The Urethra Is a Sex Organ; Why This Matters in Incontinence

Whether the problem is due to aging or cancer treatment, men (and women) don't need to suffer silently in diapers.
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-- TRANSCRIPT --
Rachel S. Rubin, MD: I'm Dr Rachel Rubin, urologist and sexual medicine specialist in the Washington, DC, area. We are coming to you live from the Mayo Clinic Urology Conference in Maui, Hawaii, with the world's leading experts in men's health, sexual health, and quality of life. I'm bringing in Dr Allen Morey from the North Dallas area, one of the world's leading experts in reconstructive urology. He deals with all things urinary incontinence, penile curvature, and sexual health.
Dr Morey said something at this conference that really put my chin on the floor. He said, "The urethra is a sex organ. It is androgen dependent." This is so important because it's true for all genders. So, Dr Morey, tell us more about why you made that comment and about the incontinence in men that you deal with all the time.
Allen F. Morey, MD: For many years, I've worked at cancer centers where, through the various treatments for prostate cancer, the men suffered from urinary incontinence and we put a lot of artificial urinary sphincters in those patients. I had one patient who asked, "Why do I keep having this erosion?" Of course, the erosion is where the cuff compresses the tissue surrounding the urethra, and the tissue gives way, leaving a hole in the urethra. I looked at him and noticed that he was pale. And I thought, Let me check his testosterone level. We started checking it on everybody who had this problem, and sure enough, the ones who had the cup erosion - who had the atrophic tissue around the urethra - most of them had low testosterone levels. Some of this was due to the cancer treatment, but in other men, it was just due to old age.
We started thinking that this is a causal relationship. And we tested it. I had a fellow who was a board-certified pathologist before becoming a urologist. He obtained some specimens from the urethra and did very sophisticated, elegant stains on that tissue. We found that it's just erectile tissue surrounding the urethra. That's why I call it a sex organ. I tell my patients, "When you are a teenager, this tissue is thin, like on your pinky finger. As you get older, it becomes thicker. And then as you get even older, and you may be having cancer treatment, that tissue is gone." You can show them your little finger; it's about that size. All the meat is off the bone. There's nothing left protecting the urinary mucosa from the device.
That's why it's important to maintain the optimal health of those tissues and for them to remain dry. Because let's face it: Urinary incontinence is a horrible quality of life. These are my happiest patients when we fix it. Before that, when they go on vacation, they have a separate suitcase filled with diapers. They can't go anywhere. They can't do anything. When they become incontinent after the prostatectomy, they gain weight. And when you put in the device to treat it, they lose weight and you can track it. The urinary incontinence patients really suffer. And we need to consider the medical optimization of those patients.
Rubin: It's so important, and I love how analogous this is to our female patients. We know that incontinence is devastating to our female patients as well, and there's a lot of hope. As we get older we start to pee every time we cough, laugh, or sneeze. Men are a little more bothered by it when it happens; they don't expect it. Among women, it's thought of as normal, but it's not normal. There is so much we can do to help these patients, ranging from conservative treatment to surgical therapies.
The connection between hormones and urethral health is true on the female side as well. As you go through menopause, the urethral tissue thins out, gets dry, gets irritated, and can cause worsening incontinence, pain with sex, and genital urinary syndrome of menopause. It's really important.
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