WEBVTT - How Often Should You Pee and Other Urination Explanations 0:00:00.600 --> 0:00:05.440 Let's talk about it. Let's talk about the man hero. 0:00:08.840 --> 0:00:13.880 Let's talk about it. Let's talk about the man hero. 0:00:17.000 --> 0:00:20.680 Welcome to the man Well, hell yeah, welcome back to 0:00:20.720 --> 0:00:21.400 the mail room. 0:00:21.640 --> 0:00:22.640 Me and Jordan Renta. 0:00:22.920 --> 0:00:25.919 I know that's not grammatically correct, hanging out and talking 0:00:25.960 --> 0:00:28.440 about all things men's health. Do you ever get a 0:00:28.440 --> 0:00:30.200 song just stuck in your head where you just can't 0:00:30.240 --> 0:00:30.840 get it out of men? 0:00:30.840 --> 0:00:32.600 I know this is a thing. Does this happened to 0:00:32.600 --> 0:00:33.440 you at all? 0:00:33.520 --> 0:00:36.400 Jordan's all the time as a former music journalist. This 0:00:36.479 --> 0:00:37.879 is definitely it's a hazard. 0:00:38.000 --> 0:00:39.880 Right, You just realize I got a little ditty there's 0:00:39.880 --> 0:00:42.400 a thing. Yeah, and me too as well. And sometimes 0:00:42.400 --> 0:00:44.200 they're good songs. And I don't want to mess anybody 0:00:44.280 --> 0:00:45.879 up because I think what I'm gonna say is a 0:00:45.880 --> 0:00:47.800 good song. So I don't want it to get in 0:00:47.920 --> 0:00:49.519 anybody's head in a way that they can't get it 0:00:49.520 --> 0:00:51.959 out and they're gonna curse me. But you remember this 0:00:52.120 --> 0:00:55.080 song by Nana in the eighties, the ninety nine Red Balloons. 0:00:55.120 --> 0:00:59.200 Oh yeah, you annoying, annoying? Yeah, And it's like you 0:00:59.280 --> 0:01:01.960 and I toy shop with a bag of balloons or 0:01:01.960 --> 0:01:03.760 the money we've got I don't know why, but that's 0:01:03.800 --> 0:01:06.280 such a little it's not even pentameter. Itau's but such 0:01:06.280 --> 0:01:08.880 a great little ditty. It's just that I can't get 0:01:08.880 --> 0:01:11.280 that out of my head. And and that song. I 0:01:11.319 --> 0:01:12.679 don't know if you know, because you were a little 0:01:12.680 --> 0:01:14.399 bit younger than I, but that came out in the 0:01:14.440 --> 0:01:17.160 sort of the very height of the Cold War, and 0:01:17.200 --> 0:01:20.800 it's basically about nuclear destruction and mutually assured destruction and 0:01:21.240 --> 0:01:25.360 war games with Matthew Broderick, and you know, messed me. 0:01:25.360 --> 0:01:27.920 That kept me up at night the day after that 0:01:27.959 --> 0:01:30.280 apocalyptic movie that came out on TV that was I 0:01:30.280 --> 0:01:33.160 guess supposed to scare us into uh into submission. 0:01:33.760 --> 0:01:35.440 Well, that kept me up at night. But do you 0:01:35.520 --> 0:01:37.440 know what else keeps me up at night? What's that? 0:01:38.640 --> 0:01:41.080 Well, I mean the worry about patients that have to 0:01:41.120 --> 0:01:43.000 get up to pee at times. I mean it's terrible 0:01:43.040 --> 0:01:45.600 getting up at night. Nocturnal urine agency. What I did 0:01:45.600 --> 0:01:46.880 there that was so smooth. 0:01:46.920 --> 0:01:49.040 As long as you need the erna's like atting you. 0:01:49.080 --> 0:01:50.840 Up in the middle of the night, That's that's right. 0:01:50.960 --> 0:01:53.160 I mean, I'm a man of a certain age, but 0:01:53.160 --> 0:01:56.080 but I know, how often is okay? And how often 0:01:56.520 --> 0:01:58.680 is not okay when I should seek medical help? And 0:01:58.720 --> 0:02:00.840 I think that's going to be somewhere in there. You're 0:02:00.840 --> 0:02:03.080 gonna find a title and you're gonna make this clean 0:02:03.120 --> 0:02:06.320 and squeaky and ready for prime time. But but we're 0:02:06.320 --> 0:02:08.880 going to talk about yeah, just you know, when is 0:02:08.919 --> 0:02:11.760 your nation normal? In other words, like everybody got a 0:02:11.800 --> 0:02:13.960 pe uh, and when is it something that you should 0:02:14.040 --> 0:02:16.799 find a doctor for? And So what I thought we'd 0:02:16.840 --> 0:02:19.120 do today, if you're game for this, is I thought 0:02:19.160 --> 0:02:24.399 I would be your human AI medical source where you're 0:02:24.400 --> 0:02:26.400 going to ask the questions that that you're going to 0:02:26.760 --> 0:02:29.880 put into your search engine. And then instead of having 0:02:30.120 --> 0:02:33.160 somebody comb the literature and the popular media and then 0:02:33.200 --> 0:02:35.840 give you a sucact answer, now I'm gonna give you, you know, 0:02:35.880 --> 0:02:39.800 an actual human physician response from a board certified urologist. 0:02:39.880 --> 0:02:43.680 So I am your doctor Mills GPT, at your service. 0:02:44.280 --> 0:02:45.960 All right, Well, I have done a little bit of 0:02:46.000 --> 0:02:49.720 research academically, but also physically. I've got my giant thing 0:02:49.720 --> 0:02:52.320 of iceed coffee and my leader of water right here. 0:02:52.560 --> 0:02:55.120 That's amazing. Yeah, so you're you're priming your kidneys for 0:02:55.200 --> 0:02:57.959 what they do best. We hope I love it well, 0:02:58.000 --> 0:03:00.160 So yeah, so let me let me give a guy 0:03:00.240 --> 0:03:03.239 a little bit of an understanding of how the whole 0:03:03.280 --> 0:03:06.200 process works. And it's a pretty amazing process. I mean 0:03:06.240 --> 0:03:09.320 it starts in the brain with a bunch of hormones 0:03:09.360 --> 0:03:12.240 that regulate the fluid. 0:03:11.880 --> 0:03:13.840 Balance in our entire system. 0:03:13.880 --> 0:03:17.040 And so basically, the kidneys are pretty amazing organs and 0:03:17.040 --> 0:03:18.880 we probably should dedicate in a whole episode to them 0:03:18.919 --> 0:03:21.919 because they keep the blood in acid base balance, so 0:03:21.960 --> 0:03:24.680 they have this perfect pH. I can tell you my 0:03:24.760 --> 0:03:26.440 thoughts on alkaline water because I don't think we have 0:03:26.480 --> 0:03:29.600 any sponsors of alkaline water. But spoiler alert doesn't really work. 0:03:29.639 --> 0:03:31.880 If you need alkaline water, it means your kidneys aren't 0:03:31.919 --> 0:03:35.640 doing their job. Because that's a beautiful thing about our 0:03:35.760 --> 0:03:38.240 kidneys is you can drink vinegar, which has a pH 0:03:38.320 --> 0:03:42.240 of two, and you could drink well, I wouldn't recommend 0:03:42.280 --> 0:03:44.760 it regularly, but you could drink baking soda, which has 0:03:44.800 --> 0:03:47.320 a much higher pH and still end up with a nice, 0:03:47.880 --> 0:03:51.040 verily well balanced urine that tends to be a little 0:03:51.040 --> 0:03:53.280 bit on the acidic side. So that's the first thing 0:03:53.320 --> 0:03:56.080 the kidneys do. But they also process fluid. You already 0:03:56.120 --> 0:03:58.440 have a question. I'm looking at you, so I do. 0:03:59.040 --> 0:03:59.960 This is me being a word. 0:04:00.520 --> 0:04:02.600 If you need alkaline water, it means your kidney's are 0:04:02.680 --> 0:04:05.280 doing their job. Conversely, if you drink a lot of 0:04:05.280 --> 0:04:07.560 alkaline water, does that have a harmful effect? 0:04:07.960 --> 0:04:08.440 I love it. 0:04:08.600 --> 0:04:11.280 No. And by the way, yeah, if you have if 0:04:11.360 --> 0:04:14.040 you have acid demi or an excess of acid in 0:04:14.080 --> 0:04:16.400 your bloodstream, drinking alkaline water is not gonna do anything. 0:04:16.400 --> 0:04:18.320 It doesn't work that way. An acid base balance is 0:04:18.320 --> 0:04:22.400 controlled both by our lungs, our respiratory system, and then 0:04:22.440 --> 0:04:25.240 also our kidneys. So no, The bottom line is that 0:04:25.480 --> 0:04:28.200 you can drink things, and you can eat things with 0:04:28.240 --> 0:04:30.760 an incredibly low pH or an incredibly high pH, and 0:04:30.760 --> 0:04:34.240 the kidneys have an amazing way of exchanging hydrogen ions 0:04:34.279 --> 0:04:37.760 across a very complex system within the meat or what 0:04:37.760 --> 0:04:39.919 we call the prank of of the kidneys to balance it. 0:04:39.960 --> 0:04:42.680 So by the time it gets to the bladder, your 0:04:42.839 --> 0:04:46.599 urinary pH is somewhere on a normal level between five 0:04:46.640 --> 0:04:49.640 point five, which is acidic up to it really doesn't 0:04:49.640 --> 0:04:52.440 get much above basic of seven point five because most 0:04:52.440 --> 0:04:56.720 of us carry an excess acid base or acid in 0:04:56.760 --> 0:04:59.560 our in our baseline diet, so In other words, if 0:04:59.560 --> 0:05:01.839 you eat kind of a normal American diet full of 0:05:01.839 --> 0:05:04.520 meat and protein, that tends to be a cidic and 0:05:04.560 --> 0:05:06.919 so you have to kind of get rid of that acid. 0:05:06.960 --> 0:05:09.120 And the way you do that is through the kidneys. 0:05:09.120 --> 0:05:11.880 Eventually, if you drink, if you have a very vegetarian diet, 0:05:11.920 --> 0:05:14.839 then actually that's one way that you can alkalinize your urine. 0:05:14.960 --> 0:05:17.000 We're gonna have an episode on kidney stones too, where 0:05:17.000 --> 0:05:20.120 we talk about how important it is to manage acid 0:05:20.120 --> 0:05:22.679 base balance. I'll bring in one of my expert guests 0:05:22.680 --> 0:05:25.120 and friends and colleagues for that sometime in the future. 0:05:25.560 --> 0:05:28.400 But the bottom line is that that you know, drink 0:05:28.440 --> 0:05:30.400 water and it doesn't have to be it doesn't have 0:05:30.400 --> 0:05:32.400 to be alkalin and the health benefits have never been 0:05:32.400 --> 0:05:34.720 shown in any clinical trials. To do anything other than 0:05:34.960 --> 0:05:36.520 I'll spend a lot of money and look cool at 0:05:36.520 --> 0:05:38.919 the gym, which again is totally fine, and you should 0:05:38.960 --> 0:05:41.520 do that, and I promise I won't I won't alkaline 0:05:41.560 --> 0:05:44.120 water shame you because you're doing what makes you feel good, 0:05:44.120 --> 0:05:45.240 and that's that's what. 0:05:45.120 --> 0:05:45.800 This is all about. 0:05:45.800 --> 0:05:47.600 Brother, I have another water based question. 0:05:47.680 --> 0:05:50.560 I'm so sorry, man, this is fine no, no, no, 0:05:50.560 --> 0:05:53.120 none of these are ones that I prep but I'm 0:05:53.160 --> 0:05:54.400 addicted to seltzer water. 0:05:54.440 --> 0:05:56.039 I'm a New Yorker. It's kind of one of the 0:05:56.040 --> 0:05:56.720 things that we do. 0:05:57.160 --> 0:06:00.280 And I have heard mixed reports on what whether or 0:06:00.320 --> 0:06:04.240 not seltzer water is completely fine same as regular water or. 0:06:04.279 --> 0:06:05.719 The right a CO two. 0:06:05.720 --> 0:06:07.960 It could be bad for you either I've heard, either 0:06:08.080 --> 0:06:09.440 internally or for the teeth. 0:06:10.320 --> 0:06:10.680 Teeth. 0:06:10.839 --> 0:06:13.480 Yeah, yeah, do you have any thoughts on that? 0:06:13.760 --> 0:06:15.279 Yeah, I mean it's kind of the same thing. 0:06:15.279 --> 0:06:18.320 And I love the whole teeth thing because you know, 0:06:18.400 --> 0:06:21.080 unless you're gargling it or switching it around, then then 0:06:21.080 --> 0:06:24.040 the amount of contact time your teeth has with anything, 0:06:24.040 --> 0:06:27.880 whether it's coffee or wine or seltzer water, it's probably 0:06:27.960 --> 0:06:31.359 not going to do that much. And so really the 0:06:31.400 --> 0:06:33.599 teeth should be pretty well excluded. It's a thing that 0:06:33.640 --> 0:06:35.320 I hear, you know, from some dentist all the time. 0:06:35.320 --> 0:06:37.560 Another Dannis say, Now, there's no absolutely no data to 0:06:37.560 --> 0:06:39.599 show that seltzer water erodes. 0:06:39.600 --> 0:06:40.359 You're enamel. 0:06:40.880 --> 0:06:44.919 It's acidic, sure, CO two, but again, your your body's 0:06:44.920 --> 0:06:47.520 able to handle that, and and it's probably better for 0:06:47.560 --> 0:06:51.320 you than say sugar sodas that that I have so 0:06:51.400 --> 0:06:53.280 much sugar in the that it is really going to 0:06:53.320 --> 0:06:55.680 be what hurts you. Though those also have seltzer water, 0:06:55.720 --> 0:06:57.840 they just also have sugar. So so no, I mean, 0:06:57.880 --> 0:07:01.400 I remember years ago people would pour coke onto car 0:07:01.400 --> 0:07:03.480 hoods and say, look how bad soda is for you 0:07:03.560 --> 0:07:06.600 because it erodes car enamel, Like, well, you're right, you know, 0:07:06.720 --> 0:07:09.400 reason why is that your car doesn't have kidneys. If 0:07:09.440 --> 0:07:11.120 your car had a kidney, it would say, hey, I'm 0:07:11.160 --> 0:07:12.800 going to look at this and I'm going to dialyze 0:07:12.840 --> 0:07:13.280 this off and. 0:07:13.280 --> 0:07:14.080 You're gonna be fine. 0:07:14.600 --> 0:07:18.520 So yeah, yeah, So so that that's the deal. So drink, 0:07:18.600 --> 0:07:21.360 drink whatever you want within reason, and celtzer water is 0:07:21.360 --> 0:07:24.320 probably a lot healthier for you than than sugar, sodas 0:07:24.360 --> 0:07:25.800 and other such things. 0:07:25.840 --> 0:07:29.000 So I'm cool with that. Totally cool with that. All right. 0:07:29.040 --> 0:07:32.720 So then you make urine and it stores in the bladder. 0:07:32.760 --> 0:07:36.440 So now we're just going to completely bypass hours of 0:07:36.480 --> 0:07:40.200 renal physiology and say your bladder is basically a storage 0:07:40.280 --> 0:07:43.200 muscle and that's really important because in a guy, and 0:07:43.200 --> 0:07:44.800 that's what really going to focus on today. Although a 0:07:44.840 --> 0:07:47.600 lot of this you can translate to women minus the prostate, 0:07:47.680 --> 0:07:50.240 which is really what we're building up to here. But 0:07:50.360 --> 0:07:54.000 the bladder is simply a muscle that it starts very 0:07:54.040 --> 0:07:56.520 small when it's when it's decompressed. In other words, that 0:07:56.600 --> 0:07:59.760 after you pee, it shrivels down to this tiny, little, 0:07:59.760 --> 0:08:02.480 maybe fist size organ that that's hollow in the middle. 0:08:02.480 --> 0:08:05.080 It just kind of collapses in on itself and waits 0:08:05.080 --> 0:08:06.400 for you to make more urine. 0:08:07.000 --> 0:08:08.920 And so as. 0:08:08.680 --> 0:08:13.800 We look at the pathology of urination, we break it 0:08:13.840 --> 0:08:18.320 down into two phases. We break it into storage problems, 0:08:18.600 --> 0:08:21.800 and then we break it down into elimination problems. And 0:08:21.840 --> 0:08:23.880 a storage problem means there's something wrong with a bladder 0:08:23.880 --> 0:08:27.160 where it doesn't it can't fill enough. And you hear 0:08:27.240 --> 0:08:29.560 this all the time, I have a shy bladder, or 0:08:29.600 --> 0:08:31.760 ever since I was you know, twelve, people made fun 0:08:31.800 --> 0:08:33.120 of me because I had to pee all the time. 0:08:33.600 --> 0:08:35.800 Some of that could be pathologic and that they truly 0:08:35.840 --> 0:08:38.640 have a storage problem where their bladder just never developed 0:08:38.640 --> 0:08:42.200 to the point where it can capacitate what we would consider. 0:08:41.880 --> 0:08:43.719 A normal amount of urine. 0:08:43.800 --> 0:08:47.080 And again there's really there's not really a set define 0:08:47.280 --> 0:08:51.640 urologic baseline for what is normal. But in general, most 0:08:51.679 --> 0:08:55.800 bladders should hold about two hundred and fifty mili liters, 0:08:55.840 --> 0:08:58.160 so a little bit, you know, less than a twelve 0:08:58.240 --> 0:09:01.520 ounce can of soda, So that's a about normal before 0:09:02.040 --> 0:09:05.200 you say you should go pee. Some bladders can hold 0:09:05.640 --> 0:09:09.920 leaders literally leaders of viurine before they have to go pee. 0:09:09.920 --> 0:09:11.160 That becomes pathologic. 0:09:11.240 --> 0:09:13.959 So somewhere between a can of soda and a leader 0:09:14.000 --> 0:09:17.920 of soda is where normal bladder capacitation should be for 0:09:18.000 --> 0:09:22.200 an adult. So that's a storage issue. If somebody is 0:09:22.240 --> 0:09:26.480 not able to expand the bladder muscle because there's something pathologic, 0:09:26.559 --> 0:09:30.800 either neurologically wrong or muscularly wrong, then that's a storage issue. 0:09:30.800 --> 0:09:33.560 And those people are going to present mostly with what 0:09:33.600 --> 0:09:37.720 we call frequency and urgency symptoms where they're peeing all 0:09:37.760 --> 0:09:40.040 the time and like they got to go, and there's 0:09:40.040 --> 0:09:44.920 a there's a classic classic diagnostic indicator we call the 0:09:45.000 --> 0:09:48.960 key in the door symptom when basically, if your brain, 0:09:49.040 --> 0:09:51.000 and this is where the brain takes over, knows that 0:09:51.040 --> 0:09:54.880 there's going to be a urinal around somewhere, then you 0:09:55.000 --> 0:09:57.960 have this little socially appropriate signal like, oh, it's go 0:09:58.040 --> 0:10:01.880 time and I got to pee. For older guys, this 0:10:02.040 --> 0:10:04.640 is one of those things where you will know exactly 0:10:04.720 --> 0:10:06.840 where every bathroom is in public places. If you're in 0:10:06.840 --> 0:10:08.880 the mall, you know, oh, it's on the first story 0:10:08.880 --> 0:10:12.160 in that department store behind shoes, and you almost have 0:10:12.240 --> 0:10:15.320 bladder maps that you've worked out, and God help you 0:10:15.360 --> 0:10:17.560 if it's closed for cleaning, right because you have that 0:10:17.679 --> 0:10:19.240 key in the door that I know, I'm aout right 0:10:19.280 --> 0:10:20.400 open the door and there's going to be urinal on 0:10:20.440 --> 0:10:22.960 the other side, and I got a peek. So those 0:10:23.040 --> 0:10:28.839 are mostly storage problems or frequency urgency, irritative voiding symptoms. 0:10:29.679 --> 0:10:32.559 That's the number one issue of what we look at. 0:10:32.800 --> 0:10:36.679 The second is voiding or elimination, where then you can 0:10:36.720 --> 0:10:39.680 have problems with when you actually start the flow of 0:10:39.800 --> 0:10:42.400 ur and it doesn't come out so well. And that's 0:10:42.440 --> 0:10:46.760 also what we call obstructive symptoms. So a little side 0:10:46.800 --> 0:10:49.960 note for bladder and prostate anatomy is that. And we've 0:10:49.960 --> 0:10:53.959 talked about prostate and a whole other series with prostate cancer, 0:10:54.360 --> 0:10:56.120 and so the side note here is that basically the 0:10:56.120 --> 0:10:58.680 prostate does two things to guys as we get older. 0:10:58.720 --> 0:11:02.400 It either gets bigger causes obstructive urinary symptoms, or it 0:11:02.400 --> 0:11:05.000 gets cancer. And that's about it other than still being 0:11:05.000 --> 0:11:07.040 an organ that makes semen and therefore. 0:11:06.880 --> 0:11:08.040 Part of sexual pleasure. 0:11:08.600 --> 0:11:12.960 So if you have the symptoms of where yeah, doc, 0:11:13.040 --> 0:11:14.800 I can hold my ear and just fine. I don't 0:11:14.800 --> 0:11:17.440 have frequency and urgency, but when I do find a 0:11:17.440 --> 0:11:19.320 good place to pee and I let her. 0:11:19.280 --> 0:11:20.920 Rip, it just trickles out. 0:11:21.320 --> 0:11:25.360 That means that you have a force differential between what's 0:11:25.400 --> 0:11:27.960 going on in the bladder where the bladder muscles contracting, 0:11:28.480 --> 0:11:31.760 but yet it's hitting what we call an obstructive process. 0:11:32.080 --> 0:11:34.960 And there's two kinds of obstructions. There's a fixed obstruction 0:11:35.040 --> 0:11:38.040 where it doesn't move at all, and then there's a 0:11:38.080 --> 0:11:41.360 more variable obstruction, which is the prostate land itself. So 0:11:41.920 --> 0:11:44.360 best definition, and this is something we don't see very 0:11:44.440 --> 0:11:47.839 much anymore. But the most common fixed obstruction and a 0:11:47.920 --> 0:11:52.360 guy is a urethral stricture. So urethral strictures were the 0:11:52.440 --> 0:11:56.480 bane of early urologists. Existence is because the most common 0:11:56.520 --> 0:11:59.120 cause of urethral stricture is really, up until the nineteen 0:11:59.160 --> 0:12:03.160 forties was on area and gonerhea was such an endemic 0:12:03.720 --> 0:12:08.760 condition globally than so many guys suffered from it women too. Obviously, 0:12:09.040 --> 0:12:11.400 it didn't affect the urethra as much in women, and 0:12:11.760 --> 0:12:12.719 it was. 0:12:13.120 --> 0:12:14.000 It was really the. 0:12:13.840 --> 0:12:16.520 Cause of a lot of medical innovations, which again I'm 0:12:16.520 --> 0:12:17.880 glad you're sitting down for, and I don't want to 0:12:17.920 --> 0:12:21.280 ruin your summer vacation with talking about these tools of 0:12:21.320 --> 0:12:23.920 the devil, as we say, but there are all kinds 0:12:23.920 --> 0:12:27.680 of strictural dilators that they really do look like torture 0:12:27.720 --> 0:12:32.240 devices of pewter made steel made straws basically that you 0:12:32.800 --> 0:12:36.160 grind into the urethra, which is as you know, since 0:12:36.240 --> 0:12:39.840 right there in heavy real estate, right in the penis 0:12:39.880 --> 0:12:42.200 to get that structure open so guys could bee. It 0:12:42.200 --> 0:12:44.880 was miserable and miserable and people would die from it 0:12:44.880 --> 0:12:47.800 there die from infections, they died from kidney failure, and 0:12:47.920 --> 0:12:51.000 so it was really a bad deal. And in fact, 0:12:51.760 --> 0:12:55.480 really the only treatment for that was to bypass that 0:12:55.520 --> 0:12:59.200 stricture surgically and do what's called a perineal urythrostomy, where 0:12:59.360 --> 0:13:02.120 again it would put a guy up in a frog 0:13:02.200 --> 0:13:04.880 leg position, get four of his best friends to hold 0:13:04.920 --> 0:13:08.080 him down, get him just absolutely shit face drunk, and 0:13:08.120 --> 0:13:10.880 then take a hot metal rod and stick it right 0:13:10.920 --> 0:13:14.560 behind the testicles through the paraneum into the bladder, and 0:13:14.600 --> 0:13:15.800 then just let it drain. 0:13:15.760 --> 0:13:18.600 And that was the that was what we made up. 0:13:18.840 --> 0:13:21.440 Then we called that term dorsal lithotomy because you were 0:13:22.160 --> 0:13:25.240 up on your back with your legs up in the air, 0:13:25.320 --> 0:13:28.520 kind of like a pelvic exam, and it was to 0:13:28.559 --> 0:13:30.680 get the stones out of the bladder, which can happen 0:13:30.760 --> 0:13:33.560 to the guys that have chronic emptying issues, and they 0:13:33.559 --> 0:13:35.400 would die if they didn't get it, and the unfortunately 0:13:35.440 --> 0:13:36.400 a lot of times they would die. 0:13:36.280 --> 0:13:37.719 If they did get that procedure. 0:13:38.200 --> 0:13:43.360 So it was a huge, huge issue in eighteenth century, 0:13:43.360 --> 0:13:45.920 all the way back to the times of Galen and 0:13:46.640 --> 0:13:52.360 Hippocrates actually that eurethral obstruction and death from bladderstones from 0:13:52.440 --> 0:13:55.200 urethral and prostate destruction was a thing. So we come 0:13:55.240 --> 0:13:58.800 a long way. But that's a fixed obstruction. So getting 0:13:58.840 --> 0:14:01.280 back to the prostate, as I said, it's not necessarily 0:14:01.320 --> 0:14:04.120 a fixed obstruction because the prostate is a muscle and 0:14:04.160 --> 0:14:07.840 a gland. And the best way that we look at 0:14:08.000 --> 0:14:10.560 at prostate as we age is that it almost everybody, 0:14:10.559 --> 0:14:12.640 it gets bigger, and it gets bigger and bigger as 0:14:12.640 --> 0:14:14.760 we age, and there are ways to treat it, which 0:14:15.120 --> 0:14:19.160 we had talked about episodes ago with doctor Wayne Brisbane 0:14:19.200 --> 0:14:20.920 in one of the most common ways is to shrink 0:14:20.960 --> 0:14:25.200 it through a hormone medication called detastoride or finasteride, And 0:14:26.080 --> 0:14:27.720 we talked about and a multiple. 0:14:27.440 --> 0:14:29.080 Episodes because a lot of side effects, a lot of 0:14:29.120 --> 0:14:29.640 benefits to. 0:14:29.560 --> 0:14:32.120 Those drugs, but the bottom line is that shrinks that glands. 0:14:32.200 --> 0:14:36.400 It's not fixed anymore, and it allows better emptying of 0:14:36.440 --> 0:14:39.360 the bladder because you've relieved some of that obstruction. The 0:14:39.400 --> 0:14:44.880 most common medication we use for BPH benign prosthetic hyperplasia, 0:14:45.320 --> 0:14:47.480 is something called an alpha blocker, and an alpha blocker 0:14:47.600 --> 0:14:51.240 just hits the muscle receptors in the prostate to open 0:14:51.240 --> 0:14:53.320 it up temporarily, and so you have to take that 0:14:53.400 --> 0:14:56.880 every day essentially forever, in order to keep that muscle 0:14:56.920 --> 0:14:58.440 relaxed so you can pee better. 0:14:58.840 --> 0:15:00.600 That's the non fit construction. 0:15:00.720 --> 0:15:03.640 But that's the thing that most people when a guy 0:15:03.720 --> 0:15:05.840 comes into the dock and says, hey, I'm getting up 0:15:05.840 --> 0:15:08.960 at night to pee one time, two times, four times, 0:15:09.200 --> 0:15:11.440 they say, Oh, it's probably your prostate. And if you 0:15:11.520 --> 0:15:14.240 don't ask the question, if your doctor doesn't ask the 0:15:14.320 --> 0:15:17.760 question about whether this is what we think of storage issue, 0:15:17.760 --> 0:15:20.240 meaning it may be a bladder problem or whether this 0:15:20.360 --> 0:15:24.560 is an outlet issue, meaning an obstructive or a avoiding problem. 0:15:24.880 --> 0:15:26.520 Then a lot of guys come in and they're on 0:15:26.600 --> 0:15:29.720 medications that don't work because they're treating a prostate issue, 0:15:29.720 --> 0:15:32.280 and in fact, a lot of guys have storage problems 0:15:32.320 --> 0:15:35.200 and they have a lot of intrinsic bladder issues frequency 0:15:35.320 --> 0:15:39.560 urgency that aren't really looked at. So that's the kind 0:15:39.560 --> 0:15:43.360 of the easy bladder physiology prosta physiology one O one. 0:15:43.840 --> 0:15:46.400 But the wheels come off in a lot of different ways. 0:15:46.440 --> 0:15:48.520 And one of the ways they come off is that 0:15:48.680 --> 0:15:52.880 if a bladder is chronically blocked over time from an 0:15:53.000 --> 0:15:56.280 enlarged prostate, then it can have problems with storage and 0:15:56.320 --> 0:16:00.400 it can either cause frequency and urgency because because the 0:16:00.400 --> 0:16:03.880 bladder is a muscle and the prostate, if it enlarges, 0:16:04.040 --> 0:16:07.560 causes a higher pressure or what we call an outflow pressure. 0:16:08.040 --> 0:16:09.480 It gets to the point where the bladder has to 0:16:09.560 --> 0:16:11.880 keep working out, it has to keep stronger and stronger, 0:16:12.200 --> 0:16:14.680 and at some point the bladder can wear out. And 0:16:14.760 --> 0:16:18.040 so that's why getting your prostate looked at and making 0:16:18.080 --> 0:16:20.080 sure that it's not getting too big and causing that 0:16:20.120 --> 0:16:22.680 obstruction is so important. Because there are guys that can 0:16:22.800 --> 0:16:25.560 end up with what we call an in stage bladder, 0:16:25.640 --> 0:16:27.520 and this is one of these warning signs that we 0:16:28.200 --> 0:16:31.160 worry about in medicine where you and it's happened actually 0:16:31.160 --> 0:16:33.200 twice in the last week to patients of mind that 0:16:33.280 --> 0:16:35.560 I was seeing for other issues that had been kind 0:16:35.560 --> 0:16:38.000 of doing just fine. They both ended up on a 0:16:38.000 --> 0:16:40.280 long plane ride to Europe. One was in London, one 0:16:40.360 --> 0:16:42.680 was in Paris and called the office saying, Hey, I 0:16:42.760 --> 0:16:44.560 can't pee, I'm in an er here and I need 0:16:44.600 --> 0:16:47.840 a catheter. And that's because they got out of their 0:16:47.840 --> 0:16:50.640 normal urinary habits and they weren't maybe getting up on 0:16:50.680 --> 0:16:53.080 a twelve hour flight to pee. And then some of them, 0:16:53.120 --> 0:16:54.760 you know, if you take a sleeping medicine to help 0:16:54.760 --> 0:16:57.200 you get across the Atlantic, that can make it worse. 0:16:57.400 --> 0:16:59.520 And then all of a sudden, you know, you need 0:16:59.560 --> 0:17:02.840 a cafe in order to avoid No. Thankfully, for the 0:17:02.880 --> 0:17:04.760 guys that I still see there, they don't have an 0:17:04.760 --> 0:17:07.159 in stage bladder. They're they're fine because we caught it early. 0:17:07.560 --> 0:17:09.240 But there are guys that ignore it to the point 0:17:09.280 --> 0:17:12.080 where even if we do do something to their prostate 0:17:12.160 --> 0:17:14.920 open it up. Either surgically, which again we're gonna have 0:17:14.960 --> 0:17:18.359 an amazing episode on or medically that bladder can just 0:17:18.359 --> 0:17:20.000 give out, and then those guys are gonna need to 0:17:20.000 --> 0:17:21.919 figure out how to drain their bladder with a catheter 0:17:22.520 --> 0:17:24.639 really for you know, potentially the rest of their lives. 0:17:24.680 --> 0:17:27.240 So so again a big, a big thing that that 0:17:27.600 --> 0:17:30.720 urination is normal, which is I'm sure one of the 0:17:30.800 --> 0:17:33.440 questions you're gonna ask me. Uh, you know, you should 0:17:33.480 --> 0:17:36.320 be peeing every few hours during there in the daytime 0:17:36.359 --> 0:17:38.680 and at night. You should be able to sleep through 0:17:38.720 --> 0:17:41.400 the night, you know, well into your fifties without getting up. 0:17:41.960 --> 0:17:46.040 We do have in our diagnostic codes actually where we 0:17:46.119 --> 0:17:47.880 where we try to say, here's a guy, he's coming 0:17:47.920 --> 0:17:51.159 in for nocturia, which is the fancy name for getting 0:17:51.240 --> 0:17:53.720 up a night to pee. If it is greater than once, 0:17:53.800 --> 0:17:56.480 then there's a separate code for that, and so so 0:17:56.600 --> 0:17:58.880 I guess that's normal. But again, if a guy's like Doc, 0:17:58.920 --> 0:18:01.000 I get at once, I can't get back to sleep, 0:18:01.240 --> 0:18:02.760 you know, then we have to start looking at sleep 0:18:02.800 --> 0:18:06.560 disorders as well as you know, at looking at the prostate. 0:18:06.600 --> 0:18:09.280 And still we're going to try to address the eurologic 0:18:09.359 --> 0:18:11.280 issues before we look at some of the other things 0:18:11.320 --> 0:18:12.960 that can get you up at night a lot to pee, 0:18:13.400 --> 0:18:16.080 Like diabetes is still one of the things that man 0:18:16.160 --> 0:18:18.639 that's a medicare as a disease. It gets involved in 0:18:18.720 --> 0:18:21.960 all parts of urology. But some guys pee so frequently 0:18:22.000 --> 0:18:25.639 because the sugar causes you to make more really poorly 0:18:25.680 --> 0:18:27.680 concentrated urine, and you got to pee all the time, 0:18:27.800 --> 0:18:29.840 you know, because you have diabetes. So you got to 0:18:29.840 --> 0:18:32.639 get that checked out. And then heart issues as we 0:18:32.680 --> 0:18:36.400 get older. The other amazing thing sometimes is a urologist 0:18:36.440 --> 0:18:39.080 that I get to diagnose is early stage heart failure 0:18:39.119 --> 0:18:42.160