Even today men’s health is surrounded by taboos and little willingness to face and solve problems, especially when it comes to sexuality and the urogenital system. Men often turn to friends, the internet or their partner before seeking a doctor’s opinion. However, for those who want to invest in their longevity and general well-being, a proactive approach to urological and andrological health is fundamental, especially after crossing the threshold of 50. That is why SoLongevity decided to include the urological consultation in two of the Age360° Longevity Check-up programs (Ultimate Check-up and Physiological Check-up).
Age360 Ultimate Checkup
The importance of a complete assessment, which includes prostate health and more, is discussed in this interview by Alberto Gheza, medical doctor and surgeon specializing in urology and andrology and sexual counselor.
Dr. Gheza, when should a man see an andrologist?
A first distinction must be made between prevention and the treatment of clinical conditions.
As regards prevention, the moments in life when an apparently healthy male should have an andrological consultation are three: between 18 and 20, around 30-35 and after turning 50.
The first check-up, the one that was once carried out during the medical examination for military service, serves to ascertain that everything is in order and that there are no conditions that, if neglected, could affect sex life and fertility; in addition, the meeting can serve to ask questions about contraception and the prevention of sexually transmitted diseases. During the consultation at 30-35, on the other hand, the state of health is ascertained, any conditions found previously (such as a varicocele) are checked and lifestyle is assessed, with advice on good habits and warnings about the impact that bad ones can have on fertility, on the prostate and on the excretory system. Finally, after 50 prostate changes are almost inevitable, so it is good to assess the condition of the organ and be informed about the symptoms to watch out for.
If, on the other hand, problems or changes related to urination, the genitals or sexual activity appear, it is always advisable to see the specialist.
Why is an andrological consultation almost a must after 50?
Because, as age advances, one of the organs of greatest interest for male health is the prostate, the gland located below the bladder, in front of the rectum, which serves to produce and store seminal fluid. Over the years it enlarges — a process, hypertrophy, considered almost physiological, but which can be accentuated, for example, by a sedentary lifestyle or by the habit of drinking alcohol or of holding back the urge to urinate. All things that can make the prostate prone to inflammation (even before 50), have an impact on sex life and increase the risk of tumors. In addition, we are all different and prostates are different too: the increase in volume can have repercussions at different levels, from the urethra to the bladder, causing very varied symptoms.
What are the main symptoms that should lead to an andrological consultation?
Among the symptoms not to be underestimated and that require a specialist consultation are difficulty urinating — from a weak urinary stream to blockage, although in the latter case it is a clinical emergency —, the need to urinate frequently, including at night, the onset of urinary urgency, burning on urination, urinary incontinence. Postponing a check can lead to chronicity and make the solution more difficult. As regards the risk of prostate cancer, the most frequent in men over 50, it is important to assess family history: if there have been cases in the family, it is best not to postpone tests (first of all PSA measurement with a blood test) and checks, which should in fact be started as early as age 40.
What are the golden rules for urological and prostate prevention?
Many problems, both urological and sexual, are the result of a cumulative issue, often linked to bad habits. Changing one’s lifestyle is important from a prevention perspective and goes hand in hand with any therapies in the case of clinical conditions.
To prevent prostate problems (and more), adequate hydration is recommended. Poor hydration, in fact, is very common and leads to the concentration of toxic substances in the urine, irritating the bladder and consequently the prostate. One should drink regularly, not only during meals. Again to avoid irritating the bladder, the excretory tract and the prostate, it is essential not to hold back the urge to urinate. Another protective habit is to increase movement. Sitting for too long is not healthy. The World Health Organization recommends getting up for a few minutes every half hour. If you work sitting down or spend a lot of time in the car, a donut cushion can help relieve direct pressure on the prostate, but the best thing to do would still be to be able to get up and perhaps stop at the bathroom. Diet can also make a difference: excessive amounts of coffee, spicy foods and shellfish can inflame the bladder and the prostate, while a diet rich in green leafy vegetables and antioxidant foods is recommended. Alcohol and smoking are very bad habits for the bladder and the prostate, and for health in general. Cigarette smoke, in particular, is an important risk factor for bladder and kidney tumors, since harmful products constantly accumulate in the urine. They act cumulatively, so much so that, unlike for the lungs, the risk of bladder cancer does not decrease once you quit smoking.
Are there more suitable sports? And which ones are not recommended?
Some sports activities are less suitable than others, especially if practiced at high intensity. For a man who spends most of his time sitting, for example, cycling is not the best physical activity for the urogenital system: you sit for hours, drinking little and rarely emptying the bladder. Anyone who has spent a long time on a bicycle saddle will have noticed that pelvic sensitivity changes and the urge to urinate is very different. Weightlifting can also be harmful if it has a strong impact on the pelvic muscles: in women it can cause incontinence problems and in men it can cause testicular pain and even a varicocele (that is, a dilation of the veins around the testicle) secondary to physical exertion. The best model, instead, is moderate aerobic physical activity, for example 30-40 minutes a day of brisk walking: it has been shown to reduce stress levels and allow better oxygenation of the tissues. This type of exercise is also the most suitable for sexual health, which in turn is connected to cardiovascular health.
Are pelvic floor exercises useful?
In men, training the pelvic muscles can be useful to improve erection and the duration of sexual intercourse. It also helps in certain forms of male incontinence, for example when the prostate is removed. This is because in men it is the physical presence of the prostate itself that makes urge or stress incontinence rare, unlike in women. Male incontinence, on the other hand, is much more often due to prostate problems, which must be treated differently. In any case, it must be stressed that pelvic floor exercises should not be improvised: in short, watching an online tutorial is not enough; you need to turn to a professional, because the wrong training could even be counterproductive. A professional will also be able to teach correct breathing, to avoid creating blocks. Finally, it must be said that exercises of this type can be considered a form of rehabilitation, so to see the benefits consistency is required in practice.
Training del respiro
You have mentioned the topic of sex life several times…
Yes, because it is an aspect of general well-being, even after 60, and it deserves attention.
Erectile dysfunction, for example, can have various causes, such as psychological and prostate problems, but it is also strongly connected to vascular health. Conditions such as diabetes, hypertension and high cholesterol have repercussions on the arteries and make the nerves involved in erection less efficient. Suffice it to say that erectile dysfunction can precede a major cardiovascular problem by as much as 5-10 years. For this reason, in the presence of erectile problems, a cardiological assessment is always advisable. Regular sexual activity (with a partner or alone), moreover, is undoubtedly beneficial for daily life, social life, and the emotional and physical aspects. Maintaining a certain ejaculatory regularity is useful to avoid congesting the prostate and to give positive feedback to the hormonal axis.
Once the problem has been identified, how is it treated?
There are various strategies for prostate problems.
Depending on the case, drug therapies may be prescribed, for example anti-inflammatories or drugs for prostatic hypertrophy. Of the latter there are two types: those that promote bladder emptying and those that act at the hormonal level. However, some of them can cause ejaculation problems. Sometimes tadalafil is also used, a drug that, at low doses and taken daily, improves both the urinary symptoms linked to prostatic hypertrophy and erectile function.
There are also supplements developed specifically for prostate well-being, most of them based on Serenoa repens, but they can also contain nettle, turmeric, myrrh. They have an anti-inflammatory-antioxidant action.
A big difference, as we have already said, comes from changes in one’s lifestyle: diet, movement, quitting smoking, moderate alcohol consumption, hydration and bladder emptying.
If prostate enlargement cannot be managed with drugs, surgery is the treatment of choice. The technology for prostatic hypertrophy is currently the laser (holmium, thulium, green laser), which aims to remove the enlarged part of the gland. There are also minimally invasive methods (such as Rezum or Urolift) that try to preserve ejaculation, but they are not always conclusive.
A relative novelty in the treatment of chronic pelvic pain (once called chronic prostatitis) is the application of low-intensity shock waves, because they have an anti-inflammatory effect. In addition, low-intensity shock waves act by stimulating the blood vessels to work better and by inducing the formation of new ones (neoangiogenesis). They are therefore also effective for vasculogenic erectile dysfunction and for the painful component of penile curvature due to the formation of calcified plaques secondary to inflammatory states.
