IamA Board certified urologist AMA!

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

3 vasectomies?

I've heard that three vasectomies can cause stuttering.

that may be true

you had 3 vasectomies?

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

I see, thanks

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

hilarious

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

Edit: thanks!

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

What do you think of the no fap movement?

Realistically how can I increase my testosterone levels without steroids?

you can not only with fertiliy drugs like clomid or hcg

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

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

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

not really

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

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

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

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

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

you will be fine!

Circumcision, advantages or disadvantages?

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

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?

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

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?

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

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

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

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.)

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

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

it can take some time to change peoples minds perhaps never

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.

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

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?

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

thanks!

my pleasure

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?

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

Interesting. Thanks again.

my pleasure

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?

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

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.

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

annual kidney ultrasound

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

my pleasure

Do you work with osteopathic physicians?

yes I do many are excellent

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.

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

What are your thoughts on prostate cancer screening?

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

Above 40, why?

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

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

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.

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/

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

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...

Unrelated but do you like pimple popping?

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

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!

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

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!

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...

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!

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

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

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....

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?

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

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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

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

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

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.

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

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

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

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..

do that all the time

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

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

How does one know if they need testosterone replacement?

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

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?

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

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 :)

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

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.

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

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

got it!

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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