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.

How To Treat Kidney Stones?

When certain minerals are in excess in the body, they accumulate in urine. The urine becomes more concentrated as the levels of minerals and salts increase, particularly when the body is not well hydrated. As a result, hard masses of minerals and salts called kidney stones — often made of uric acid or calcium — form inside the kidney and can travel to other areas of the urinary tract. About 1-in-11 Americans will have a kidney stone at some point in their lifetime, but stones occur more often in men, people with diabetes and those who are obese.

Stones come in different sizes

Kidney stones vary in size. While some may be as small as a fraction of an inch and others only a few inches across, some stones can be very large and may take up the whole kidney. Smaller stones tend to remain in the kidney and rarely cause pain as they pass out of the body. In most cases they are not noticed until the kidney stones pass into the ureter. But larger stones may block urine flow, cause pain and result in urinary tract problems. Fortunately, the stones rarely cause permanent damage, and there are effective treatments for them.

Pain due to kidney stones

Pain is the most common characteristic and frequent symptom of kidney stones. Although the pain associated with stones varies from person to person, it can be quite intense and agonizing when it occurs — accounting for over 1 million visits to the emergency room every year. Many women who have had the condition attest that the pain is worse than the cramps and spasms of childbirth; others say it’s like being stabbed with a knife. The pain is felt along the side and back and below the ribs, though it may radiate to the belly and groin area with the movement of the stone along the urinary tract. It also generally occurs in waves, each wave lasting a few minutes, before disappearing and coming back.

Treatment of kidney stones

At St Pete Urology, we admit many patients in our emergency department because of painful kidney stones. Some patients also present with symptoms such as nausea, vomiting and hematuria (blood in urine). We determine how to manage kidney stone disease depending on the location and severity of the stones. For patients with small stones — several millimeters in size — we may allow time for the stones to pass without intervention. In that case, a patient is given pain medication, advised to drink plenty of water and waits for the stones to pass, under our close observation. But for large stones or complex ones causing problems such as severe pain, infection or kidney failure, we usually intervene to remove the stones.

Types of treatments

We often intervene to remove kidney stones that fail to pass spontaneously, are affecting kidney function, are accompanied by too much pain to wait for their passage, are blocking the flow of urine or are causing repeated infections. The interventions involve tiny or no incisions, minimal pain and a short time off work. At St Pete Urology, the treatments we commonly provide for kidney stones are extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and ureteroscopy.

1. Extracorporeal Shockwave Lithotripsy (ESWL)

ESWL (Extracorporeal Shockwave Lithotripsy) is the use of highly-focused sound waves released and focused from outside the body to crush kidney stones. The intense waves are able to reduce the stones into sand-like granules that can pass normally in urine over a few weeks. Before ESWL, patients are given a sedative or placed under regional or general anesthesia and ultrasound or X-rays used to pinpoint the location of the stones.

The procedure takes about 1 hour, but larger or more complex stones may need several ESWL treatments. Patients return home the same day and are able to resume normal activities in 2-3 days. Shockwave lithotripsy is not used for hard stones, such as cystine, struvite, and some types of calcium phosphate and calcium oxalate stones. It’s also not ideal for stones larger than 1 inch in diameter and for pregnant women.

2. Ureteroscopy (URS)

For some kidney stones, especially those located in the kidney and ureter, ureteroscopy is the preferred treatment. The treatment involves passing a small fiber-optic instrument called ureteroscope into the urethra and bladder, then into the ureter. The telescopic instrument enables the urologist to see the stone and to use a small, basket-like device to pull out a smaller stone. For larger stones that can’t be removed in one piece, the urologist uses laser or a similar stone-breaking tool to shatter the stone into smaller pieces.

Flexible ureteroscopes are used for stones located in the kidney and upper ureter while rigid ones are used when stones are located in the lower ureter near the bladder. During the procedure, you are placed under general anesthesia to keep you comfortable. A stent (or small tube) is left in the ureter to keep it open and drain urine from the kidney and into the bladder, but it’s completely within your body and doesn’t require an external urine collection bag. You can return home the same day and resume normal activities in 2-3 days, but the stent must be removed in 4-10 days to avoid infection and potential loss of kidney function.

3. Percutaneous nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is the most appropriate treatment for larger or more complex kidney stones. It’s also the best treatment if several small stones are bundled up in one kidney. During the procedure, the surgeon makes a half-inch incision in the side or back and then guides a nephroscope (rigid telescope) through the incision and into the area of the kidney where the stone is located. Using the nephroscope, the urologist reaches the stone with instruments that fragments it into pieces that are then suctioned out. The ability to suction tiny pieces of stone from the urinary tract makes PCNL the best treatment option for larger stones.

PCNL is performed with the patient under general anesthesia. The procedure requires hospitalization and you are discharged after 24 hours but resume normal activities after 1-2 weeks. Usually at the end of the procedure a tube is placed in the kidney to help drain urine into a bag outside the body. The tube remains for a few days or just overnight. Before you are discharged from hospital, the urologist may do X-rays to check if any pieces of stone remain. The nephroscope may be inserted again if any stone fragments are detected to remove the leftover fragments and to make sure you are completely free of the condition.

At St Pete Urology, we have experienced urologists, specialized equipment and highly-skilled support personnel to help us deliver excellent outcomes for patients with kidney stones. We use both surgical and non-surgical methods to tackle this painful condition, including the minimally-invasive procedures of shockwave lithotripsy, percutaneous nephrolithotomy and ureteroscopy, robotic surgical procedures, advanced imaging technology, medications and dietary changes. For us, the goal is not only to cure kidney stones but also to prevent a recurrence — striving to make your first stone surgery your last. So if you have symptoms of kidney stones or want advice on how to avoid this painful condition, come see us for help. For more information on prevention, diagnosis and treatment of kidney stones, visit the “St Pete Urology” site.

Meet Dr. Adam Oppenheim

Urology is a great blend of surgery and medicine and a specialty that provides an amazing work-life balance. It also brings profound satisfaction from the excellent outcomes with most cases. It is a wonderful opportunity to help people with embarrassing conditions and a chance to provide life-saving and life-extending treatments. Being passionate about making a difference in the lives of people, I found urology the perfect specialty for me.

Becoming a urologist

I was born and grew up in Yorktown, Va., and went to Virginia Tech for my Bachelor of Science in Biology. I went to the Nova Southeastern University, College of Osteopathic Medicine for my medical education. While a lot of factors were involved in choosing to become a doctor, my dad was a big influence. He was an ophthalmologist who spoke fondly about the joy of caring for patients — both in his office and in the operating room. My dad made medicine such a noble career that I was inspired to follow in his footsteps.

But it was when I was a third year medical student that I chose to become a urologist. My general surgery rotations allowed me to interact closely with many urologists. During those sessions I spent with them, I saw the enthusiasm the urologists brought to their work and it inspired me. They really appreciated their work and their passion and commitment translated into great care and excellent outcomes for their patients. They instilled that love for urology in me — a love that has continued to flourish ever since.

I completed my general surgery and urology residency at the Einstein Medical Center in Philadelphia. During those years in Philadelphia I also received urology oncology training at the Fox Chase Cancer Center — one of the nation’s top centers in cancer care. My urology training included working with the country’s leading doctors in penile implant surgery, enabling me to be solidly grounded in knowledge, skill and experience in penile prosthesis. Likewise, I took extra-curricular courses in mid-urethral sling insertion for stress incontinence in women, urologic prosthetics, GreenLight laser therapy and InterStim sacral neuromodulation for BPH.

What do we do as urologists?

We are specialists in treating medical problems of the urinary tract and the male reproductive system. The problems are found in organs such as kidneys, uterus, urethra, urinary bladder and male reproductive organs. When necessary, we perform surgeries to remove kidney stones, genital abnormalities present at birth, urinary tract obstructions, and other issues causing problems for patients. We diagnose and treat enlarged prostate, erectile dysfunction, urinary problems, urologic cancers, overactive bladder, urethritis, prostatitis and interstitial cystitis, among other conditions. We see patients of all ages, from babies and children to seniors.

Urology is a specialized field with a lot of things that I like. We do many procedures to improve the quality of life of our patients. For instance, we do prostate procedures to help patients pass urine, treat erectile dysfunction which is quite embarrassing to those who struggle with it, treat kidney stones that can cause agonizing pain, and tackle life-threatening conditions such as prostate cancer and kidney cancer. I practice every aspect of general urology but I have a special interest in erectile dysfunction, kidney stones, urinary problems, enlarged prostate, prosthetics and men’s health, spending the better part of each day doing exams on the male genitalia and performing a lot of surgeries on balls and penises.

Job Satisfaction

As a urologist, I always feel that I’m in a unique position. I am able to have a lasting relationship with my patients, which is something I find really gratifying. And after almost every successful diagnosis and treatment, my patients improve quickly and are able to enjoy life again — something that fills me with joy and satisfaction.

During our work, the most difficult part is usually for patients struggling with embarrassing and awkward conditions to walk in, sit down and discuss sensitive issues openly and honestly. With every encounter I try to provide a caring and compassionate environment that allows for frank and open conversations. The goal for me is to craft a personalized treatment plan that suits the goals and lifestyle of each patient. A plan may be as simple as changing medications or as complex as conducting surgery with sophisticated equipment.

Why St Pete Urology

St Pete Urology is a wonderful place with great professionals and state-of-the-art equipment. Working here always fills me with pride because of the excellent outcomes we achieve for our patients and the unwavering commitment to improving the standards of care through innovative and advanced techniques. It’s always buzzing with people sharing jokes and smiling, and that positive attitude is contagious. It also helps because we have to perform tests and procedures in an uncomfortable area of the body and there are often times we have to deliver news about diagnoses that patients may not want to hear. It has been an amazing time being here and I have only good things to say about urology — I would choose urology if I had to do so again.

For more information on our urologists and range of services, visit the “St Pete Urology” site.

What are the symptoms of infertility in males?

Defined as inability of a couple to achieve pregnancy after at least one year of frequent, unprotected sexual intercourse, infertility affects women and men equally. Up to 15 percent of couples are unable to achieve pregnancy after one year of unprotected sex while 10 percent of couples are unable to have a successful pregnancy after two years. In couples suffering from infertility, about 35 percent of the cases are caused by male factors, 35 percent are caused by female factors, 20 percent are due to both female and male factors, and the remaining 10 percent are due to unexplained causes. These figures indicate that male infertility is a significant contributor to infertility of couples. To get his female partner pregnant, a man must:

1. Produce healthy sperm: That includes proper growth and development of reproductive organs during his puberty, with the testicles functioning properly, and his body must make enough testosterone and the other hormones necessary for sperm production.

2. His sperm must reach semen: After sperm production in the testicles, they must be transported in the tubes until they get into semen for ejaculation through the penis.

3. He must have enough sperm in semen: The sperm count (numbers of sperm found in semen) must be sufficient in order to increase the odds of fertilizing the ovum (egg). A lower-than-normal sperm count is having fewer than 39 million sperm per ejaculate or less than 15 million sperm in every milliliter of semen.

4. His sperm must be both functional and motile: If the function and movement (motility) of sperm is abnormal, the sperm may not reach or penetrate his partner’s ovum (egg).

Male infertility symptoms

The most obvious sign of infertility in men is inability to make a wife pregnant. But in most cases, male infertility occurs because of an underlying problem, such as low sperm production, a blockage preventing sperm delivery, abnormal sperm function, hormonal imbalance, inherited disorder, dilated veins in the testicles, illnesses and chronic health problems, lifestyle choices, injuries, and other factors. So even though most infertile men may not notice any symptoms apart from their inability to make their female partners pregnant, other male infertility symptoms do exist.

Symptoms of infertility include:

  1. A lump, swelling or pain in the testicular region.
  2. Sexual function problems, such as reduced sperm volume, difficulty with ejaculation, difficulty achieving and maintaining erections, or reduced sexual desire.
  3. Inability to smell.
  4. Recurrent respiratory infections.
  5. Decreased body or facial hair and other signs of hormonal or chromosomal abnormality.
  6. Gynecomastia (abnormal breast growth).
  7. A lower-than-normal sperm count (total sperm count below 39 million per ejaculate or less than 15 million sperm in each milliliter of semen).

Male Infertility Causes

Male infertility may be caused by a number of medical, environmental and lifestyle issues.

1. Medical causes

a. Varicocele: Refers to the swelling of veins draining the testicles. It’s the most frequent reversible factor in male infertility and it triggers infertility by hampering testicular temperature regulation, which in turn reduces sperm quality. When varicoceles are treated, sperm function and numbers improve, and the outcomes are better than opting for assisted reproductive techniques like in vitro fertilization.

b. Infections: Infections that interfere with sperm health and production or obstruct the passage of sperm, such as epididymitis (inflammation of epididymis), orchitis (inflammation of testicles) and certain sexually transmitted infections like HIV or gonorrhea, may contribute to male infertility. Though some infections may lead to permanent testicular damage, sperm is still often retrievable in most infections.

c. Sperm-attacking antibodies: Anti-sperm antibodies are typically immune system cells which mistakenly recognize sperm cells as harmful invaders and try to eliminate them.

d. Tumors: Cancers and non-malignant tumors of the male reproductive organs and the glands releasing reproductive hormones, like the pituitary gland, may lead to male infertility. In some instances, chemotherapy, radiation or surgery used to treat these tumors may affect male fertility.

e. Undescended testicles: During fetal development, one or both testicles may fail to move from the abdomen to the scrotum (sac that usually contains the testicles). Men who have had undescended testicles have a bigger risk of infertility.

f. Hormone imbalances: Disorders of the testicles and abnormalities of hormonal systems such as pituitary, hypothalamus, adrenal and thyroid glands can contribute to male infertility. Likewise, male hypogonadism (low testosterone) and other hormonal issues can affect fertility.

g. Defects of tubules transporting sperm: Tubes that carry sperm can be blocked through inadvertent injury during surgery, trauma, prior infections or abnormal development, including cystic fibrosis and similar inherited conditions. Blockage may occur at any level, such as within the testicle, in the epididymis, tubes draining the testicle, in the urethra, near ejaculatory ducts or in the vas deferens.

h. Ejaculation problems: During ejaculation, semen may occasionally enter the bladder instead of coming out through the tip of the penis. This is called retrograde ejaculation and it can be caused by various conditions, including spinal injuries, diabetes, medications, and bladder, urethra or prostate surgery. In men with spinal cord injuries or certain diseases, sperm is produced but semen can’t be ejaculated. In these cases, sperm can be retrieved and used in assisted reproductive techniques.

i. Chromosome defects: Abnormal development of male reproductive organs can be caused by inherited disorders like Klinefelter’s syndrome — whereby a male is born with two X and one Y chromosomes instead of the normal one X and one Y chromosomes. Other genetic syndromes related to infertility include Kartagener’s syndrome, Kallmann’s syndrome and cystic fibrosis.

j. Celiac disease: This is a digestive disorder resulting from sensitivity to gluten. It can cause infertility in men, but improves with adoption of a gluten-free diet.

k. Sexual intercourse issues: Problems such as premature ejaculation, erectile dysfunction, painful intercourse, relationship or psychological problems that interfere with sex, or anatomical abnormalities like hypospadias (having a urethral opening underneath the penis) can contribute to infertility.

l. Certain medications: Drugs such as cancer medications (chemotherapy), long-term anabolic steroid use, testosterone replacement therapy, some ulcer drugs, certain antifungal medications and various other medications can impair sperm secretion and reduce male infertility.

m. Prior surgeries: Inguinal hernia repairs, vasectomy, prostate surgeries, testicular or scrotal surgeries, and large abdominal operations performed for rectal and testicular cancers, among others, can reduce the chances of having sperm in the ejaculate. In most cases, the blockage can be reversed surgically or sperm can be retrieved directly from the testicles and epididymis.

2. Environmental causes

Excessive exposure to environmental elements like heat, chemicals and toxins can reduce sperm production and function. Specific environmental factors include:

a. Exposure to heavy metals such as lead.

b. Prolonged exposure to toluene, xylene, benzenes, herbicides, pesticides, painting materials, or organic solvents, which results in lower sperm counts.

c. Overheating the testicles: Elevated temperatures can impair the production and function of sperm. For instance, frequent use of hot bath tubs or saunas may temporarily lower your sperm count. Wearing tight clothing, long periods of sitting, or working for long stretches of time on a laptop may increase scrotum temperature and slightly decrease sperm production.

d. Exposure to X-rays or radiation can lower sperm production, though eventually it will return to normal. But exposure to high doses may reduce sperm production permanently.

3. Lifestyle, health and other male infertility causes

a. Alcohol use: Excessive consumption of alcohol can reduce testosterone levels, decreasing sperm production and causing erectile dysfunction. Liver disease due to excessive drinking also may cause fertility problems.

b. Drug use: Use of marijuana or cocaine may temporarily lower sperm numbers and viability. Anabolic steroids used to stimulate muscle growth and strength can reduce testicle size and decrease sperm production.

c. Tobacco smoking: In men who smoke, sperm counts are generally lower than in non-smokers. Likewise, male infertility may occur in men frequently exposed to secondhand smoke.

d. Weight: Obesity can directly impact sperm themselves or cause hormonal changes that may reduce male fertility.

e. Depression: In men with depression, sexual dysfunction and subsequent infertility can result from erectile dysfunction, reduced libido, or inhibited or delayed ejaculation. In fact, the likelihood of pregnancy is lower in couples where the male partner suffers from severe depression.

f. Emotional stress: Prolonged or severe stress can interfere with various hormones necessary for sperm production and affect sperm count.

So what are the infertility risk factors in men:

  1. Being overweight
  2. Being severely stressed or depressed
  3. Using alcohol
  4. Smoking tobacco
  5. Using certain drugs
  6. Trauma to the testicles
  7. Overheating the testicles
  8. History of undescended testicles
  9. Exposure to certain toxins
  10. Having certain present or past infections
  11. Prior pelvic surgery, major abdominal surgery or vasectomy
  12. Family history of a fertility disorder or being born with such a disorder
  13. Certain medical disorders, including chronic illnesses (like sickle cell disease) and tumors
  14. Undergoing medical treatments (like radiation or surgery for treating cancer) or taking certain medications.

How can you prevent infertility?

You can do so by avoiding some of the known causes of infertility. For instance:

  1. You should not smoke.
  2. You should abstain from or limit alcohol consumption.
  3. You should stop using illicit drugs.
  4. You should lose some weight.
  5. You should reduce stress.
  6. You should avoid exposure to heavy metals, pesticides and other toxins.
  7. You should avoid activities that result in prolonged heat to the testicles.

When should you see a doctor?

You should see a doctor if you’ve been unable to achieve pregnancy after 1 year of frequent, unprotected sexual intercourse. But you may need to see a doctor sooner than that if:

  1. You have ejaculation or erection problems.
  2. You have low sex drive or any other issues with sexual function.
  3. You have discomfort, pain, a swelling or lump in your testicles.
  4. You have a history of prostate, testicle or sexual problems.
  5. You have previously undergone a penis, groin, scrotum or testicle surgery.

For more information on male infertility and how to deal with it, visit the “St Pete Urology” site.

Vasectomy Reversal – Does it REALLY work?

A vasectomy reversal is the procedure to reconnect the tubes (vas deferens) that are cut and sealed off during a vasectomy. Though still considered a permanent method of birth control, advances in microsurgery have ensured that it can be reversed even after 15 years or more. Men can choose to undergo a vasectomy reversal after a remarriage, a change of heart, loss of a child, or to treat testicular pain associated with a vasectomy. The reversal is typically an outpatient procedure performed under general or local anesthesia, taking around 3 hours and followed by a short recovery period. Nevertheless, only about 6 percent of men who undergo a vasectomy choose to have it reversed later.

Success rate of vasectomy reversal

The success rate of reconnecting the tubes severed during vasectomy is quite high, about 90 percent. After a successful reconnection of each tube, sperm is again able to pass from the testicles through the tubes and reach semen, and a man may again be able to get his partner pregnant. But the success of a vasectomy depends on a number of factors, such as the state of the tubes during the reversal and how many years have elapsed since the vasectomy was done.

If you undergo a vasectomy reversal within seven years of the vasectomy, the reversal is a simple procedure of putting the vas deferens back together. But if the tubes are too short to reconnect, if there is scarring or it’s been more than seven years since you had the vasectomy, the reversal process may be more complex. However, even with the more complex procedure, the success rate is still around 50-60 percent with no much difference in pregnancy rates — the average being 50-60 percent likelihood of pregnancy, which drops to 44 percent if time since a vasectomy is greater than 15 years.

If the time since vasectomy is less than 15 years, the reversal provides a pregnancy rate that’s higher than in vitro fertilization (IVF) and sperm aspiration with intra-cytoplasmic sperm injection (ICSI). And even after intervals greater than 15 years since a vasectomy, the reversal still gives outcomes equal or greater than IVF with ICSI.

Vasectomy reversal techniques

Vasectomy reversal is usually performed in two ways. The first technique is vasovasostomy (VV), which is basically the piecing back together of the two sides of the tubes (vas deferens) — that is vas deferens to vas deferens. The other technique is vasoepididymostomy (VE), which involves reconnecting the vas deferens to epididymis, the duct that transports sperm to the vas deferens. Generally vasovasostomy (VV) is done if sperm is present in the vas fluid. If sperm isn’t present in the fluid, vasoepididymostomy (VE) is the go-to procedure. In some cases, a combination of both techniques may be necessary, with a vasoepididymostomy done on one side and a vasovasostomy on the other.

A vasoepididymostomy is slightly more complicated and therefore chosen only when a vasovasostomy is impossible or can’t work. You won’t know the technique that the surgeon will use until the operation begins and that usually depends on whether sperm is present in the fluid found in the vas deferens at the time of surgery. Both are outpatient procedures that take less than 3 hours. A man has a successful vasectomy reversal if sperm evaluations performed several months later indicate he has the normal sperm count necessary for conception.

How should you prepare for a vasectomy reversal?

A vasectomy reversal is a complex and expensive procedure that’s often not covered by insurance. So you should find out what you’ll need and all the costs well ahead of time. The procedure is generally more successful when performed by surgeons who are trained and experienced in microsurgical techniques and who have done the procedure several times. So when choosing a doctor for the procedure, find out how many reversals the surgeon has performed, the techniques used, how often pregnancy has occurred after surgery, and the risks and complications involved.

Similarly, you’ll need to buy tight-fitting undergarments (like an athletic supporter) that you will wear after the procedure to hold bandages in place and support your scrotum. You also will need to stop taking medications that increase the risk of bleeding, including pain relievers (like ibuprofen or aspirin) and blood-thinning drugs. You should make arrangements for your travel to and from the hospital and for the length of time you will need to recover after surgery.

What should you know before a vasectomy reversal?

Vasectomy reversal is performed as an outpatient procedure that doesn’t require an overnight stay in a hospital. Before the procedure, the surgeon will take your medical history and conduct a physical examination to make sure you’re not having any health problems that may lead to complications after or during surgery. If your physical exam shows abnormal results or you’ve got sexual function issues, the doctor may consider running some blood tests. Likewise, a review of your surgical history is done to assess whether you had any previous surgeries other than the vasectomy or prior injuries that can hinder the vasectomy reversal. The doctor also will confirm whether you can produce healthy sperm. While evidence of fathering a child before is usually sufficient proof of the health of your sperm, additional testing may be necessary if there is uncertainty.

What happens during a vasectomy reversal?

Once you’re in the operating room, anesthesia is applied to minimize discomfort during the procedure. That may either be general anesthesia to keep you unconscious throughout the procedure or a local, spinal or epidural anesthesia to minimize pain but without putting you to sleep. The surgeon then makes a small incision on the underside of your scrotum to expose the tubes (vas deferens) and free them from surrounding tissues. Cutting open the vas deferens, the surgeon examines the fluid inside the tubes to establish whether sperm is present. If it’s found that sperm is present, the doctor simply reconnects the ends of the tubes to enable sperm passage. If the fluid inside the vas deferens is pasty, thick or contains partial or no sperm, that’s usually an indication that there’s a blockage of sperm flow and that vasovasostomy may not work. In that case, vasoepididymostomy is the more appropriate procedure.

What happens after the procedure?

After the procedure, the doctor applies bandages to cover the incisions. Make sure to ask your doctor when it will be OK to take the bandages off. The stitches applied should dissolve in 7-10 days. You will be required to wear tight-fitting undergarments (like athletic supporter) and apply ice to minimize swelling. The area may feel sore for many days, but the pain shouldn’t be severe and should improve within a few days to one week.

Once back at home, make sure to take it easy and avoid any activities that may move the testicles excessively or pull on the scrotum or testicles, such as heavy lifting, biking, jogging or sporting activities. For the next several weeks, wear an athletic supporter at all times, removing it only when showering. Avoid activities such as swimming and bathing for the first two days following surgery because they can make the surgery site wet. If your job requires much driving, walking or physical exertion, seek your doctor’s advice on when it’s safe to return to work. But for a desk job, you can return to work within a few days after surgery — only making sure that nothing harms the surgery site. Do not ejaculate or engage in sexual intercourse until your doctor gives you a go ahead — that is often 2-3 weeks after surgery.

What results should you expect?

To assess the success of a vasectomy reversal, the doctor will examine your semen 6-8 weeks after surgery. If the procedure is successful, sperm will be present in the semen. The appearance of sperm in semen should happen within a few months, but may take a year or more in some cases. So the doctor may have to conduct periodic semen analysis to evaluate the success of the procedure, unless your partner gets pregnant soon after the reversal. The prospect of achieving pregnancy usually depends on a number of factors, including the age of your female partner and the duration of time that has elapsed since the vasectomy.

Can the reversal fail to work?

If a blockage develops in the tubes after surgery or there is an underlying issue with your testicles that wasn’t recognized during surgery, a vasectomy reversal can fail to work and you may need a second-attempt reversal procedure. Doctors often opt to collect and freeze some sperm during a vasectomy reversal, which can then be used if the procedure doesn’t work. But if sperm isn’t frozen during the procedure or you completely lack sperm in your ejaculate, sperm can still be retrieved directly from your epididymis or testicle to help you have children via assisted reproductive techniques, like in vitro fertilization.

At St Pete Urology, we have a huge pool of urologists trained in andrology and experienced in microsurgical techniques. We conduct the procedure under very high-level magnification using incredibly small sutures. We perform several vasectomy reversals every year and boast significantly high success rates. So if you are looking for specially trained and skilled doctors to reverse a vasectomy in a way that will maximize your chances of having children, come and see one of our urologists. For more information on vasectomy and vasectomy reversal procedures, visit the “St Pete Urology” site.

GreenLight PVP Laser, a Great Treatment Option for BPH

Photo-selective Vaporization of Prostate (PVP) is increasingly becoming a popular method of treating benign prostatic enlargement (enlarged prostate or BPH). Using a combination of a high-powered laser beam and fiber optics to vaporize overgrowths of cells in the prostate, PVP helps to shrink the prostate gland quickly and accurately and swiftly relieves symptoms of Benign Prostatic Hyperplasia. The GreenLight Laser PVP is an alternative to the more common TURP (Transurethral Resection of Prostate). While the PVP procedure offers equal effectiveness in improving BPH symptoms, it’s simpler, has minimal short-term side effects, and offers quicker symptom relief, comfort and ease of urine flow.

How Is The Procedure Performed?

Conducted as an outpatient procedure by a urologist trained in the technique, the GreenLight Laser PVP requires nerve-blocking, spinal or general anesthesia along with sedation. During the procedure, the urologist inserts a cystoscope (tube supplied with light) via the urethra into the prostate, then runs a thin fiber through the cystoscope and places it in the urethra just adjacent to the obstruction. The urologist directs the laser at the prostate with intense pulses of light radiating from the ends of the fiber that are absorbed by blood.

As the blood absorbs light its temperature increases rapidly, heating up and vaporizing nearby cells. The surgeon continues to apply the laser light to destroy tissue overgrowth and reduce restriction on the urethra. The tissue that’s evaporated seals the blood vessels and reduces bleeding. The procedure takes roughly 40-60 minutes and a temporary catheter is usually inserted to help drain urine from the bladder.

So what are the benefits of Laser PVP?

  1. Minimal bleeding.
  2. Patients return home the same day.
  3. Return to normal activities in 2-3 days with caution.
  4. Only about 30 percent of patients require a post-op catheter.
  5. Return to strenuous activities in 4-6 weeks.
  6. Complications are rare, but quite mild if they occur.
  7. No post-operative impotence.
  8. PVP has not been associated with erectile dysfunction.
  9. Less likely to cause retrograde ejaculation.
  10. Lasting improvement in urine flow.
  11. Urinary obstruction is less likely with PVP.

Recovery after GreenLight Laser PVP

After laser PVP, patients remain in a recovery area where they are observed and prepared for discharge, typically within a few hours. If a temporary catheter is inserted, it’s usually removed 2-3 days after treatment, but may be left for a longer period in men who have had very severe symptoms or suffered prior bladder damage. During the first week following the procedure, a slight burning and discomfort may be experienced when urinating and small amounts of blood may occur in urine. While a dramatic improvement of symptoms and urine flow occurs within 1-2 days after the procedure, patients may still experience frequency and a sudden urge to pass urine for some time after treatment since the urethra is still adjusting to changes. And those with multiple health problems may not realize improvement that quickly.

Many men resume normal activities three days or so after laser PVP, but it’s recommended that they refrain from heavy lifting, pushing, strenuous exercise and vibrating equipment for at least 2 weeks because such activities may aggravate the urogenital area and cause bleeding. Sexual activity should be avoided for 2-3 weeks and only resumed when the patient is really comfortable doing so. It’s crucial to take things slowly and realize that it’ll take a while to get everything back to normal, including sexual desire. At times, retrograde ejaculation or reduced volume may occur, but these do not affect sexual pleasure or orgasm.

Is Laser PVP Safe?

The GreenLight Laser PVP is a significant improvement on the other minimally-invasive procedures used to treat BPH. It accurately vaporizes the overgrowth of the prostate gland without damaging any surrounding tissues and vessels. High-powered energy beams are delivered through a very thin laser fiber resulting in safe and precise vaporization of the overgrown tissue that’s blocking normal urine flow. As the high-pulsed laser removes the tissue causing blockage, it coagulates blood vessels and minimizes bleeding. Compared to other options for treating BPH, the GreenLight Laser PVP is much safer, simpler, faster, more precise and more effective. And most importantly, it allows quicker recovery than the other treatment options.

How does laser PVP compare with TURP?

Previously, effective BPH treatment required open prostatectomy — a major abdominal operation that needed a longer hospital stay and several months for recovery. But with the availability of instruments for accessing the prostate via the urethra instead of through the abdomen, TURP (transurethral resection of prostate) became the preferred treatment as it offered more safety, efficiency and effectiveness. However, there was still need for a better treatment that could offer quicker results, shorter recovery times and fewer long-term side-effects. The GreenLight Laser PVP has proven an improvement on TURP by being less invasive, delivering more immediate results and providing shorter recovery periods.

At St Pete Urology, we recommend transurethral vaporization procedures, most commonly the PVP GreenLight Laser and HoLAP (Holmium Laser Ablation), as alternatives for the previous gold standard TURP (Transurethral Resection of Prostate) because they are minimally-invasive outpatient operations with lower risks, durable results, safe use on large glands and patients on blood thinners, and high patient satisfaction. We perform the PVP GreenLight Laser on patients eligible for TURP, but discuss all the treatment options with our patients before we make a choice. For more information on treatment and care for BPH, visit the “St Pete Urology” site.

What Does A Urologist Do?

If you have never been to a urologist, you may feel uneasy about your first visit. You may be seeing the urologist about a very awkward and distressing condition. In truth, though, there is no reason really to worry or feel squeamish. Urologists make every effort to keep their patients at ease and as comfortable as possible. So you can be sure that you’ll meet warm, friendly and candid professionals in the urologist office, be handled with respect, courtesy and friendliness, and have your problem solved.

Who is a urologist?

Urologists are physicians with specialization in diseases of the genitourinary tract — urinary bladder, kidneys, urethra, male reproductive organs, adrenal glands and urethra. In men, urologists tackle disorders of the prostate, penis, epididymis, testes and seminal vesicles and help resolve male sexual dysfunction and infertility. But most routinely, they see both men and women for various reasons, including recurrent urinary tract infections, urinary incontinence, kidney disease, renal transplants, urologic cancers, bladder prolapse, enlarged prostate, urethra stricture, erectile dysfunction, Peyronie’s disease, painful bladder syndrome, ureteral and kidney stones, and prostatitis. They also may see children with urological problems that are too complex to be handled by non-specialized pediatricians.

Prostate and bladder cancer

For most men, a visit to the urologist is often associated with the prostate exam. The exam is quite a crucial part of assessing the overall prostate health and enables the urologist to plan well for treatment of any prostate problems. But the prostate exam is no longer at the heart of every urologist visit and you now can see a urologist and leave without being examined. In fact, with increased use of PSA tests to screen for prostate cancer, the exams are now just performed when very crucial. You shouldn’t avoid those necessary visits to a urologist merely because you don’t like prostate and rectal exams.

Remember also that if after testing you are diagnosed with prostate cancer, your urologist can help by offering timely, lifesaving care. Actually, because the physician can detect and help you recover from a disease that can potentially incapacitate you and reduce your joy of life and the time you spend with your family and your loved ones, it’s very important to visit a urologist whenever you are directed to do so.

Urologists use some of the best medical techniques and technologies to deliver safe, painless and effective treatment for urologic cancers. For example, if your urologist opts for robotic surgery then you will not be in the hospital for more than a week after a kidney, prostate or bladder cancer surgery. Most likely, you will take only a few days, even a single day — leaving soon after procedure. That’s fast and convenient, indeed. So you shouldn’t suffer in silence and have your prostate cancer spread to other areas of the body just because you believe the treatment will be painful, uncomfortable or inconvenient.

Prostate enlargement

If you have had to habitually wake up at night to pass urine and always find it difficult to produce a steady, quick urine stream as you once did, you probably have an enlarged prostate and a urologist can help you overcome the condition. This specialist doctor is quite similar to that neighborhood plumber you call to your home when pipes are clogged. So when you visit a urologist, are examined and found to have an enlarged prostate, the doctor will use a number of techniques such as laser therapy and steam treatment to remove the pressure on your bladder and obstruction on your urethra, relieving your urinary symptoms. And you can return home the same day you undergo treatment.

Erectile dysfunction

As men get older, they may experience erectile dysfunction. In fact, for men in their 40s or 50s, erections aren’t what they once were. So what should you do when you have issues with your erections? Well, one great option — a visit to a specialist who can identify the cause of your erectile problems and provide effective treatment. And that’s a urologist — a physician with training and experience in treating erectile dysfunction and male infertility issues. Since erectile dysfunction also may indicate that you have health problems in other areas of your body which may require more careful attention, a visit to a urologist can help detect a more serious disease and save your life.

Kidney stones

The pain and discomfort of a major kidney stone is something you may never forget. But with a visit to a urologist, kidney stones of all sizes can be broken down and removed from your system. A urologist sees such cases routinely, knows exactly what to do and will help you find quick relief from the pain and discomfort of the stones. And since kidney stones may recur, you will require the long-term care and well-coordinated follow-up provided by urologists. The urologist will recommend effective ways you can use to prevent kidney stones and manage any painful stones you may develop. That means you can rest easy before or after you have kidney stones knowing that you have an expert to help you deal with such troubles. So if you suspect that you have or are at risk of kidney stones, visit a urologist for proper examination and treatment.

What if you are a woman?

Urologists see women too and there is no discrimination in terms of sex. In fact, because kidney stones and bladder problems can occur in both men and women, the doors of all urologists are always open for both sexes. Nevertheless, about two-thirds of all patients seen by urologists are still men because of the lower awareness levels among women on how these specialist physicians can help them. Likewise, visits to urologists are generally practice-specific and vary according to a doctor’s area of specialty training.

While it doesn’t really matter whether you see a male or female urologist — as the quality of care will be the same — some women prefer to be treated by female urologists while some men prefer seeing male urologists. That’s just a matter of choice and you are encouraged to see the urologist you feel most comfortable with. But as you do so, remember that all urologists are focused on holistic care, effective treatment, superb outcomes and improved quality of life for all. So even if you are a guy who is generally bashful when around females, you shouldn’t fear seeing a female urologist, for whatever condition you have isn’t something the female urologist hasn’t seen before. Don’t suffer in silence because you are anxious about being attended to by a urologist of opposite gender.

What of pain?

Pain isn’t part of the treatment process. So every time you see a urologist for a procedure, you should expect the use of an anesthetic to prevent pain and keep you comfortable. For instance, before undergoing a bladder scope, you’ll be numbed first; while the first step during a vasectomy is the injection of a nice, healthy-sized local anesthesia. Similarly, before a prostate biopsy, a prostate block is done. Whereas you may feel things moving around or some pressure during a procedure, you should not feel pain. And the point here is that you should know urologists are there to help you deal with inconveniencing problems, such as sexual function issues, urinary problems, cancer or kidney stones. But when doing so, they endeavor to keep you as comfortable as possible, aiming to eventually improve your quality of life.

Friendly, compassionate care

Urologists are skilled and experienced in treating problems that people are often unwilling to talk about or which are found in body areas that people find difficult to discuss. So your urologist knows that you are already distressed, embarrassed and feel awkward about your condition even before you visit, and has already taken steps to make you feel as comfortable as possible. By being frank and friendly throughout the treatment process, with humor coming in handy to help lighten the mood around your discussions, the doctor will ensure that you feel at home as your problem is tackled. Hence, don’t be surprised when some “potty” humor is thrown your way during your chat with the urologist.

Well, that’s it. There is nothing to dread or feel restless about in seeing a urologist. In fact, you will find a long-term friend who will help you overcome troubling urological issues and improve your quality of life. At St Pete Urology, we have a big pool of skilled, experienced, board-certified urologists to help you find relief from embarrassing and distressing genitourinary problems, such as kidney stones, urinary incontinence, erectile dysfunction and enlarged prostate. And we have a culture of collaborative, compassionate, patient-centered care that helps us deliver the high-quality of treatment and care we promise our patients. Find out more about our services by visiting the “St Pete Urology” site.

10 FAQs to Urologists

Urologists tackle a variety of distressing and embarrassing conditions, improving the quality of life of their patients. From awkward urine leaks, agonizing kidney stones and humiliating failures to have an erection to life-threatening urologic cancers, urologists resolve issues that many people would rather not discuss. And because some of these issues are shrouded in secrecy, myths and untruths have developed around them which, if not tackled, may keep patients from getting treatment. There are also questions that people often seek answers for from the wrong people and which can only be properly answered by urologists. Here are 10 common, questions that urologists respond to quite frequently.

1. I feel something in my scrotum or testicle. Is that normal?

Well, there are lots of normal structures in the scrotum, particularly outside the testicle. But there are also a number of abnormal structures that may occur in the scrotum. For instance, a hydrocele is a collection of fluid around the testicle while a spermatocele is a cyst or excess fluid in the epididymis. A varicocele is a collection of unusually large blood vessels that feels like a bag of worms in the scrotum and often occurs on the left side. When a varicocele occurs, it can reduce the size of the testicle and lead to infertility. A man also may feel an actual lump in the testicle, which could indicate testicular cancer.

Whether you have a hydrocele, spermatocele, varicocele or lump in your scrotum, you should know that these are abnormal. To detect these abnormalities earlier and treat them before they advance, you should examine your testicles at least once a month. You will need to check when showering by supporting your testicle with one hand and using the other hand to feel them. If you feel anything hard or irregular inside your testicle, contact your doctor for diagnosis and treatment.

2. Can I break my penis?

Yes. While the penis is boneless, it’s made of a strong layer of tissue called tunica albuginea, which gives it rigidity during an erection. When blood flows at high pressure through these erectile bodies in the penis, this strong layer of tissue retains the blood inside and allows for erection. However, during intercourse, the fibrous connective tissue of the penis may “break” resulting in a penile fracture. When this occurs, usually in a loud, painful snap, you will bleed through the break and the erection will subside (detumescence). You also may experience swelling and bruising of the penis, which usually requires emergency surgery.

3. Should I be worried when there is blood in my semen?

Semen is typically white and thick, but may come in different consistencies. Should you have persistent blood in your semen (hematospermia), then you should definitely be worried as this may indicate a prostate problem. Likewise, you should visit your doctor for a check-up if you have painful ejaculations or a foul-smelling ejaculate as this could indicate an infection.

4. Can a young man fail to get an erection?

Only about 5 percent of men under the age of 50 have severe erectile dysfunction. So you need to speak with your doctor if you are young and can’t get an erection. Erectile dysfunction in young men may be due to a past trauma, vascular problem, disease affecting blood vessels or nerves, such as hypertension or diabetes, or some illegal drugs, prescription drugs and smoking. While this occurs only in a small proportion of young men, it should worry you if it occurs frequently.

5. How long is a normal penis? Can my small penis be made bigger?

A normal penis is 3.5-7.5 inches, with the average being about 5.5 inches. If you have a normal-size penis, just be contented with it as there is no safe way of increasing penis size.

6. Should I be concerned when my penis or scrotum has acne? Which spots are abnormal?

The hair follicles on your scrotum or penis can be infected or irritated. This is quite common and should not worry you. However, you should see your doctor if you have something that appears like the head of a cauliflower (probably a wart), an ulcerous wound or skin breakdown with a weeping wound, or something that begins as a red area then expands and produces pus (probably a signal of a serious infection).

7. Are urinary tract infections sexually transmitted? Can a toilet seat spread sexually transmitted diseases?

While some urinary tract infections have similar symptoms to sexually transmitted diseases, UTIs are generally not considered STDs. In fact, a standard UTI, such as E. coli (the most common type) is not transmitted sexually and is often caused by bacteria that’s abundant in the affected area. While a woman who is prone to UTIs may have an infection after sexual intercourse, this doesn’t mean the partner carried an STD. The woman also can not transmit a UTI to the male partner. Similarly, although it’s possible to get an infection from a contaminated toilet seat, it is quite rare for infections to be transmitted this way.

8. Should I be circumcised?

The health or medical benefits of circumcision are still debated and no doctor can make this decision on behalf of a patient. But you can choose to undergo circumcision for personal reasons. While the AAP (American Academy of Pediatrics) has reported that the health benefits of circumcision outweigh the risks involved, it does not endorse routine circumcision of newborn males. But the procedure may be valuable for treating infections of the penis and phimosis (foreskin that fails to retract) in older boys and men.

9. Should I be worried about my curved penis?

Curving of the penis is called Peyronie’s disease. Generally, curvatures of 30 degrees or less cause no functional problems and should not worry you. But if the curvature is greater than 30 degrees, it can affect intercourse and should be fixed. There are various ways of treating Peyronie’s disease. For instance, collagenase injection into the scar tissue can reduce the curvature. Likewise, a surgical removal of the scar tissue with a penile prosthesis or graft can help. Or your doctor can perform a surgical unbending (plication) of the penis.

10. I struggle to start urinating and take a long time to complete, should I be worried?

That’s probably an enlarged prostate. Also called BPH (benign prostatic hyperplasia), the condition puts pressure on the bladder and urethra and makes it difficult to start a urine stream or empty the bladder completely. There are medicines that can help relieve most cases of BPH, but if your urinary problems are very severe to the extent you can’t empty your bladder, then surgery may be necessary. If you’ve just started experiencing urinary symptoms, then you shouldn’t be worried about prostate cancer as such urinary problems occur only at a very late stage of the cancer.

Need answers for other urology-related questions? Visit the “St Pete Urology” site to find the answers to your questions.

Addressing 7 Vasectomy Myths

Alright guys, it’s time now to talk about the big V! When you hear about different birth control methods, whether through word-of-mouth, billboards, newspapers, TV or radio, you seldom hear anything about vasectomy. We want to talk to you about vasectomy now, explain away the myths and fears around it and shift the birth control discourse from the most common approach of what women should do to what men can do.

So what’s a vasectomy?

It is a simple, 15-minute non-drug permanent sterilization procedure for men. It’s performed under localized anesthesia and involves sealing off or cutting a portion of the sperm-conveying tubes (called vas deferens) in order to stop sperm from reaching the ovum when ejaculation occurs. If you are a man who has had all the children you wanted to have or are sure that you will never want to have any children in the future, vasectomy is a safe and cost-effective way to sterilize yourself.

Lots of questions

Yet, if you are like most men, you have probably heard the horror stories associated with vasectomy and you are worried that things may go wrong for you. Will it reduce my sexual pleasure? Will it turn me into a “eunuch” — a sad miserable man looking back constantly to his youthful years with nostalgia? And what if disaster strikes late in my life, or my life plans change, and I decide to have children? Can I reverse it? These and many more questions can make you have doubts about having a vasectomy. But it turns out these fears are baseless myths that shouldn’t stop you from a vasectomy.

What are the most frequent myths about vasectomy?

1. It will be intolerably painful

Honestly, for most men, the idea of the whole procedure can seem quite awkward. And since most of us have the habit of protecting our testicles from any type of direct assaults, a vasectomy seems like a real intrusion into a protected zone. But the truth is doctors who conduct vasectomies have gone through many years of study and training. They know what they are doing. They use the latest minimally invasive techniques to perform the procedure, ensuring that you feel no pain. The procedure is done under local anesthetic, so you will probably only have to worry about the needle going in. After that, you will remain aware of the procedure as it goes on but you will feel no pain or uncomfortable sensations.

2. Your penis won’t work

That’s wrong, mate. In reality, the procedure isn’t done anywhere near your penis — except of course if it’s causing an obstruction and the urologist has to move it out of the way. The snip is entirely about your balls and affects only those little tubes inside your balls that are called the vas deferens. Remember too that when you have sex and reach orgasm, the fluid that comes out, called ejaculate, is 97 percent semen and only 3 percent sperm. After vasectomy, you will still achieve orgasm and produce this ejaculate, except it won’t contain sperm and you won’t be able make your partner pregnant. That means your erections will remain exactly the same and your penis will stay as sensitive during sex as it was before the vasectomy. Likewise, your ability to enjoy sex and achieve orgasm will remain unchanged, though now you’ll be able to do so without having to worry about making anyone pregnant.

3. You will no longer ejaculate

That’s wrong, too. If you ejaculated before the snip, you’ll continue to do so after. Semen, the main component of ejaculatory fluid, is produced in the seminal vesicles and the prostate, which aren’t cut or blocked off during a vasectomy. And since only a small portion of fluid comes from the testicles with sperm, the overall volume of your ejaculate will reduce only slightly after a vasectomy — you won’t even notice it. Likewise, because the muscle contractions that propel fluid out during ejaculation typically come from the pelvis, your ejaculations won’t be affected by a vasectomy.

4. Your sperm production will shut down

Not true. Vasectomy doesn’t block sperm production and you’ll continue to make sperm after the snip. The only difference is that sperm will no longer reach semen and form part of the ejaculate. Because the sperm will go nowhere after a vasectomy, it will live for 3-5 days and decay naturally in the body. This is the same thing that happens naturally in men if they don’t ejaculate every 5 days or so. They produce sperm continuously but the sperm goes nowhere and is reabsorbed naturally in the body.

5. You can’t reverse it once it’s done

No, you can if you want. Vasectomy can be reversed through a surgical procedure called vasovasostomy (vasectomy reversal). During the procedure, the vas deferens (tubes) are reconnected, with each tube re-joined as it was before the snip in order to create a passageway for sperm, allowing sperm to again be present in semen. A successful reversal procedure restores your fertility and you can again make your partner pregnant. But when considering a vasectomy reversal, you need to consult an experienced urologist. That will ensure that no tissues are irreparably damaged during the reversal procedure.

6. Even if it’s reversed, you’ll remain impotent

Not really. With microsurgical advances currently used in vasectomy and vasovasostomy, the reversal has become more precise and more successful. So while vasectomy reversal is still technically expensive and demanding, doctors can now successfully restore a man to his pre-vasectomy condition. Although many men think that vasectomy can make them impotent, they should know that the procedure has no effect on blood flow to the spongy veins of the penis. These veins cause an erection. A vasectomy tends to make love-making more pleasurable and fun through the exhilarating feeling accompanying the ejaculation of spermless semen and also by erasing the fear of pregnancy.

7. It’s harder than a woman getting her tubes tied

A nice try indeed, but still wrong. Tubal ligation is performed under epidural or general anesthesia and typically takes longer than the 10-20 minutes required for a vasectomy. Tying a woman’s tubes also comes with a much more serious complication rate than a vasectomy. So why not just take the simpler route to contraception and block the source of sperm in order to remove the burden of birth control from women instead of looking for excuses to pressure women with contraception? After all, vasectomy is more effective than tubal ligation, costs much less and guarantees better results. In fact, for partners and couples considering family planning, vasectomy is a great cost-saving and effective solution to consider.

What if you are just one of those men who want to have multiple sexual partners without any additional responsibilities? Well, vasectomy works for that too. If you get a vasectomy, you can enjoy your lifestyle without having to worry about the possibility of fatherhood.

Want to know more about vasectomy? Speak with your partner and assess whether you have had all the children you want. Once you are sure of your decision, visit your doctor to discuss this birth control method. For more information on vasectomy and vasectomy reversal, visit the “St Pete Urology” site.

How To Manage The Pain Of Kidney Stones?

Marked by an agonizing, excruciating and intolerable pain, kidney stones account for over 1 million annual emergency room visits in the United States. The pain usually starts in the upper flank, as a sudden twinge on the side, escalates to the loins and migrates to the front of the body. The sharp stabbing pain of kidney stones is worse than childbirth pain and quickly makes it impossible to function. It is important for you to know how to prevent kidney stones and how to deal with the pain if you get the stones.

What are kidney stones?

Kidney stones are small, hard pebble-like lumps formed when there are high levels of various minerals in urine. The minerals and other substances crystallize and form hard masses before they can be flushed away. Classic stones are a blend of calcium and oxalate (an organic acid found in urine), but lumps of uric acid, calcium phosphate and other substances also may form. A stone may sit in the kidney or ureter with little or no pain. But often when the stone leaves the kidney or gets stuck in the ureter, it blocks the flow of urine and causes pain.

Symptoms of kidney stones

When a kidney stone moves around in the kidney or gets lodged in the ureter, it may block the passage of urine. Such a blockage causes:

  1. Sharp, stabbing pain on the side or in the back.
  2. Painful urination.
  3. Pain episodes that come and go.
  4. Blood in urine.
  5. Fever, nausea and vomiting in case of an infection.

Kidney stones are perhaps the most painful condition known. In fact, most patients with stones often find themselves in the hospital emergency department. In all cases of pain due to suspected kidney stones, urologists first rule out other possible causes of pain, such as bowel, gynecologic and musculoskeletal problems. The presence of kidney stones is confirmed by X-rays or CT scans. Blood and urine tests also may be used to assess the levels of various stone-forming substances in your system.

Managing Pain Due To Kidney Stones

Once it is confirmed that you have kidney stones, the urologist will give you intravenous painkillers to relieve pain. You then will be sent home with oral drugs (such as acetaminophen, aspirin, diuretics, and antibiotics) to use as you wait for the stone to pass out of your system. Drinking plenty of water, taking hot showers, sitting in a warm water tub and taking drugs that dilate the ureter will bring relief and allow the stone to pass. Eventually the agony will end when the stone passes out.

Smaller stones are more likely to pass on their own. In fact, 80 percent of kidney stones are usually less than 4 mm in diameter and typically pass on their own, though that takes up to 31 days. It is more difficult for larger stones to pass on their own. Stones of 4-6 mm in diameter tend to pass on their own 60 percent of the time while those larger than 6 mm only pass out 20 percent of the time. Therefore in most cases, a non-invasive or minimally-invasive medical procedure is necessary to remove stones larger than 4 mm and those stuck in the ureter.

Surgery for Kidney Stones

Non-obstructive stones rarely cause pain. So surgery is not necessary when kidney stones are not causing any obstruction. And even if they cause pain, medications are usually sufficient. But surgery is required when there is bothersome flank pain and imaging evidence of one or more obstructive stones.

Common surgical treatments include:

  1. Shockwave lithotripsy: A simple outpatient procedure in which sound waves are directed on kidney stones, breaking them into smaller pieces capable of passing on their own in urine.
  2. Ureteroscopy: An outpatient procedure for small-to-medium stones in which a small tube (ureteroscope) is inserted into the urinary tract and used to pull out stones or to direct laser to the stones to break them into smaller pieces.
  3. Percutaneous nephrolithotripsy: A procedure in which the urologist makes a small incision in the back and directly into the kidney, using the incision to access and remove stones. It is the most effective method for very large kidney stones.

Preventing Kidney Stones

Lifestyle changes can help you to avoid having kidney stones. For instance, drinking at least two-and-a-half liters of water every day will help you to achieve a daily urine production of two liters, which prevents stones. Fluids such as coffee and citrus juices also are very effective in preventing kidney stones. Citrus (especially from lemon and grapefruit) makes urine more alkaline and reduces the risk of almost all kinds of stones. But you must avoid sugary juices, as the sweetener in them may increase your risk of having stones and undo the good effects of the juice.

If you have had a bout of kidney stones before, you have a greater risk of getting stones. So depending on the chemical constituents of your first kidney stones, you may have to limit intake of certain foods, such as sugar, salt, proteins and dairy products. For calcium oxalate stones, you will have to cut down the amount of meat, eggs, shellfish, peanuts, spinach, chocolate, sweet potatoes, rhubarb and beetroot from your diet. For uric acid stones, taking allopurinol (a gout medication) will help prevent future episodes. Potassium citrate pills and thiazide family of diuretics (indapamide, chlorthalidone and hydrochlorothiazide) are also effective in preventing all calcium-based stones.

Looking for advice or help with kidney stones? At St Pete Urology, we offer timely and accurate advice, diagnosis and treatment of kidney stones. Our multidisciplinary, compassionate, patient-centered approach will ensure you get the best possible care. Don’t suffer the pain of kidney stones for a day more while we can help you get quick relief. For more information, visit the “St Pete Urology” site.