Urologic oncologist talks about the new Men’s Sexual Health Clinic at Roswell Park
By Chris Motola
Q: You have a fairly uncommon subspecialty. Tell us more about that.
A: My training is mainly dealing with urologic oncology. We do a bit of general urology, but our main focus is urological cancers and their treatment.
Q: What kinds of cancers fall into your subspecialty?
A: Different urological cancers, including kidney cancer, prostate cancer, bladder, penile cancers. The ones that may have sexual side effects are mainly prostate cancer, bladder and penile cancers.
Q: Roswell Park has recently established a new Men’s Sexual Health Clinic. What’s the most common issues and concerns you’re hearing from patients?
A: Some of the most common issues are urine leak and issues with urination. This can be from bladder dysfunction after certain types of surgery or a benign enlargement of the prostate, which can happen as men get older. In some situations, it can significantly affect quality of life or even the ability to make plans. You can come to us for a candid discussion about what’s going on, and we can offer you solutions to help you regain your health and confidence.
Q: How treatable are the types of sexual health issues?
A: Basically, the range of treatments can vary widely. We can start with physical therapy and then, if we need to, add medication. So we might start with exercises to strengthen the pelvic floor muscle. We even have an app that helps instruct the patient in how to do the exercises in the right way and monitor their progression. We’re also running studies on urine control using just exercises over time.
Q: What sort of options are available for patients who are having these issues?
A: There are medications we can use, particularly for sexual dysfunction. The medications are very tolerable and most patients improve after taking them. The response to the medications depends on the patient’s age, and the baseline sexual function. If the patient didn’t have good sexual functioning prior to a surgery, then the chances of them recovering sexual function after a surgery become less. In that case, they may need more treatment in addition to education. And the final thing that matters with regard to sexual function is our ability to preserve nerves during the surgery. In most cases we’re able to perform nerve-sparing surgery. If the medications don’t work, we kind of take it to the next level, with options such as injections or even a vacuum device.
Q: One of the other issues you see is erectile dysfunction — what can cause that?
A: In addition to surgery, even more common is cardiovascular disease. An early sign of cardiovascular disease can be erectile dysfunction. We advise patients to start exercising, watch their diet, stop smoking — all of that is to improve their cardiovascular health, which in turn reduces your chances of having erectile dysfunction. At the very least, it can help avoid the more invasive treatments.
Q: It sounds kind of like it can be a multidisciplinary problem. Is that the case?
A: Yes. Your side effects do not have to be permanent. Addressing men’s sexual health issues in cancer care is as vital as physical therapy, mental health, and pain management. We often work with experts across all disciplines — from primary care to cardiology and psychiatry.
Position: Urologic oncologist at Roswell Park Comprehensive Cancer Center
Hometown: Cairo, Egypt
Affiliations: Roswell Park Comprehensive Cancer Center; Mount St. Mary’s Hospital Niagara Falls Memorial Medical Center
Education: Cairo University Medical School, Cairo, Egypt; Royal College of Surgeons, United Kingdom
Organizations: American Urologic Association; Society of Urologic Oncology
Family: Married, one daughter
Hobbies: Basketball; jogging; reading