Urologists have an opportunity to be the captain of men’s health. Let’s compare a man taking his car to a mechanic for maintenance with a man going to the doctor for a medical problem. In both situations, men will wait for an appointment unless it is an emergency. However, almost no routine automobile service lasts only 15–20 minutes, but a routine physical examination with a doctor is supposed to fit into that 15- to 20-minute time frame. Consider the average middle-aged man with hypertension and high cholesterol who owns a Volvo. The regular maintenance schedule for his car is every 10,000 miles. According to a J.D. Power 2013 U.S. Customer Service Index Study, car owners visit a dealer service department an average of 2.8 times per year.¹ The patient will most likely see his doctor twice a year for a total of 40 minutes, compared to time spent with his car mechanic 3 times a year—usually for at least an hour or 2 for each visit. The take-home message is that this prototypical patient will be spending much more time with his car mechanic than face-to-face with his doctor.

Where women will start seeing a doctor, usually an obstetrician/gynecologist, in their 20s, men don’t start seeing a doctor until age 50, when prostate symptoms bring them to the attention of a urologist. The conditions of erectile dysfunction (ED), hypogonadism, nephrolithiasis and vasectomy will bring a man aged 20–50 years to see a urologist. Oftentimes these men presenting with ED are given prescriptions for phosphodiesterase type 5 inhibitors to resolve the symptoms of ED. However, we are aware that a man aged 40–60 years presenting with ED is 50 times more likely to experience a cardiac event. The ED is the symptom that foretells of a future myocardial infarction since the penile artery is 1–2 mm in diameter compared to the coronary arteries, which are 3–5 mm in diameter, with symptoms of ED occurring before cardiac symptoms.² This difference in rate of occurrence of symptoms is caused by the different size of the arteries, which allows a larger vessel to better tolerate the same amount of plaque compared with a smaller one.

So, how can we harness this opportunity when so many men will be visiting their urologist prior to developing urinary tract obstructive symptoms? This requires educating young men and also our nonurological colleagues. There is an abundance of evidence that ED is a “red flag” risk for cardiovascular disease. This information should be made available to primary care doctors, endocrinologists and cardiologists, and these men need a cardiac evaluation besides treatment for their ED. Any patient who arrives in the office of a urologist with ED symptoms should be referred for further cardiac workup.

Another opportunity is to provide educational material to partners of young men and let them know that sexual problems often portend cardiac problems and need to come to the attention of a health care provider. It is common for partners to direct the health care of men, and we need to be certain that they are aware of the connection between ED and endothelial dysfunction.

Much of this education of the public and our colleagues can be accomplished through using social media and blogs for getting the word out to the public. We can present grand rounds on this topic to our colleagues. When we do see a patient with ED, it is helpful to send patients to colleagues with educational material that demonstrates ED uncovers cardiovascular disease, diabetes, hypertension and metabolic syndrome.

Another area where we can offer education to young men is the importance of testicular self-examination. When we compare the number of women who perform breast self-examinations to men conducting testicular self-examination, we see that we have an opportunity to reach out to young men about the importance of conducting this self-examination.³

Bottom Line: Let us not squander the opportunity to provide more service and education to our patients than just treating symptoms and prescribing medications. We can be a great resource for men, especially younger men, before they develop urinary symptoms.