my dear brothers
ItalianguyinLA32
(miamiguy,rhemium, and dr jd i thank all of u for your knowledge my
brothers)..first my brothers we seem to be spending all this time trying to
find a cure for this problem..since we all have not found one true cure..we are
all forced to continue to live with this shit...so why don't we all base more
emphasis on the cause of our little problems..(u no like we learned in high
school..cause and effect).....for example for the past 3months i was believing
i was the cause of my problems...with my compolsive masterbating and sexual
acts along with my prolonging ejaculation for a week...i believe this was my
down fall (holding that shit in to long)....but three months later i am no
longer sure it was me causing this problem...i now believe my problem may be
work related...for i am a courier with fed ex so i drive a lot.on a bumpy as
road all day long...everday i come home from work i still feel like my whole
urological and digestive system is still vibrating...that includes my ass and
my dick my brothers..so i ask u all to take a long around and analyze what u r
all doing...for the men with pains in there nutts..maybe your underwear or
jeans are too tight..maybe your chicks or boyfriends are sucking on your nutts
to hard (no offense to my gay brothers) or maybe we are sticking our dicks in
places where it should not be and maybe some of us are having dicks put in
places where they should not be (again no offense my gay bros)..so my brothers
in closing pay close attention to what the cause are to our problems...stop
just looking for the cure..maybe we all can beat this problem ..stayed tuned
for my next posting till then piece out bros...love u all
JORDAN DIMITRAKOV, MD, PhD
Thanks for your message. Yes, I'm sure we all want to know what the cause of
all this is. It has, for a long time, been appreciated that sitting on a
bicycle seat has urological consequences, in the forms of prostatitis,
urethral stricture, hemospermia, penile numbness and, more recently,
erectile
dysfunction (ED). More recently, there has been an accumulation of evidence
demonstrating the deleterious effects of perineal compression when sitting
for
prolonged hours (as you mention) or bicycling. In 1983, Kerstein et al
(Perineal trauma and vasculogenic impotence. J Urol 1982; 127:57-60)
demonstrated that healthy medical students with normal erectile function had
a
significant reduction in their penile brachial index (PBI) measurement when
sitting on a bicycle seat. Mulhall and Goldstein have clearly demonstrated
that being seated on a narrow sports bicycle seat causes a dramatic
reduction
in peak systolic velocity (PSV) during penile Doppler ultrasound. This
reduction is significantly greater than that during compression using a wide
("exercise bike") padded seat or when being seated on a chair. There was a
60
% reduction in PSV and some men had complete occlusion of their cavernosal
arterial blood flow. On dynamic infusion cavernosometric analysis, using
perineal compression with a mounted bicycle seat, cavernosal artery
occlusion
occurred when a mean of 12 % of body weight was applied. Using a simliar
perineal compression model during selective internal pudendal arteriography,
arterial occlusion was demonstrated to exist anatomically beneath the
ischiopubic ramus. This is the exact point at which traumatic arterial
occlusion is seen following pelvic fracture and blunt perineal trauma (which
includes prolonged erection and masturbation).
I will be presenting more details on these mechanisms in Anaheim.
Several comments based on these data:
It appears that sitting on a narrow bicycle seat causes a reduction in
cavernosal artery blood flow. There is still a scientific bridge to cross to
prove that cycling causes ED and CPPS. However, three factor make this more
plausible.
First, the belief that arterial intimal disruption is required to cause
occlusions erroneous. It has been demonstrated that non-denuding injuries
may
set up a cascade of events that result in intimal proliferation and
occlusion.
Second, the position of the internal pudendal/perineal arteries in Alcock's
canal predisposes them to compression injury. Indeed, some cyclists, esp.
those cycling long-distance or cycling on frequent basis, experience penile
numbness. This is a hallmark of compression injury to Alcock's canal. These
sensory changes may imply that high compression forces have been applied to
the perineal nerve, which sits alongside the artery. Therefore, both artery
and nerve must have been exposed to the compression force. Continued
arterial
compression may set up a peri-arterial fibrotic reaction, or intimal
proliferation might ensue. Current opinion indicates that anti-fibrotic
medications rather than operation (release techniques) result in better
long-term success rates.
Third, and most important, recent epidemiological data indicate a two-fold
incidence of sexual dysfunction in men belonging to a cycling club as
compared
with age-matched controls belonging to a running club [Salimpour P,
Dousonian
M, Cantey-Kiser et al. Sexual and urinary tract dysfunction in cyclists. Int
J
Impot Res 1998;10(Suppl 3): S63.]Based on the available data young men
should
be aware that cycling practices, prolonged erection, prolonged sitting that
all involve significant perineal compression forces, such s mountain or
off-road biking or cycling, which are associated with penile numbness, may
lead to arteriogenic erectile dysfunction and cpps which cannot be treated
surgically.
This communication is intended to provide general information, and in
no way is a substitute for face-to-face medical care. No implication
of a doctor-patient relationship should be assumed by the reader.
Best regards,
Jordan Dimitrakov, MD, PhD
Are you a twin with CPPS or IC? Do you have a brother, sister, or other
relatives with CPPS/IC? If you want to make a change, help yourself and
others with these devastating conditions, please e-mail me at:
jdimi...@my-deja.com. Anonymity guaranteed!
NiceShyMiamiGuy
get better - ahahahahahahahaha
bob...@homo.com
Using a similar
> perineal compression model during selective internal pudendal arteriography,
> arterial occlusion was demonstrated to exist anatomically beneath the
> ischiopubic ramus. This is the exact point at which traumatic arterial
> occlusion is seen following pelvic fracture and blunt perineal trauma (which
> includes prolonged erection and masturbation).
What exactly is one of the consequences of prolonged erection in this
sentence?
> M, Cantey-Kiser et al. Sexual and urinary tract dysfunction in cyclists. Int
> J
> Impot Res 1998;10(Suppl 3): S63.]Based on the available data young men
> should
> be aware that cycling practices, prolonged erection, prolonged sitting that
> all involve significant perineal compression forces, such s mountain or
> off-road biking or cycling, which are associated with penile numbness, may
> lead to arteriogenic erectile dysfunction and cpps which cannot be treated
> surgically.
>
I cannot understand this sentence either. These two sentences imply
that there are some adverse consequences to prolonged erection. What
are those adverse consequences they are referring to?
JORDAN DIMITRAKOV, MD, PhD
>"JORDAN DIMITRAKOV, MD, PhD" wrote:
>
> Using a similar
>> perineal compression model during selective internal pudendal
arteriography,
>> arterial occlusion was demonstrated to exist anatomically beneath the
>> ischiopubic ramus. This is the exact point at which traumatic arterial
>> occlusion is seen following pelvic fracture and blunt perineal trauma
(which
>> includes prolonged erection and masturbation).
>
>What exactly is one of the consequences of prolonged erection in this
>sentence?
----> ED ----> pain (diagnosed as CPPS/prostatitis)
>> M, Cantey-Kiser et al. Sexual and urinary tract dysfunction in cyclists.
Int
>> J
>> Impot Res 1998;10(Suppl 3): S63.]Based on the available data young men
>> should
>> be aware that cycling practices, prolonged erection, prolonged sitting that
>> all involve significant perineal compression forces, such s mountain or
>> off-road biking or cycling, which are associated with penile numbness, may
>> lead to arteriogenic erectile dysfunction and cpps which cannot be treated
>> surgically.
>>
>I cannot understand this sentence either. These two sentences imply
>that there are some adverse consequences to prolonged erection. What
>are those adverse consequences they are referring to?
========Arteriogenic ED - prolonged erection etc. results in the release of
substances (referred to as "factors" here) which lead to proliferation of
the
arterial wall, narrowing (obliteration) and Ed and CPPS symptoms. Hope this
answers your question.
Derek
"JORDAN DIMITRAKOV, MD, PhD" wrote.......
Mulhall and Goldstein have clearly demonstrated
> that being seated on a narrow sports bicycle seat causes a dramatic
> reduction
> in peak systolic velocity (PSV) during penile Doppler ultrasound. This
> reduction is significantly greater than that during compression using a
wide
> ("exercise bike") padded seat or when being seated on a chair. There was a
> 60
> % reduction in PSV and some men had complete occlusion of their cavernosal
> arterial blood flow. On dynamic infusion cavernosometric analysis, using
> perineal compression with a mounted bicycle seat, cavernosal artery
> occlusion
> occurred when a mean of 12 % of body weight was applied. Using a simliar
> perineal compression model during selective internal pudendal
arteriography,
> arterial occlusion was demonstrated to exist anatomically beneath the
> ischiopubic ramus. This is the exact point at which traumatic arterial
> occlusion is seen following pelvic fracture and blunt perineal trauma
(which
> includes prolonged erection and masturbation).
These are tests I have asked the specialists 3-4 times, and they always
refuse? I've been told that there are no more tests they can do? Blood flow
and pudendal nerve damage could be important in diagnosing bilateral
testicular pain! The only chance I have of getting this done is if I
convince my GP with research to back it up, and then he might agree to set
it up! Both my uros stick to the cystoscopy, urine, scrotal/abdominal
ultrasounds, and then of course.....referral to chronic pain specialist!!
JORDAN DIMITRAKOV, MD, PhD
>"JORDAN DIMITRAKOV, MD, PhD" wrote.......
>These are tests I have asked the specialists 3-4 times, and they always
>refuse? I've been told that there are no more tests they can do? Blood flow
>and pudendal nerve damage could be important in diagnosing bilateral
>testicular pain!
The only chance I have of getting this done is if I
>convince my GP with research to back it up, and then he might agree to set
>it up!
=====I doubt you'll convince him but ...good luck.
Both my uros stick to the cystoscopy, urine, scrotal/abdominal
>ultrasounds, and then of course.....referral to chronic pain specialist!!
=====Cystoscopy is importnat only if it combined with hydrodistension (to
exclude IC), at least IMHO
Anonymous
> Thanks for your message. Yes, I'm sure we
> all want to know what the cause of all this is.
> It has, for a long time, been appreciated that
> sitting on a bicycle seat has urological
> consequences, in the forms of prostatitis,
> urethral stricture, hemospermia, penile
> numbness and, more recently, erectile
> dysfunction (ED).
Yes, this was discussed here some time back. But here is an excellent
article, which discusses the neurogenic pain aspects too, which I feel
are **far** more important than the blood flow aspects in the etiology
of CPPS:
http://www.drkoop.com/news/focus/july/cycling.html
I think we need to stress the nerve damage aspects more. Blood flow in
CPPS prostates seems more than adequate.
_____________________________________________________
\\\/ Questions about CPPS/CP/Prostatitis/IC?
(..) Visit http://cpps.50megs.com
/C \
/____\ Having a biopsy? Be sure to ask for
\\++// a mast cell evaluation!
__> <__
_\/_
Are you a twin with CPPS, or do you have close relatives
with lower urinary tract symptoms? Contact Dr Jordan
Dimitrakov at jdimi...@yahoo.com with details of
your case to help him with research in progress.
bob...@homo.com
> ======Prolonged erection ----> arterial occlusion ----> decreased blood flow
>
> ----> ED ----> pain (diagnosed as CPPS/prostatitis)
> ========Arteriogenic ED - prolonged erection etc. results in the release of
> substances (referred to as "factors" here) which lead to proliferation of
> the
> arterial wall, narrowing (obliteration) and Ed and CPPS symptoms. Hope this
> answers your question.
>
Thank you very much doc!
A couple of questions now:
1. How can I tell whether I have this condition (arteriogenic ED) or
not?
2. Are there any tests to determine whether or not one has
arteriogenic ED and what is the likelihood of my doctor ordering them?
3. Are there any known treatments for this condition and is it
permanent? Does it tend to get better with time? Does Viagra help?
4. When you speak of prolonged erection, are you talking only
specifically about priapism (which is well-known to cause this) or
also about non-priapic instances such as might occur prolonged
erection during intercourse or masturbation?
jqp
tests. You may have to look into seeing someone in the status of a
Goldstein (Boston), Mulcahy (Indy), Montague (?Cleveland), or Lue (SF) to
get these. Your "average urologist" may not have access to these tests, nor
know how to interpret the findings even if he could.
Just my $0.02
jqp
_____
"Derek" <ban...@telus.net> wrote in message
news:07AN6.31487$Rd.54...@news0.telusplanet.net...
Derek
"jqp" wrote.....
I know of only a limited number of centers who routinely do these sorts of
> tests. You may have to look into seeing someone in the status of a
> Goldstein (Boston), Mulcahy (Indy), Montague (?Cleveland), or Lue (SF) to
> get these. Your "average urologist" may not have access to these tests,
nor
> know how to interpret the findings even if he could.
>
> Just my $0.02
I'm Canadian........health care is basically free. Broken arm, leg...etc,
no problem, but when it comes to specialized tests, it's difficult up here
too! I may have to go to some other country, but I'm going to exhaust every
option up here first........
Jeff Parker
JORDAN DIMITRAKOV, MD, PhD <dimit...@MailAndNews.com> wrote in article
<3B2D...@MailAndNews.com>...
> >===== Original Message From "bob...@homo.com" <bob...@homo.com> =====
> >"JORDAN DIMITRAKOV, MD, PhD" wrote:
> >> Impot Res 1998;10(Suppl 3): S63.]Based on the available data young men
> >> should
> >> be aware that cycling practices, prolonged erection, prolonged sitting
that
> >> all involve significant perineal compression forces, such s mountain
or
> >> off-road biking or cycling, which are associated with penile numbness,
may
> >> lead to arteriogenic erectile dysfunction and cpps which cannot be
treated
> >> surgically.
> ========Arteriogenic ED - prolonged erection etc. results in the release
of
> substances (referred to as "factors" here) which lead to . . .
>narrowing (obliteration) and Ed and CPPS symptoms.
I bicycled seriously prior to the onset of CPPS, w/occasional numbness; my
latest flare-up followed several sessions on a stationary bicycle, albeit a
recumbent (i.e. no narrow seat). My symptoms include suprapubic and
testicular pain. What exactly causes the pain -- is it reduced blood flow
to the nerve or direct compression damage to the nerve? Given the pain I
describe, is bicycling a plausible explanation for these symptoms? What
would the treatment be, if any? Thank you. JP
JORDAN DIMITRAKOV, MD, PhD
=====
>snip<
I bicycled seriously prior to the onset of CPPS, w/occasional numbness; my
>latest flare-up followed several sessions on a stationary bicycle, albeit a
>recumbent (i.e. no narrow seat). My symptoms include suprapubic and
>testicular pain. What exactly causes the pain -- is it reduced blood flow
>to the nerve or direct compression damage to the nerve?
cascade of cytokines some of which, in addition to their direct
proinflammatory action, have a pro-fibrotic activity - e.g. TGF-beta
(transforming growth factor beta). Obviously, there is an interface between
inflammation and fibrosis.
Given the pain I
>describe, is bicycling a plausible explanation for these symptoms?
=====Yes.
What
>would the treatment be, if any?
====First, an evaluation of the intactness of the arteries. Second,
anti-fibrotic medications (obviously, not antibiotics).
Prostate Anonymous
Is Mulcahy a good person to see for prostatitis in general? I took a
look and he is in my area and is covered by my insurance.