Interview with NYC Urologist Dr. Michael Rotman

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Michael Rotman, MD, is a board-certified Urologist who offers his patients over two decades of expertise. He graduated from the Mount Sinai School of Medicine in 1997. Dr. Rotman is affiliated with Lenox Hill Hospital, Mount Sinai Beth Israel and St. John’s Episcopal Hospital.

Dr. Rotman’s reputation is outstanding, both amongst his patients and among his peers, and he has authored numerous published works. He is active in a number of professional and academic societies. As a true polyglot, Dr. Rotman is pleased to conduct your appointment in English, Russian, Spanish, or Yiddish.

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Affiliations

American Urologic Association
American Foundation for Urologic Diseases
New York State Medical Society
American Society of Reproductive Health

Here are some of the more common conditions he treats:

Anejaculation
Bladder cancer
BPH
Delayed Ejaculation
Erectile Dysfunction
HSDD
Infertility
Kidney stones
Kidney cancer
Low Testosterone
Peyronie’s Disease
Premature Ejaculation
Prostate Cancer
Retrograde Ejaculation

Dr. Rotman will be answering questions periodically on ExcelMale.com. We are excited and honored to have him as an active member helping us with our mission to educate all men about how to proactively take charge of their health.

To make an appointment with him, email support@primebody.com

These are questions previously posted by Excelmale.com members for Dr. Rotman. I included links for further reading. This is the first of a series of short interviews about urology-related health issues that we will have every quarter with Dr. Rotman.

1-Under what conditions should a man see an urologist instead of a primary care physician if you are self-insured?

A urologist can be seen for any conditions involving the kidneys, urethra, bladder, prostate, penis, scrotum, incontinence, impotence, or infertility. We are specially trained in treating these areas and surgical management of any urological conditions. In recent years we have become adept at treating hypogonadism which was in the past pushed aside in favor of other conditions.

2- As a man gets older his prostate normally enlarges, my understanding is daily Cialis can bring it back to normal size? Can an enlarge prostate cause ED?
Yes, it is true a prostate does enlarge as one gets older but Cialis (aka tadalafil) does NOT shrink prostates nor stall its growth. It does however relieve irritating lower urinary tract symptoms and therefore is approved for treatment of BPH as a first line drug.

Though an enlarged prostate does not cause ED directly, studies have shown patients with BPH tend to have worse erectile function.

3-How common are hard to treat prostatitis? What protocols are used to treat refractory cases?
Prostatitis is very common and “hard-to-treat ” (or refractory) cases are very common as well. Cases refractory to standard treatments such as antibiotics require a multimodal approach of dietary changes, pelvic floor therapy, and treatment of any BPH related symptoms. The use of alternative medicines/supplements can be employed as well.

Most cases of prostatitis are chronic non-bacterial prostatitis. Frequently antibiotics are prescribed multiple times with relief but then symptoms recur upon cessation of antibiotics. This is because they have an anti-inflammatory effect similar to ibuprofen. Thus after initially treating acute bacterial prostatitis, further treatment should not include antibiotics as it will only create resistance. Pelvic floor therapy is a generic term describing therapies such as trigger point therapy, acupuncture and other forms of physical therapy aimed at pelvic disorders.

4-For years I had urine low flow issues that some urologists thought it was BPH. Finally an urologist used ultrasound and detected calcium deposits in my urethra. Should all men with urinary flow restrictions get an ultrasound test?
Calcium deposits in the urethra and in prostatic tissue are not an uncommon finding. By itself it does not indicate anything significant nor require treatment. An ultrasound of the prostate is one of the many tests used in the diagnosis of BPH and/or lower urinary tract symptoms. No, not all men are required to have ultrasound in the diagnosis of BPH.

5-When do you use prostate ultrasound?
Ultrasound is used to indicate size and shape of prostate to guide one in selecting a form of therapy for a patient’s enlarged prostate. DRE is not accurate alone, but in combination with ultrasound and prostate biopsy it will pick up almost all significant cancers.

6-The Green Light laser technology used to remove my urethra calcium deposits caused retrograde ejaculation. How can that be prevented or reversed while using this procedure or other similar?
Retrograde ejaculation is an orgasm that results in no semen being ejaculated. It is being propelled backwards into bladder. It will result from most prostatic surgical procedures other than some minimally invasive techniques. It cannot be reversed. It can also occur with some medications and in diseases such as diabetes and spinal disorders.

Unfortunately one of the side effects of de-obstructing procedures such as Greenlight Laser, TURP, is retrograde ejaculation due to surgery on the bladder neck. It is usually irreversible and cannot be prevented by the standard Greenlight procedure.

7-When do you decide to do prostate biopsies? Has any progress been made to make that procedure less painful? How reliable is it in diagnosis cancer?
Prostate biopsies are performed on individuals with elevated PSA tests but each case has to be evaluated on an individual basis. A 75 year old man with a PSA of 4 and a negative rectal exam will not be treated the same as the 45 year old with the same results.

8-Do you rule out prostate infection that may be causing high PSA?
It is common to treat a high PSA initially with some antibiotics to eliminate the possibility of infection and/or inflammation. However the recommendation now is not to treat with acute bacterial prostatitis ( see question 3 above) but rather to make sure urine is sterile and to repeat PSA.

9-Why don’t more TRT/HRT doctors run a full thyroid panel when diagnosing a new patient? I realize thyroid issues aren’t as prevalent in men, but I would think it would help to get a more complete picture up front and further clarify the proper diagnosis/treatment for a new patient.
I always do run that in my panel but in my experience most patients in my experience have their thyroid condition diagnosed already by their primary care physicians when undergoing a full physical. It is rare that I am the first one to pick it up though it still happens as was the case this week in a patient with significant fatigue.

10-When would you recommend treatment for a hydrocele?
A hydrocele is the accumulation of fluid around the testicle and is very common. Treatment is indicated in patients with large hydroceles causing discomfort. Diagnosis via physical examination and sonogram as well as symptoms assessment is usually required to eliminate possibility of a hernia or other testicular masses such as malignancy.

11-What is the typical decision matrix for determining when a man has to stop TRT due to rising PSA or worsening of lower urinary symptoms?
Prostatitis- generally refers to inflammation of the prostate, but can and many times is part of larger syndrome called chronic pelvic pain syndrome which require a multidisciplinary treatment of the condition involving a multimodal approach. Antibiotics are generally not enough and may be the wrong approach in many cases.

PSA- Any significant rise in PSA (>0.3) should concern the patient and/or the urologist when starting TRT. Of course it is case dependent and a full examination and other blood tests such as a 4KScore, as well as risk factors and age, should be taken into consideration of discontinuation of TRT. This is a complicated question and requires the input of an experienced urologist who does TRT on a regular basis.

12-How does TRT impact varicoceles?
TRT doesn’t cause or impact varicoceles. Varicoceles which are varicose veins of the testicles can impact fertility in some cases and occasionally cause discomfort. A sonogram and semen analysis is part of the workup but if asymptomatic and not concerned about fertility they can be managed conservatively.

15-Can varicoceles decrease the testicles’ production of testosterone?
Varicoceles can cause decreased growth of testicles therefore can result in low testosterone if the disparity in testicular size is significant.

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