Comments: 1275 • Responses: 56  • Date: 

SuperFreakonomics260 karma

Do you have any idea the physical toll that three vasectomies has on a person!?

gburomd88 karma

3 vasectomies?

fubbleskag25 karma

I've heard that three vasectomies can cause stuttering.

gburomd44 karma

that may be true

gburomd46 karma

you had 3 vasectomies?

jinx150059 karma

It's a reference to a hilarious comment by Michael Scott in The Office

gburomd48 karma

I see, thanks

takeandbake26 karma

Here is the clip that has the quotation. The quality is absolutely horrible but it's the first clip I found that contains the entire joke.

https://www.youtube.com/watch?v=uJGw6wCmTcY

gburomd76 karma

hilarious

SecondRyan169 karma

Have you ever treated anyone for side effects of anabolic steroid use? If so, what conditions did they have? Did they recover?

Edit: thanks!

gburomd227 karma

long term use of anabolic steroids will cause testicular atrophy ( the testicles shrink), down to a very small size and this can be non recoverable...meaning they are reliant on steroids longterm. this can also cause longterm infertility

laser_gg125 karma

What do you think of the no fap movement?

Realistically how can I increase my testosterone levels without steroids?

gburomd123 karma

you can not only with fertiliy drugs like clomid or hcg

wackyvorlon113 karma

What is the most memorable case you've ever had?

gburomd302 karma

In a previous career I did research and wrote article i had an idea several years ago to try a new surgical technique that would lead to less pain and a shorter recovery but it had not been tried I encountered a patient who was willing to try...and it worked!...very memorable

Suprasong109 karma

Have you ever seen a freakishly huge penis in all years in the field?

gburomd125 karma

not really

Mec2679 karma

What's the most awkward issue you've ever adressed?

gburomd505 karma

did a vasectomy on a man and a few years later he called upset that his girlfriend was pregnant I looked up the report and I had the analysis (pathology) of both tubes indicating I cut the correct tubes and he submitted 2 negative semen analyses after the vasectomy that proved he was shooting blanks conclusion, you are not the father

TasteMyAsshole30 karma

No way it could have refused in the following years? This is my greatest fear.

gburomd83 karma

a vasectomy done right is a very secure, safe and effective procedure

turtlepowerpizzatime3 karma

I'm getting one in September. Still scared shitless.

gburomd10 karma

you will be fine!

Roadrowed78 karma

Circumcision, advantages or disadvantages?

gburomd210 karma

only recommend circumcision if there is a problem with the foreskin, cant retract properly during hygiene or sexual activity the head of the penis afterwards does become slightly less sensitive

SecondRyan57 karma

If you get a vasectomy and then get it reversed, is your fertility affected at all? Also, is there any chance a vasectomy could not be reversed?

gburomd119 karma

a vasectomy is not always reverseable....the results are better if it is reversed within 10 years of the vasectomy as opposed to more than 10 years some men produce anti sperm antibodies after a vasectomy I tell all men before a vasectomy to consider banking (freezing) sperm before the vasectomy

vanity6_949 karma

Do you have experience working with women? If so what do you recommend for women who constantly get UTIs from intercourse despite practicing self care (urinating afterwards)? Are D-mannose supplements effective?

gburomd53 karma

yes, I strongly recommend a daily cranberry pill and a daily d mannose this will decrease infections a lot but antibiotics may periodically be necessary some women do well with one antibiotic pill before or after sex, if sex seems to bring them on post menapausal women should use vaginal estrogen cream as this will help with infections

DarthBall48 karma

I've always wondered this about certain specialties(proctologist, podiatry, etc) in medicine, but what made you want to focus on urology?

gburomd137 karma

usually in medical school you find a mentor, someone who spends extra time talking to you, someone you can relate to and someone who does something you feel you can my mentor was a urologist, needless to say many of us physicians could have been many different things and I suspect mentors had a lot to do with it

MattyD8546 karma

What's the youngest you've done a vasectomy on someone? I'm 30. Have a 2 year old. When my son was born I was sure I was one and done. Asked doctor about it. He said no way, you're too young. Now we're talking about a 2nd child. Asking because I'm sure a lot of people ask for them when they're in a bad state of mind like I was (i.e. Not sleeping and constantly dealing with crying newborn.)

gburomd398 karma

I am of the opinion that a urologist should not make that judgement for someone, so if a 25 year old comes in and understands everything, I encourage him to bank sperm but I will do it. The flip side is that there are way too many unwanted pregnances.. if someone can vote, be drafted, buy a gun and get married they should be able to make independant decisions about their body

jemmary17 karma

Excellent philosophy. Now can you get the rest of the medical community to think the same way? Thanks in advance.

gburomd5 karma

it can take some time to change peoples minds perhaps never

meladory_magpie40 karma

I have two kidney stones and am scared of passing them. How do I know when they've left my kidney to make their hellish journey down to my bladder? Also, Cystoscopys are fucking painful. At least give your patients a DVD of the procedure.

gburomd90 karma

you should have them blasted with ESWL (extra corporeal shock wave lithotripsy) or sound waves that should break them up and have the sand pass painlessly

fubbleskag30 karma

I'm 37 and in the last few years feel like the force of my ejaculation has lessened. I also sometimes need to urinate 5-10 minutes after defacating. Is that just a normal part of the aging process, or should I have my prostate looked at?

gburomd65 karma

you should see a urologist you are a little young to have a prostate issue but could have a urethral stricture, scar tissue in the urethra also get your testosterone checked

fubbleskag8 karma

thanks!

gburomd30 karma

my pleasure

SecondRyan29 karma

Ok, a technical question...if you are removing a prostate gland, how do you attach the urethra to the bladder afterwards? Is that difficult to do? And is the part of the urethra that runs through the prostate totally removed with the gland or is it spared?

gburomd50 karma

the urethra that runs through the prostate is totally removed. the end or the bladder is sewn to the other end of the urethra it can be difficult depending on the situation and the robotic technique is very helpful for this part this surgery will mimic the female bladder which simply is void of a prostate

SecondRyan12 karma

Interesting. Thanks again.

gburomd20 karma

my pleasure

SecondRyan24 karma

What is your opinion of the Da Vinci Robot for radical prostatectomy? Ten years ago I read a lot about how the technique had superior results to traditional surgery but a few years ago I saw a study disputing those reports. What's your take?

gburomd33 karma

the Da Vinci robot is preferable to open surgery for certain types of surgeries; for instance when the prostate is removed for cancer, or the uterus..it is still debated for other types of surgeries

mrrp19 karma

Have you heard anything new and exciting about kidney stone prevention (or treatment) in the last few years?

I'm trying to stay hydrated and drinking some lemon juice water when I remember to, but I'd rather just pinch my left earlobe twice a month or snap my fingers once a year or something like that if it's equally effective.

gburomd45 karma

nothing really new, water, water, water decrease red meat and salt, moderate intake of calcium/dairy get an annual kidney ultrasound to see if anything is forming before it causes pain

mrrp12 karma

annual kidney ultrasound

That I'll check into. It wasn't suggested by my doc after the last one. Thanks.

gburomd8 karma

my pleasure

DrZo1dberg17 karma

Do you work with osteopathic physicians?

gburomd24 karma

yes I do many are excellent

GIJason15 karma

I had a vasectomy after my ex and I decided we didn't want anymore children. Now it is almost 9 years later and I have met a wonderful woman who wants a child. I am almost 40 but I am willing to give it a try. What are my options? I didn't have any sperm frozen ahead of time unfortunately. What is the reversal procedure like? I understand that this late after the the vasectomy I only have a 30% chance of being able to conceive even after the reversal so is it, In your opinion, really worth it or should I be looking more into artificial insemination? We have an appointment with a urologist next month but it is always worth getting another opinion.

gburomd18 karma

you should see a urologist who specializes in infertility and performs a lot of vasectomy reversals...most don't a lot of it depends if you are going to try to start a new family or have one child..if you want several vasectomy reversal is the way to go either way vasectomy reversal is a good option and probably cheaper than insemination

Jaguarenvy15 karma

What are your thoughts on prostate cancer screening?

gburomd24 karma

I am a big fan every man above 40 should get an annual PSA and prostate exam

Jaguarenvy13 karma

Above 40, why?

Less than 2% of prostate cancer deaths are men under 55. http://seer.cancer.gov/statfacts/html/prost.html

gburomd51 karma

you get a baseline and a running record of the PSA its helpful when you get your first PSA at 50 and it is a little high

Geokinus13 karma

Proctalgia fugax (fleeting pain due to rectal muscle spasm) What is the best treatment for this? Happens about 4-6 times a month.

gburomd48 karma

probably in the realm of a colorectal doctor; as a urologist we are specialists of the genital and urinary tracts...the rectum is our close neighbor...

Darkstars3113 karma

Do you often come a cross males who have had Peyronie's disease? If so what is the best method of treatment for the long term effects it causes? Thanks in advance.

gburomd18 karma

unfortunately peyronies is a common problem in my practice the good news is now we have a rather effective therapy called xiaphlex https://www.xiaflex.com/

kay280412 karma

Unrelated but do you like pimple popping?

gburomd25 karma

can be gratifying on occasion we drain an abscess (collection of pus) in the scrotum or elsewhere...an abscess is essentially a very large pimple yes can be gratifying as you fix a problem pretty quickly

hozzyann11 karma

What do you recommend doing for chronic UTI'S? I've done almost everything I can preventatively and am still have issues! I've gone to a urologist but figured you might have a different opinion!

gburomd11 karma

how old are you? man/woman? brought on by sexual activity?

hozzyann9 karma

26 year old female. I don't think it has to do with sex. I'm fairly certain its sugar that brings it on, my doctor told me that has nothing to do with it. He recently prescribed me a "super" antibiotic and I've been feeling better for about a week now. I also have one to take daily. It's a frustrating process!

gburomd17 karma

got it you can try a daily cranberry pill and a d mannose daily if that doesnt work a low dose of an antibiotic like macrobid can work well don't worry...this is not forever...

hozzyann6 karma

That's exactly what I already do! D-mannose has been a lifesaver. Macrobid is the one I'm taking daily. I'm just glad to know that you've said the same thing. Thank you so much! I hope it doesn't last forever, it's pretty annoying!

gburomd16 karma

the goal is to avoid infections and break a cycle stay strong

FestiveSpleen11 karma

What's the grossest thing you have seen in your career?

gburomd50 karma

in general the body is not gross I did once see a poor young woman who had sex with her boyfriend but neglected to tell him she had a tampon. The tampon got pushed deep inside and she came in a week later for help to have it removed....

titantool9 karma

Hi Dr. Bellman, I did an AMA a while back about having a penis implant. I was in an accident that caused a spinal cord injury and after trying everything, learned that the implant was my best option. It works great! Here's my question about testosterone (have to have that too now), they've recommended I get the Testopil but my hematocrit has been 56-60. I do self injections once a week at 200mg. I feel fantastic when it's up and crappy when it's down. I just read a lot of conflicting data on the safety of testosterone therapy. What's your opinion and do you like the Testopil? Is it more even in it's distribution of testosterone vs. the roller coaster of injections?

gburomd7 karma

both testosterone injections and pellets (testopel) works well younger men under 40 need to inject twice a week to keep things smooth; the pellets keep things smooth as well testosterone stimulates blood production and donating blood every 6 months helps keep that under control

highideas9 karma

[deleted]

gburomd13 karma

tough question depends on the age and condition of the patient healthy, younger surgery, older, other medical problems, cryoablation is an option...cryoablation in general is a newer technque but in some can avoid a bigger surgery

__chw8 karma

Though this isn't your specialty, what's your opinion on robot-assisted prostatectomies? Are there any drawbacks to this type of procedure?

gburomd23 karma

I used to do robot assisted prostatectomies and I am a big fan better than open surgery!

__chw5 karma

That is so exciting! It's a pretty new concept if I'm not mistaken right?

Is robot-assisted surgery easier to perform than open surgery?

On another note, I actually read an article recently where the researchers from the study found that both types of surgeries yield similar outcomes for the patients.

I thought this was interesting because (for some reason) I'd assume that robot would yield better results.

gburomd11 karma

it really depends on the training, the age and the comfort of the surgeon older surgeons do better with open techniques but younger ones have been trained on the robot in 20 years from now we will not be having this debate because many of the older surgeons will retire

averykrouse7 karma

What percent of your clients feel like they should have bigger equipment down there? Of those, how many are legitimately below average?

gburomd28 karma

the average flaccid penis is 3 inches and erect is 5 many men wish they were bigger in my opinion there is no good safe penis enlargement surgery that I would recommend

brokenwirefixer18 karma

When I had my vasectomy, I wanted to get the doc to walk out of the room and exclaim " man that thing is massive" in front of my wife... Never got the chance to ask..

gburomd6 karma

do that all the time

FestiveSpleen7 karma

What's the worst case you've ever seen?

gburomd39 karma

someone who was a victim to a knife wound to the kidney and bled so much we couldn't save him

23Tawaif6 karma

How does one know if they need testosterone replacement?

gburomd15 karma

if you lack overall energy, sexual energy, physical endurance or sexual deficiency get a blood test!

sightsworthseeing5 karma

How is pain managed during and post- circumcision? Specifically, is general or local anaesthetic used? Is something stronger than paracetamol prescribed for pain management? Is one able to go about one's routine for the weeks following the procedure? What's the recovery time like?

Edit: what would a typical patients pain rate on a scale of 1-10 for the weeks following the surgery?

gburomd6 karma

the pain is really not that bad....at the time of the surgery we do a nerve block that lasts for several hours there is some pain during involuntary erections you are fine after 1 week

BuddhasIronFist5 karma

I had bilateral testicular torsion surgery back in 2008. As far as I know the surgery/recovery resulted in me producing low test. My numbers are 98 when I should be above 300 to 1200 according to my doc. I have been on TRT for 2 years and have to get off and on HCG for 90 days before I can get my wife pregnant. This has successfully happened 3 times now. Is there a way for me to be on both TRT and not have to get off to get my wife pregnant? I produce "0" viable sperm while on TRT. Also, I have many side effects from TRT like sore joints which can be extreme at time, please advise :)

gburomd5 karma

t replacement often functions as a male contraceptive and can inhibit sperm productions for many months HCG is an excellent choice for both stimulating t production as well as enhancing fertility there are men who just stay on HCG on an ongoing basis

BuddhasIronFist5 karma

my doctor who prescribed me trt says people who are on testosterone and hcg are abusing steroids and there is no need. i plead with him because getting off trt is a nightmare with sleepless nights of soaking my mattress with sweat. But I am seeing a military doc due to being active duty and can't afford to go outside my system.

gburomd7 karma

unfortunately many doctors are not well versed in trt and have old fashion opinions many experienced doctors in trt dont take insurance..... it sucks I know but true

chajinom2 karma

which can mean a flow of urine, with a drip while urine passes out...?ಠ_ಠ

gburomd2 karma

got it!

[deleted]1 karma

[deleted]

gburomd3 karma

testosterone is related to your interest in the bedroom, board room and gym your desire to chase a partner, chase a deal in the work realm and work out men with low t do not crave sex