18370 Burbank Blvd.  |  Tarzana, CA  |  Tel: 818.996.4242  |  Directions?  |  7345 Medical Center Dr.  |  West Hills, CA  |  Tel: 818.346.8736  |  Directions?

Male Urology


Low Testosterone

Testosterone is the male hormone that is responsible for many of the differences between men and women. Though it is found in women in much smaller amounts, certain levels of testosterone are required in men. Low testosterone can cause sexual problems and reduced desire and libido. Recently, information has come out showing that men’s testosterone level can reduce abnormally with age. The term "male menopause" has been used to describe what happens in some men as they age. This can include weakening of muscles, loss of mental function, depression, weakening of bones, anemia, and loss of sexual function and desire.

Recent estimates show that approximately 13 million men in the United States experience testosterone deficiency and less than 10% receive treatment for the condition. Studies have shown that men with obesity, diabetes, or hypertension may be twice as likely to have low testosterone levels.

Diagnosis is through a blood test which should be performed in the morning and is best performed at least twice, as fluctuations are normal. San Fernando Valley Urological Associates performs testosterone testing in the office.

Treatment is done by replacing testosterone to its normal levels. Testosterone pills are not available in the United States and can be dangerous. The simplest treatment is a gel that is applied every morning to the shoulders or belly. The hormone is absorbed through the skin. This method most closely resembles the body’s natural release of testosterone in the body. The most common drawback is cost.

Testosterone patches are also available.

Testosterone injections are common. This involves an injection in the arm, optimally done weekly but can be done less often. We can instruct patients on self injection or they come into the office. The drawback of this treatment is erratic testosterone levels.

Risks of testosterone replacement are a theoretical enlargement of the prostate gland and unmasking of an occult prostate cancer.

Please contact us to schedule an appointment.

To learn more about this condition we recommend you visit the following website:

 

 

Hydroceles and Inguinal Hernias

Hydroceles and inguinal (groin) hernias can create problems in males.

About 10 percent of male infants have a hydrocele at birth. Seldom causing symptoms, this swelling of the scrotum does not bother a baby and usually disappears in the first year of life, even though the appearance may worry new parents. In older males, a hydrocele usually remains painless but may cause discomfort due to the increased size of the scrotum.

Only about 25 percent of hernias cause pain or discomfort. However, you may be able to see and feel the bulge that often occurs at the junction of the thigh and groin. About one percent of boys develop hernias, with premature infant males having a higher incidence. Sometimes, the protruding intestine enters the scrotum and causes pain and/or swelling in the scrotum.

Please contact us to schedule an appointment.

To learn more about this condition we recommend you visit the following website:

Male Incontinence

Urinary incontinence is the involuntary loss of urine. The cause of incontinence is different in men and women.

Incontinence in men often occurs as a result of prostatic problems. Leakage can result if the prostate has completely occluded the bladder and the bladder is completely full, causing leakage as it overflows. Long term prostatic enlargement can also cause the bladder to decompensate, meaning that it loses elasticity and gets effectively smaller. Incontinence can occur because the decompensated bladder gets thick and spastic and involuntarily contracts, pushing urine out. Post-void dribbling is a situation where urine drips out of the penis after voiding is completed. This soils pants and underwear and is often very embarrassing. This occurs because urine gets trapped in the urethra and is released moments later when the prostate and sphincter relax. Unfortunately, little can be done about it.

Other forms of incontinence in men may result from injury to the urinary sphincter, most commonly from previous prostate cancer surgery, or botched BPH surgery. Other causes of incontinence are lower urinary tract injury due to radiation or neurologic disease.

Treatment of incontinence in men related to BPH is usually done through treatment of the BPH. Success is dependent on how early the problem is caught and if the bladder has the ability to recover. Bladder problems that have occurred as a result of many years of obstruction may only partially respond to treatment, if at all. There are also medications available to prevent bladder spasticity, but these must be used with caution in men. The best defense against incontinence is prevention, which is why a regular check up by a urologist is recommended.

Treatment for incontinence due to prior surgery is more complex. In this case, leakage occurs as a result of malfunction of the urinary sphincter or "valve". Treatments are aimed at restoring, replacing or enhancing the sphincter.

  • Intaurethral bulking agents can be injected at or near the sphincter to create a tighter seal. They have limited success in men and have to be repeated periodically in most cases.

  • Male sling procedures use a sling of synthetic material to reposition the sphincter or to compress the sphincter or urethra to enhance closure pressure. There are several techniques that a qualified urologist can assess for suitability. This is often effective for mild to moderate incontinence. It can be done on an outpatient or overnight status.

  • Artificial urinary sphincter is a mechanical device that is implanted as a new sphincter. It is controlled by the patient through a pump in the scrotum that opens and closes. This is a complex procedure and requires a specialist who has extensive experience, as we have at San Fernando Valley Urological Associates. Because it is a mechanical device it can malfunction over time, although that has become less common as of late.

Please contact us to schedule an appointment.

 
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