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Laparoscopic surgery for bladder cancer leads to good long-term cancer control

Bert Vorstman, MD,MS,FAAP,FRACS,FACS www.urologyweb.com

Findings indicate that long-term survival rates for bladder cancer after laparoscopic surgery are comparable that those of open surgery. The study, published in BJU International indicates that prospective randomized trials comparing these two bladder cancer surgeries are warranted.

A treatment for muscle invasive and high-risk non-muscle invasive bladder cancer is the open radical cystectomy or removal of the bladder through open surgery. The other is chemo-radiation. However, conventional surgery can also lead to serious complications. Laparoscopic radical cystectomy is one of the minimally invasive procedures that some hospitals are using but there is little information on the effectiveness of these procedures for preventing cancer recurrence over the long term.

The European Association of Urology (EAU)-section of Uro-technology has been building a large database of laparoscopic radical cystectomy procedures performed across Europe to address this. Simone Albisinni, MD and Roland van Velthoven, MD, PhD, of the Université Libre de Bruxelles of Belgium lead an international team in exploring this database and found that laparoscopic radical cystectomy can lead to reliable cancer control even many years after surgery. Sixty-five percent of patients had no signs of bladder cancer recurrence after 5 years and among those followed for 10 years, 62 percent had no signs of recurrence.

“Analyzing over 500 patients and with a median follow-up of 5 years, these results are vital to globally evaluate the efficacy of this procedure. They suggest that a laparoscopic approach to bladder cancer, when performed correctly, can be as safe as open surgery with regards to cancer control, though maintaining the benefits of a minimally invasive approach,” said Dr. Albisinni.

The authors noted that there is growing interest for robotic-assisted radical cystectomy, another minimally invasive procedure, in the international community as well; however, many hospitals in Europe do not own a robot. Laparoscopic equipment, on the other hand, is

more widely available. “As such, this data represents crucial information for urologists who are performing laparoscopic surgery, or who wish to implement laparoscopic cystectomy in their departments. In spite of the technical difficulty and the need for a learning curve, these findings support the use of a laparoscopic approach for the management of bladder cancer,” said Dr. Albisinni.

To learn more visit Dr. Vorstman at http://www.urologyweb.com/ exclusive-medical-reports/ Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/
Contact him directly at bvorstmanmd@gmail.com

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Method to assess UTI risk in women after pelvic-floor surgery

Bert Vorstman, MD,MS,FAAP,FRACS,FACS www.urologyweb.com

The latest issue of PLOS ONE reported that researchers may have found a method to assess the women at risk for developing a urinary tract infection (UTI) following pelvic-floor surgery.

Urinary tract infections (UTI), the most common type of bacterial infection, have estimated treatments costs exceeding USD$1 billion a year in the United States alone. Women who undergo surgery for pelvic-organ prolapsed or urinary incontinence are more likely to develop a UTI following the procedure. Due to a lack of effective methods to identify the risks, clinicians found it difficult to treat specific patients with an increased UTI risk in the past.

Findings found that certain urinary bacteria and antimicrobial peptides, which normally help the bladder immune system function, may identify women at increased risk for a UTI following pelvic-floor surgery.

“This information may help us improve UTI prevention and treatment strategies for women down the road,” said Katherine Radek, PhD, senior author, assistant professor, Department of Surgery and a member of Loyola’s Burn & Shock Trauma Research Institute.

Relationship between urinary bacteria, antimicrobial peptides and UTI symptom severity in 54 women undergoing pelvic-floor surgery were the focus of the study. Participants completed a questionnaire and provided a catheterized urine specimen obtained under anesthesia on the day of surgery. The urine was analysed using advanced DNA-based detection methods. Of these 54 women, 10 or 18.5% developed UTI symptoms after surgery while four or 7% had positive urine cultures after surgery. Thirteen participants, or 24% of the group, had positive urine cultures before surgery. The rest had negative urine cultures before surgery.

Researchers found that the diversity and abundance of specific urinary bacteria and the amount of a specific antimicrobial peptide were different in women who developed a UTI following surgery compared with those who did not: lower risk of post-operatvie UTI correlated with greater bacterial diversity, greater abundance of the Lactobacillus species and higher levels of the antimicrobial peptide β-defensin-1.

Further insight into the mechanisms by which bladder bacteria and antimicrobial peptides communicate during normal and disease states will facilitate the development of better prevention and/or treatment strategies for UTI-susceptible populations.

For more information about various urological conditions, visit Dr. Bert Vorstman at http:// www.urologyweb.com/exclusive-medical-reports/
Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/
Contact him directly at bvorstmanmd@gmail.com.

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New device spots kidney disease and prostate cancer in an instant

Detection of kidney disease and prostate cancer is now made easier with a new device that tests urine samples.

Brighan Young University chemist Adam Woolley and his students made a new device that can detect markers of kidney disease and prostate cancer in an instant. The new device is a tiny tube lined with DNA sequences that latch onto disease markers in urine. All you have to do is drop a urine sample into the tube and see how far it goes. Healthy samples flow freelance; a diseased sample gets clogged and stops short of the mark.

“In a disease state, this particular marker is equal to about one billionth of a percent of the content of urine.” Woolley said. “We can detect close to those levels. If we can get below that, it would give us better sensitivity for somebody at an early stage of the disease.”
For more information about various urological conditions, visit Dr. Bert Vorstman at http:// www.urologyweb.com/exclusive-medical-reports/

Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/ Contact him directly at bvorstmanmd@gmail.com.

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Testing for drug-resistant bacteria before prostate biopsy can reduce infections

Bert Vorstman, MD,MS,FAAP,FRACS,FACS www.urologyweb.com

Simple rectal swab cultures prior to prostate biopsy procedures can stop some infections found after the procedure due to drug-resistant Escherichia coli. Rhode Island Hospital researchers found that the cultures test for antibiotic-resistant E. Coli and the findings are used to direct the selection of antimicrobial prophylaxis used for the procedure.

For patients undergoing transrectal ultrasound (TRUS)-guided biopsies, Ciprofloxacin may not be the best prophylactic option to use for patients colonized with Ciprofloxacin- resistant E. coli.

“Aware of the increasing number of resistant strains of E. coli, our urologic physicians sought to decrease the number of post-biopsy infections and readmissions by conducting cultures on patient fecal samples to identify antibiotic-resistant strains before the biopsy is done, and the results were used to make the best antibiotic choice for prophylaxis,” said Leonard Mermel, D.O., medical director of the department of epidemiology and infection control at Rhode Island Hospital. “As effective as biopsies are for diagnosing cancer, they do carry some risk of infection.”

According to the Centers for Disease Control and Prevention, of nearly 1 million prostate biopsies conducted in the U.S. annually, 209,292 men were diagnosed with prostate cancer. Most post-biopsy infections are caused by E. coli and arise from direct inoculation of bacteria from the rectal mucosa in the urinary tract and surrounding area. The reported rates of post- biopsy infections range for 2 to 6 percent, and overall hospital readmissions have been reported as high as 6.3 percent.

Researchers assessed the incidence of fluoroquinolone resistance in E. Coli of adult patients undergoing prostate biopsy based on the study at Rhode Island Hospital. The researchers evaluated the effect of culture-directed prophylaxis on the risk of infectious complications after biopsy and found that 12.8 percent of the patients had pre-existing, drug-resistant E.coli on the rectal swab cultures. Additionally, they noted that there was a lower likelihood risk of

infectious complications for patients receiving prophylaxis based on pre-biopsy rectal swab cultures, but the differences did not reach statistical significance because of the study size.

Nevertheless, patients had longer hospitalizations for post-procedure infection (3 days versus 1.6 days) when they did not have the pre-biopsy rectal swab cultures done and they developed an infectious complication after the biopsy. While 40 percent required continued outpatient treatment with IV antibiotics for those infections, compared with the 16.6 percent of the group treated with culture-directed antibiotics.

“As men are increasingly opting for active surveillance of prostate cancer, infectious risks associated with prostate biopsy are becoming particularly relevant,” said Jessica Dai, M.D., a co-author who is now with the University of Washington. “We hypothesized that the incidence of infections would decline after instituting this new screening process, and they did. Not only did we see that, we also met our secondary aim of establishing the local incidence of fluoroquinolone-resistant and extended-spectrum beta-lactamase (ESBL)- producing bacteria in rectal swab cultures.”

For more information about various urological conditions, visit Dr. Bert Vorstman at http:// www.urologyweb.com/exclusive-medical-reports/
Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/
Contact him directly at bvorstmanmd@gmail.com.

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Healthy lifestyle linked to better kidney disease (CKD) outcomes

Data suggests that four healthy behaviours were associated with a 68% decreased risk of all- cause mortality.

Patients with chronic kidney disease (CKD) who have a healthy lifestyle has been linked to lower risks of heart attack, stroke, and other ailments in the general population, but also raised some new questions.

Ana C. Ricardo, MD, of the University of Illinois at Chicago, and colleagues assessed adherence to four healthy lifestyle factors such as regular physical activity, body mass index (BMI) 20.0 to 24.9 kg/m2 (normal weight), smoking abstinence, and a healthy diet – using baseline data for 3,006 adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study.

According to results that the investigators compared with these lifestyle factors 4 years later, adhering to all behaviours was associated with a 68% lower risk of early death from all causes. Published online ahead of print in the American Journal of Kidney Diseases, the results revealed that regular physical activity and smoking abstinence were also specifically linked with reduced odds of early death. In addition, not smoking was associated with decreased risks of kidney disease progression and cardiovascular events such as heart attack and stroke.

Investigators found reduced risks of renal and cardiovascular events for BMI 25 kg/m2 and above (overweight) and early death for BMI 30 kg/m2 and above, which means higher BMI was linked to better outcomes. Meanwhile, a BMI below 20 kg/m2 (underweight) was linked to double the risk of premature death from all causes.

“The current findings emphasize the need for further research to evaluate the relationship between BMI and outcomes in patients with CKD and determine what represents an ideal BMI for this population,” the researchers wrote.

For more information about various urological conditions, visit Dr. Bert Vorstman at http://www.urologyweb.com/exclusive-medical-reports/

Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/

Contact him directly at bvorstmanmd@gmail.com.

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Novel Peyronie’s Disease Treatment Shows Efficacy

Spanish researchers reported in The Journal of Sexual Medicine that penile traction therapy (PTT) is an effective treatment for the acute phase of Peyronie’s disease (PD).

About 55 patients who underwent PTT, a novel penile extender device therapy, were studied for 6 months for acute phase (AP) of Peyronie’s by Juan Martinez-Salamanca, MD, PhD, of the Department of Urology at the Autonomous University of Madrid. These patients were compared with 41 patients in the acute phase of Peyronie’s disease who receive no active treatment.

Mean curvature in patients treated with PTT had decreased from 33° to 15° at 6 months and 13° at 9 months from baseline with a mean decrease of 20°. The proportion of patients unable to achieve penetration decreased from 62% to 20% which shows that erectile function and hardness improved significantly.

PTT was associated with the disappearance of sonographic plaques in 48% of patients treated. Thus, the need for surgery was reduced in 40% of patients who would otherwise have been eligible and the complexity of surgical procedures was further simplified in 1out of 3 patients.

The non-active treatment group had a significant increase in penile deformity, where function and hardness worsened and stretched flaccid penile length had decreased.

“PTT seems an effective treatment for the AP of PD in terms of pain reduction, penile curvature decrease, and improvement in sexual function,” the authors concluded.

For more information about various urological conditions, visit Dr. Bert Vorstman at http://www.urologyweb.com/exclusive-medical-reports/

Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/

Contact him directly at bvorstmanmd@gmail.com.

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Urologists play vital role in tobacco, bladder cancer intervention

According to a study published in Cancer, patients with bladder cancer, smoking status and primary source of information correlate with awareness of the harms of tobacco use.

Jeffrey C. Basset, M.D., M.P.H., from the University of California in Los Angeles, and colleagues surveyed a stratified, random sample of bladder cancer survivors about tobacco use, risk factors, and sources of information on the causes of bladder cancer.

Of the 790 eligible participants who completed the survey, 68 percent had a history of tobacco use and 19 percent were active smokers at baseline. It was found that tobacco use was the most cited risk factor for bladder cancer, with active smokers more knowledgeable than former or non smokers (90 versus 64 and 61 percent, respectively; P < 0.001).

Urologists were the predominant source of information, with active smokers most often citing them (82 percent). Multivariate analyses revealed that active smokers had 6.37-fold higher odds of endorsing tobacco use as a risk factor for bladder cancer compared to non smokers.

Meanwhile, smokers who cited their urologist as their information source had 2.80-fold higher odds of believing their cancer was caused by tobacco use. “Urologists play a critical role in ensuring patients’ knowledge of the connection between smoking and bladder cancer, particularly for active smokers who may be motivated to quit,” the authors write.

For more information about various urological conditions, visit Dr. Bert Vorstman at http://www.urologyweb.com/exclusive-medical-reports/

Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/

Contact him directly at bvorstmanmd@gmail.com.

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Preventing male infertility: 12 natural ways to make healthy sperm

The American Society for Reproductive Medicine have released a recent study done on couples, that for about 30 percent of them, the cause of infertility has something to do with the male’s health.

The men may have normal semen analysis results; unfortunately, there are still factors that are affecting the chances of getting couples pregnant. Moreover, a study in The Journal of Neuroscience found that children born to men who are stressed had a reduced response to stress, and are also linked to anxiety and depression.

So, you want to get pregnant? Boost your guy’s fertility and increase your chances of getting pregnant with these tips:

  1. Junk the junk food.

    Bridgit Danner, a licensed acupuncturist and fertility specialist at Blue Sky Wellness Studio in Portland, Oregon and author of “Making Super Sperm,” said, “It takes away nutrients you could be using to make sperm.” Fertility is affected due to an inflammation in the body from eating processed, packaged and fast foods.

  2. Pomegranate diet.

    “Testosterone has bad side effects and it’s not for everyone,” according to Dr. Patrick Fratellone, an integrative physician and an herbalist in New York City. Pomegranate seeds are better alternatives to boosting the hormones because they are a natural aromatase inhibitor, which prevents testosterone from being converted into estrogen.

  3. Grab that gym bag.

    Danner adds, “Exercise raises your testosterone and that helps you make sperm.” However, excessive exercise or overtraining can deplete vitamins and stored hormones. Too much time on a bike or in spinning class can also put excessive pressure on the testicles.

  4. Do away with anything plastic.

    A study in Fertility and Sterility found that men who are exposed to phthalates, a group of chemicals present in plastic containers and hair products, took 20 percent longer to get their partners pregnant. Opt for glass over plastic and check the Environmental Working Group’s website for safer products that you can use.

  5. Beat the squirrel to the punch.

    A study in the Journal Biology of Reproduction found that men who include almonds, Brazil nuts and walnuts in their diet improve their sperm vitality, motility and morphology. It has been known that most nuts are filled with selenium, zinc and copper which help sperm count.

  1. Mushroom treat

    Fratellone added that Reishi mushrooms, which strengthen the immune system, anti-inflammatory and can prevent and treat candida yeast growth in the colon, a phenomenon that makes it hard for sperm to function. Include these mushrooms into your diet and reap the benefits. Shiitake and cordyceps are also good choices and can be eaten whole and much better than taking a pill.

  2. The building blocks of protein

    Proteins are important to make healthy sperm and the amino acids, as the building blocks of protein, are believed to give you that healthy sperm. L-arginine and l- carnitine are two that have been used to reverse male infertility and these are available in many food sources. If you will be taking the capsule form, be sure to check with an integrative physician, naturopathic or herbalist for the correct dosage.

  3. Keep the sunscreen to a minimum

    The National Institutes of Health have recently released a study that high levels of exposure to two UV filters – BP-2 and 4OH-BP, found in sunscreen and other personal care products, had a 30 percent reduction in fertility. Cut down on using too much of these products as much as you can and better hit the shower after a day under the sun and using sunscreen, as those ingredients may not be listed on the label and washing it off may help remove the filters from your body.

  4. Smoking is hazardous to your health.

    If you really want to get pregnant, quit smoking – that gives you another reason to refrain from buying the cigarettes next time. Smoking and taking marijuana can cause oxidative stress and damage your sperm. Also, a recent study in the Journal Human Reproduction found that smoking marijuana can change the size and shape of the sperm, let alone destroy your brain cells.

  5. Try herbs

    The American ginseng, rosemary, green tea, turmeric, resveratrol and saw palmetto are just some of the herbs that can help sperm production. Additionally, Tribulus is also a well known herb to help testosterone and increase sperm count and aid the motility of the sperm. It also prevents anti-sperm antibodies from partying in your body.

  6. Go commando

    It doesn’t only induce sexual come-ons but not wearing underwear occasionally or wearing loose fitting cotton underwear can also help increase sperm production.

  7. Stress-free life

    Aim for a stress-free life and get enough sleep. No sleep and stress can take a toll on your adrenal glands and affect sperm production. Give yourself time to relax, sleep an extra hour and have as much fun with your spouse and friends as you can.

For more information about various urological conditions, visit Dr. Bert Vorstman at http://www.urologyweb.com/exclusive-medical-reports/

Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/

Contact him directly at bvorstmanmd@gmail.com.

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AUA Kidney Stone Guidelines Unveiled

Orlando – The American Urological Association (AUA) unveiled its first guidelines on the medical management of kidney stones. Margaret S. Pearle, MD, PhD summarized the recommendations in a presentation during the announcement at AUA’s 2014 annual meeting.

Dr. Pearle, who chaired the panel that reviewed the available evidence that formed the basis of the guidelines, noted that kidney stones are a common problem with a high rate of recurrence. Evidence suggests that medical management is underused despite effective and established treatment regimens. She added that management of patients with recurrent stones lacks uniformity.

The first guidelines include 27 statements under the categories of evaluation, diet therapies, pharmacologic therapies and follow-up. Dr. Pearle, professor of urology and internal medicine at the University of Texas Southwestern Medical Center in Dallas said that all patients diagnosed with a stone should have a screening evaluation that consists of dietary intake, medical therapies, serum chemistries, urinalysis, and urine culture. She added that the evaluation is aimed at identifying medical conditions associated with stone formation, specifically primary hyperparathyroidism or type 2 diabetes, dietary aberrations, such as low or high calcium intake or excessive intake of animal protein, or medications such as topiramate.

Primary hyperparathyroidism or distal renal tubule acidosis are some of the underlying conditions that may be associated with recurrent stones. Serum chemistries should be obtained to define these conditions and measuring serum parathyroid hormone is considered an optional study that should only be obtained if primary hyperparathyroidism is suspected.

In addition, Dr. Pearle stated that “a stone analysis should be obtained at least once if a stone is available because knowledge of stone composition can implicate certain underlying etiologies, such as a low urine pH in patients with uric acid stones.”

Metabolic testing should be performed in high-risk or interested first-time stone formers as well as in recurrent stone formers and should consist of one or preferably two 24-hour

urine collections obtained under random diet. “The 24-hour urine is then used to guide recommendations regarding dietary measures and medication.” These urine collections should then be analysed for total volume, pH, calcium, oxalate, uric acid, citrate, sodium, potassium, and creatinine.

The guidelines also recommend that:

  • ●  All stone formers should be advised to drink enough fluids to achieve a urine volume of at least 2.5 liters daily.
  • ●  Patients with calcium stones and high urinary calcium should be advised to limit their sodium intake and to consume the recommended daily allowance of calcium of 1,000 to 1,200 mg daily.
  • ●  Patients with uric acid stones and calcium stones and high urinary uric acid should be advised to limit their intake of non-dairy animal protein. About 30% of urinary uric acid is derived from dietary purine intake, and animal protein accounts for most purine intake, Dr. Pearle noted.
  • ●  Patients with high urinary calcium and recurrent calcium stones should be offered thiazide diuretics because these medications act directly on the distal renal tubule and indirectly at the proximal renal tubule to promote renal calcium reabsorption.
  • ●  Patients with recurrent calcium stones and low urinary citrate should be offered potassium citrate because this medication provides an alkali load that promotes a citraturic response and increases urinary inhibitory activity.
  • ●  Patients with recurrent calcium stones and who have hyperuricosuria should be offered allopurinol.
  • ●  Thiazide diuretics and/or potassium citrate should be offered to patients with recurrent calcium stones in whom no metabolic abnormality is identified or in whom appropriate metabolic abnormalities have been addressed but stone formation persists.
  • ●  Allopurinol should not routinely be offered as first-line therapy to patients with uric acid stones. Uric acid nephrolithiasis is primarily a disease of urinary acidification, and at a pH greater than 6 to 6.5, most uric acid will be found in its soluble or dissociated form, and even high amounts of uric acid at these higher urinary pHs will be fully solublized, Dr. Pearle explained.

    Dr. Pearle concluded her talk by mentioning the importance of follow-up. “Success in gauged by improvement in urinary stone risk factors and ultimately by reduction in stone formation,” she said. Serial urine collections must be obtained to address changes in urinary risk factors.

For more information about various urological conditions, visit Dr. Bert Vorstman at http://www.urologyweb.com/exclusive-medical-reports/

Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/

Contact him directly at bvorstmanmd@gmail.com.

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Study links sunscreen to impaired male fertility

Men’s ability to father children in a timely manner may have been caused by certain sunscreen chemicals, according to a recent National Institutes of Health (NIH) study on male infertility called ‘interesting but very preliminary.”

The NIH and the New York state Department of Health’s Wadsworth Center has agreed and noted that the results are initial findings only and that additional studies are needed to confirm the findings.

Sunscreens and other personal care products that protect skin and hair from sun damage have chemicals such as Benzophenone (BP) – type ultraviolet (UV) filters, comprises a class of about 29 other chemicals in the product. Upon absorption by the skin, some of these chemicals can interfere with the body’s hormones and endocrine system processes. Men with high exposure to UV filters of BP-2 or 4OH-BP had a 30% reduction in fecundity – the biological ability to reproduce, researchers found.

“In our study, male fecundity seems to be more susceptible to these chemicals than female fecundity. The women participants actually had greater exposure to the UV filters overall, but their exposure wasn’t associated with any significant pregnancy delays,” said Germaine Louis, PhD, of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, MD in a news release. “Our next step is to figure out how these particular chemicals may be affecting couple fecundity or time to pregnancy—whether it’s by diminishing sperm quality or inhibiting reproduction some other way.”

Study findings were published online in the American Journal of Epidemiology (Nov. 13, 2014).

The study was conducted on 501 couples who were trying to conceive, who were recruited from 16 countries in Michigan and Texas in 2005 through 2009. These couples were part of the Longitudinal Investigation of Fertility and the Environment (LIFE) study. This study was established to examine relationships among fertility, lifestyle factors, and exposure to environmental chemicals. The female participants ranged from 18 to 44 years old and the men were over 18; none of them had a medical diagnosis of infertility.

The couples were observed until pregnancy or up to one year of trying to conceive and the researchers recorded the time it took for the women to become pregnant. The researchers tested the participants’ urine samples and measured concentrations of five selected UV filters

associated with endocrine-disrupting activity. The researchers controlled for age, body mass index, and smoking, among other factors.

Their findings suggest that some, but not all, UV filters may be associated with diminished fertility in men, independent of their partners’ exposure. About 75th percent and above among the men were observed with the highest exposure to UV filters BP-2 or 2OH- BP.

For more information about various urological conditions, visit Dr. Bert Vorstman at http://www.urologyweb.com/exclusive-medical-reports/

Dr. Vorstman also blogs at http://www.urologyweb.com/uro-health-blog/

Contact him directly at bvorstmanmd@gmail.com.

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