"Ask the Doctor": Urology

March 8, 2000

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CoryM18: Recently my friend asked me to look at something on his scrotum, and there are white bumps all over, that look like facial acne. I'm wondering what it could be, and if this is just that and will go away with the goodness of soap and water or if it needs to be treated medically?

Dr Fishman: Most likely these little bumps, white bumps as you call them, are sebaceous cysts. Sebaceous cysts refer to cysts that form around sweat glands. They usually will get smaller after warm baths. If they get bigger and there's redness and tenderness around them, they may have become secondarily infected. Usually if the duct through which the fluid empties opens, then the cysts will disappear.

Curoo: What are some of the main physical causes of ED?

Dr Fishman: Main physical causes can be divided into one, hormonal; two, neurological; three, anatomic; and four, vascular. If there is an impairment in the normal hormonal balance of the body (for example if the serum testosterone is low, or the female hormone is too high), the incidence of erectile dysfunction goes up. As a result of surgical interruption of the blood supply, as occurs sometimes after a radical prostate operation, then the erection will be deficient. If the anatomy of the penile tissues is distorted or injured by a variety of diseases including Peyronies Disease, where there is spontaneous onset of scarring of the penis, then again the erections will be affected. Another phenomenon that has recently been emphasized among urologists is a phenomenon called Venous Leak. This refers to the inability of the patient's penile tissues to trap the blood inside the penis, a condition which is necessary in order to achieve a firm erection. The patient may still be able to achieve partial tumescence, or partial erection, but not firm enough for penetration.

Junko9: I know that some depression medications like Paxil can have 'effects' on male genitalia. Are there detrimental urological effects from some of these and what are they?

Dr Fishman: There is mild anticholinergic effects from Paxil and similar antidepressants. This may affect one's ability to urinate by decreasing the pressure that is generated in the bladder. Other urologic effects have not been significantly established.

Peppie: I have had two kidney stones in the past. Can you tell me what causes them and what I can do to prevent them?

Dr Fishman: Kidney stones can be caused by a variety of processes. A stone is usually formed around a nidus or a nucleus of crystal that forms because of supersaturation of some calcium, calcium oxalates, or other basic elements such as uric acid, when inadequate fluid is consumed. So, it is most important in patients who are stone formers, to drink at least eight eight-ounce glasses of water or fluid per day. In addition, if you are known to have a high uric acid, then there are medications that can diminish the level of uric acid, and also prevent stone formation. If there's a familial history of stone formation, then there are evaluations or tests that can be run on a 24-hour urine collection that can point to the abnormality which would be correctable by diet, hydration, or medication.

Dale: If a man has prostate cancer, what effect will it have on their kidneys?

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