FAQ

Yes, it can. Erectile Dysfunction (ED) develops at around 1/3 of men with Peyronie's disease(PD). ED in PD can be treated with the same drugs and procedures that are used to treat ED caused by other reasons.

The question is often asked by young men, young people who are making their first steps in sexual life. More often tmany of them are impressed watching movies with pornographic content and on their basis perform WRONG CONCLUSIONS. Basically, the duration of sexual intercourse is sufficient individual indicator for each particular couple. It  depends on satisfaction level of both sexual partners, as well as their behavioral characteristics, such as temperament. However, if you move to the figures, I can bring an example of research of European scientists published in The Journal of Sexual Medicine, Vol. 2 Issue 4, 2005 (http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2005.00070.x/abstract). 500 couples from 5 different countries, aged 18+, who were in regular, stable, sexual intercourse for 6 months were interviewed to determine the average duration of sexual intercourse. The duration of sexual intercourse means as the time from penetration to ejaculation. The average duration of sexual intercourse in all countries was 5.4 minutes (range, 0.55 - 44.1 minutes). This rate is significantly reduced with age, ranging from 6.5 min in the age group 18-30 years old, and 4.3 minutes in the age group over 51 years old. Also, the average duration of sexual intercourse varied between countries, the lowest rate in Turkey - 3.7 minutes (range 0.9 - 30.4). Moreover, this figure was compared in men who underwent circumcision (circumcision) - 6.7 (range 0.7-44.1) min, with men who are not circumcised - 6.0 (range 0.5-37.4) min. The indicator is estimated in cases of sexual intercourse without using a condom.

Thus, the average duration of vaginal intercourse was 6.5 minutes for men aged 18-30 years old, 4.3 minutes for men aged 51+, the average for all men - 5.4 min, ranging 0.55 - 44.1 min.

Many teenagers, young men, men are interesting the answer for this question. As if they did not deny it, but the fact remains. So! According to a recent study of the American scientific publication PLOS ONE women made the following preferences. It was found that the size issue is relevant only in the situation of occasional sex. Optimal in this case, the length of 16.3 centimeters and a circumferential length of 12.7 centimeters has been recognized that it is not too high than the average size. For long-term relationship, the ideal length of 16 centimeters in length and circumference of 12.2 cm was selected.

ESWL (lithotripsy), even multiple, does not affect the potency in men.

According to statistics of the European Association of Urology possible complications are the following:

Erectile dysfunction (ED) is a very common male disorder; thete is correlation of ED prevalence with diabetes mellitus and vascular diseases. The process of aging is accompanied by a progressive decline in testosterone levels. ED is often accompanied with a decrease in testosterone levels, but it is not the main reason for its development. Nevertheless, testosterone are increasingly used for the treatment of erectile dysfunction, especially in patients who do not respond to 5-alpha phosphodiesterase inhibitors. Although animal models experiments have demonstrated the importance of testosterone for the regulation of several mechanisms of erectile function, cause-and-effect relationship between low testosterone levels and erectile dysfunction has not been established. About 60% of testosterone in the blood connected with globulin, almost 40% -  with albumin, about 1.2% testosterone is circulating in free form. Free and bound testosterone have biological activity, and the activity of globulin bound testosterone is largely inhibited. The level of free testosterone and bioavailable testosterone are inversely related with erectile dysfunction, whereas the positive relationship between the total testosterone and erectile dysfunction most likely associated with an increase of levels of sex hormone binding globulinin in blood.

Types of urinary incontinence

Stress urinary incontinence. Stress urinary incontinence (SUI) manifests when the pressure in the bladder becomes higher than in the urethra, due to the weakness of the pelvic floor muscles or sphincter weakness. In most cases there is a combination of the both sauses. This is most often type of urinary incontinence in women, especially after multiple childbirth. The men are rare and may occur after prostate surgery. Emptying occurs by increasing of intra-abdominal pressure (coughing or sneezing). Cough test is positive during perineal examination; uteral or vaginal prolapseis not uncommon . Physiotherapy is particularly effective, but if SUI is permanent and causes a serious inconvenience, surgical treatment are necessary.

Urgent urinary incontinence. Urgent urinary incontinence (UUI) manifests due to the increased activity of the detrusor contractility, which dramatically increases the pressure in the bladder and lead to the disclosure of the urethral sphincter. Urgency with or without incontinence can also be due to hypersensitivity of the bladder (sensory imperative incontinence) due to a urinary tract infection or a bladder ston. Prevalence of UUI increases with age: it is found in 17% of people over 65 years of age, 50% of these people are in need of constant care. It is also observed that UUI disappears after the removal of the obstruction of lower urinary tract (benign prostate hyperplasia / obstruction) in men. Diagnosis is based on symptoms and the urinary retention exclusion with using ultrasound; control urodynamics is used for confirmation. Treatment is based on the training of the bladder: it is necessary to teach the patient to force yourself to arbitrarily hold more urine in the bladder. Anticholinergic drugs are obligative. Surgical treatment is indicated only when, despite treatment, UUI is retained  in the daytime.

Permanent urinary incontinence. This type of incontinence indicates the presence of a fistula between the bladder and the vagina (vesico-vaginal) or between the ureter and the vagina (vagino-urethral). Such fistulas are often formed after gynecological operations, but can also occur during gynecologic malignancies and subsequent radiotherapy. In countries where maternity services is poorly developed, prolonged labor is the most common cause of vesicovaginal fistulas. Permanent incontinence is also observed in children with congenital ectopia ureter. In some cases, SUI manifests such that urine is outflows continuously. The diagnosis is confirmed by inspection of the perineum, as well as through intravenous urography. The treatment is surgical .

Overflow urinary incontinence. This type of incontinence develops in case of bladder chronic hyperextension. Most often in men with benign prostatic hyperplasia or bladder-neck obstruction, but can also occur during sexual intercourse as a result ofdetrusor failure (atonic bladder). The latter condition can be idiopathic, but most often as a result of pelvic nerves damage during surgical procedures (usually during hysterectomy or extirpation of the rectum). Other reasons are injuries, infections, or as a result of compression of the cauda equina with hernia or  tumor. Incomplete emptying can be detected by ultrasound - there is a significant volume of residual urine after urination (> 100 ml). Obstruction of the bladder requires surgical treatment. If there is no obstruction, it is necessary to drain the bladder, intermittent self-catheterization is preferable. Control urodynamics can help determine the cause of incontinence

Postmictional dripping. This phenomenon often occurs in men, even quite young. The process is due to a small amount of urine bend in the bulbar urethra. This urine sample will expire when the patient moves. Postmictional dripping is more obvious if the patient has a diverticulum or stricture of the urethra. It can also exist in female with urethral diverticulum and simulate stress incontinence.

Circumcision is surgical excision of the prepuce to the level of the coronary sulcus.

Controversial issues of circumcision. Despite of that in the 1960s circumcision in newborns become a common intervention, debates about how this operation is necessary in newborns broke out at the end of the decade. After a thorough evaluation of the results, especially with regard to the frequency of the penis cancer, cervix cancer in sexual partners, the American Academy of Pediatrics in 1971 came to conclusion that there is no valid medical indications for circumcision in the neonatal period. Main reasons of male circumcision are to reduce the risk of urinary tract infections, cancer, sexually transmitted diseases, phimosis and paraphimosis.

Circumcision and infection. After the first report published in 1975, new data confirming the correlation of foreskin infections with sexually transmitted diseases. Small boys with urinary tract infection are dominated among the 100 surveyed infants aged 5 days - 8 months. Almost 95% of them were not subjected to earlier circumcision. Analysis of the United States Army soldiers survey showed that the incidence of urinary tract infections is 10-20 times higher in men without circumcision. The lower the circumcision frequency, the more frequently urinary tract infection are detected. Overall statistics on the survey of large groups and prospective analysis confirmed the above data. Some researchers have shown that circumcision in the neonatal period prevents the development of urinary tract infections. Aetiological link between the infection of the foreskin and the urinary tract can be explained by an increased ability of certain bacteria to settle and "stick" to the foreskin.

Circumcision and cancer. Penile cancer is developing only in uncircumcised men. The mortality rate for penile cancer is 25%. According to the summary statistics, including a large number of men with penile cancer, noone was circumsized in infancy. That's why circumcision significantly reduces the likelihood of penile cancer.

Circumcision and sexually transmitted diseases. Retrospective analysis of the survey of the United States and Canada military, has confirmed a correlation between circumcision and sexually transmitted diseases. Ulcers, such as chancroid, syphilis, genital herpes, genital warts, candidiasis, acquired immunodeficiency syndrome, often found in men who are not circumcisedt. Several studies show suggested correlation between carcinoma of the cervix in women who have had sex with uncircumcised men. Reliable confirmation was not provided.

Indications for surgical intervention. Phimosis, paraphimosis and recurrent balanopistitis are absolute indications for circumcision. Among men who were not circumcised, 5-14% are in need of this intervention. In all cases of paraphimosis manipulation of eliminationof must first be attempted, which is greatly facilitated by using local anesthesia (block) of the penis. In case of  failure of this attempt it is necessary to perform incision of the foreskin from the dorsal side of the middle line  to the level of the coronary sulcus to remove compression. Sometimes circumcision can be postponed to a later date. Relative indication for circumcision is a recurrent urinary tract infection in young children, especially after the age of a 1 year when opening of the urethra is dificult. Recurrent balanoposthitis (without other pathology) is also a relative indication for circumcision, because there is a opinion that foreskin protects the glans penis by inflammation associated with the dermatitis ammonia.

Obviously, chronic prostatitis must be treated first with conservative methods. Among these methods, doctor must select those that will provide a stable, long-term remission (subsidence). And here, in my opinion, it is necessary to apply the most sparing modalities with focus on the complex physiotherapy. Such approach allows to stop the inflammatory process, remove an attack of chronic prostatitis (pain in the perineum, frequent and sudden urge to urinate, sense of incomplete emptying of the bladder).

As example, Urologists of Ryazan Uronephrology Center during preparing patients for BPH surgery used complex treatment to eliminate manifestations of chronic prostatitis. As a result, in 30 (!) cases managed it has become possible to cancel the operation. Of course, BPH/BPO has not disappeared and not resolved. But without the symptoms of a prostatitis quality of life of patients with BPH/BPO early stages is quite acceptable.

Diagnostic difficulties associated with the differentiation of  gallbladder diseases and right renal colic are caused by common localization of the pain. Patient often can not distinguish renal colic and gallbladder disease (acute cholecystitis). It is necessary to make an examination by a urologist, because symptoms sometimes are so complex that other doctors can not understand it. Unbearable pain in the upper quadrant in hepatic colic associated with acute dilation of the gallbladder. Quite often, errors in diet provoke the development of catarrhal calculous cholecystitis; this fact doctor should look for when taking .  associated with breathing that is not present at renal colic. It is necessary to consider that for renal colic is characterized by back pain, and сholecystitis pain concentrated in the right upper quadrant of abdomen wall. However, a great role especially plays irradiation of pain. Hepatic colic pain is localized from the appearing in the upper quadrant. Later the pain begin to radiate to the right side of the chest, shoulder, in the region of the right scapula angle, interscapular region. Renal colic is characterized by irradiation of pain down to the groin, testicle, inner thighs, penis. Gallbladder diseases, as well as renal colic, accompanied by nausea, vomiting. In both diseases, vomiting is frequent, small amounts, not bringing relief to the patient. Leukocytosis as a differential diagnostic test for renal colic and acute catarrhal calculous cholecystitis is inappropriate, since in both diseases observed a moderate increase in the number of leukocytes in peripheral blood. Positive tapping symptom, dysuria confirm the diagnosis of renal colic, but a symptom of weak positive tapping may be at an acute cholecystitis. Kidney ultrasound ,cystochromoscopy, excretory urography may be very useful.

Surgery is required only when the signs of urination disorder are present (residual urine volume is more 50 cm3) or the pathological process had already spread to the kidney (dilation of ureter and kidney on one or both sides). On early stages conservative treatment is available; periodically the patient should visit a urologist for blood and urine analyses, uroflowmetry.

Urinary incontinence is involuntary outflow, or loss, of urine. This condition may exist in the absence of pathology of the urinary system: due to lower cognitive function and physical inactivity, temporarily during acute illness or hospitalization, especially in the elderly. Diuretics (drugs, alcohol or caffeine) may increase the urinary incontinence.

Clinical evaluation. Characteristics of urinating is essential for the diagnosis of incontinence, so the patient should keep a diary of urination, which is necessary to specify the frequency of urination, urine volume, precipitating factors and the accompanying sensations, such as urgency.

Laboratory and instrumental examination. Examination includes evaluation of cognitive function and mobility, sensitivity in the crotch area, the anal sphincter tone, as it is innervated by sacral nerve (as bladder and sphincter). Overall neurological status is required for the detection of some diseases (eg, multiple sclerosis), in which disturbed innervation of the bladder; the lumbar examination is necessary to rule out spina bifida. Digital rectal examination is performed to evaluate the prostate and elimination of constipation as the cause of incontinence. It should also examine the genital organs for the elimination / confirmation of phimosis and paraphimosis in men and atrophy of the vaginal mucosa, cystocele and rectocele in women. The urine general analysis and urine culture should be performed in all patients. It is obligative the residual volume estimation, either by ultrasound immediately after urination, or by catheterization. Sometimes you may need urodynamics and uroflowmetry.