a number of different problems. One of the most common causes is an abnormal accumulation of clear fluid, called a hydrocele. A hydrocele may be found in children as well as adults. In children, the fluid is typically associated with an abnormal connection between the abdomen and the scrotum. This connection should close within the first few years of life. In adults, the source of the fluid usually relates to an imbalance in production and absorption of fluid by tissue surrounding the testicles. This imbalance may be associated with infection, trauma, and rarely, tumors. Most commonly, no cause is known. Surgery is indicated if the swelling causes discomfort.

Q: When I laugh or sneeze, I leak urine. Is there any treatment other than surgery?

A: Leakage of urine during activities such as sneezing, laughing or lifting is called stress incontinence. This is common in women after childbirth and can be seen in men after prostate surgery. Conservative treatment options are available to help strengthen the muscles in the pelvis. The most common treatment involves pelvic floor exercises that can be done at home, called Kegel exercises. If the Kegel exercises do not provide improvement, other non-surgical options exist. One very effective office treatment involves pelvic floor therapy, or biofeedback. Most patients require some simple testing in the office prior to starting therapy. Biofeedback typically consists of a series of four to eight office visits, lasting about 45 minutes. During these visits, patients can be taught various techniques to strengthen weakened muscles. Electrical stimulation may also be added to the treatment sessions to help retrain the pelvic muscles. Most women will experience improvement in the degree of leakage with pelvic floor therapy.

Q: How old must my child be before he can remain dry through the night?

A: The age at which children become dry is variable. Up to fifteen percent of five year olds still have nighttime wetting. This is described as persistent bedwetting occurring at least two nights per month after five years of age. If this persists after the age of five, you should speak with your pediatrician. There are many treatments available, but most nighttime wetting will resolve on its own as the child gets older. By the age of fifteen, ninety-nine percent of children are dry at night.

Q: I've had repeated urinary tract infections. After extensive testing, my physician put me on Macrobid daily. Is this safe? How long can I be on this drug? I'm afraid to stop for fear of the infections returning.

A: Recurrent urinary tract infections may be caused by many different factors. After a detailed evaluation, a patient may be placed on low dose, preventative antibiotics to decrease the risk of further infections. These antibiotics are typically given once at night for six to twelve months. Macrobid is one of the more common antibiotics used for urinary tract infections. This is a very safe medication, but can have side effects like all medications. Serious lung problems hive been reported in a very small percentage of patients taking Macrobid. Any side effects should be reported to your physician immediately.

Q: My 10 year-old daughter had a kidney stone. Will this be a reoccurring problem for her? What can I do to help prevent this? Should she be checked periodically?

A: Kidney stones in children are rare. When stones are found in children, however, they are commonly associated with specific problems. Children who form stones require a thorough evaluation because they are at a very high risk of forming more stones in the future. After a complete evaluation, a treatment plan may be developed to help prevent further stone formation.

Gregory Andros, M.D.

Q: I am a 65-year-old woman who has been using five pads a day for six years because of leaking urine. Is there anything I can do to fix the wetting?

A: Urinary incontinence is a very common problem. The risk of incontinence increases with age, number of births, low estrogen states, and with a "dropped" bladder. In the past, most people would live with the wetting by using pads and adult diapers. The good news is that there are many new treatments now available for incontinence. Treatments include taking a pill once a day, biofeedback, or an outpatient surgical procedure. If the right treatment is initiated, most people can be dry and will not require pads.

Q: I have frequent kidney infections and am on antibiotics often. Can they become less effective? It seems to take longer for my symptoms to abate lately.

A: Frequent urinary tract infections (UTI) can often lead to resistant infections. Choosing the wrong antibiotic may prove to be ineffective. It is important to have the urine cultured with antibiotic sensitivities to determine if a resistant bacteria is present. Frequent UTIs can occur with incomplete bladder emptying, urinary incontinence, and other bladder pathology. There are conditions when the urine culture shows no bacteria but all the symptoms of a UTI are present. Antibiotics will not help in this situation. Further bladder testing such as a scope of the bladder may be indicated to rule out interstitial cystitis or bladder cancer. Please consult your physician or urologist for further information.

Q: I often have urinary tract infections and my doctor has suggested that I stop drinking beverages with caffeine. Will this actually help?

A: Discontinuing caffeine consumption will not reduce your risk of urinary tract infections. However, caffeine affects the urinary system in two ways. Caffeine is a diuretic, which means it will increase your daily urine output thereby causing an increase in urinary frequency, urgency, and even incontinence. Caffeine can also aggravate preexisting bladder problems such as interstitial cystitis or an overactive bladder.

Q: Does prostate surgery always mean impotence?

A: No. Depending on the type of prostate surgery, there is a range of risk of impotence. The surgery for an enlarged prostate known as TURF carries less than 10% risk of impotence. Surgery for prostate cancer is associated with a 50-90% risk of developing impotence. The better the erections are prior to the surgery, the lower the risk of impotence. Postoperative impotence can be successfully treated with medications such as Viagra.

Q: I have been told drinking cranberry juice will protect me from urinary tract infections. Is this true?

A: There is one article showing that drinking 8 to 16 ounces of cranberry juice per day decreases urinary tract infections to about 25% of what they were. In medicine, this is not enough data to tell you that this is truly beneficial. My concern is that you really have documented urinary infections and not treating yourself for symptoms. Interstitial cystitis mimics urinary infections, but there are no bacteria in the urine and cranberry juice will not be helpful.

Q: My husband seems to have to get up several times a night to urinate. What could cause this?

A: The medical term for waking up at night to urinate is nocturia. The most common cause of nocturia in older men is the enlargement of the prostate gland. As men age, their prostate glands become bigger, leading to increasing nocturia and a weaker urinary stream. Treatment for enlarged prostate glands range from medications to surgery. Your husband should have a prostate exam and a simple urine flow test to determine his best treatment options.

Q: My kids refuse to use the bathrooms in school, so they hold it all day. Is this harmful?

A: On average, a child should urinate every three to four hours. Holding the urine longer can increase the risk of urinary tract infections and set a pattern of unhealthy voiding habits. Encourage your children to increase their fluid intake and this will facilitate their need to urinate while at school. Address their concerns using the restrooms at school such as embarrassment, cleanliness, excuse from the teacher, etc.