Patient Resources & Frequently Asked Questions

Question 1

What is erectile dysfunction?

Accepted Answer

Erectile dysfunction (ED) is the consistent inability to achieve or maintain an erection firm enough for satisfactory sexual activity. It can be caused by physical conditions, psychological factors, or a combination of both, and is highly treatable at any age.

Question 2

What treatments are available for erectile dysfunction?

Accepted Answer

Treatments for ED range from non-invasive options to surgery, including oral PDE5 inhibitors (Viagra, Cialis), penile injections, vacuum erection devices, low-intensity shockwave therapy, platelet-rich plasma (PRP), and inflatable penile implants for refractory cases. With appropriate treatment, 80-90% of patients achieve satisfactory results.

Question 3

Is ED a normal part of aging?

Accepted Answer

ED is not an inevitable part of aging. While it becomes more common with age, most causes are treatable, and effective options are available at any age.

Question 4

Can erectile dysfunction be cured?

Accepted Answer

Many causes of ED are treatable or reversible. Some require ongoing management, but the underlying condition often improves with the right combination of medical, lifestyle, and procedural therapy.

Question 5

Will ED medication affect my ability to have natural erections later?

Accepted Answer

No. ED medications do not prevent or weaken natural erections; they enhance the body's natural erectile response only when taken.

Question 6

Are there side effects to ED medications?

Accepted Answer

Most men tolerate ED medications well. Possible side effects are generally mild, such as headache, flushing, or nasal congestion, and typically resolve. Individual concerns should be discussed with Dr. Liu.

Question 7

What is Peyronie's disease?

Accepted Answer

Peyronie's disease is a wound-healing disorder in which fibrous scar tissue (plaque) forms inside the penis, causing painful erections, curvature, indentation, or shortening of the penis when erect.

Question 8

Did I cause my Peyronie's disease?

Accepted Answer

No. Peyronie's disease is not caused by anything you did. Most men do not remember the trauma that triggers it because it is usually minor and unnoticed.

Question 9

Will Peyronie's disease go away on its own?

Accepted Answer

Peyronie's disease rarely resolves on its own. Some men experience slight improvement during the first year, but most do not, and treatment is recommended when there is functional impairment.

Question 10

How is Peyronie's disease treated?

Accepted Answer

Peyronie's disease is treated in two phases: the acute phase focuses on pain management and stabilization with oral therapies, traction, and Xiaflex injections, while the stable phase uses surgical correction such as penile plication, plaque incision and grafting, or a penile implant when refractory ED is also present.

Question 11

How long does Peyronie's disease treatment take?

Accepted Answer

Medical treatment for Peyronie's disease may take 3-6 months to show benefit, while surgery typically provides immediate correction with a 4-6 week recovery period.

Question 12

What is penile rehabilitation?

Accepted Answer

Penile rehabilitation is a structured program of medications, vacuum therapy, and injections used before and after prostate cancer surgery or radiation to prevent erectile tissue atrophy and restore erectile function.

Question 13

When should penile rehabilitation start?

Accepted Answer

Recent research supports starting penile rehabilitation several weeks before prostate cancer surgery or radiation to optimize erectile tissue resilience, then continuing through the recovery period.

Question 14

What does a penile rehabilitation protocol include?

Accepted Answer

A typical penile rehabilitation protocol combines low-dose daily PDE5 inhibitors, scheduled use of a vacuum erection device, and penile injections when needed, along with periodic monitoring of penile blood flow.

Question 15

How long does penile rehabilitation take to work?

Accepted Answer

Erectile recovery after prostate cancer treatment typically unfolds over 12-24 months. Penile rehabilitation does not produce immediate results but maximizes the chances of recovering natural erectile function within that window.

Question 16

What is testosterone deficiency?

Accepted Answer

Testosterone deficiency, or hypogonadism, is below-normal testosterone production that can cause fatigue, low libido, depressed mood, brain fog, muscle loss, and reduced bone density. It is diagnosed with blood testing and treated with carefully monitored testosterone replacement therapy.

Question 17

Is testosterone therapy safe?

Accepted Answer

Testosterone therapy is safe when appropriately prescribed and monitored. Regular blood work and PSA screening are essential parts of treatment.

Question 18

How long does testosterone therapy take to work?

Accepted Answer

Some effects of testosterone therapy appear within weeks, such as improved mood and energy, while others take 3-6 months, including changes in muscle mass, bone density, and sexual function.

Question 19

Will testosterone therapy affect my prostate cancer risk?

Accepted Answer

Testosterone therapy in healthy men is not currently believed to increase prostate cancer risk, but men with a personal or family history of prostate cancer require special consideration and careful monitoring with Dr. Liu.

Question 20

What is BPH (benign prostatic hyperplasia)?

Accepted Answer

BPH is a non-cancerous enlargement of the prostate that compresses the urethra and causes lower urinary tract symptoms such as weak stream, hesitancy, urgency, frequency, and waking at night to urinate.

Question 21

How is BPH treated?

Accepted Answer

BPH is treated in a stepwise approach starting with behavioral changes and prostate-relaxing medications, then minimally invasive options such as UroLift, Aquablation, GreenLight laser, and prostatic artery embolization, and finally surgery such as TURP or HoLEP for larger prostates or refractory cases.

Question 22

Is frequent urination normal?

Accepted Answer

Bothersome frequent urination is not normal and warrants evaluation. Many treatable causes exist, including BPH, overactive bladder, infection, and diabetes.

Question 23

What are kidney stones?

Accepted Answer

Kidney stones are hard mineral and salt deposits that form inside the kidneys. They can cause severe flank pain, blood in the urine, nausea, and infection when they pass through the ureter.

Question 24

How are kidney stones treated?

Accepted Answer

Kidney stones are treated based on size and location with shock wave lithotripsy (ESWL) to break stones from outside the body, ureteroscopy with laser lithotripsy and stone extraction, and prevention strategies including hydration, dietary changes, and medications.

Question 25

How can I prevent kidney stones from coming back?

Accepted Answer

The most effective ways to prevent recurrent kidney stones are drinking enough water to produce 2-2.5 liters of urine daily, reducing salt and animal protein, maintaining adequate dietary calcium, limiting oxalate-rich foods if you form calcium-oxalate stones, and taking targeted medications based on a 24-hour urine analysis.

Question 26

When should I go to the ER for a kidney stone?

Accepted Answer

Seek emergency care for a kidney stone if you have severe pain that cannot be controlled with oral medication, fever or chills (suggesting infection), persistent vomiting, inability to keep fluids down, or have only one functioning kidney.

Question 27

What is male infertility and how common is it?

Accepted Answer

Male infertility is the inability to achieve pregnancy with a fertile partner after one year of regular unprotected intercourse. Male factors contribute to approximately 50% of infertility cases.

Question 28

Can male infertility be treated?

Accepted Answer

Yes, many causes of male infertility are treatable. About 40-70% of cases can be improved with appropriate intervention such as hormonal therapy, microsurgical varicocele repair, or assisted reproductive techniques.

Question 29

How long should we try before seeking help for infertility?

Accepted Answer

Couples should seek evaluation after 1 year of regular unprotected intercourse without conception, or after 6 months if the female partner is over 35 years old.

Question 30

What is involved in a semen analysis?

Accepted Answer

A semen analysis is a laboratory test that evaluates sperm count, motility, and morphology from a sample collected at the lab. Multiple samples are ideal for accuracy.

Question 31

When should I be concerned about blood in my urine?

Accepted Answer

Any visible blood in the urine, or persistent microscopic hematuria found on testing, should be evaluated by a urologist to rule out serious causes such as bladder cancer, kidney disease, or stones.

Question 32

How is hematuria evaluated?

Accepted Answer

Hematuria evaluation typically includes urine testing (urinalysis, culture, cytology, tumor marker testing), imaging such as CT urography or kidney ultrasound, and cystoscopy to inspect the bladder.

Question 33

What does microscopic blood in the urine mean?

Accepted Answer

Microscopic hematuria means red blood cells are detected on urine testing even though the urine looks normal. It can be caused by infection, kidney stones, vigorous exercise, kidney disease, or, less commonly, bladder or kidney cancer, which is why a urology evaluation is recommended.

Question 34

Is hematuria a sign of cancer?

Accepted Answer

Hematuria is most often caused by benign issues such as urinary tract infection or stones, but it can be the first sign of bladder or kidney cancer, especially in adults over 35 or those with smoking history. That's why every episode of unexplained gross hematuria warrants a urologic workup.

Question 35

What is a varicocele?

Accepted Answer

A varicocele is an abnormal enlargement of the veins within the scrotum, similar to a varicose vein in the leg. Varicoceles are found in up to 40% of men evaluated for infertility and are a leading correctable cause of impaired sperm production.

Question 36

How are varicoceles treated?

Accepted Answer

Treatment depends on symptoms and fertility goals. Asymptomatic varicoceles with normal fertility can be observed; microsurgical varicocelectomy is the gold standard repair with the highest success and lowest complication rates; varicocele embolization is a minimally invasive radiologic alternative.

Question 37

Do all varicoceles need treatment?

Accepted Answer

No, not all varicoceles need treatment. Varicoceles only require treatment when they cause testicular pain, testicular shrinkage, abnormal semen analysis with infertility, or significantly low testosterone.

Question 38

What is the recovery from microsurgical varicocelectomy like?

Accepted Answer

Microsurgical varicocelectomy is performed as an outpatient procedure through a small groin incision. Most men return to desk work within a few days and to full activity within 2-3 weeks, and improvements in sperm quality typically appear 3-6 months after surgery.

Question 39

When should I start screening for prostate cancer?

Accepted Answer

Most men should begin discussing prostate cancer screening with a doctor between ages 50 and 55, or earlier (40-45) if they have higher risk factors such as a family history of prostate cancer or African American ancestry. Screening decisions should be individualized based on age, risk factors, and family history.

Question 40

How often should I see a urologist?

Accepted Answer

How often you should see a urologist depends on your conditions and treatments. Some men benefit from annual exams, while others need more frequent follow-up or only as-needed visits.

Question 41

What lifestyle changes most impact urological health?

Accepted Answer

Regular exercise, maintaining a healthy weight, not smoking, limiting alcohol, adequate hydration, and managing stress are foundational lifestyle changes that improve urological and sexual health.

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