What happens during a vasectomy procedure and how does it work?

Vasectomy is considered a permanent birth control method because it prevents the release of sperm during ejaculation. During a vasectomy, the tube (vas deferens) from each testicle is carefully clamped, sealed or cut to prevent the mixing of sperm with ejaculated semen. The testicles will continue to produce sperm but the female egg cannot be fertilized without sperm in the semen. Since the tubes are sealed off before the seminal vesicles and prostate, a man will still ejaculate the same amount of fluid.

So what happens during a vasectomy?

  • (a) The testicles and scrotum are first cleaned with antiseptic and may be shaved.
  • (b) You may be given an intravenous (IV) or oral medicine to minimize anxiety and make you sleepy. If given the medicine, you may not remember much of what happens during the procedure.
  • (c) The urologist will locate each vas deferens by touch and then inject a local anesthetic into the area.
  • (d) The doctor will make 1 or 2 small openings on the scrotum. Then through an opening, the 2 vas deferens tubes are cut, tied and stitched, or sealed. Scar tissue from the operation will help block the tubes.
  • (e) The urologist will then replace the vas deferens inside the scrotum and close the skin with stitches that dissolve on their own. A vasectomy procedure takes 10-30 minutes and can be done in a clinic or office of a urologist, general surgeon or family medicine doctor.

How does vasectomy work?

The scrotum will be numb for 1 to 2 hours after the surgery. You are expected to apply cold packs to the area and get as much rest as possible while lying on your back. Wearing a jockstrap or snug underwear will protect the area and ease the discomfort. You may experience minor pain and swelling for a few days, but rarely anything more serious. After two days you can resume light work, but must wait for at least a week for heavy lifting and strenuous work.

While you can resume sexual intercourse as soon as you feel comfortable, waiting for a week is advisable. Remember, your sperm count will not be zero and you can still get your partner pregnant, so use an alternative birth control method such as condoms until follow-up sperm count tests show no sperm in the semen, usually two months after the procedure.

Vasectomies are 99.85% effective, with only 1 or 2 women in 1000 getting pregnant after their partners have undergone the procedure. It will not interfere with your sex drive, sensation of orgasm, ability to ejaculate or ability to have erections. However, it is a permanent birth control method that must only be considered by those who do not want to have children in the future. For more information on vasectomies, visit St Pete Urology in St Petersburg, Florida.

Women’s Health: Do Women See A Urologist?

It is a common mistake to believe that only men see urologists. In fact, women are more likely than men to have a urinary problem at some stage of life. When it comes to a condition affecting the urinary tract, bladder or kidneys, a urologist is the expert who can offer the best treatment. Urologists see women, men and children to treat common disorders of the urinary system.

Women’s Urological Conditions

(a) Overactive bladder: A woman with an overactive bladder experiences a sudden, frequent or hard-to-control urge to urinate, wakes up more than once at night to urinate, or urinates eight or more times in 24 hours. A urologist will perform various tests to diagnose the disorder and then recommend treatment according to the cause.

(b) Urinary incontinence: Characterized by a loss of bladder control that often results in accidental leakage of urine, urinary incontinence affects up to 57% of women between 40-60 years and requires the attention of a urologist.

(c) Urinary tract infections (UTIs): Urinary tract infections can cause serious complications if they spread to the kidney. They require prompt and effective treatment. Since women are more susceptible than men to UTIs because of their anatomy, they should see a urologist if they have frequent or persistent infections.

(d) Fallen bladder: Because the bladder is held in position by the pelvic floor, it may drop onto the vagina when the pelvic floor is weakened or stretched due to obesity, menopause, aging or prior pelvic surgery. A woman should see a urologist with experience in female urology to correct a fallen bladder.

(e) Painful bladder syndrome (interstitial cystitis): Interstitial cystitis (IC) comes with lower belly and bladder discomfort, a feeling that the bladder is always full, and a sudden and severe urge to urinate (even up to 60 times per day), which can interfere with everyday activities. Some women have been forced to skip social events or avoid travelling away from home, while some find sex uncomfortable or painful due to the condition. Women who have the disorder need to see a urologist.

(f) Urinary stones: Urinary stones are hard masses that form in the kidneys, bladder or ureters. While drinking 2-4 quarts of water in 24 hours may help to move a urinary stone, a urologist can break them apart with ultrasound-based treatment or remove them surgically.

(g) Cancer: Women can have cancer in the bladder, bladder lining, kidneys or urethra. The cancer may show signs such as pain during urination, lower back pain, blood in urine and frequent visits to the bathroom. Seeing a urologist may help to detect and treat the cancer early.

Ideally, women should see a urologist when experiencing:

  • Pelvic pain
  • Burning sensation or discomfort when urinating.
  • Frequent urination
  • Blood in urine
  • Pain in the back or sides
  • Leaking urine

At St Pete Urology, we have specialized urology services that cater to the unique needs of women. We deal with many urological conditions affecting women, including incontinence, pelvic organ prolapse, bladder infection, overactive bladder, kidney stones and cancer. Male or female, feel free to contact St Pete Urology when you have a urine or bladder issue.

3 Main Causes of Erectile Dysfunction and Treatment Options

Erectile dysfunction (ED) occurs when a man is incapable of having an erection firm enough for sexual intercourse. While occasional inability to have an erection is considered normal, frequent or prolonged difficulty to get or keep an erection, along with reduced sexual desire, is classified as erectile dysfunction. The condition often leads to an unsatisfactory sex life and may result in other problems such as low self-esteem, embarrassment, anxiety, depression and relationship problems.

Causes of Erectile Dysfunction

Erectile dysfunction is caused by physiological (physical) factors, psychological (mental) factors, or a combination of both. Generally, psychological problems are more likely to cause ED in younger men while physical problems are often the cause in older men.

The major psychological causes of ED are:

1. Depression

2. Stress at work or home

3. Worries about sexual performance with a new sexual partner or new situation

4. Unresolved relationship conflicts

5. Fatigue

6. Temporary issues such as loss of a job, studying for exams or financial concerns

7. Deep-rooted negative attitudes about sex, intimacy, or strict religious beliefs

8. History of sexual abuse

For a man to have a normal functioning erection, it helps to have self-confidence and arousing behavior or thoughts while being free of anxiety. If at least one of these conditions is chronically absent, a man’s inability to perform sexually can become a lasting issue.

The major physiological causes of ED are:

1. Diseases such as diabetes, liver disease, kidney disease, multiple sclerosis, high blood pressure, atherosclerosis, chronic alcoholism, neurological disease, and vascular disease.

2. Drugs for treating hypertension (high blood pressure), depression, anxiety and psychosis, and regular consumption of alcohol, marijuana, cigarettes and other recreational drugs.

3. Injuries such as spinal cord injury and nervous system injury (like pinched nerves due to slipped vertebral discs).

4. Atherosclerosis (hardening of arteries due to a buildup of fat/cholesterol deposits inside arterial walls).

5. Hormonal imbalances such as low testosterone levels or due to diseases of the pituitary, adrenal or thyroid gland.

6. Cigarette smoking.

The main risk factors for erectile dysfunction are:

1. Age over 50

2. Lack of exercise

3. Diabetes (high blood sugar)

4. High cholesterol

5. High blood pressure

6. Smoking

7. Obesity

8. Cardiovascular disease

9. Drug and alcohol abuse

10. Cancer radiation therapy

11. Prostate surgery

12. Medicines such as antihistamines, antidepressants and blood pressure drugs.

Men spending a lot of time bicycling are also at risk of ED because bicycle seats can damage the nerves and blood vessels involved in erections.

Treatments for Erectile Dysfunction

The treatment for erectile dysfunction depends on the cause. Often, the urologist will suggest a change of certain habits or recommend that you stop smoking, using drugs or stop alcohol use. The urologist may also recommend treatments for emotional problems, depression, performance anxiety or relationship conflicts.

The most common treatments for ED are:

1. Oral medications (erection pills) such as Cialis (tadalafil), Levitra (vardenafil), Stendra (avanafil) and Viagra (sildenafil).

2. Counseling and psychotherapy if your ED is related to psychological problems.

3. Injection of drugs in the penis: If oral medications fail, the urologist may recommend the injection of Caverject (alprostadil) in the penis. Suppositories of the same drug may also be placed in the urethra as an alternative to injection.

4. Vacuum erection devices: These devices create a low-pressure vacuum around erectile tissue, resulting in erection.

5. Testosterone replacement therapy may be recommended for a man with below-normal testosterone hormone.

6. Surgery: Surgery is usually recommended by a urologist when other treatments fail to improve the ED. The operation is performed to either fix blood vessel issues or for penile implants (like inserting penile prostheses, bendable implants or inflatable implants).

7. Penile arterial revascularization: A surgery for men under 45 years of age who have pelvic or penile injuries, helping to fix blocked or injured blood vessels in the penis.

8. Venous ligation surgery: Aimed at improving the firmness of the penis, this surgery corrects leaky penile vessels that cause softening of the penis during an erection. This technique is rarely used for correcting ED due to its low success rate of around 5%.

Are you having difficulties with sexual performance? Talking with an experienced urologist at St Pete Urology might help you solve the problem. For more information on dealing with erectile dysfunction, visit the website of St Pete Urology in St Petersburg, Florida.

Debunking 4 Myths about Urinary Incontinence

Urinary incontinence is an embarrassing condition affecting more than 200 million people globally. Characterized by bladder leakage, painful urination, strong urge to urinate and incomplete emptying of the bladder, the condition can negatively impact the quality of life of affected individuals by restricting their ability to participate in various activities. Riddled with several misconceptions and accompanied by considerable stigma, bladder leakage is a highly misunderstood condition that even those affected do not want to talk about. Yet by debunking some of the myths associated with the condition and establishing a clearer understanding of the problem, affected individuals can get on the right track for healthy and happy bladder management. Here are four of the more common myths about urinary incontinence:

Myth 1: Only the elderly experience urinary incontinence.

Even though the risk of urinary incontinence increases with age, virtually any person can experience incontinence at any stage of life. For instance, bladder weakness typically affects 1 in every 3 women above the age of 18 with many young women experiencing sensitive bladder symptoms after pregnancy and labor. Urinary incontinence can also result from an enlarged prostate, nerve damage, weakened pelvic muscles, medical conditions such as obesity, onset of menopause in women due to a drop in estrogen levels, infection, and as a side effect of certain medications.

Myth 2: Reducing fluid intake reduces urinary incontinence.

Limiting fluid intake may sound like a brilliant idea since drinking plenty of water increases the frequency and urgency of urination. However, it has been shown that drinking adequate amounts of fluid in small doses throughout the day helps to prevent leakage. In fact, severe limitation of fluid intake can make urine more concentrated, increasing the risk of bladder irritation and worsening urinary incontinence. Drinking enough water also helps to reduce odors. Doctors recommend that you sip water between meals, avoid fluids for two hours before bed, and reduce or avoid citrus juices, caffeine, carbonated beverages and alcohol.

Myth 3: Surgery is a necessary treatment for urinary incontinence.

While surgery is one effective treatment for incontinence, it comes with more risks than other treatment options. For instance, invasive surgical procedures such as sling surgery and retropubic suspension have associated risks such as difficulty urinating and worsened incontinence. Therefore, affected individuals should always be offered the option of trying nonsurgical treatment first and only opt for surgery when nonsurgical options fail. In fact, for most people, simple lifestyle changes, medications for relaxing the bladder and treating urinary infections, medical devices like pessaries, weight loss, dietary changes, and pelvic floor muscle exercises provide considerable improvement in symptoms. Surgery should only be considered as a last resort.

Myth 4: Delaying urination strengthens the pelvic floor.

While many think that delaying going to the bathroom can help to strengthen the pelvic floor, the truth is that this can overstretch the bladder, resulting in a flaccid and dysfunctional bladder. Therefore, for a person living with urinary incontinence, it is important to avoid actions that may weaken your bladder and instead seek immediate medical treatment. Remember, urinary incontinence may be a symptom of an underlying medical condition that requires a prompt visit to a urologist. So stop living quietly with urinary incontinence and thinking that you can crudely wish it away. Talk to your doctor about what could be causing the problem and what might be the best individual treatment option for you. For more information on managing urinary incontinence, visit the St Pete Urology website or make an appointment for a consultation with a urologist.

Technological Innovations in Urology

Technological innovations in urology have resulted in far-reaching improvements in patient care. At St Pete Urology, the implementation of new technologies and innovations has improved diagnostic accuracy, enhanced the safety and quality of treatments, and streamlined patient information systems. For example, the use of advanced imaging technologies has enabled urologists to visualize and diagnose different conditions more precisely while minimally invasive surgery results in significantly reduced pain and quicker recovery and convalescence.

Laparoscopic Surgery

Our urology specialists use laparoscopic surgery when applying miniature instruments inserted using a small tube (known as a laparoscope) through small incisions in the patient’s body. We use novel biological sensors, techniques and instruments to ensure less pain, faster recovery and better outcomes for urologic problems. For example, we offer minimally invasive laparoscopic surgery for kidney stones, pelvic organ prolapse, live donor nephrectomy, uretal stricture, uretopelvic junction obstruction, renal cysts, renal cell carcinoma, prostate cancer and more. Our urologists in St Petersburg have also refined laparoscopic surgery for use in children to remove dysfunctional or malformed kidneys, correct blocked ureters and treat undescended testicles.

Robotic Surgery

At St Pete Urology, every urologist is trained in the use of robotic surgery to perform operations with more precision. Robot-assisted surgery is a minimally-invasive operation similar to laparoscopy (performed through smaller incisions than open surgery), but in which small surgical tools are mounted on a robotic arm controlled by the surgeon using a computer. The urologist makes tiny incisions for inserting the instruments into the body then uses an endoscope to view enlarged 3-D images of the affected area during the operation. Our urology clinic boasts of the da Vinci machine, the world’s most advanced surgical robot, enabling our specialists to conduct operations with better vision, precision and control.

External Beam Radiation Therapy (EBRT)

Also called Image Guided Radiation Therapy (IGRT), this form of treatment has been implemented at St Pete Urology with great success for prostate patients. Our state-of-the-art imaging enables urologists to direct radiation with more precision to the area of the prostate that requires treatment. With better preparation and planning, this technology ensures more accuracy and allows the urologist to target the same area of the prostate for all additional treatments. In fact, EBRT ensures less radiation and pinpoint accuracy for better outcomes and reduced side effects associated with radiotherapy.

Cryosurgery and Cryosurgical Ablation

We have implemented new cryosurgical technologies for treating prostate cancer, making it easier for our urologists to map cancerous cells more precisely, and freezing and killing cells not reachable by means of radical prostatectomy surgery. Similarly, we use cryosurgical ablation to destroy diseased tissues and eradicate prostate cancer in patients who decline radical surgery (involving prostate removal). Our cryosurgical procedures can be performed on an outpatient basis and without incisions, ensuring minimal blood loss or side effects.

Selecting the Best Technologies

In a world with seemingly endless urology innovations and technologies, we have carefully selected and implemented only those that are effective and appeal to both patients and doctors. This means that all technologies at St Pete Urology have a proven efficacy, cause the least discomfort to patients, and can easily be performed by every urologist. For more information on safer and effective use of the latest technological innovations in the treatment of urological conditions, make an appointment at St Pete Urology in St Petersburg, Florida.

Urology Patient Testimonial

Dr. Graves is the kindest, most thoughtful, genuinely caring doctor I have ever encountered in my entire life; and my brother had cancer when we were three and mom had a triple by-pass at twelve. I grew up in hospitals, but I have not spent much time in them for myself since very recently. I would rather pass a stone at home-and have twice- than have the kidney stone blasted at the hospital because of the pain afterward from endometriosis. Dr Graves called me HIMSELF to check on me. Choose him. – Kendra Burke

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The Prostate Cancer Test That Saved My Life

“So, yeah, it’s cancer.”My urologist segued from talking about how inconvenient it was picking his daughter up at school that morning to dropping a cancer diagnosis on me without missing a beat. Two weeks earlier, I didn’t even have an urologist.

“Yeah,” he said, in a slightly nonplussed way, gazing at the results, “I was surprised myself.”

As my new, world-altering doctor spoke about cell cores and Gleason scores, probabilities of survival, incontinence and impotence, why surgery would be good and what kind would make the most sense, his voice literally faded out like every movie or TV show about a guy being told he had cancer… a classic Walter White moment, except I was me, and no one was filming anything at all.

I got diagnosed with prostate cancer Friday, June 13th, 2014. On September 17th of that year I got a test back telling me I was cancer free. The three months in between were a crazy roller coaster ride with which about 180,000 men a year in America can identify.

Right after I got the news, still trying to process the key words echoing dimly in my head (probability of survival–vival-vival-val…” “incontinence-nence-nence-ence …), I promptly got on my computer and Googled “Men who had prostate cancer.” I had no idea what to do and needed to see some proof this was not the end of the world.
John Kerry… Joe Torre… excellent, both still going strong. Mandy Patinkin… Robert DeNiro. They’re vital. OK great. Feeling relatively optimistic, I then of course had to do one more search, going dark and quickly tapping in “died of” in place of “had” in the search window.

As I learned more about my disease (one of the key learnings is not to Google “people who died of prostate cancer” immediately after being diagnosed with prostate cancer), I was able to wrap my head around the fact that I was incredibly fortunate. Fortunate because my cancer was detected early enough to treat. And also because my internist gave me a test he didn’t have to.

Taking the PSA test saved my life. Literally. That’s why I am writing this now. There has been a lot of controversy over the test in the last few years. Articles and op-eds on whether it is safe, studies that seem to be interpreted in many different ways, and debates about whether men should take it all. I am not offering a scientific point of view here, just a personal one, based on my experience. The bottom line for me: I was lucky enough to have a doctor who gave me what they call a “baseline” PSA test when I was about 46. I have no history of prostate cancer in my family and I am not in the high-risk group, being neither — to the best of my knowledge — of African or Scandinavian ancestry. I had no symptoms.

What I had — and I’m healthy today because of it — was a thoughtful internist who felt like I was around the age to start checking my PSA level, and discussed it with me.

If he had waited, as the American Cancer Society recommends, until I was 50, I would not have known I had a growing tumor until two years after I got treated. If he had followed the US Preventive Services Task Force guidelines, I would have never gotten tested at all, and not have known I had cancer until it was way too late to treat successfully.

Now, in my case, my doctor, Bernard Kruger, watched my PSA tests rise for over a year and a half, testing me every six months. As the numbers continued to rise, he sent me to the urologist, who gave me a slightly invasive physical check in his office using a gloved finger. This took all of 10 seconds. While I don’t recommend it for fun, amazingly some don’t recommend it at all. After this exam, and looking at my rising PSA numbers, he suggested an MRI to get a roadmap of my prostate.
It’s a non-invasive procedure like the one athletes get to check for torn ACLs. Loud, but painless. Only after studying the MRI results did my doctor recommend a not-fun-at-all biopsy. Unlike the MRI, the biopsy was as invasive as it gets: long needles in sensitive places and more small talk about kids and school pick ups while it was all going down.

Then the biopsy came back positive. Of course “positive” for medical tests is usually not so positive. I had a Gleason score of 7 (3+4), which is categorized “mid-range aggressive cancer.” Surgery was recommended. At this point I decided to go out and get a few different opinions. All the doctors I talked to concurred that the tumor needed to be taken out.

Ultimately, I found a wonderful surgeon named Edward Schaeffer who I felt comfortable with. He performed a robotic assisted laparoscopic radical prostatectomy. Due to a lot of skill and a little beneficence from some higher power, he got all the cancer. As of this writing I am two years cancer free and extremely grateful.
So. What is the deal with this PSA test and why the controversy?

It is a simple, painless blood test. It is not dangerous in itself in any way. If the PSA (Prostate Specific Antigen) value is elevated in the blood, or levels rise sharply over time, it could indicate the presence of prostate cancer. It is definitely not foolproof.

The criticism of the test is that depending on how they interpret the data, doctors can send patients for further tests like the MRI and the more invasive biopsy, when not needed. Physicians can find low-risk cancers that are not life threatening, especially to older patients. In some cases, men with this type of cancer get “over-treatment” like radiation or surgery, resulting in side effects such as impotence or incontinence. Obviously this is not good; however it’s all in the purview of the doctor treating the patient.

But without this PSA test itself, or any screening procedure at all, how are doctors going to detect asymptomatic cases like mine, before the cancer has spread and metastasized throughout one’s body rendering it incurable? Or what about the men who are most at risk, those of African ancestry, and men who have a history of prostate cancer in their family? Should we, as the USPSTF suggests, not screen them at all? There is growing evidence that these guidelines have led to increased cases of prostate cancers that get detected too late for the patient to survive the disease.

Five years after their initial recommendation to stop PSA testing, the USPSTF is presently, per their website, “updating their recommendations.” I think men over the age of 40 should have the opportunity to discuss the test with their doctor and learn about it, so they can have the chance to be screened. After that an informed patient can make responsible choices as to how to proceed.

I count my blessings that I had a doctor who presented me with these options. After I chose to take the test, he directed me to doctors who worked at centers of excellence in this field to determine the next steps. This is a complicated issue, and an evolving one. But in this imperfect world, I believe the best way to determine a course of action for the most treatable, yet deadly cancer, is to detect it early.