25 Jan 2017 News

DR AGINS, today announced that his hundredth patient had been treated with the UroLift® System, the first permanent implant to treat symptoms due to urinary outflow obstruction secondary to benign prostatic hyperplasia (BPH) in men 50 years of age or older.  Cleared by the U.S. Food and Drug Administration in 2013, the UroLift System is designed to relieve symptoms caused by an enlarged prostate, while preserving sexual function.  DR AGINS performs the most UroLift procedures in Arizona.

Said DR AGINS: “The UroLift System provides rapid relief to men suffering from an enlarged prostate without affecting erections or ejaculation.  UroLift offers a beneficial first-line treatment alternative to drug therapy or more invasive surgery and can be performed in the office under local anesthesia.”

The UroLift System permanent implants, delivered during a minimally-invasive procedure, act like window curtain tie-backs to hold the lobes of an enlarged prostate open. Patients recover from the procedure quickly, and return to their normal routines with minimal downtime.

Data from clinical trials showed that patients receiving UroLift implants reported rapid symptomatic improvement, improved urinary flow rates, and sustained sexual function. Patients also experienced a significant improvement in quality of life. Most common adverse events reported include hematuria, dysuria, micturition urgency, pelvic pain, and urge incontinence. Most symptoms were mild to moderate in severity and resolved within two to four weeks after the procedure.


About BPH Treatment

More than 500 million aging men worldwide have an enlarged prostate. Medication is often the first line therapy but relief can be inadequate and temporary. Side effects of treatment can include sexual dysfunction, dizziness and headaches, prompting many patients to quit using the drugs. For these patients, the classic alternative is surgery that cuts or ablates prostate tissue to open the blocked urethra. While current surgical options, such as the ‘gold standard’ surgery, Transurethral Resection of the Prostate (TURP), can be very effective in relieving symptoms, they can also leave patients with permanent side effects such as urinary incontinence, erectile dysfunction and retrograde ejaculation (dry orgasm).


About UroLift

The UroLift System provides an alternative to tissue removing surgery for the treatment of an enlarged prostate. Performed through the urethra, a urologist uses the UroLift System to push aside the obstructive prostate lobes and positions small, tailored permanent UroLift implants to hold the prostate lobes in the retracted position. This opens the urethra while leaving the prostate intact. Adverse reactions associated with UroLift System treatment were comparable to other minimally invasive surgical therapies as well as standard cystoscopy. The most common adverse events reported during the study included pain or burning with urination, blood in the urine, pelvic pain, urgent need to urinate, and the inability to control urine because of an urgent need to urinate.  Most symptoms were mild to moderate in severity and resolved within two to four weeks after the procedure.


16 May 2016 News

Motorcyclists beware!  A study out of Japan identified motorcycling as an independent risk factor for erectile dysfunction (ED).

Although interesting in concept, it was only through fancy statistical manipulations that the researchers were able to propose that motorcycling could be a risk factor for ED as opposed to showing an actual difference in ED between bikers and non-bikers.

Thank goodness, because I’m not ready to sell the Triumph just yet!

All kidding aside, I was recently giving an interview for the Arizona Republic newspaper and we were talking about the well-known fact that men will ignore many health issues before going to see a doctor.  Please don’t ignore ED!  Erectile dysfunction is a predictor of heart disease.  Low testosterone is a predictor of diabetes.  Whatever process that is preventing blood flow to your penis is also preventing blood flow to your heart.  And this is not just for motorcyclists.

I am a Urologist in Arizona specializing in Men’s Health.  I can help you with your low testosterone and erectile dysfunction.  I perform the Urolift procedure for men with the symptoms of an enlarged prostate and I perform the penile implant surgery as well as procedures for Peyronie’s Disease.  Thank you for reading and please feel free to contact me with any questions.


5 May 2016 News

A picture is worth a thousand words and in this final installment of my series of essays on erectile dysfunction, I will include visual representations of all of the treatment options we can offer based on the underlying problem, including a video of a penile implant.


Vacuum Erection Devices

A vacuum erection device sucks blood into the penis and a rubber ring then traps the blood, creating an erection.  Pros: it works.  Cons: there is no circulation once the ring is on and the penis will become cold and blue during sex.   Another issue is that this system is somewhat complicated.  It is not intuitive and does not lend itself to spontaneity.




Injection and Suppositories

Penile injections or urethral suppositories use medication to dilate the arteries of the penis.  Pros: it works, unless there is underlying venous insufficiency (although the little blue pill can be used in combination with injections).  Cons: I think the pictures speak for themselves.


All kidding aside, these medications do work.  They take about ten minutes to work and they must be stored in the refrigerator.  Again, spontaneity is lacking here.  These medications can be painful and the injections could lead to scarring.

Penile Implant

Another option is the penile implant.  You are about to view a video of one of my patients who was generous enough to allow me to video and post his implant.  Just so you know, he is awake during the video and is in the operating room for an unrelated procedure.  The orange stuff you see is the sterile prep for the unrelated surgery.

In my hands, the penile implant is a 45 minute outpatient procedure done through a tiny incision.  It is completely invisible.  No one, not even your sexual partner, would know that you have one.  It is completely natural.  You will have normal orgasms and normal ejaculation. It restores normal erectile function and you can have a rock-hard erection in seconds.  And it is covered by Insurance.

I hope that you have found value in following this series over the past few weeks.  We have discussed causes, the evaluation, and several solutions.  Please know that whatever the problem, I can fix it.  Contact me if you have any questions.


2 May 2016 News

The New York Attorney General recently targeted GNC, Target, Walgreens, and Walmart for selling misleading and/or adulterated dietary supplements.

The supplement industry is a 30 BILLION dollar a year industry and half of Americans are taking a self-prescribed supplement.  How do we know that the products we take are safe?  How do we know that the product is actually what the label says it is?  How do we know it will do what the manufacturer claims? And what the heck is Horny Goat Weed anyway?

Here is a list of ingredients in the most popular products sold by the largest retailer of dietary supplements, GNC.  These products are marketed to men to “improve sexual health”.

Ginseng:  The most common ingredient in sexual health supplements.  It works by increasing nitric oxide production which results in better blood flow in the penis.  The molecules responsible for this action are distributed unevenly through the plant so there will be variability in concentration in the final product.  Use in diabetic men is not advised due to blood sugar effects.  Ginseng appears to be safe, however, with minimal adverse effects.  While studies support its use, the small number of studies prevents me from recommending it as first-line therapy.

Zinc:  Zinc deficiency is associated with low testosterone and supplementing men with zinc deficiency resulted in reversal of the low testosterone.  But zinc is so plentiful in the Western Diet that a true deficiency is rare.  Supplementing zinc in men with normal zinc levels does not result in increased testosterone.

Magnesium:  Magnesium deficiency is rare and has not been associated with any sexual disorders.  No studies have shown a relationship between supplementing magnesium and improved sexual function.

Tribulis terrestris:  A common weed found in many products.  Advertisers claim that T. terrestris improves sexual and sports performance by increasing testosterone.  Although there are a few animal experiments showing an increase in testosterone, there are no human studies showing this.  In fact, the human studies show no difference in ED or testosterone with T. terrestris use.  There are also cases of seizures and severe liver toxicity associated with T. terrestris and supplements rarely specify the amount of T. terrestris contained in each dose. Buyer beware!

Selenium:  No studies can be found on sexual health.  There are studies that associate low selenium levels and prostate cancer, but supplementing a normal selenium level did not decrease risk of prostate cancer.

B-vitamins:  Mood, arousal, libido, and energy can be associated with low B-vitamin levels and supplementation can improve these aspects of Men’s Health.

Fenugreek (aka “methi”):  There is one published report showing improved sexual function with Trigonella foenum-graecum, especially arousal and orgasm.  There was no change in testosterone levels.  No adverse effects were reported.  This is an exciting one!

L-Arginine:  Nitric oxide is essential for normal erectile function and impaired NO activity is associated with ED.  L-Arginine is the precursor of nitric oxide and supplementing with L-Arginine has been shown to raise NO levels.  This did not translate to better erectile function, however.

Maca:  A vegetable used in Peru for centuries to improve “male sexual health”.  There are two studies using mice that did show increased sexual behavior and improved semen parameters.  The mechanism of action is unknown and no human studies have shown any improved function.  If you are a mouse, feel free to use it.

DHEA: This is a tough one.  For every study showing improved testosterone and sexual function, there is another study showing no change at all.  DHEA is one of least common ingredients found in supplements leading me to believe that it is not effective or advertisers would be promoting the heck out of it.

Ginkgo biloba: The study that put Ginkgo biloba on the map was later shown to have possible misrepresentation of the data and statistical miscalculations.  Subsequent studies showed no benefits in sexual health, but did find some major complications including major bleeding and seizures with reported fatality.  Probably want to stay away from this one.

Horny Goat Weed:  Remember all the advertising?  I do!  The extract of the Epimedium plant has never been studied in humans.  The rat studies are limited.  Can’t really recommend this.  And that’s too bad because it has such a great name.

I am a Urologist in Phoenix, AZ specializing in Men’s Health.  I perform the Urolift procedure as well as penile implant surgery and penile straightening procedures.  I do not claim to be an expert in supplements, but I can help figure out which ones might help you and which might hurt you.  I can also help you figure out if there is another way to address whatever your problem is.  I’d love to hear from you!


25 Apr 2016 News

There has been a lot of controversy regarding screening for prostate cancer but one point that cannot be argued is the decreased death rate from prostate cancer since the approval of the use of PSA (the blood test for prostate cancer) by the US Government.  Screening for prostate cancer saves lives.

Screening consists of a DRE (digital rectal exam) and the PSA (prostate specific antigen) blood test.

When do we have to worry about prostate cancer?  In this essay, I will touch on risk factors, prevention, and screening.

Age: We have all seen Prostate Cancer diagnosed in men under forty, but this fortunately is rare.  The most common age range is 50-70.  As we get older, the odds are greater.

Race: Black men get prostate cancer twice as often as any other racial group and are 2.5 times more likely to die from the disease.

Family History: Absolutely.  Especially if your dad, uncle, grandfather, or brother was diagnosed younger than 55.  Breast cancer is intimately related to prostate cancer and a family history of breast cancer worsens your odds (and vice versa).

Diet: Obesity is related to more aggressive cancer.

Chemical Exposure:  Veterans exposed to Agent Orange are nearly 50% more likely to get prostate cancer.  Firefighters are also at increased risk.

Can you prevent prostate cancer?  There are certainly enough products claiming to improve prostate health (this is a multi-BILLLION dollar industry, by the way).  What about the data?

There are plenty of studies supporting what we already know: eat better, exercise better, don’t smoke.  There is an interesting nutraceutical product called Prostate 2.4 by a company called Theralogix.  Prostate 2.4 now has the attention of a lot of government agencies interested in population health because there is real science behind it and good data is being collected.

What if you are diagnosed with prostate cancer?  I tell my patients that there are two types of prostate cancer; a “good” kind and a “bad” kind.  Treatment options depend on the kind you have.  Active Surveillance is great for early diagnosed, non-aggressive prostate cancer, but would not work for a more aggressive case.  In my practice, we have a team approach that includes a Urologic Oncologist, Medical Oncologist, and Radiation Oncologist, to insure you get the best treatment designed specifically for you.  There is not a one-size-fits-all approach to this.

If you have any questions or would like a second opinion on an already diagnosed case of prostate cancer, feel free to contact me.  I am a Urologist in Phoenix, AZ, specializing in Men’s Health.


16 Apr 2016 News

I get this question all the time: do I really need my prostate?  The prostate is important for reproduction, so I guess if you’re done having kids you technically don’t need it.  The problem is you can’t just remove it without a whole host of sexual and urinary side effects, so the best thing to do is to keep it as healthy as possible and stay in front of any potential problems.  Here are a few of the things that can “go wrong” with the prostate:

Enlarged Prostate (BPH): The prostate is a walnut-sized gland located between the bladder and the penis.  It surrounds the urine tube (the urethra).  Kind of like a donut around the donut hole.  As we get older and that “donut” gets bigger (this is normal and expected for all men over the age of forty), the “hole” gets smaller and we can develop a weaker flow and/or more frequent urination, including waking up at night to pee (nocturia).  This is so easy to treat.  Click on this link to learn more.

Prostatitis: Some men will suffer a bout of prostatitis at some time in their life.  This is a benign but very frustrating condition that is difficult to cure.  It is difficult because no one really knows what causes it.  There are a number of options that can provide a degree of relief of the pain, frequency, and discomfort urinating associated with prostatitis.

Prostate Cancer: This is the most common cancer in men in the US and the second leading cause of death from cancer.  More than 200,000 men are diagnosed each year.  1 in 7 men will develop prostate cancer and 1 in 38 will die from it.  Prostate cancer is a fatal disease, but it is generally very slow-growing giving us lots of treatment options, including observation (active surveillance).  Early diagnosis is the key.

I am a Urologist in Phoenix, AZ, and I specialize in Men’s Health, including vasectomy, enlarged prostate and the Urolift procedure, low testosterone, erectile dysfunction, and Peyronie’s Disease.   Thanks for reading!


16 Feb 2015 News

Normal testosterone is essential for normal erectile function and is an integral part of the evaluation for erectile dysfunction.  Aside from its importance in our sex drive, testosterone is necessary for the viability of the blood vessels and smooth muscle of the penis.  Researchers have found that castration decreases blood flow to the penis, causes leakage of blood out of the veins of the penis, and decreases nerve response.  Low T can also induce death of the muscle cells of the penis which can result in penile shortening, a common complaint as men age.

Low T and it’s relationship to chronic disease has been discussed elsewhere on this site and is well documented in the literature.  In addition, there are conditions which cause testosterone to decrease, including brain tumors, which I will diagnose a few times a year.

Any evaluation for ED in my practice will include blood work to insure that hormonal function is normal.  If your T is low, it is simple enough to normalize through natural means as well as supplementation.

I am always grateful for anyone taking the time to read what I have written.  I would be honored to answer any questions.