Penis Surgery

5 questions to ask before having penis surgery

By Elizabeth Cohen, CNN Senior Medical Correspondent August 25, 2011 7:24 a.m. EDT The penis is a highly vascularized organ, which means there’s a lot of blood running through it, so cutting into it can be risky.STORY HIGHLIGHTS Doctors urge men with erectile dysfunction to try other, less risky, treatments first For implants, also try to find a doctor who does at least two or three a month Cutting into the penis leaves you vulnerable to infection RELATED TOPICS Male Sexual Dysfunction Men’s Health Sexual and Reproductive Health Surgery (CNN) — If you’re a woman contemplating surgery on your female parts, you’ll find plenty of ladies chatting and blogging away about their experiences, often on websites adorned with pink ribbons. But if you’re a man considering male surgery there’s not so much out there. There’s no ribbon for, say, penis surgery, and comparatively few men trading stories and sharing advice. “Women are much more engaged with their health,” says Dr. Dennis Pessis, president-elect of the American Urological Association. “It’s gotten better in the past 15 years, but still, men don’t always seek out the best treatments for themselves.” Penis surgery has been in the spotlight this week as a civil trial in Kentucky made national headlines. Phillip Seaton, a Kentucky truck driver, sued his urologist, Dr. John Patterson, saying he went in for a circumcision but left the surgery with part of his penis amputated. Patterson says Seaton had cancer and needed the amputation or he would have died. The doctor won the case on Wednesday, according to CNN affiliate WDRB. Seaton’s experience is certainly rare, surgery on the penis isn’t. While good statistics are hard to find, tens of thousands of men in the United States get circumcised as adults. Other common surgeries include implants for men suffering erectile dysfunction and removal of genital warts. Here’s the Empowered Patient list of questions every man should ask before having these procedures on this most valued and delicate of organs. 1. Do I really need this procedure? Think twice (or more) before having the surgery. It’s a highly vascularized organ, which is a fancy way of saying there is a lot of blood running in and out of it, so cutting into it can be risky. Men getting circumcised as adults should consider the risk of bleeding, especially if they’re on a blood thinner, including aspirin. Getting implants requires cutting, too, and doctors urge men with erectile dysfunction to try other, less risky, treatments first, such as drugs like Viagra, penile injections, or a penis pump, an external device that fits over the organ. You’ll also need to choose what kind of anesthesia you’ll want for your circumcision. You can opt for a local anesthetic and a sedative — you’ll be (or should be) relaxed but awake. Men who are especially anxious about the surgery often opt for general anesthesia, which is slightly more risky but ensures they’ll be totally out for the procedure. As for genital warts, if a man is not experiencing problems such as itching, burning or pain, he may not need treatment, according to the Mayo Clinic. 2. What are my treatment options? There is more than one type of penile implant and there is more than one way to remove genital warts. Doctors tend to specialize in one method over the other, so make sure your doctor lays out all the options and refers you to another doctor who can perform the procedure the way you prefer. There are two types of implants. With inflatable implants, doctors put cylinders inside the penis, a pump in the scrotum, and a fluid reserve inside either the scrotum or the abdominal wall. Before sex, you pump the fluid into the cylinders to create an erection. After sex, you activate a release valve in the scrotum to let the fluid out. The second type of implant involves putting semi-rigid rods into the penis, and it is bent away from the body to have sex (think of it as a goose-necked desk lamp that can be pointed in various directions). For more on various types of penile implants, see information from the Mayo Clinic and the American Urological Association. For warts, you can treat them yourself or your doctor can treat them. If you choose the DIY approach, your doctor prescribes a medicine for you to apply at home. If you prefer to have your doctor treat the warts, there are several options: Your doctor can apply a medicine, which is sometimes a stronger version of what you can apply at home. There is also an option to cauterize or laser the warts, or to freeze them off with liquid nitrogen. “You should give yourself some time to make the right decision,” says Dr. Gopal Badlani, a urologist at Wake Forest Baptist Medical Center. “You don’t want to decide at the first appointment.” For more information on the various options for removing genital warts, see information from the Centers for Disease Control and Prevention. 3. Doctor, how many of these procedures have you done? Look for a urologist who regularly performs the procedure you need. “Some urologists do nothing but treat kidney stones or urinary incontinence, and you don’t want that urologist doing your circumcision,” says Dr. Irwin Goldstein, director of San Diego Sexual Medicine. “They need to know what they’re doing so they don’t remove too much or too little skin, or create a new problem like an angled penis.” While there’s no magic number, Goldstein says if you’re having a circumcision, find someone who does at least two or three a month. Plus, you should ask the doctor for names of his or her previous circumcision patients. “It’s sort of like fixing your roof — you want to talk to a client who’s used that roofer,” he advises. “Ask about the doctor’s follow-up: Was he available, or did he just do the surgery and you didn’t hear from him again?” For implants, also try to find a doctor who does at least two or three a month, Goldstein advises, not someone who just dabbles in the procedure. “We did three implants Monday, just to give you a sense of how often some doctors do these,” Goldstein adds. The removal of genital warts isn’t as complicated as circumcision or implant surgery, but still make sure it’s something your doctor does regularly. 4. Will the treatment really cure my problem? Badlani says no matter how much he counsels his patients before implant surgery, most are disappointed the implants didn’t give them as large an erection as they had when they were 18. “Ninety-five percent of the time, after the surgery the patient feels shortchanged. They say, ‘Doc, I expected it to be much longer,’ ” Badlani says. “Men need to have more realistic expectations.” Men are also sometimes surprised that their genital warts come back after treatment. But the Mayo Clinic says genital warts “are likely to recur” because even after you remove them, you still carry the virus that causes warts, called the human papillomavirus (HPV). 5. Should I clean up before the surgery? Cutting into the penis leaves you vulnerable to infection, so ask your doctor if you should be scrubbing at home before surgery day. Goldstein tells his circumcision patients to clean with a special antiseptic once a day for three days before the surgery. He has his implant patients wash up morning and night for seven days before surgery, and take antibiotics for three days before. “We’re inserting a foreign body into the penis. The chances for things to go wrong are magnified, so we want to take all precautions,” he says. CNN’s Sabriya Rice contributed to this report.

PSA Screening

Change Screening Attitudes, Cancer Researcher Says

By Nancy Walsh, Staff Writer, MedPage Today
Published: November 25, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
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Action Points

    • A researcher believes that the time has come for a fundamental shift in attitude toward cancer screening, with greater emphasis on providing the public with information about absolute risks and the potential for harm associated with screening.
  • It was recommended that patients and the public should be given clear information — based on science rather than opinion or advocacy — that explains cancer incidence and mortality, and provides transparent information about the risks and benefits of screening.

The time has come for a fundamental shift in attitude toward cancer screening, with greater emphasis on providing the public with information about absolute risks and the potential for harm associated with screening, according to a behavioral oncology researcher.

The firestorm that erupted after the U.S. Preventive Services Task Force recommended against mammograms for women ages 40 to 49 was emblematic of the controversies generated among healthcare providers, the public, and advocacy groups every time new guidelines are announced, according to Michael Edward Stefanek, PhD, of Indiana University in Bloomington.

A perspective that is unappreciated is that at least 1,900 women in their 40s would need to undergo mammography to avoid one death over 11 years. During that follow-up time, there would be 2,000 false-positive tests, “along with the resulting unnecessary biopsies, overdiagnosis, and overtreatment,” Stefanek explained in a commentary in the December 20 issue of the Journal of the National Cancer Institute.

Even routine mammography for women ages 50 to 70 — a recommendation that has not been seen as controversial — has considerable opportunity for harm, with 838 women having to be screened during six years to prevent a single death from breast cancer.

And among women in their 50s, five in 1,000 can be expected to succumb to breast cancer during a ten-year period, but annual screening during that time would only prevent one of those five deaths. Nearly 1,000 women “screened for ten years will have gained nothing, and may have been subject to as many as 50% false-positive tests, unnecessary biopsies, overdiagnosis, and overtreatment for breast cancer,” he argued.

The public has not been well served by policy makers and institutions that have taken the approach of emphasizing the benefits of cancer screening, particularly in reducing mortality, and downplaying the consequences, particularly of unnecessary treatments, he stated.

“There will come a time when all the patients have been followed, all the analyses done, all the groups assembled, and all the editorials written, and we still will not be secure in our knowledge of the individual harms and benefits of cancer screening. It appears that this time has come,” wrote Stefanek, who has previously held positions at the National Cancer Institute and the American Cancer Society.

The evidence for prostate cancer screening also is ambiguous. For instance, one study that included 20,000 men who had prostate-specific antigen (PSA) testing every two years or no screening found a decrease in deaths from prostate cancer of nearly 50% with the test over 14 years.

Yet a meta-analysis that included almost 400,000 men found no improvement in either overall mortality or prostate cancer-specific deaths.

Moreover, a randomized trial determined that 1,410 men would have to undergo screening and 48 cancers treated to prevent a single prostate cancer-related death, according to Stefanek.

And for the more recent notion of screening smokers for lung cancer using CT scans, the potential harms associated with screening have been clearly demonstrated by the finding that about 95% of positive screens were, in fact, false positives.

To address these concerns, Stefanek offered a number of possible strategies.

An important shift must emphasize the education of healthcare providers and the public, rather than encouraging a specific approach or behavior.

Patients and the public should be given clear information — based on science rather than opinion or advocacy — that explains cancer incidence and mortality, and provides transparent information about the risks and benefits of screening.

Furthermore, risks should be presented as absolute rates and in ways that can be easily understood, the researcher advised.

Another component of the new strategy would be the creation of a partnership among scientific and advocacy groups, but not to further develop and disseminate guidelines.

Rather, the task should be to develop the clearest educational materials so patients and caregivers can together make the most appropriate individual decisions on screening.

This informed decision-making approach should be accompanied by the implementation of measures that evaluate the number of patients who have been educated, rather than how many are screened.

In addition to these strategies, “and critically important, we need to energize work to identify markers that discriminate minimal-risk disease likely to have little impact on mortality versus high-risk disease,” he wrote.

Shifting screening decisions away from a public health perspective to an informed individual approach will allow consideration of factors typically overlooked, such as anxiety about illness, acceptable degrees of risk, and the negative consequences of unnecessary treatment.

Such an approach, clearly informing patients about both benefits and harms of screening “involves a fundamental respect for individuals and a tolerance for truly informed decisions even if, as individuals ourselves, we would not make the same choice,” Stefanek concluded.

Mustaches and Prostate Cancer?

‘Movember’ gets hairy, for a cause


By Emily Smith, CNN
updated 9:13 AM EST, Tue November 1, 2011


Neil Van Helden, right, proudly displays his mustache at last year's Movember event at Johnny's Hideaway in Atlanta.
Neil Van Helden, right, proudly displays his mustache at last year’s Movember event at Johnny’s Hideaway in Atlanta.


  • During November men grow mustaches to raise money for men’s health issues
  • Movember, a nonprofit group, lays out specific rules on how to maintain your mustache
  • Chicago, America’s most mustache-friendly city, will hold the 5th annual ‘Stache Bash

(CNN) — A word of warning: You might notice a few more unshaved upper lips proudly displayed by men in the next few weeks.

Don’t worry, it’s not males the world over being lazy. They’re actually growing that Fu Manchu for a good cause.

During Movember (the month formerly known as November), men around the globe grow mustaches (hence the name) while raising money for men’s health issues. Movember started in Australia in 2003. It has spread from down under to South Africa and Europe, and five years ago it reached American shores.

This will be the fifth year Sydney native Neil Van Helden has participated in the global charity event. Van Helden came to the United States two years ago for work and said he is just like any other guy.

Submit your Movember photos to iReport!

His reasons for joining the Movember movement are simple: “I had family members deal with prostate cancer and friends with depression issues. … There’s not a whole lot out there in terms of support for men with charities. It’s not talked about that much.”

He said men in general aren’t good at committing to regular health screenings. “We’re pretty terrible at it.”

But before you sign up and start growing a ‘mo all willy-nilly, there are rules for this sort of thing, as laid out by the nonprofit group.

First and foremost, the registered participant must start November 1 clean-shaven.

Second, you need to maintain your mustache: Grooming is key.

There are also rules pertaining to gentlemanly behavior, as well as rules preventing the mustache from touching one’s sideburns (as this is a beard) or joining the mustache’s handlebars to your chin (as this is a goatee).

The goal is to get your friends to donate money to your Movember cause, which is then donated to the Prostate Cancer Foundation, LiveStrong and other men’s health research and awareness programs.

So far Americans have raised $7.5 million for Movember. Worldwide, participants have raised $174 million, which, according to Movember, makes the group the largest nongovernment funder of prostate cancer research in the world.

According to the American Cancer Society, one in every six men will get prostate cancer during his lifetime, and one in every 36 will die from the disease. Behind lung cancer, prostate cancer is the second leading cause of cancer death in men.

Van Helden got some interesting looks when he started growing his stateside ‘stache.

“It’s a lot bigger thing in Australia. Every second guy has a mustache. Everyone applauds it,” he said.

With a chuckle, he added: “Back home, the ladies like it when you have a mustache growing in Movember. Here, not so much.”

First-time mustache grower Michael Erickson is excited about his friends’ reaction to his new facial hair. He has never grown a mustache and was prompted to join Movember by some Twitter buddies. The “marriage of social media and Movember is perfect,” said Erickson, who is actively involved in social media in his job as director of marketing for a popular restaurant group in Atlanta.

For Erickson, Movember kills two birds with one stone. “I wanted to help bring attention to men’s health issues, which is something, I believe, that doesn’t get the attention it deserves. Plus, I always wanted to try to grow a mustache.”

Like most men, he recognizes that he doesn’t go for health screenings as often as he should. “That’s another reason I’m doing this: to make a commitment to myself to take better care of my own health.”

At the end of the month, parties are held around the globe to celebrate those “who sacrificed their upper lip for the month.”

Men dress up as famous mustache-sporting characters, such as the Village People. Van Helden went as Sherlock Holmes last year– complete with tweed and his pants tucked into his socks. He likes that “everyone (there) has something in common. You’re all there for a good cause.”

‘Stache soirees have grown in popularity, prompting the fifth annual “Stache Bash,” put on by the American Mustache Institute. This year the bash will be held in Chicago, which was deemed to be America’s most mustache-friendly city.

The event also benefits LiveStrong and the Prostate Cancer Foundation. The facial hair advocacy group has been around since 1965 and touts itself as “committed to battling a demonstrated discriminatory culture against people of mustached American heritage” by “promoting the growth, care and culture of the lower nose forest.”

All jokes aside, the American Mustache Institute and Movember hope to raise awareness about an often less thought about issue, men’s health.

So, if you happen to see more mustaches in November, don’t give that person a funny look. Instead, think about donating to their hairy cause or at least be inspired to get a health screening.

Patient Testimonial

“I would like to share this patient testimonial written by my patient’s wife who underwent Green Light Laser vaporization of the prostate for enlarged prostate and holmium laser lithotripsy for bladder stones.”  David Robbins, MD

Dear Dr. Robbins – I  just wanted to take a moment to thank you for such a positive experience this past week when my husband had surgery to remove his bladder stones. We dreaded the whole thing and had postponed the inevitable long past the time when he should have dealt with it. Had we known that you and your staff would make the experience so stress-free, we would have scheduled his surgery sooner. He was up and around in no time and is feeling so much better now. We really appreciate the care and attention you showed and just wanted to make sure you knew how much that meant to us. You can be certain that we will recommend you highly in the future. Thank you!

Actos and Bladder Cancer

“Many Miami urology patients have asked me recently about the association of the diabetes drug, Actos and bladder cancer.  I have posted some info below from WebMD to provide some insight.”  David Robbins, MD


New Bladder Cancer Warning for Diabetes Drug Actos

FDA: Increased Risk of Bladder Cancer for Patients Taking Actos the Longest
WebMD Health News
Reviewed by Louise Chang, MD


June 16, 2011 — The FDA has issued a new warning of increased bladder cancer risk associated with use of the diabetes drug Actos (pioglitazone).

The warning comes after a review of data from a five-year analysis of an ongoing study of Actos by the manufacturer, Takeda Pharmaceuticals.

The results show that although there was no increased risk of bladder cancer among Actos users overall, there was an increased risk of bladder cancer among those who had used the drug the longest. There was also a greater risk of bladder cancer among Actos users who had been exposed to the highest cumulative dose of the drug.

Officials say information about this risk will be added to the label of the drug as well as the patient medication guide.

FDA officials say in light of this new information, Actos should not be prescribed to people with bladder cancer or people with a history of bladder cancer.

New Warning for Actos

In September, the FDA launched a safety review of Actos after initial data from the manufacturer’s ongoing 10-year study suggested that the drug may increase the risk of bladder cancer.

The agency says it is also aware of a recent epidemiological study in France that also suggests an increased risk of bladder cancer associated with Actos. Based on this study, France has suspended use of the drug and advised not starting Actos in new patients.

Actos is part of a class of drugs known as thiazolidinediones that is used to treat type 2 diabetes. It is designed to help control blood sugar levels by increasing the body’s sensitivity to insulin.

The FDA says people currently taking Actos should continue taking it until advised otherwise by their health professional. Those who are concerned about the possible risk of bladder cancer should talk to their health care provider.

Debate about prostate tests rages

“This article from North Caroloina highlights the issues involoved in the PSA debate that continues to affect the lives of patients in Miami and around the country.” David Robbins

Debate about prostate tests rages

By: RICHARD CRAVER | Winston-Salem Journal
Published: November 19, 2011

Turning 50 proved to be a milestone for Mike Tyson not just in terms of age.

Tyson, of Winston-Salem, credits the symbolic birthday for saving his life because he chose to undergo a routine prostate-specific antigen test at that time. The test measures a specific protein released by prostate cells.

Because his PSA level was elevated for his age, Tyson underwent a biopsy that revealed prostate cancer. He had surgery in February.

He said his recovery was slow but that in August, he began feeling more like himself, particularly after participating in the Livestrong program for cancer patients and survivors at local YMCAs.

The necessity of the PSA test — and the consequences of what it might reveal — has become a significant topic at local urologist offices since October, when the U.S. Preventive Services Task Force recommended against it.

For men, prostate cancer is second only to skin cancer in frequency of cancer cases. It also is the second leading cause of death, behind lung cancer.

In 2009, health-care lobbying groups criticized the task force for recommending that most women wait until age 50 to get mammograms and then have one every two years. The American Cancer Society’s longstanding recommendation is annual screening starting at 40.

Opponents of the PSA test say it tends to lead to potential misdiagnosis and unnecessary biopsies and treatment for men, particularly for those 50 and older. They say urologists support PSA testing because it can be a significant revenue source.

After conducting five clinical PSA trials, the task force said, “There is moderate or high certainty that the service has no net benefit and that the harms outweigh the benefits.” According to a New York Times report, the task force said the test “cannot tell the difference between cancers that will and will not affect a man during his natural lifetime.”

Proponents point to examples, such as Tyson, as to why the test is pertinent.

Tyson said he’s convinced PSA testing is not only necessary but should be done sooner.

“I had no symptoms of prostate cancer,” Tyson said. “Having my wife die of bone cancer in February 2008 after fighting it valiantly for seven years, and with an 11-year-old daughter to care for, I didn’t consider anything other than surgery.

“If I had gone with the watch-and-wait approach, I might not have been checked for months, if not years, because of being 50. Who knows how much the prostate cancer could have spread in that time?”

Urologists affiliated with Forsyth and Wake Forest Baptist medical centers support the stance of the American Urological Association.

“Until there is a better widespread test for this potentially devastating disease, the task force — by disparaging the test — is doing a great disservice to the men worldwide who may benefit from the PSA test,” said Dr. Sushil Lacy, president of the association.

“It is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, or risk assessment and monitoring of prostate cancer patients.”

This issue isn’t one that affects just urologists, said Karen Richardson, a spokeswoman for Wake Forest Baptist. “Many men get their prostate cancer screenings from their primary-care physicians,” she said.

Dr. Jeremy Hubbard, a urologist at Carolina Urological Associates, said he disagrees with the task force’s recommendation because it is a sweeping declaration for a decision that is individual in nature.

“We’re concerned that some patients — and some primary physicians — may only consider the task force’s recommendations and not access all the pertinent information they may need,” Hubbard said.

In 2008, the task force recommended against PSA testing in men ages 75 or older, relying instead on the watch-and-wait approach because treating the prostate cancer for men of that age could cause more harm than the disease itself.

Hubbard said that because some prostate cancer is slow to grow, “it requires reasonable active surveillance by physician and patient.”

“Treatment recommendations for someone with prostate cancer are different for someone in their 40s and 50s compared with 60s and 70s,” he said.

The American Council on Science and Health supported the task force’s recommendations because it said tens of thousands of men have had serious complications from unnecessary prostate surgery, ranging from blood in the urine to incontinence and impotence, and even death.

Dr. Gilbert Ross of the council said a more specific test for prostate cancer is needed — one that will identify only cancer cells that are likely to develop into dangerous tumors and metastases.

“The PSA test should not continue to wreak so much havoc on people’s lives,” Ross said.

Taking more medications may raise risk of erectile dysfunction

By Jeannine Stein, Los Angeles Times / For the Booster Shots blogNovember 15, 2011, 1:42 p.m.

The more medications men take, the worse their erectile dysfunction may be, a study finds.

The British Journal of Urology reports Tuesday that men who take multiple medications may be increasing their risk for erectile dysfunction. Although some of the conditions they’re being treated for might carry an ED risk, the medication on its own may also increase the danger of erectile problems.

Researchers from Kaiser Permanente surveyed 37,712 men who were part of the California Men’s Health Study about their health and current medications. More than half the men — 57% — were taking more than three medications, and higher drug use was found among older study participants and those who were African American. Taking more medications was also linked with a higher body mass index.

Overall, 29% of men surveyed said they had experienced moderate to severe erectile dysfunction. Frequency of ED was associated with taking a larger number of medications. Among men taking up to two medications, ED prevalence was 15.9%; among men taking three to five medications it was 19.7%, among men taking six to nine medications it was 25.5% and among men taking 10 or more medications it was 30.9%.

When researchers controlled for factors that could also affect ED, such as age, diabeteshigh blood pressure and smoking, taking more medications was still associated with a greater risk of ED.

“Clinically, the findings from this study suggest that a crucial step in the evaluation of ED would be to review the current medications the patient is taking and their potential side effects,” said lead author and urologist Dr. Diana Londono in a news release. “When appropriate, decreases or changes in the amount or type of medication should be considered.”

Copyright © 2011, Los Angeles Times