What to Know About Overactive Bladder

Like the name suggests, an overactive bladder is a bladder that does more than it should. The normal functioning of a bladder is that as urine drains from the kidneys to fill the bladder, nerve signals in the brain communicate the need to discharge the urine. The urge to urinate grows gradually so a person can delay the passage of urine for a while. During the discharge of urine, the bladder contracts, letting out the urine through the urethra.

An overactive bladder contracts suddenly and involuntarily, so a patient cannot hold the urine. It also contracts often, even when it contains just a little urine. This forces the patient to take numerous bathroom breaks. Due to the frequency and suddenness of the contractions, an overactive bladder is known to cause the leaking of urine, otherwise known as urine incontinence. It affects both men and women.

Causes of an Overactive Bladder

An overactive bladder cannot be attributed to one single cause or factor. In most cases, it is caused by a combination of factors. These include:

1. Serious case of a urinary tract infection;

2. A neurological disorder that damages the communication of nerves in the brain and in the bladder;

3. Bladder complications such as bladder stones or tumors;

4. Stroke and multiple sclerosis;

5. Acute urine retention. When urine is retained in the bladder for long, there is no longer space for storage of urine. This may result in an overactive bladder;

6. Pelvic organ prolapse in women and benign prostate hyperplasia in men; and

7. Diabetes.

Social and Emotional Impact of an Overactive Bladder

Patients with an overactive bladder often worry a great deal about stigma. They find the frequent bathroom visits embarrassing and the fear of leaking urine in any social or work environment can be debilitating. These fears affect the normal day to day life of a patient and make it necessary to seek treatment as soon as possible.

Treatment of an Overactive Bladder

A patient can receive treatment in the form of medication, injections and in few cases, minimally invasive surgical procedures. Very often these treatment options are combined with physical therapy and behavioral modifications. Such modifications include:

1. Kegel exercises. These are administered to help strengthen the muscles of the pelvic floor;

2. Exercise aimed at achieving and maintaining a healthy weight;

3. Going on scheduled bathroom visits; and

4. Use of absorbent pads.

An overactive bladder is manageable and treatable. In order to avoid the difficulties that accompany the condition, it is advisable to seek the help of a qualified urologist for a proper diagnosis followed up by efficient treatment. Our team of experts at St. Pete Urology can help with any questions, as well as diagnosis and treatment of an overactive bladder. For more information, visit the St Pete Urology website.

What is a Varicocelectomy?

An apt introduction to varicocelectomy would be to describe the relatively common condition known as varicose veins. Varicose veins occur with the swelling and enlargement of the veins in a patient’s legs to the point that the veins become easily visible under the skin. This condition sometimes occurs in the scrotum and the enlargement is known as a varicocele. Varicocelectomy is a surgical procedure that is performed to remove varicoceles from the scrotum. The main cause of varicoceles is a malfunctioning of the valves inside the veins, which causes an accumulation of blood in the veins and causes them to expand. Upon a physical examination, a varicocele is said to feel like a bag of worms.

When to go for a Varicocelectomy

Having a varicocele is not in itself reason to have a varicocelectomy. In most instances, the varicocele does not manifest any symptoms. It does not cause pain or interfere with the sexual or reproductive function. In such cases, a urologist will advise that the varicocele be left undisturbed. However, if the varicocele causes any of the following, then a varicocelectomy should be performed.

  1. Reduced sex drive;
  2. Reduced sperm production resulting in inability to conceive
  3. Pain and swelling of the scrotum;
  4. When the varicocele is on the right side — ordinarily varicoceles occur on the left side of the scrotum. When it occurs on the right side, it is likely that it is the result of a tumor. The urologist will remove the tumor and the varicocele.
  5. Testicular atrophy — where the testes shrink or fail to develop normally because of a varicocele.

Procedure of Varicocelectomy

A varicocelectomy is a minor surgical procedure that allows the patient to leave the hospital the same day. It is a procedure involving cutting or sealing off the affected vein to restore normal blood flow. A surgeon can choose to do it in either of two ways:

1. laparoscopic varicocelectomy — a surgeon makes several small incisions in the lower abdomen and inserts the laparoscope, which projects an image of your anatomy on a screen. He also inserts other small tools which he uses to cut the affected vein.

2. Open Surgery — The surgeon makes incisions large enough to access the affected veins and cut them or seal them off.

Even though self examination can reveal a varicocele, the question of whether to undergo a varicocelectomy can only be answered by a urologist. A urologist who has specialized in the treatment of varicoceles, such as those in St. Pete Urology, should be contacted if a patient finds any of the symptoms listed above. For more information on prevention, diagnosis and treatment, visit the “St Pete Urology” website.

What are 5 warning signs of testicular cancer?

Testicular cancer is cancer of the testes, the male organ responsible for producing male hormones and sperms. It is understood to be one of the rarer cancers, especially when compared to the prevalence of prostate cancer. In addition to its rarity, testicular cancer is also distinguished by the fact that it is one of the most treatable. Research estimates indicate that up to 95 percent of those diagnosed with it are treated successfully. This success rate holds even for cases in which the cancer has spread outside of the testes. Testicular cancer is most common among men of 15-35 years old.

Symptoms of testicular cancer

Testicular cancer does not always exhibit any symptoms and when it does, its symptoms are similar to those of non-cancerous conditions or inflammations. For these reasons, testicular cancer is often diagnosed at a late stage.

Any one or a combination of the following symptoms should serve as warning signs:

1. Lump and swelling in the testicle

A painless lump or a swelling, or a general change in the size of the testes is one sign of testicular cancer. It is not unusual for one testicle to seem larger than the other. However, a noticeable change from what is usually the normal size of either testes should be treated as a warning sign.

2. Pain or discomfort in the scrotum

Ordinarily a lump or swelling does not cause pain. In some cases of testicular cancer, however, patients report an ache in the scrotum holding the affected testes. It also could be a feeling of heaviness in the scrotum causing discomfort.

3. Enlargement and tenderness of breasts

In rare instances, the presence of testicular tumors encourages the development of breast tissue. This is a condition known as gynecomastia.

4. Accumulation of fluid in the scrotum

A sudden and perceptible collection of fluid in the scrotum should be treated as a red flag.

5. Pain in the groin area, abdomen or lower back

This occurs as an extension of the pain in the testes, if any. It also occurs if the cancer has spread from the testes to the lymph nodes around the groin and the abdomen.

It is noteworthy that the symptoms described above could arise from a non-cancerous condition. That may be reassuring news, but any symptoms also should be considered with caution, because they make testicular cancer that much harder to detect. It is advisable to see a urologist if you have experienced any of the above symptoms, if only to eliminate the presence of testicular cancer. Experienced urologists at St Pete Urology can offer help and treatment for urological problems. Their pool of trained urologists can offer consultation and guidance with any questions and concerns you may have. For more information about testicular cancer, visit the St Pete Urology website.

What is the best treatment for urinary incontinence?

The sling procedure is the best, safest and most effective surgical operation for treating urinary stress incontinence. During the procedure, the urologist creates a sling using an artificial mesh, animal tissue or human tissue and places it under the urethra to support the urethra and bladder neck and to prevent unintentional urine loss.

What is stress incontinence?

Unintentional urine leakage (loss) occurs when you engage in physical activities or movements, such as running, sneezing, heavy-lifting, coughing or any action that puts stress (pressure) on your bladder. The condition is triggered by the weakening of pelvic floor muscles (the muscles supporting your bladder) and urinary sphincter muscles (muscles that control the release of urine).

Normally, as the bladder fills with urine and expands, the valve-like muscles in the urethra remain closed to prevent leakage of urine until you have reached the bathroom. However, if those muscles weaken and are not able to withstand pressure, then anything that exerts pressure on your pelvic and abdominal muscles can cause unintentional loss of urine.

Your sphincter and pelvic floor muscles may weaken because of:

  1. Type of childbirth/delivery.
  2. Previous pelvic or abdominal muscle surgery.
  3. Obesity/increased body weight.
  4. Smoking, which may trigger frequent coughing.
  5. Prolonged involvement in high-impact activities, such as running and jumping for several years.
  6. Age — the muscles weaken with increasing age.

You have stress urinary incontinence if you frequently leak urine when you:

  1. Sneeze
  2. Cough
  3. Stand up
  4. Laugh
  5. Have sex
  6. Get out of your car
  7. Exercise
  8. Lift something heavy

While stress incontinence does not imply that you will lose urine every time you do these things, you will most likely experience frequent leakage of urine when you engage in pressure-increasing activities.

Why should you undergo the sling procedure for stress urinary incontinence?

Having stress incontinence can be really awkward and embarrassing. In fact, with frequent leakage of urine, you may begin isolating yourself and limiting your social and work life. For instance, you may find it difficult to engage in exercise and in different leisure activities for fear of urine leakage. But with treatment, you can manage the incontinence and improve your overall quality of life and well-being. The sling procedure is ideal for you if you’ve tried other measures and still find urine leakage disruptive to your life.

How does the sling procedure work?

The sling procedure is aimed at closing your urethra and the neck of your bladder. For the procedure, your surgeon uses strips of synthetic mesh, animal tissue, donor tissue or your own tissue to develop a sling (hammock) that is inserted under your urethra or bladder neck. Once the sling is placed, it supports the urethra and ensures it remains closed — particularly when you are engaged in pressure-increasing activities such as coughing, laughing, sneezing or exercise — preventing the leakage of urine.

How is the sling procedure performed?

Before the procedure begins, you are placed under either general or spinal anesthesia. With general anesthesia, you will remain asleep throughout the procedure and will feel no pain. With spinal anesthesia, you are completely awake except that the area of your body from the waist down is numb and you don’t feel pain as the procedure is performed. Following application of anesthesia, the urologist places a tube (catheter) into your bladder to drain any urine already inside it.

The surgeon then proceeds to place the sling in any of the following ways:

1. Retropubic Method (Tension-Free Vaginal Tape/TVT Method): The surgeon makes a tiny incision inside your vagina, just under the urethra. Two other cuts are then made above your pubic bone — large enough to allow needles through. The surgeon uses a needle to place the sling beneath the urethra and behind the pubic bone. Using stitches or skin glue that is easily absorbed by the body, the surgeon closes off the cuts.

2. Single-Incision Mini Method: The surgeon makes a single tiny incision in the vagina, then passes the sling through it. No stitches are used to attach the sling, but over time the scar tissue grows and forms around it, keeping it in place.

3. Transobturator Method: The surgeon makes a tiny cut inside the vagina, just under the urethra. Two more cuts are made, one on each side of the labia (folds of skin on either side of the vagina). Using the incisions, the surgeon inserts the sling under the urethra.

At St Pete Urology, we perform hundreds of sling surgery procedures every year with remarkable results for our patients. The sling procedure is an outpatient operation that takes about one hour to complete and the patient is free to go home the same day. After the procedure, we arrange for follow-up sessions with our patients in the doctor’s office to assess the efficacy of the procedure and help with any complications that may arise. So if you are feeling embarrassed by stress urinary incontinence or have tried other measures without success, check with us to find out if the sling procedure can help you overcome the condition. For more information, visit the “St Pete Urology” site.

Treating Erectile Dysfunction with Inflatable Penile Prosthesis

Prescription medications are typically the first treatment offered for men with erectile dysfunction. But for those who don’t respond well or are unable to be treated with these pills, a penile implant is a useful alternative. The penile implant (also called penile prosthesis) is a medical device that is placed surgically into the penis to generate a natural-feeling and natural-looking erection.

Simple, outpatient procedure

The operation to place a penile prosthesis is a quick and simple procedure that takes about 1 hour to complete. The device is inserted into the penis and custom-fitted to help with erection. After it is placed, a man can go home the same day and is ready to enjoy sex after a 4-6 week recovery period.

What is a penile prosthesis?

An inflatable penile implant is a self-contained, fluid-filled, supple and durable system designed to mimic both the look and performance of the penis during a natural erection. It has three components: a reservoir that is placed in the abdomen, two cylinders inserted in the penis and a pump located in the scrotum. The two cylinders situated in the penis are connected to the saline reservoir using a tubing. Because of the three components, the penile prosthesis is known as the three-piece inflatable penile implant.

How does the penile implant work?

To inflate the penile prosthesis, a man presses the pump to transfer the saline from the reservoir into the cylinders located in the penis. The cylinders are then inflated and the penis becomes erect. When the deflation valve found at the base of the pump is pressed, the fluid moves back to the reservoir, deflating the penis and making it flaccid. So the penile implant is capable of producing erections that are satisfactory for sexual intercourse.

Why should men with ED consider penile implants?

Once placed surgically by a urologist, an inflatable penile prosthesis helps a man to regain control of his body. Unlike other ED treatment options which require a slightly longer waiting period before use, the implant can be used at any time. Penile implants are an ideal option for men whose ED has not been resolved by other treatment options. It is a cost-effective option that achieves 98 percent satisfaction rate with patients and is not noticeable in a flaccid penis. In fact, even your sex partners will not know that you have the implant unless you inform them.

If you are looking for something to make you a confident, self-assured man again, a penile prosthesis may be just what you need. It effectively mimics the look and performance of a natural penis and will enable you to begin enjoying sex as soon as you are recovered from the surgery. Unlike remembering to take your medication every time you want to have sex, a penile prosthesis offers a more permanent and natural solution. For more information on treatment of erectile dysfunction, visit the “St Pete Urology” site.

What kinds of prostate problems are common in men over 50?

The prostate is a tiny walnut-sized gland that surrounds the urethra. But with hormonal changes that come with age, men of all ages usually experience changes in their prostate. As a result of these changes, prostate issues are quite common in men, particularly older ones. For example, the prostate often grows and swells with age, compressing the urethra and causing urinary issues.

Benign Prostatic Hyperplasia

With the prostate, there are usually two main issues: benign prostatic hyperplasia and prostate cancer. For men older than 50, benign prostatic hyperplasia (BPH) is the most frequent prostate issue. BPH, also called an enlarged prostate, means a non-cancerous increase in the number and size of prostate cells — so basically, it is an unhealthy increase in prostate size. While what triggers BPH isn’t well understood, it is believed that factors such as aging, inflammation, fibrosis and hormonal changes are the causes of the condition.

An enlarged prostate presses hard on the urethra and makes urination difficult. In men with the condition, symptoms include:

  1. Frequent urination, particularly at night.
  2. Difficulty starting a urine stream.
  3. Dribbling after passing urine.
  4. Weak urine stream, or a stream that starts and stops.
  5. Inability to empty the bladder completely.

But BPH also may have rare and more severe symptoms like:

  1. Urinary tract infection
  2. Blood in urine
  3. Inability to urinate

Prostate cancer

Prostate cancer is another frequent condition in men. In fact, it is the most common cancer after skin cancer, with about 1-in-6 American men being diagnosed with the disease during his lifetime. And like BPH, the cancer is most common in older men, with two-thirds of men diagnosed with the condition usually over age 65.

The cause of prostate cancer isn’t clear, but risk factors include age, family history, race and diet. The cancer grows slowly and rarely shows symptoms, so most men may never know that they have developed the disease until it is in advanced stage. But that also means only around 1-in-35 men with the cancer dies of the disease. Nevertheless, while some prostate cancers grow slowly and often require no or minimal treatment, there are other types that are quite aggressive and spread really quickly.

When caught early, there is a better chance of successfully treating the cancer. However, since it has similar symptoms to BPH, the condition is quite difficult to diagnose and by the time men see blood in their urine or feel chronic pain in their thighs, hips or lower back, it is often quite late. That is why it is critical for men of average to high risk of the cancer to have annual screening as early as appropriate.

Actually, for men of average risk of prostate cancer, the discussion to begin screening should start at the age of 50. While for those of higher risk, it is prudent to begin this discussion a little earlier, though not earlier than 40. But before screening, it is vital to discuss the risks and benefits of the testing with the doctor so the test offered meets the personal preferences and values of the patient.

For more information on prostate problems and how to prevent, diagnose and treat them, visit the “St Pete Urology” site.

How can I prevent recurrent kidney stones

Kidney stones occur when tiny crystals form and stick together as solid masses in urine. Often, due to increased concentration of various chemicals in urine, crystals form and then grow into larger masses that move through the urinary tract. As they move, the stones may get stuck somewhere along the tract and block urine flow, causing pain. Most kidney stones are a combination of calcium with either oxalate or phosphate, but stones also may form when uric acid levels increase in urine as a result of protein metabolism.

Preventing kidney stone recurrence

For many people who have had a kidney stone, it is not a one-time thing. In fact, in about 50 percent of those who have had a stone, another one will appear within 7 years if no preventive measures are in place. At St Pete Urology, we ensure that our patients take the necessary steps to prevent a recurrence. That is why, after treatment, we conduct a special urine test on our patients to find out why the stone formed in the first place. Using the results of the test, we guide our patients on how best they can avoid a recurrence.

Some of the measures we recommend to avert kidney stone recurrence include:

1. Drinking enough water

Water dilutes urine, reduces the concentration of substances in it and prevents kidney stones. To prevent recurrent kidney stones, you should endeavor to drink enough fluid to pass at least 2 liters of urine per day. Increased fluid intake that is distributed throughout the day decreases kidney stone recurrence by about 50 percent and with virtually no adverse effects.

For better results, you may add orange juice or lemonade to the water so there is increased citrate in the fluid to block stone formation. Medication such as allopurinol, citrate or a thiazide diuretic can be taken with the fluid to minimize the chance of kidney stone recurrence. However, if you are already drinking that much fluid before your kidney stones, you should not increase your fluid intake.

2. Making dietary changes

Once you are treated for kidney stones, we will recommend that you reduce your intake of eggs, seafood, poultry, red meat and other animal protein. These foods increase uric acid levels while also reducing citrate levels in the body, which can trigger a recurrence of kidney stones. That is why after treatment for kidney stones, we recommend that you should cut down your daily meat portions to a size no larger than a pack of playing cards. Likewise, you should avoid foods such as chocolate, strawberries, wheat bran, beets, spinach, tea, rhubarb and most nuts that contain oxalate or the phosphate containing colas that may trigger kidney stone recurrence.

3. Increasing calcium intake

Oxalate levels may rise and trigger kidney stones if the level of calcium in the diet is low. So after treatment, it is important to ensure that you increase your calcium intake to match your age. For example, if you are a man 50 and older, you should get 1,000 milligrams of calcium every day, together with 800-1000 IU (international units) of vitamin-D to ensure your body absorbs the calcium properly. With increased dietary calcium, you can prevent a recurrence of kidney stones.

4. Reduced sodium intake

Kidney stones may recur if there is a lot of sodium in your diet because increased sodium leads to high concentration of calcium in urine. So after treatment for kidney stones, we usually recommend that you lower the amount of sodium in your diet, limiting your total daily sodium to 2,300 mg. But if sodium was responsible for your previous kidney stones, then we recommend that you should take at most 1,500 mg of sodium per day. Such a low level of sodium also will be good for your heart and your blood pressure.

Those are some of our most common recommendations for averting kidney stone recurrence. As you might have noticed, they are not complicated things to do, but they do require some commitment. For more information on prevention and treatment of kidney stones, visit the “St Pete Urology” site.

3 Effective Minimally Invasive Surgical Treatment For Kidney Stones

Over the last 15 years, kidney stone prevalence has doubled in United States. Today, roughly 1-in-10 Americans will have a kidney stone attack at some point during their lifetime. When they occur, kidney stones can cause agonizing and unbearable pain in the back and side, and may sometimes trigger nausea and vomiting. You can pass a stone by drinking plenty of water — taking pain medications to control the discomfort as you wait for the stone to pass. But if you have a large stone or one that’s causing complications, then a more extensive treatment may be necessary to remove the stone.

Minimally-invasive surgical treatments

At St Pete Urology, we offer surgical treatment for kidney stones, focusing on minimally-invasive procedures even for the largest stones. Most operations for smaller stones can be done as same-day surgeries, giving patients greater flexibility and a faster return to their work and other routine activities. For larger stones, the planning and execution of the procedures may take a little more time, but with the use of small incisions only large enough to allow insertion of thin tubes, fiber-optic lights, cameras and other tiny surgical tools, we are able to ensure significantly less pain, less scarring, shorter hospital stay, faster recovery and increased accuracy than with traditional open surgery for the stones.

There are three main minimally-invasive techniques for removal of kidney stones. The least invasive being extracorporeal shockwave lithotripsy, followed by ureteroscopy then lastly percutaneous nephrolithotomy. The choice of a surgical technique depends on multiple factors, including the type of stone, size and location, medications taken by the patient, other medical problems the patient may have, and patient preferences.

Extracorporeal Shockwave Lithotripsy (ESWL)

This is the most popular option for treating small and medium-sized stones. Performed in an outpatient setting with the patient placed under general anesthesia, ESWL is the least invasive and takes 20-30 minutes to be completed. During the surgical procedure, intense sound waves are focused on the kidney stone, shattering the stone with minimal effect on surrounding tissue. Smaller pieces of stones that are produced get washed out of the urinary system with the normal flow of urine, often with slight or no discomfort. ESWL is a highly effective treatment for most stones that form in the kidney or ureter.

Advantages of ESWL include:

  1. It’s an outpatient procedure so patients return home after a few hours.
  2. It offers excellent success rate with most small-sized and medium-sized stones.
  3. It doesn’t require incisions or invasive techniques.
  4. It has minimal postoperative discomfort.
  5. It has a fast and easy scheduling.

Limitations of ESWL include:

  1. It’s ineffective for stones that are very hard or resistant to breakage by shockwaves.
  2. It’s not appropriate for stones that are invisible on X-ray such as uric acid, monohydrate and cystine stones.
  3. It’s not ideal for larger stones or those located in the lower part of the urinary tract.
  4. It’s not appropriate for patients with certain conditions or using certain medications, such as pregnant women or patients on blood thinning medications.

Ureteroscopy

Ureteroscopy is another surgical procedure often used to treat small and medium-sized stones. The advantage it offers over ESWL is that it can treat kidney stones occurring in any part of the urinary tract. It’s a same-day procedure done after the patient is placed under general anesthesia. The procedure involves passing a small scope via the urinary opening and into the bladder then into the ureter. Once the stone is reached, it is targeted with laser so that it’s broken down into smaller pieces that are extracted out of the system or into pieces of dust left to wash out with normal urine.

Ureteroscopy is a little bit more invasive than ESWL, but it’s preferred in situations where kidney stones are too hard to respond to ESWL, or for stones that are invisible on X-ray. Ureteroscopy is also a better choice than ESWL when stones are located in the lower portion of the urinary tract, especially the region near the bladder. After the procedure, a small tube — a stent — is temporarily placed into the urinary system to help drain the kidney. The stent is totally internal, and is usually removed 3-10 days after the procedure. Stent removal is a quick and easy process done in the doctor’s office and without anesthesia.

Advantages of ureteroscopy are:

  1. Great results for small-sized and medium-sized stones.
  2. It’s an outpatient procedure.
  3. No incisions are necessary.
  4. Fast and easy scheduling.
  5. Done without stopping the use of blood-thinning medications.
  6. Effective for stones that are resistant to ESWL.

Limitations of ureteroscopy are:

  1. It’s not effective for very large stones.
  2. In some rare instances, scopes may not reach the stones.
  3. Many patients find the stents placed after the procedure a source of unease and discomfort.

Percutaneous Nephrolithotomy (PCNL)

For kidney stones that are exceptionally large, complex or several small stones bundled in one kidney, percutaneous nephrolithotomy (PCNL) is the most appropriate treatment. Conducted by a urologist, often assisted by an interventional radiologist, PCNL is typically an inpatient procedure requiring an overnight hospital stay. During the procedure, the urologist and radiologist collaborate to open a direct channel into the kidney’s drainage system via a small incision made in the back, often not larger than a dime.

After making the incision, the urologist uses a set of specialized tools to break the stones into pieces, which are then plucked out or vacuumed out of the kidney. With the procedure completed, a drainage stent or tube is left in place for temporary drainage of the kidney. For stones that are unusually large or complicated, the urologist may schedule a second “clean-up” surgery. In most cases, patients leave the hospital after PCNL within 24 hours of the procedure. And despite PCNL being a more invasive procedure than ureteroscopy and ESWL, it remains an effective and safe treatment that sees a high level of patient satisfaction.

Advantages of PCNL are:

  1. It is the gold standard treatment for very large or really complex stones.
  2. It is the most appropriate surgery for patients with a number of small stones bundled in one kidney.
  3. It clears most kidney stones fully in one procedure.
  4. It is highly safe and effective.

Limitations of PCNL are:

  1. A drainage tube or stent is necessary after the procedure, which may be uncomfortable for most patients.
  2. It is not appropriate for patients on blood-thinning medications.
  3. It is more invasive and so an overnight stay in hospital is a necessity.
  4. Though it clears most stones in one procedure, a repeat procedure may be necessary for the largest or most complex stones.

At St Pete Urology, we perform hundreds of minimally-invasive surgeries for kidney stones every year. We have several surgeons with extensive training, skill and experience in ESWL, ureteroscopy and PCNL, delivering excellent outcomes even for the most difficult kidney stones. Our collaborative, compassionate and patient-centered approach to care also means our patients enjoy utmost comfort and convenience throughout their procedures. So if you have symptoms of what you suspect to be kidney stones, don’t hesitate to come see us. We fix kidney stones safely and effectively. For more information on the prevention, diagnosis and treatment of kidney stones, visit the “St Pete Urology” site.

What are the risks of vasectomy?

You have all the children you want and have decided not to have any more. You can now enjoy a sex life with your partner without worrying about pregnancy if you opt for an effective method of contraception. There is no form of male contraception more reliable than a vasectomy, so is it the right decision for you?

Choosing a competent, experienced surgeon for your vasectomy procedure

If you’ve made the decision, what must you do to improve the success of your vasectomy and minimize the risk of complications? You must make sure it’s done by a qualified and experienced surgeon. When a vasectomy is performed correctly by a skilled and experienced physician, only about 1 in 1,000 vasectomies may fail to prevent sperm reaching the semen. But when done by a doctor who performs less than 50 vasectomies a year, the likelihood of failure is as high as 10-17 percent or more.

How are vasectomies done?

Your sperm is generated in the testes then stored in the epididymis, a sac adjacent to the testes. The sperm is driven through the shoestring-sized tube known as the vas deferens, about 15 inches long, by a whip-like motion of a tail. Because the vas deferens is connected to the prostate gland that produces semen and also with the seminal vesicles located near the bladder, sperm is able to find its way into the semen to reach the ova after an ejaculation, causing a pregnancy. Failure of sperm to reach the semen means a pregnancy won’t occur.

To conduct a vasectomy, a surgeon kneads the scrotum tenderly until the vas deferens are located — a process similar to a guy looking for a tie-string that has withdrawn into his sweatpants’ waistband. Once the doctor finds the vas, a needle is used to poke a hole in the scrotum before tiny clamps are applied to draw out a small portion of the vas. Then the surgeon cuts, closes or inactivates the two clipped ends of the tubes so sperm won’t get out of them.

There are a number of techniques for achieving this, but the best method currently is the intraluminal cauterization and fascial interposition, That is a technique involving the slicing of the vas in two, scarring the inside (lumina) of the vas using a heated needle, then pulling up the fascia (tissue that surrounds the tube) and clamping or suturing it over the vas end. With the procedure completed, you are ready to return home the same day and take a few days off work to recover.

Fascial interposition improves vasectomy success

During the vasectomy procedure, the doctor sews up the tubes to prevent “recanalization,” which may occur if microscopic channels develop between the tubes’ cut ends. And when recanalization happens, sperm may pass through micro-channels and get into semen, leading to a failure of vasectomy.

When the ends are only clipped but not cauterized up to 1-in-300 men can still get their mates pregnant after a vasectomy. In fact, according to one study of 14,000 men who had undergone a vasectomy, there were six pregnancies and up to 10 percent of men had significant numbers of sperm in semen months after their vasectomy.

However, with the fascial interposition technique, the surgeon puts tissue between the cut ends, which acts as a double zip and lock. The result is that pregnancy rates drop to 1-in-7,000 and only about one vasectomy may be redone per year. Nevertheless, the skill and experience of the urologist conducting the vasectomy still remains the most critical factor for success and minimal complications.

Improving vasectomy success

Three months following a vasectomy there will still be sperm swimming around “downstream” beyond the cut area. It is crucial to use another birth control method such as condoms to prevent pregnancy. At 12 weeks after the procedure, a follow-up test for the presence of sperm in semen is necessary — with a negative result confirming that the procedure was successful.

But even with the negative result, there is still a 1-in-2,000 chance that you can later regain your fertility. If a pregnancy does occur, you should assume that the body has healed and you’re again capable of making your mate pregnant.

Vasectomy pain

A significant number of men fear getting a vasectomy because of pain. But how bad is the vasectomy pain? While the procedure is almost painless when properly performed, it’s common to feel some soreness afterward. Studies show that somewhere between 1-50 percent of men have chronic testicular soreness, including epididymitis (blue balls) for up to a year after the procedure. And as many as 15 percent of men may experience a seriously aggravating pain after the procedure. The pain, however, is managed with painkillers and would rarely hamper your ability to engage in routine tasks.

Sexual intercourse should be postponed for at least a week after a vasectomy. Some men who have tried sex a day or two after the procedure have reported terrible pain and swelling of the scrotum. Again, it’s important to remember that the surgeon’s experience and technique will determine how much pain you experience after a vasectomy.

What of the link between prostate cancer and a vasectomy?

A few studies were published in early to middle 1990s that reported that prostate cancer is linked to a vasectomy. However, a more conclusive survey conducted in New Zealand disproved such a link. Another study by researchers from the University of Toronto and Mayo Clinic in Rochester examined results of 40 different studies with over 12 million participants and concluded that a vasectomy does not enhance the risk of a man developing prostate cancer. So as we now know it, there is no link between prostate cancer and a vasectomy.

Vasectomy and dementia

A 2006 study by researchers from Northwestern University appeared to relate vasectomy with dementia, causing some concern by highlighting a plausible, even if unlikely, mechanism through which vasectomy can result in brain damage. Triggered by a patient at an Alzheimer’s clinic complaining that his aphasia (speech problems) started soon after a vasectomy, the researchers surveyed 47 clinic patients with early-stage aphasia and found that 19 of them had undergone a vasectomy.

According to the study, sperm can leak into the body’s normal tissue after the vas deferens is cut resulting in the development of antibodies to sperm in the blood. This was observed in about two-thirds of vasectomized men (sperm doesn’t normally get into the bloodstream). From the observation, the Northwestern study theorized that if antibodies to sperm — which contain some proteins also found in brain cells — appear in blood, they may lead to an autoimmune attack of the brain cells resulting in dementia. Nevertheless, being a small study that hasn’t been replicated, it’s still quite early to draw much from it. And for now, dementia still remains only hypothetically linked to a vasectomy — though the association requires further research.

Effectiveness of vasectomy reversals

Vasectomies are reversible. That’s true. But when making the decision to undergo the procedure, it’s important to approach it as a permanent method of sterilization and not by expecting it to be undone. In fact, when done well, it can only be reversed successfully about 50 percent of the time and with no guarantees that you’ll have children. Only go for a vasectomy if you are sure you have had enough children or don’t want any children. Also make sure to ask all the questions and go for the procedure only when you are truly ready for it.

At St Pete Urology, we offer both vasectomy and vasectomy reversals using procedures that ensure maximum comfort and the least pain for our patients. We have assembled a team of skilled, knowledgeable and experienced urologists who perform hundreds of vasectomies every year. So you can be sure that your procedure will follow the right technique and have the highest chance of success. For more information on vasectomy and vasectomy reversals and their risks and benefits, visit the “St Pete Urology” site.

What treatments are available for erectile dysfunction?

Are you struggling to achieve or maintain an erection? Whether you are under 35 or over 65, you are certainly not alone. Erectile dysfunction (ED) is quite common in American men, affecting more than 20 million men. Statistically, 52 percent of men between 40 and 70 years old have some form of erectile dysfunction while 25 percent of men younger than 40 suffer from the problem on a regular basis. At St Pete Urology, we see a lot of cases of erectile dysfunction every month, administer treatments and achieve excellent results for our patients.

Types of ED treatments

There are a number of safe and effective treatments for erectile dysfunction which, when properly applied, help in achieving and maintaining an erection for satisfactory sexual intercourse. The main treatments include oral medications, penile injections, vacuum erection devices and surgery. The choice of treatment depends on factors such as underlying causes and severity of the dysfunction, and overall health and preferences of the patient.

Oral medications

Dr. Adam Oppenheim of Advanced Urology InstituteAt St Pete Urology, oral medications are typically our first line of treatment. The medications commonly given are vardenafil (Levitra, Staxyn), sildenafil (Viagra), avanafil (Stendra) and tadalafil (Cialis). All these medications work by improving the action and efficacy of nitric oxide, which is a natural chemical produced by the body and used to relax penile muscles. With increased activity of nitric oxide due to these drugs, there is increased relaxation of the smooth muscles, improved blood flow to and in the penis and greater likelihood of developing an erection when there is sexual stimulation.

Though the oral ED drugs are similar in their mechanism of action, they vary slightly in chemical makeup, timing of dosage and expected period of effectiveness, and potential side effects. For instance, sildenafil (Viagra) produces the best effect when taken without food about one hour before sex and its effect lasts six hours. Vardenafil (Levitra, Staxyn) can be taken with or without food one hour before sex and its effect lasts seven hours. Like vardenafil, avanafil (Stendra) can be taken with or without food, but 15-30 minutes before sex (depending on the dose) and its effects lasts six hours. Tadalafil (Cialis) should be taken in small daily doses or in a large dose (as needed) with or without food about 1-2 hours before sex and its effect lasts 36 hours. Doctors usually consider these differences before prescribing oral ED medications.

Penile injections

An effective alternative to oral medications is injectable ED medicine. The specific injectable medication may vary, but some of the most commonly used ones are papaverine hydrochloride, alprostadil, prostaglandin E-1 and phentolamine. An injection of one or a blend of these ingredients will relax arterial wall muscles, cause increased blood flow into the penis and result in an erection. A small, sharp needle is used for the injection and there is only minimal discomfort. At St Pete Urology, we teach patients how to do the injections and once they have mastered it, then drugs are ordered and sent to them to do the injections at home.

Vacuum constriction devices

A vacuum device is an external pump supplied with a band to help trigger an erection by driving blood into the penis. Vacuum constriction devices (VCDs) have three components: the plastic tube placed around the penis, the pump that draws out air from the tube and creates a vacuum, and the elastic ring that helps to maintain an erection during intercourse by preventing the flow of blood back into the body. The elastic ring should only remain in place for a maximum of 30 minutes and then should be removed to restore normal blood circulation and prevent potential skin irritation. Using a vacuum pump requires adjustment and practice — it may make the penis feel numb or cold, purple in color and bruised, although such effects are often painless and go away in a few days. The devices also may weaken ejaculation, but they do not affect orgasm (pleasure of climax).

Implant surgery

Surgery is often a last resort treatment for ED. At St Pete Urology, we speak with our patients about whether or not surgery is right for them. Surgery can be done either to implant a device into the penis that makes it erect or rebuild the arteries and veins around the penis to improve blood flow. Implanted devices (prostheses) are an effective treatment for ED with implant surgeries typically taking about one hour to complete and usually done in outpatient setting.

There are two types of penile implants: inflatable implants that make the penis wider and longer via a pump in the scrotum and malleable implants that are basically rods allowing for manual adjustment of the position of the penis. Patients leave the hospital the day after their implant surgery and are able to use the implant to achieve an erection 4-6 weeks after surgery. Possible challenges with the implants include infection and breakage, but they are generally effective in getting and maintaining an erection.

Vascular reconstructive surgery

Another option is the urologist can perform a vascular or arterial reconstruction surgery to improve blood flow to and in the penis. Vascular reconstructive surgery is a highly delicate procedure involving either the re-routing of arterial pathways leading to the penis to bypass blocked arteries that are restricting blood flow, or to unblock blood vessels causing an obstruction. An artery can be bypassed by moving an abdominal muscle artery to a penile artery. Alternatively, a penile vein can be modified to work like an artery.

Men who are younger than 45 are the ideal candidates for reconstructive surgery, especially those who have experienced trauma or injury that resulted in the damage to blood vessels at the base of the penis. The goal of the procedure is to remove or bypass any blockages that may impede blood flow to the penis. And with the obstruction removed, there is increased blood flow to the penis and greater likelihood of an erection.

If you have erectile dysfunction, the first step is to speak with a doctor. The right treatment for you will depend on your overall health and the underlying cause of your ED. At St Pete Urology, we see a lot of cases of erectile dysfunction and endeavor to achieve the best possible outcomes for our patients. For more information on treatment of erectile dysfunction, visit the “St Pete Urology” site.