Man Doing Pushup

#GatekeepersofMen Series

Episode 17

News & Events

Why is my penis getting shorter?

Why is my penis getting shorter?

A very common concern for men of all ages is: SIZE.   I often see men who come in to my office concerned about the size of their penis.  Sometimes they are originally being seen for a completely unrelated complaint, such as urinary problems secondary to an enlarged prostate (BPH) or interested in a vasectomy.  Then, all of a sudden, the question comes up:  “Hey doc, now that I am here, I wanted to ask you about one more thing. I have noticed that my penis is shrinking…” or ” My penis is getting shorter”… And you can imagine the rest of the conversation.

But first let’s dig into a very popular question:

Continue reading “Why is my penis getting shorter?”

A Men’s Health Specialist’s True Purpose

The 3 R’s of Men’s Health

People often ask me what I do as a urologist who specializes in Men’s Sexual Health.   It is simple. I sum it up in 3 words. I refer to them as the 3 R’s of Men’s Health:

1.     Rehabilitate

2.     Reconstruct

3.     Restore

younger man with beard

September is Sexual Health Awareness Month.

Continue reading “A Men’s Health Specialist’s True Purpose”

How a urologist can help men live LONGER…

Helping men live LONGER and BETTER…

A male’s life expectancy 

Every day I see men of all ages who come into our office concerned about their erections.   These range from men in their early 20s to those in their late 80s.  But what they do not know is that in many occasions, their sexual or reproductive concerns can be the effect or aftermath of something far more serious.   In our last post we discussed the relationship between erectile dysfunction and heart disease.  Today, we will dive in deeper and discuss how a we, as a men’s health specialist, can help men live longer.

Middle aged couple riding bikes

 

June is the official month for Men’s Health!

This week the European Urology Focus journal published a scientific article that immediately caught my attention.  The title was “Male Sexual and Reproductive Health – Does the urologist have a role in addressing inequality in life expectancy?”. [1]  We all know life expectancy for men is less (70.5 years) when compared with women (75.6 years).   This study aimed to evaluate the association between male sexual and reproductive health-related diseases and life expectancy.  In other words, if there is a correlation between these two, then a urologist (the physician who focuses in male sexual and reproductive health) can play a vital role to improve life expectancy for men. So… if you are wondering what research has shown are the leading causes of death in men, here you go:

Main contributors of Death in Men

  1. Cardiovascular disease (CVD)
  2. Cancer
  3. Diabetes
  4. Respiratory disease
  5. Injuries (Trauma)

Studies indicate men have higher premature death rates from CVD because they tend to have higher rates of all major risk factors.  These risk factors include high blood pressure, obesity, diabetes, high cholesterol and smoking.   The number one cause of respiratory disease in men is smoking.  Research has shown that men start to smoke earlier than women and smoke more cigarettes per day than women. [2] Smoking can also lead to CVD, cancer and erectile dysfunction.

Think about it.   All these can be prevented!

If you exercise regularly, eat a healthy diet and control your blood pressure and cholesterol levels, you can prevent or at least delay heart disease and diabetes.  

How can we screen for CVD?

A urologist regularly evaluates men with erectile dysfunction and, as discussed in our previous post, erectile dysfunction can be a sign of CVD.  Simple screening tools for CVD include measuring your blood pressure and obtaining blood work. Important labs are a lipid profile to check your cholesterol and triglyceride levels,  and a hemoglobin A1c to screen for diabetes.  

Low Testosterone: Helping men live longer

There is a strong connection between testosterone deficiency and diabetes. The American Diabetes Standards of Care recommend to check testosterone levels in every man with diabetes and decreased sexual drive (libido) or erectile dysfunction. Even more, research shows that testosterone can improve overall health and hence, help men live a longer healthier life.  Testosterone, when used appropriately, can offer MAJOR health benefits for men.    Even though there is still a controversy between testosterone replacement therapy and cardiovascular safety, most research studies and experts believe that testosterone treatment is SAFE when managed adequately.

Prostate Cancer and Survivorship

The most common cancer in men (second to skin cancer) is prostate cancer.  Given African-American and Hispanic men are more likely to not only be diagnosed with prostate cancer, but die from it, we strongly encourage prostate cancer screening.  Also, even though there is no conclusive evidence that any single diet will protect men from acquiring prostate cancer, a study published in the World Journal of Urology in 2017 reported that physical activity, controlled body weight and a diet rich in vegetables can reduce the risk of prostate cancer progression.  Therefore, we encourage men diagnosed with prostate cancer to aim to improve their diet and increased their physical activity. 

We need to remember that prostate cancer therapies have increased cure rates and overall survival. When detected early, prostate cancer is CURABLE! Surgery and radiation can cure early stages of prostate cancer.   If you survived prostate cancer and now suffer from erectile dysfunction, low testosterone symptoms, urinary incontinence or changes in orgasm, an urologist specialized in sexual health is primed to help you.

In Conclusion…

Many men who come to see me haven’t even seen their primary care doctors in years.  As a urologist and Gatekeeper of Men  I pledge to help screen men to improve not only their sexual and reproductive lives but their OVERALL health. I encourage EVERYONE reading this to visit their primary care doctors and visit your local urologist. We can help and are here to serve you!

 


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s sexual health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

1.     Tharakan T, et al. Male Sexual and Reproductive Health – Does the Urologist Have a Role in Addressing Genter Inequality in Life Expectancy? European Urology Focus 2020; 6(4): 791-800.

2.     The WHO regional Office of Europe. The heatlh and well-being of men in the WHO European region: better health through a gender approach. 2018 www.euro.who.int.

3.     Peisch SF, et al. Prostate cancer progression and mortality: a review of diet and lifestyle factors. World J Urol 2017;35: 867-74.

Erectile Dysfunction: A Sign of Heart Disease

Erectile Dysfunction: A Sign of Heart Disease

“The penis is the gate way to the heart”

This week I had a patient who was scheduled to undergo a surgery for enlarged prostate.  I was excited to finally be back in the operating room after weeks without being able to perform elective procedures due to the Covid-19 pandemic.  As soon as I step into the surgery center’s building, I received a call from the anesthesiologist who suggested postponing the surgery.  We found that the patient’s blood pressure was very high and not well controlled. Upon questioning, the patient mentioned he decided to stop his blood pressure medications several weeks prior without consulting with his primary care physician.  After listening to the story, one of the nurses then told me:  “My husband does the same.  They notice that medications cause erectile dysfunction and he would rather continue with elevated blood pressure than lose his erections.”  This remark drove me to write today’s article.

Older man doing pushup

 

June is the official month for Men’s Health!

Therefore, today I wish to focus on a very important topic.   Erectile dysfunction (ED) can be an indication of a man’s risk for heart disease and early death.   Yes, you read that correctly.   Erectile dysfunction is not only a problem that can affect the intimacy between you and your partner but can also be a symptom of something far more serious.

Remember there are 4 types of Erectile Dysfunction

(Do not worry, we will soon discuss and describe each and every one of these in the near future!)

  1. Psychogenic
  2. Neurogenic
  3. Hormonal (low testosterone)
  4. Vascular

However, the most common type is vascular erectile dysfunction.   Vascular ED occurs when there is not enough blood flow getting to the penis (arterial insufficiency) or the penis is unable to “trap” the blood inside (corporo-venous occlusion, also known as ‘venous leak’).  In order to understand how this works we have to remember that the blood vessel that brings blood flow to the penis (penile artery) is extremely small and much smaller than the vessels feeding the heart.  A clogged artery will impede the blood flow necessary to create an erection. Therefore, if a man has heart disease (also known as coronary artery disease), it is very likely that the penile artery will get clogged before the coronary arteries in the heart.

That is why erectile dysfunction can indicate if a man is at risk for heart disease and early death.  The phrase “The penis is the gateway to the heart” stems from this concept.  Men with atherosclerosis, or build-up of plaque in the arteries that cause blockage of blood flow, will have problems with blood flow in the penile artery before the coronary artery.  As we celebrate Men’s Health Month, I feel obliged to let all men know:   

Sexual Health Graphic

Erectile dysfunction can be both prevented and treated by practicing a healthy lifestyle.  

If we treat risk factors for heart disease, which include smoking, high blood pressure, high cholesterol, diabetes, obesity, among others, you will not only be able to perform in the bedroom, but also live a longer life.   It is very important that men discuss sexual symptoms with their doctors to help us identify cardiovascular or other risk factors that might be affecting your overall health.

In Conclusion…  

So… please, follow your doctor’s orders.  Take those blood pressure medications. Control your cholesterol levels. Try to quit smoking. Do not let the diabetes to get out of control.  We (doctors) are only here to help you.  If you have problems with your erections, we have all the tools to help you.  If you are searching for an urologist, Come visit us!   It will be an honor to help you get back in the game and continue playing the game for a loooooooong time!


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s sexual health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

Section Editor AUA Core Curriculum

We are proud to announce that Dr. Jonathan Clavell has been invited to become the new

Section Editor for the Surgical Peyronie’s Chapter

in the

American Urological Association (AUA) Core Curriculum.

 

The AUA Core Curriculum is an educational section in the American Urological Association website. The Core Curriculum serves to educate urologic surgeons in training all over the world regarding the most updated guidelines and surgical techniques.  Dr. Clavell previously authored the chapter on Surgical Peyronie’s and has now been promoted to become the new Section Editor. 

Men’s Health during the Coronavirus Pandemic

Men’s Health during the Coronavirus Pandemic

First of all, I want to disclose that I am NOT an infectious disease expert and just like you, I am learning about this new Coronavirus every day. We all know that the human race as a whole is going through a difficult time that will impact our lives, if it hasn’t already. This can be physically, socially and financially. However, when you listen to the experts, there is one great thing about it…  WE HAVE THE POWER TO CONTROL IT.  We can ALL contribute to avoid spreading this disease.

 A good friend of mine, and sexual health expert, recently said “Today, Men’s Health has a different meaning”.  He is correct!  We have to focus on what we have in front of us.  This motivated me to write a blog post describing the different things we, as men,  can do at home while we try to #FlattenTheCurve by practicing social distancing.  These practices should be continued even after the pandemic is controlled. The goal of this post is to appease our minds. There is no need to panic, we will get through this. 

I was recently diagnosed with prostate cancer and my treatment has been delayed, what should I do?

This is probably one of the most common concerns and a very important one for men.  First of all, remember that prostate cancer is curable. Most prostate cancers are considered “slow-growing”, meaning:  they do not progress as fast as other cancers do.  Some research studies found that certain prostate cancers DO NOT become more aggressive in up to 6 months without treatment. In other words, if you were recently diagnosed with prostate cancer of low or intermediate risk, the probability of it becoming more aggressive while you wait to get treated is low.  However, if you were diagnosed with prostate cancer make sure you contact your urologist to ensure that he or she discusses the severity of your diagnosis and the plan of care. 

I have Peyronie’s disease, what can I do at home?      

Traction therapy is one of the least invasive therapies for Peyronie’s Disease and its success has been shown to be dependent on one thing: TIME.  Fortunately for us, the coronavirus has given us more TIME to be at home.   Men who have penile curvature, can go ahead and use their traction devices to help improve their curvature.

Xiaflex is the only FDA approved medication for the treatment of Peyronie’s Disease. These are injections administered in cycles. Each cycle involves 2 injections delivered into the Peyronie’s plaque 2 days apart.  Your doctor will then wait 6 weeks to start the next cycle. What are patients supposed to do in between each cycle? MODELING exercises which can be achieved with or without Traction Therapy.  

If the coronavirus interrupted your injections, do not worry.  Peyronie’s disease should not get worse if injections are being delayed.  Take advantage of the time you have at home and exercise the penis through modeling and traction therapy!

I have Low Testosterone, will I need to stop my therapy?

Many men who come to our office with low testosterone are boosting their T levels with Bio-available testosterone pellets.  These pellets are slowly absorbed and usually last in our bodies  3 to 6 months.  If you were getting testosterone pellets and fear to be exposed to the coronavirus or cannot get to your doctor’s office, hope is not lost. You should consider injectable (intramuscular or subcutaneous) testosterone shots while you wait for your next testosterone pellet administration.  These are injections that you or your partner can administer in the commodity of your home once or twice a week.   Moreover, if you are getting weekly injections at a “Men’s T-clinic”,  there is no need for you to do that anymore.  You can give yourself those injections at home! Lastly, for those wondering if pharmacies will run out of testosterone injections, we do not anticipate this happening.

I have ED and my penile implant surgery was cancelled, what should I do?   

Recently, the Surgeon General of the United States, World Health Organization and CDC recommended hospitals to cancel all elective surgeries.  Hospitals are trying to preserve beds and ventilators for those who will need it.  We understand penile implant surgery is considered outpatient and will not require a long hospitalization.  For those men who were scheduled for surgery, we have your best interest at heart.  We do not want you to be exposed to the virus and want you to stay healthy. 

Rest assured, your surgery will be re-scheduled as soon as we feel it is safe for you to undergo the procedure. 

That being said, if you are wondering what you can do while you wait for your surgery… 

Penile Injections

If you haven’t tried Trimix injectable therapy: now is the time to consider using it!  Penile injections work similar to oral medications. They expand the blood vessels that bring blood into your penis to help you gain an erection.  Trimix injections should be first administered by your doctor to ensure what’s the best dose for you. Our goal is for you to have a strong erection for intercourse that will last how long YOU want it while limiting side effects. Call our office and I will be glad to prescribe you the medication.

Vacuum device

If you have already tried and failed injectable therapy and can’t wait for your penile implant, the best thing you could do while you wait is vacuum therapy.   Imagine you are going to run a marathon. The only way you will finish that race successfully is with TRAINING.  Your penis is about to go through a marathon (surgery), and we want your penis to be ready for that “marathon”.  Vacuum therapy can help “train” your penis for surgery and keep its tissues strong and elastic by preventing scar formation, also known as fibrosis. Vacuum therapy will also stretch your penis and allow your surgeon to put in the biggest implant possible. 

I was planning on visiting the office, and now I am unsure if I should go.

I have GREAT NEWS for you.  Our office is equipped to provide TeleMedicine visits.  TeleMedicine allows for you to “visit” us and talk to me, your doctor, from the comfort of your home. Call us for more information! 

One last thing, take advantage of the extra time and give your body some love: rest, hydrate, EXERCISE! Also, remember to continue washing your hands, practice social distancing and follow the CDC and World Health Organization recommendations.  This too shall pass and hopefully, soon we will get you back in the game! 


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

5 Major Advantages of Rezum Prostate Therapy

Why you should choose Rezum Therapy to treat your Enlarged Prostate

Gatekeepers of Men is BACK!  It’s been several months since my last post and I am certainly excited to bring #GatekeepersofMen back into action. I want to start out this post with a fun fact: 50% of men above 50 years old suffer from symptoms of an enlarged prostate (BPH). Do you understand those numbers?  In other words, if you are above 50 years old and you are reading this, either you or just best friend (assuming he is also your age) have some type of obstructive urinary symptom secondary to BPH.

Men tend to suffer with these symptoms without knowing that there are minimally invasive procedures that can help restore urination patterns. Therefore, today we will talk about the major advantages of REZUM Water Vapor Therapy.  After being designated as one of the few Centers of Excellence in the United States for Rezum Prostate Therapy, I felt the obligation to describe these advantages for everyone to know.

Middle Aged Man Wearing Glasses

1. Opportunity to discontinue medications

We all know that men want to stay away from anything related to medicine.  We do not like going to the doctor and we certainly do not like taking medications.  Prostate medications include alpha blockers (e.g Tamsulosin or Flomax), 5-alpha reductase inhibitors (e.g. Finasteride or Dutasteride), and PDE5 inhibitors (e.g. Cialis or Tadalafil).  All these medications have side effects, some of which can be detrimental to your health.   Rezum Therapy is a minimally invasive procedure that gives you the opportunity to have a strong steady stream WITHOUT having to take your prostate medications.  After you recover from your Rezum therapy, you have a very high likelihood that your doctor will take you off those medications.

2. No general anesthesia required. Rezum is an in-office procedure.      

Rezum is NOT a surgery.  It is a minimally invasive procedure that can be safely done in the office. 

Therefore, you do not have to wait long hours in the hospital or need to go to the operating room.   You do not have to undergo the risks of general anesthesia. And, most importantly, you will be able to go home right after the procedure.  There is no need to stay in the hospital.   The procedure can be done successfully under local anesthesia and light sedation with minimal discomfort.

3. Preserves Sexual Function (Erections and Ejaculation)

The goal of every procedure in medicine is to provide the best possible outcome while minimizing adverse effects.  Most surgeries that are available for enlarged prostate, like the Transurethral Resection of the Prostate, commonly referred to as the TURP or “Roto-Rooter”, carry potential adverse effects.  In most occasions, men who undergo the TURP find themselves exchanging their ability to ejaculate for a better urinary stream.  The TURP and other prostate procedures can also increase the risk of erectile dysfunction. 

Now we have a solution that can help preserve your ejaculation and erections! Research studies show that Rezum is able to successfully treat obstructing prostate tissue while preserving sexual function.  In the initial clinical trial, there were no patients developing ED after 4 years and ejaculation seemed to improve over time.

4. Duration of the procedure is less than 5 minutes

Most prostate procedures done in the operating room take anywhere between 30 minutes to up to 2 to 3 hours.  I have vast experience utilizing the Rezum technology and the procedure has never surpassed 4 minutes (even for bigger prostates).  Rezum is a quick procedure that most of the time takes no more than 2 minutes for it to be completed.  It is both quick (therefore minimizing discomfort) and efficient.

Rezum BPH Treatment Diagram

Click here to Watch the Rezum Therapy

5. Rezum provides long lasting results

Research shows re-treatment rates similar to the TURP surgery after 5 years.  Now, remember that Rezum is a fairly new technology that’s only been available to patients for less than 6 years.  The available research studies reveal that after 4 years, only 4.4% of men required another procedure to help them urinate and only 5.2% of men had to restart their medications. These numbers are very similar to the TURP that has shown up to 14 % of patients requiring surgical re-treatment after 5 years.

In Conclusion…

We believe Rezum is a great solution for the treatment of urinary symptoms secondary to an enlarged prostate. At the time of the publication of this post, our office is one of the few Rezum Center of Excellence offices in the United States, and one out of three in the state of Texas.  If you suffer from obstructive urinary symptoms, are tired of taking medications, or are having complications from an enlarged prostate, call us!  We would be honored to help improve your quality of life. 


 

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

Emerging Implanters Insight Panel

Emerging Implanters Insight Panel 

 

We are proud to announce that on January 21 ,2020 Dr. Jonathan Clavell was invited to be part of the Emerging Implanters Insight Panel at this year’s Boston Scientific National Sales Meeting in Denver, CO!  Emerging Implanters are a group of young urologic prosthetic surgeons who have excelled in the field of Sexual Dysfunction and Prosthetic Urology. These doctors proved to provide excellent care to men with erectile dysfunction. 

Dr. Clavell shared his journey to becoming a High-Volume Penile Implant Surgeon and gave insight on how Boston Scientific can help other doctors provide better care for men all across the United States! 

Estamos orgullosos en anunciar que el Dr. Jonathan Clavell fue parte del Panel de Implantadores Emergentes en la Conferencia Nacional de Ventas de la compañía Boston Scientific en Denver, CO. Los Implantadores Emergentes son un grupo de urólogos jovenes especializados en cirugía protésica (prótesis de pene) que han demostrado en proveer cuidado de excelencia a hombres con disfunción eréctil. 

El Dr. Clavell compartió su trayectoria en convertirse un Cirujano de Alto Volumen para Implantes de Pene y compartió ideas en como Boston Scientific puede ayudar a otros doctores a proveer cuidado con calidad a hombres en el país.

 

Rezum Center of Excellence

First Center of Excellence in the State of Texas

 

We are excited to announce that on January 9,2020 Clavell Urology was recognized as the first Center of Excellence for Rezum Water Vapor Therapy in the state of Texas! 

We are committed to provide quality care with compassion and EXCELLENCE to all men having urinary problems secondary to an enlarged prostate. Come visit us and find out if Rezum is the treatment for you! 

Estamos honrados en anunciar que el 9 de enero del 2020, Clavell Urology fue reconocido como el primer Centro de Excelencia para el tratamiento de Rezum en el estado de Texas. 

Estamos comprometidos en proveer servicios de calidad a todo hombre que padece the síntomas urinarios secundarios a prostata agrandada.  Visítanos y descubre si este es el tratamiento correcto para usted.