Dr. Tobias Wagner is a specialist in urology and is part of the renowned Center for Urology, which offers comprehensive urological care at its Wiesloch, Walldorf and Sinsheim locations. With his many years of experience and expertise, Dr. Wagner is an important part of the specialist medical team, which is characterized by first-class expertise and a holistic approach to the treatment of urological diseases. The Center for Urology is renowned for its cutting-edge diagnostics and treatment, particularly in the areas of men's health and urological oncology. Dr. Wagner plays a key role in the treatment of patients with urological cancers and precancerous lesions.
By working closely with prestigious institutions such as the Charité in Berlin and using the latest diagnostic techniques such as fusion biopsy and recurrence treatment of the prostate, he ensures precise and modern care. Dr. Wagner's commitment to the treatment of potency disorders and erectile dysfunction is particularly noteworthy, where he offers a variety of innovative treatment options, including drug treatments and shock wave therapy procedures. He also offers excellent diagnostics and therapeutic support in the field of andrology and the treatment of infertility. Dr. Wagner is also active in preventive care and the treatment of urinary incontinence, both areas that affect both men and women and require differentiated, sensitive care.
Patients benefit from his in-depth expertise and ability to develop individual treatment approaches tailored to their needs. With his affiliation to the Center for Urology, Dr. Wagner offers excellent medical care in a network that has gained a national reputation, especially in the field of outpatient surgery. Through the use of modern techniques and his empathetic patient care, Dr. Wagner makes a significant contribution to the high quality of urological care.
The editors of the Leading Medicine Guide were able to speak with Dr. Wagner on the subject of men's health.
Men's health is a central aspect of modern medicine that often receives too little attention, although many men are confronted with specific health problems in the course of their lives. Prostate problems and erectile dysfunction are particularly common in middle and old age. The prostate is an essential organ of the male reproductive system and its diseases, such as benign prostatic hyperplasia or prostate cancer, can cause both physical and psychological stress. In addition, many men suffer from erectile dysfunction, which can significantly affect their sexual well-being. Both issues are often associated with shame and reticence, which can lead to men seeking medical help too late. However, early diagnosis and an individualized treatment approach are crucial to maintaining quality of life and avoiding long-term health consequences.
"Prostate cancer screening as early detection is also very useful for symptom-free patients. If the tumor is detected at an early stage, limited to the prostate, the patient can be completely cured of the disease. However, early treatment not only improves life expectancy, but also functional results and therefore long-term quality of life. This is why all men over the age of 45 should have regular check-ups. However, there are various reasons why men often avoid going to the doctor. On the one hand, many men are embarrassed by the subject, and on the other hand, there are often misconceptions about preventive check-ups, which are often anticipated as unpleasant and rejected in advance. In addition, screening is not yet as well established for men as it is for women. Here, regular visits to the gynecologist are part of the routine. We men have to follow suit. Patients often start their visit with the sentence: ‘My wife sent me, otherwise I wouldn't have come’. That's why I'm always pleased to see so many women at information evenings and patient events," says Dr. Wagner at the beginning of our conversation.
Benign prostate enlargement (benign prostatic hyperplasia, BPH for short) and malignant changes such as prostate cancer differ both in their development and in their course and health consequences.
BPH is a widespread, age-related phenomenon that occurs in many men from middle age onwards. It is caused by hormonal changes, in particular a shift in the testosterone/dihydrotestosterone balance, and leads to an increase in prostate tissue, usually in the inner area of the gland. This increase in tissue can narrow the urethra and cause typical discomfort when urinating.
"The dangerous thing about malignant changes is that they usually don't show any symptoms at first. Often, symptoms only arise when a prostate tumor is locally advanced or has already spread. This is why prevention is so important. In contrast, benign enlargement of the prostate (benign prostatic hyperplasia) is a common clinical picture and a visit to the doctor is usually prompted by symptoms. Patients typically report a weakening of the urinary stream, more frequent and more urgent urination, nocturnal urination, dribbling and residual urine. These symptoms should be taken seriously and a urologist should be consulted. In the later stages, irreversible changes often occur, the symptoms get worse and complications such as infections, bleeding, stone formation and ultimately even urinary retention and kidney failure can occur. Early monitoring and treatment are therefore very important," explains Dr. Wagner emphatically.
A number of modern and proven procedures are now available for the reliable diagnosis of prostate diseases, which can be combined depending on the suspected diagnosis and individual risk situation.
"A distinction must be made here between the diagnosis of BPH and that of prostate cancer. In the case of BPH, a detailed medical history is taken first. Diagnostic tools include ultrasound, urinary stream measurement, transrectal palpation and standardized questionnaires. The size of the prostate can be determined most reliably by transrectal ultrasound. In Germany, transrectal palpation is currently the most common method for detecting prostate cancer. The main reason for this is that this is the only screening examination currently reimbursed by statutory health insurance companies. In my opinion, however, this is not sufficient. The PSA value, which is determined via a blood test, as well as other diagnostic procedures, can detect a significantly higher rate of prostate cancer. In particular, the combination of PSA, palpation and transrectal ultrasound is a sensitive form of early detection. This assessment also fits in with the current changes in the guideline recommendations. The trend is increasingly moving towards PSA, ultrasound and MRI-supported early detection," explains Dr. Wagner and continues:
"In the event of changes in PSA, palpation or ultrasound, a multiparametric prostate MRI can be performed for further diagnosis. Unfortunately, despite the high diagnostic potential and the central role that MRI now plays in the German prostate cancer guidelines, the costs are not covered by statutory health insurance, a situation that I find difficult to understand and which understandably often leads to resentment among my patients. However, this does not change the great benefit that this examination brings us. If necessary, the MRI can also spare the patient a prostate biopsy if an experienced radiologist finds the prostate to be unremarkable. If a biopsy is nevertheless necessary, this should only be carried out in accordance with the latest medical standards after a prostate MRI has been performed, and then as a so-called ‘fusion biopsy’ of the prostate. In this modern form of biopsy, the MRI and ultrasound images can be superimposed in real time in order to specifically target conspicuous areas in the MRI. Sophisticated and very helpful AI systems are now available for both MRI and fusion biopsy to support diagnostics and procedures".
Transrectal ultrasound (TRUS) is another method that is often used as part of the biopsy or to assess the size of the prostate, but often does not provide sufficient information about the nature of a change on its own. If prostate cancer is suspected, histological confirmation by means of a tissue sample - i.e. a biopsy - is still crucial for diagnosis and treatment planning.
Lifestyle factors play a significant role in the development and progression of prostate diseases as well as in the development of erectile dysfunction. A balanced diet, regular exercise and reducing stress can significantly reduce the risk of both health problems and have a positive impact on quality of life.
"Erectile dysfunction in particular is significantly influenced by our lifestyle. Cardiovascular diseases and diabetes are very common conditions that are linked to an unhealthy diet, stress, lack of exercise and obesity. These conditions in particular very often lead to erectile dysfunction caused by organic factors. Stress, worries and pressure to perform can also significantly affect the psyche, which can then also lead to a manifestation of erectile dysfunction. Accordingly, the first measures also include the recommendation to change lifestyle habits. In digital health applications, for example, this is promoted under guidance in a programme lasting several months, as the importance of sport, exercise and mindfulness in relation to erectile dysfunction has been recognized. Although these factors play a lesser role in prostate diseases than in erectile dysfunction, a healthy lifestyle is also protective here," recommends Dr. Wagner.
Studies have shown that a diet rich in fruit, vegetables, fiber and healthy fats (such as omega-3 fatty acids) can reduce the risk of prostate disease. On the other hand, a diet high in fat, red meat and processed meat can increase the risk. Foods such as tomatoes, which contain lycopene, and green leafy vegetables, which provide antioxidants, have been shown in some studies to be beneficial in reducing the risk of prostate disease. Adequate intake of vitamin D and zinc has also been linked to better prostate health.
Erectile dysfunction (ED) can be caused by a variety of medical, psychological or hormonal factors.
"As already mentioned, concomitant diseases such as diabetes, high blood pressure and cardiovascular disease are the main causes of erectile dysfunction. However, psychological stress can also have a significant impact on erectile function. In many cases, a combination of both occurs. Furthermore, a testosterone deficiency can also lead to erectile dysfunction as well as a loss of libido and other symptoms. Any patient who is affected and burdened by these symptoms should consult a urologist. But even if there is no subjective impairment due to erectile dysfunction, a patient with this clinical picture should seek an internal examination. Erectile dysfunction is often the first symptom of an undetected cardiovascular disease," says Dr. Wagner.
If erectile dysfunction occurs regularly or suddenly for no apparent reason, a urologist or specialist should be consulted. This is especially true if ED is accompanied by other health problems such as chest pain, shortness of breath or changes in hormone levels. A medical examination is also necessary if the symptoms do not improve despite lifestyle changes or if other sexual dysfunctions occur, such as a reduced libido or ejaculation problems. An early visit to the doctor is crucial in order to identify possible underlying conditions such as diabetes or high blood pressure and to find the right treatment.
Modern treatment approaches for erectile dysfunction (ED) and benign prostate enlargement include a variety of treatment options that are individually adapted depending on the cause and severity of the condition.
Dr. Wagner explains: "The most common form of treatment for erectile dysfunction is medication, with so-called phosphodiesterase 5 inhibitors (PDE5 inhibitors). These are now available to patients in a wide variety of forms and modes of action at mostly affordable prices. Unfortunately, however, these drugs can often not be prescribed safely due to existing cardiovascular diseases. The situation then becomes more difficult and alternatives have to be used. Fortunately, there are also sensible alternatives for patients with heart disease, such as ESWT, a shock wave therapy of the erectile tissue, or PRP therapy, in which the body's own plasma, which has previously been directly processed, is injected into the erectile tissue. The digital health applications already mentioned are also available. The respective therapy can and must be selected and individualized according to the pre-existing conditions and the underlying problem. In the case of benign prostate enlargement, there are now also a large number of different treatment options, particularly in the surgical field. The days when patients had to be treated with open incision operations are long gone. A wide range of gentle and minimally invasive procedures that are performed endoscopically, i.e. using a camera through the urethra, are available for treatment. For large prostate volumes, laser-based surgical methods have become established, which can also be used for extremely large prostate volumes. The procedures are also becoming increasingly gentle and minimally invasive. The Rezum method, for example, involves injecting steam into the prostate, which reduces the volume of the prostate without an incision or laser. The procedure is so minimally invasive that it can be performed on an outpatient basis and hospitalization is no longer necessary. The treatment options are therefore becoming increasingly modern and less stressful and can be individually tailored to each patient's clinical picture and personal situation.
Thank you very much, Dr. Wagner, for this important and helpful information!
The Center for Urology is available with a total of six doctors at three locations.
On average, the following operations and treatments take place every year:
Rezum: 52 surgeries
vasektomies: 288 surgeries
fusion biopsies: 62 patients
ESWT: 234 patients
PRP: 72 patients
