The Hindu Business Line : Tackling urological disorders

A man will say: `Guess what; I'm having this problem', and his friend says: `But I too had this problem a few years ago and went to my urologist for an opinion and this is what happened.' And that will inspire him to get medical opinion.

Dr Ajay Nehra: Stress management in prostrate therapy. - BIJOY GHOSH

You'd think men, as also women, would be embarrassed and hesitant to talk about what are considered age-related problems such as incontinence, overactive bladders that give people the urge to ease themselves immediately, or dribbling of urine.

But if you thought so, you'd be wrong, says Dr Ajay Nehra, Professor of Urology, Mayo Clinic College of Medicine, US. "On the contrary, you'd be shocked at the discussion that takes place at the golf courses or the tennis courts. Men talk all the time about such problems to their close friends and colleagues, and the best place outside the boardroom or the office to do this happens to be the club. A man will say: `Guess what; I'm having this problem', and his friend says: `But I too had this problem a few years ago and went to my urologist for an opinion and this is what happened.' And that will inspire him to get medical opinion."

Women too, says Dr Nehra, have issues such as frequency and urgency and are prone to discuss them frankly. "Actually women in general are much more forthcoming in giving their medical history and confide with family members and friends on such issues."

The good news is that such problems can today be treated with oral therapy; "Ranbaxy has come out with some good drugs... one of them an effective beta blocker which is time tested in Europe and North America and works very well as single or combined therapy."

He was in India to take part in a urology conference organised by the Indian pharma major. He says the exciting development in this medical speciality is the "evolution of a number of minimal invasive therapies, new oral therapies on the horizon, as well as robotic surgery for treating prostrate enlargement.

Male infertility

He sees many cases of male infertility; "the classic teaching is that 33 per cent of infertility is purely a woman's issue, one third a male issue and the remaining one third is a combined issue. But unfortunately in our culture, the woman always tends to get the blame if a couple cannot get a child."

But in this day and age, when both men and women are so busy with their demanding careers, do all young couples want children?

"They do, every married couple does. Human tendencies are the same everywhere, though there may be cultural differences, and which couple would not want their own progeny, with their own genetic material, under ideal circumstances? Sure, younger women, particularly in their mid to late 20s, want to pursue their careers aggressively, and may choose to defer pregnancy by 5-7 years, but eventually they do want a child."

He adds that the early-thirties is a viable age for such women to conceive, and "after that it becomes tricky to conceive." While this is true for women's fertility, in men too, "there is a decline for sure but not as dramatically as in women. There is a male menopause definitely, but it is latent."

The most common causes for male infertility are drug abuse, steroid abuse; "muscle enhancing drugs which are very detrimental and very popular in the US. Take for instance the Balco scandal and the baseball hero Barry Bonds who is currently under indictment for its abuse. The problem is that kids always want to emulate their sports stars... `How do I get bigger faster; how do I get tall and lanky like a Munaf Patel'. So drug/steroid abuse, history of cocaine and marijuana, cigarette smoking; all these can cause infertility."

Mobile phones

Dr Nehra dismisses the surmise that mobile phones carried by men on their waist belt might trigger infertility due to the electromagnetic waves. "I doubt this is true, though there is literature that rather than mobiles, keeping the notebook computers on the lap may be detrimental to fertility. But there is only a single published study on this."

On treatment for infertility, he says it is today possible to help "100 per cent of the couples coming to us; we either assist them through natural reproductive techniques, whether these are IVF or donor insemination. Many couples are receptive to donor insemination procedures because at least half the genetic material is from the parents."

Stress too plays a role in triggering infertility. "Both stress and anxiety... that's why our older and younger generation ought to be aware that apart from hypertensive vascular disease which may alter issues related to erection, or management of prostrate therapy, stress plays a role."

Coming to prostrate related problems — "a very important aspect in male health issues" — Dr Nehra gives this startling figure on the incidence. In the US about 70 per cent of men in the age group "61-70 years have prostrate problems, though much of it can be benign."

While such epidemiological studies were not available in India, in the US, the current average age at which prostrate is diagnosed is about 51 years. "This is because we are aggressive in regular check-up of men, and screen those with family history because there is a genetic background to prostrate cancer."

The most common reason why men in the US come for prostrate evaluation, says Dr Nehra, "is lower urinary tract symptoms, which can be with or without prostrate enlargement; it could be a secondary prostrate enlargement where men have frequency, urgency, intermittent stream or decreased flow of urine — what we call hesitancy — or potential overflow incontinence, so that they empty but notice that they are still dripping at the end of each episode."

The urologist says that most men tend to think: `Oh, these are the natural processes of aging'. "But guess what, these are reasons for going to a urologist because these symptoms can be treated."

The treatment, in the best-case scenario, involves oral therapy, if the patient comes early enough and there is a good history of physical examination.

The treatment can be a single or combined drug therapy, and can at least help to defer surgery in many cases by "a number of years, tentatively a few decades as well." The crucial thing is that if diagnosed early, prostrate cancer is curable, and some centres are even doing robotic surgery.

Affordability

How expensive is oral therapy for such ailments?

"The word `expensive' is relative... but clearly these drugs are a lot cheaper in the Indian subcontinent than in the west. Even though these drugs are very affordable, frankly we have to get beyond the issue: `Can we afford it.' If your health is important to you, your family and your work, you have to go beyond the issue of affordability, and today you have young couples with dual careers and good incomes."

Dr Nehra is happy to note that health is indeed becoming a priority for young Indians. "I find more and more young couples in health clubs in Delhi, Chandigarh and Hyderabad, the three centres I visit; young kids exercising at 5 a.m., and doing yoga too."

Asked if yoga can help prevent or reduce urological problems, he says, "Yoga can be a great asset because it's a de-stresser, and no single product or drug is helpful. Does it help 100 per cent? I don't think anything helps 100 per cent."

Sexual dysfunction remains a major issue, not only secondary to ageing, but to hypertension, coronary artery disease and diabetes, and "Indians have a genetic propensity for diabetes. We're in a major crisis on that front; in men diabetes can affect erection, and in both men and women it can paralyse the bladder resulting in incontinence. Alzheimer's and Parkinson's too can cause sexual dysfunction, which is a major cause for male depression. A lot of it can be treated with drugs and some of it with surgery. Drugs have a 60-65 per cent efficacy rate."

On future advances in urology, Dr Nehra says the challenge is to identify markers in certain patients that might predict health problems, "so that we can not only treat but also potentially prevent and delay progression. For overactive bladder, a new drug that halts the frequent urge syndrome is on the horizon," he adds.

Response may be sent to rasheeda@thehindu.co.in