The evaluation of microscopic hematuria is one of the most common reasons a patient is sent to see a urologist. The big three things we look for are kidney tumors, bladder tumors or stones. The most common evaluation is a non contrasted Ct scan and cystoscopy (looking into the bladder with a scope). Benign reasons for blood in the urine include irritation of the urethra in a female and the vascular lining of the prostate through which urine passes. Even the evaluation is usually negative, because blood in the urine can represent an early sign of malignancy, it is usually evaluated to assure there is no asymptomatic underlying cause.
In the picture above even though the urine appears clear there can still be significant microscopic blood in the specimen that the patient cannot see and also causing no symptoms.
François Gigot de la Peyronie (pronounced: [fʁɑ̃swa ʒiɡod la pɛʁɔni]; 15 January 1678 – 25 April 1747) was a French surgeon who was born in Montpellier, France. His name is associated with a condition known as Peyronie’s disease.
As a teenager he studied philosophy and surgery in Montpellier, where in 1695 he received his diploma as a barber-surgeon. He continued his education in Paris as a student of Georges Mareschal (1658–1736), who was chief-surgeon at the Hôpital de la Charité. Afterwards he returned to Montpellier as lecturer on anatomy and surgery, and was surgeon-major at the Hôtel-Dieu de Montpellier. In 1714 Peyronie returned to Paris, where he was appointed surgeon-major at the Hôpital de la Charité. In Paris he also taught anatomy at the Jardin du Roi and at the amphitheatre of Saint-Côme.
In 1736, after the death of Mareschal, he became first-surgeon to King Louis XV. He took interest in the medical educational system, and was instrumental in reorganization of surgical schools. He was a major factor regarding the creation of a 1743 law that banned barbers from practicing surgery. With Georges Mareschal, he founded the Académie Royale de Chirurgie (1731), and was its chairman from 1736 to 1747. At Montpellier, Peyronie donated the money for construction of an amphitheatre based on the Collège Saint-Côme de Paris. In 1752 construction began, and in 1757 the grand opening of the Hotel Saint-Côme de Montpellier took place.
What is Peyronie’s Disease?
Peyronie’s disease is where plaques (segments of flat scar tissue) form under the skin of the penis. These plaques can cause the penis to bend or become indented during erections. The plaques can often be felt through the skin, and can also be painful.
Alternatives to Viagra: Pills, Herbal Remedies, and Other Treatments
Last reviewed: Mon 28 November 2016
Viagra is a well-known drug for the treatment of erectile dysfunction, a distressing and common condition.
There are many alternatives to Viagra, which can improve or reverse the symptoms of erectile dysfunction. These options include drugs, medical treatments, lifestyle changes, and alternative remedies.
Contents of this article:
What is Viagra?
Erectile dysfunction can be distressing, but there are solutions.
Viagra was developed in the United Kingdom. In 1998, the American pharmaceutical company, Pfizer Inc., put it on the market.
The generic name for Viagra is sildenafil. The trade name is Viagra, and the drug also goes by the name of Revatio. Viagra works by slowing down the action of PDE5, an enzyme that works in the tissues of the penis.
The PDE5 enzyme breaks down a substance that is responsible for blood flow in the penis. Inhibiting PDE5 increases blood flow to the penis. This helps men to achieve and maintain an erection.
However, sildenafil can only assist in maintaining an erection if the penis is physically stimulated. Without a physical stimulus, sildenafil cannot cause an erection.
What is erectile dysfunction?
If a man is unable to get or keep an erection that is firm enough to engage in sex, does not achieve an erection at all, or loses an erection during sex, this can signal erectile dysfunction.
Erection problems are common, and they affect almost all adult men at some time. However, an ongoing issue that frequently affects erectile function may be classed as erectile dysfunction.
Figures indicate that erectile dysfunction affects over 600,000 men in the United States each year. Although the frequency of this problem increases with age, it is not confined to older adults.
Causes of erectile dysfunction
Erectile dysfunction can result from factors that are medical, psychological, emotional, or a combination of these.
Medical conditions that are linked with erectile dysfunction include:
- High blood pressure
- Heart disease
- Atherosclerosis, when plaque builds up in the arteries
- Kidney disease
- Multiple sclerosis
- Peyronie’s disease, where scar tissue forms in the penis
- Injury to the penis, prostate, bladder, pelvis, or spinal cord from surgery or other means.
Lifestyle choices that have been linked to erectile dysfunction include:
- Alcohol or drug use
- Excess weight
- Lack of exercise
When to see a doctor
As erectile dysfunction is a medical problem, cases that persist for several weeks or more should be seen by a doctor. This is particularly important for those who suspect their erectile dysfunction may be related to another cause, such as heart disease or diabetes.
Some prescription medications are linked to erectile dysfunction. Those taking certain prescribed drugs may wish to discuss possible side effects and alternatives to these medications with their doctor.
Drug alternatives to Viagra
There are several alternatives to Viagra available to men with erectile dysfunction.
Oral drugs, including Viagra, are frequently the first course of treatment offered to men with erectile dysfunction.
Alternative PDE5 inhibitors to Viagra, only available by prescription, are:
- Vardenafil: Sold under the brand names Levitra and Staxyn, this drug is available in tablet and disintegrating tablet form. To be effective, it should be taken an hour before sex. It can be effective for up to 7 hours.
- Tadalafil: Sold under the brand names Adcirca and Cialis, tadalafil can be taken 1 to 2 hours before sex. These tablets are effective for 36 hours.
- Avanafil: Marketed in the U.S. as Stendra, avanafil tablets can be taken 15 to 30 minutes before sex and last up to 6 hours.
Alternatives to oral medications include:
- Penile self-injections: Medications such as alprostadil, papaverine, and phentolamine can be injected directly into the side or base of the penis. These can help achieve or maintain an erection for up to 40 minutes.
- Urethral suppository: Very small alprostadil suppositories can be placed in the penile urethra using a special applicator. This stimulates an erection to begin within 10 minutes, which can last for up to 60 minutes.
- Testosterone replacement: This treatment may be suggested for those whose erectile dysfunction is linked to low levels of testosterone. The testosterone hormone can be delivered by a variety of methods including injection, patch, or oral medication.
Other medical treatments
There may be some men for whom medication is unsuitable, either because of other medical conditions or another reason. In these situations, other medical treatments may be suggested.
Vacuum erection devices are hollow tubes, also known as penis pumps. They are attached to a hand- or battery-operated pump and work by drawing blood into the penis. They help to achieve an erection that can be maintained using a tension ring.
Implants are inflatable or bendable rods that are surgically implanted into the erection chambers of the penis. This type of treatment is usually only recommended after trying other options first.
All of these treatments must be delivered by a qualified healthcare professional.
Dietary supplements and herbal remedies
Several dietary supplements, herbal preparations, and food products are sold as remedies for erectile dysfunction.
Ginseng may help in cases of erectile dysfunction.
Some of the better-known alternative treatments, which have shown positive results in small studies and are generally considered safe, include:
However, consumers should be careful when purchasing or consuming any alternative products, including those that claim to be herbal versions of Viagra.
The U.S. Food and Drug Administration (FDA) have issued several statements warning consumers about the safety of such goods. They say these products may contain hidden synthetic chemicals or other ingredients which could be harmful. There has not been enough research to support the usage of these supplements fully.
According to the FDA, lab tests show that nearly 300 of the supplements or foods marketed to enhance sexual function contain undisclosed drug ingredients. Anyone who is using a supplement must let their doctor know.
Lifestyle changes for erectile dysfunction
Certain lifestyle choices can contribute to erectile dysfunction in some men. Research indicates the condition may be successfully reversed in some situations by focusing on lifestyle factors.
The following changes may be helpful for those with erectile dysfunction:
- Eating a balanced diet: Some research suggests that eating flavonoid-rich foods, such as blueberries, strawberries, blackberries, and citrus fruits, can reduce erectile dysfunction in both young and middle-aged men.
- Maintaining a healthy body weight: Being overweight or obese can cause or worsen erectile dysfunction.
- Engaging in regular exercise: Physical activity can benefit those with erectile dysfunction in several ways. It improves circulation, reduces stress, and it contributes to a healthy body weight.
- Quitting smoking: Research indicates a strong link between the intensity of cigarette smoking and the degree of erectile dysfunction. Stopping smoking can improve erectile dysfunction in many smokers.
- Avoiding too much alcohol and illicit drug use: Drinking too much, or taking illegal drugs, can affect sexual function in men. Smoking marijuana can cause erectile dysfunction.
- Seeking help for psychological or emotional issues: Addressing stress, anxiety, depression, and other types of emotional distress can improve or resolve symptoms.
A medical professional can give the best advice for men who are experiencing erectile dysfunction.