Editorial
P.I.E.D. in Sturgis

from Infections in Urology ®

Stacy J. Childs, MD, University of Colorado Health Sciences Center, Denver.

Take black leather, add a few past Presidents, mix in a few spots, and you have the recipe for filling blanks in your 
appointment book.

Early in August each year, almost a half million motorcycle enthusiasts visit the Black Hills of South Dakota for 10 days of 
sightseeing, motorcycle events and exhibits, and having a good time. I happened upon this occasion last year and was so 
overwhelmed by its potential for urologic problems that I felt led back to the area this year -- from a professional 
standpoint, of course. It became obvious to me that these riders and their significant others most likely suffered from at 
least 3 urologic problems. Not purposely trying to be cute, I've summed up these problems in the acronym P.I.E.D., which 
stands for Prostatitis, Incontinence, and Erectile Dysfunction.

Last year I casually observed so many potential patients that I decided to conduct a more "scientific" study. This year I 
returned and can tell you that I ran out of business cards on the third day of the rally!

Having given this "clinical trial" much thought, I came up with the following materials and methods: I'd wear a nontypical 
Harley-Davidson T-shirt with "urologist" printed on the front and back. This would allow me entrée to a discussion about 
erectile dysfunction -- you just don't walk up to a biker and ask him if he is impotent. Wearing the T-shirt, I assumed a 
reasonable sample would ask, "What's a urologist?" I would include each questioner in my sample, but only if his significant 
other accompanied him. I would reply, "The urologist is a doctor who takes care of a variety of problems, including male 
potency problems." The biker would be included in the sample if he said he had that problem or if he said, "Hey, I sure don't
have that problem." I would then look quickly at his significant other, and if she nodded her head or smiled, I knew he was 
telling the truth. If, however, she rolled her eyes, I considered the biker's statement a lie. We know that men who ride 
bicycles inflict significant, long-term damage to their perineal vasculature and that impotence does occur. In my sample of 
men who ride motorcycles, over 40% had erectile dysfunction.

One of the more difficult problems to assess was female incontinence. There is a large population of "coughers and leakers" 
at the Sturgis Rally, because of the number of females who smoke and are overweight, but you don't casually ask a biker if 
his "biker-chick" wets her pants! You know from your own practice that when females leak a lot, they tend to wear black. 
Well, heck, at a motorcycle rally, everyone is in black -- black jeans, black leathers, black T-shirts. And to make things 
worse, 99% of motorcycle seats are black! My "unscientific" method of assessing female incontinence was to watch couples 
getting off their motorcycle. If the female on the back was more than 25% overweight, after the couple left, I would stroll 
to the motorcycle and examine the rear seat for stains. A subtle ring or dollop of discoloration on the rear seat with no 
corresponding stain on the front seat I considered positive for rear seat incontinence. The study is "biased" in that I did 
not include solo female bikers because of the inability to compare front and rear seats. Among my skewed population, the rear
seat incontinence rate was at least 30%.

Diagnosing prostatitis was the easiest of all. The sample was taken on the 90-minute run from Sturgis to Mt. Rushmore. I just
pulled into the parking lot at Mt. Rushmore and watched male bikers get off their bikes. Any biker with prostate inflammation
or prostate pain I assumed would reflect his discomfort by some gesture immediately upon dismounting from the motorcycle 
seat. In fact, a whopping 60% in my sample reached for their groin, scrotal area, or perineum within 20 seconds of 
dismounting. Some pulled, some adjusted, and some massaged these areas uncontrollably before walking to visit the sculptures 
of our past presidents.

These bikers should be "thundering" my way over the next year. Now that the secret is out, I would suggest that if any of you
in highly penetrated managed care areas want to supplement your income while having a great time, hop on your Harley and haul
it to Sturgis on August 7, 2000.

...	

Dr. Childs is Associate Clinical Professor of Urology at the University of Colorado Health Sciences Center in Denver, and has
a private practice in Cheyenne, Wyo. He is Editor-in-Chief of Infections in Urology.

Infect Urol 12(5):126, 1999. © 1999 Cliggott Publishing, Division of SCP Communications