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Monday, November 24, 2014

Saturday, November 22, 2014

A better way to biopsy a prostate

Prostate biopsy is undergoing a period of rapid change.   The days of the blind biopsy are gone and the era of the random 12 core biopsy is coming to a close.  New technology that is now availaible right here Suffolk County Long Island will revolutionize the evaluation and even the management of prostate cancer.  
The Artemis System for prostate biopsy and fusion biopsy is an amazing tool in our fight against prostate cancer.  I can see a future of improved detection, less often used radical treatments and focal therapy as a result of this techniques' accuracy.  
At present, the technology is available in Suffolk County only though Dr Schoor and Zwanger-Pessiri Radiology.  Makes me proud.  

Wednesday, November 12, 2014

Ejaculatory Duct Obstruction: A Challenge to Diagnose

EDO, or blockage of the ejaculatory duct, is a rare but treatable cause of severe male factor infertility. Men have severe oligopermia with low volume ejaculate, low to no seminal fructose, and no sperm on post ejaculate UA.   TRUST may show dilated seminal vesicles, a dilated ejaculatory duct, and on occasion a midline prostate cyst.   Often all findings are not present and a certainly of diagnosis remains elusive. In these cases MRI may help verses the more traditional approach of vasography followed by TUR-ED--resection of the ejaculatory ducts.  When the diagnosis is correct, outcome of treatment is dramatic and full fertility can be restored immediately following the procedure.   

Tuesday, November 11, 2014

AUA Vasectomy Guidelines: Part 1

  • The minimum and necessary concepts that should be discussed in a preoperative vasectomy consultation include the following:
    • Vasectomy is intended to be a permanent form of contraception.
    • Vasectomy does not produce immediate sterility.
    • Following vasectomy, another form of contraception is required until vas occlusion is confirmed by post- vasectomy semen analysis (PVSA).
    • Even after vas occlusion is confirmed, vasectomy is not 100% reliable in preventing pregnancy.
    • The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have post-vasectomy azoospermia or PVSA showing rare non-motile sperm (RNMS).
    • Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a technique for vas occlusion known to have a low occlusive failure rate has been used.
    • Patients should refrain from ejaculation for approximately one week after vasectomy.
    • Options for fertility after vasectomy include vasectomy reversal and sperm retrieval withfertilization.  These options are not always successful, and they may be expensive.
    • The rates of surgical complications such as symptomatic hematoma and infection are 1-2%.  These rates vary with the surgeon’s experience and the criteria used to diagnose these conditions.
    • Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.
    • Other permanent and non-permanent alternatives to vasectomy are available.

Sperm Freezing

Sperm freezing, or cryobanking, is a great technology that can enhance and preserve a couple's fertility.  Indications for banking include:
Fertility preservation prior to cancer therapy
Fertility preservation for men with severe oligopermia--low sperm counts. 
Prior to elective vasectomy
During and after vasectomy reversal
After sperm extraction procedures: TESE, PESA, MESA

Sperm can remain viable once frozen for an indefinite period.   

Sunday, November 09, 2014

Not all stones are easy to localize

Some stones can be seen plain as day on a standard x-ray.  Follow-up and treatment of these stones is typically easy and straight forward.  Yet how does the urologist follow the 15% of stones that can be seen at all on plain X-ray  films?   

The options are repeat CT scan, which is expensive and the most radiation intensive (albeit very low dose for adults). 
Renal sonogram is pretty good for kidney stones, especially larger ones and is totally safe.   This modality can also be used to follow ureter stones that are obstructive.  Bladder ultrasound can be used to folllow stones at the junction of bladder and ureter, the UVJ.  Intravenous urography is the final option.  Old school for sure,  the IVP as it is known, is still quite good.  Disadvantages are that the test is time consuming, requires IV dye that may be allergenic and nephrotoxic to some, and utilizes low dose ionizing radiation.  

Monday, June 02, 2014

Official AVEED warnings: Read Before Consenting

What is the most important information I should know about AVEED?
AVEED may cause serious side effects, including:
 A serious lung problem. AVEED can cause a serious lung problem called a pulmonary oil
microembolism (POME) reaction. POME is caused by tiny droplets of oil that have traveled to
the lungs. Symptoms of a POME reaction may include:
o cough or urge to cough
o difficulty breathing
o sweating
o tightening of your throat
o chest pain
o dizziness
o fainting
 Serious allergic reactions (anaphylaxis). AVEED can cause a serious allergic reaction
right after receiving the injection. Some of these allergic reactions may be life threatening.
These reactions can happen after you receive your first dose of AVEED or may happen after
receiving more than 1 dose.
You may need emergency treatment in a hospital, especially if these symptoms get worse
over the 24 hours after your AVEED injection.
These side effects may happen during or right after each injection. To be sure that
you are not having one of these reactions:
 You need to stay in the doctor’s office, clinic, or hospital for 30 minutes
after having your AVEED injection so that your doctor can watch you for
symptoms of POME or a serious allergic reaction.
 You can only get AVEED at your doctor’s office, clinic, or hospital

Thursday, May 29, 2014

Women take note: it is testicular size not penis size that matters!

In man, the penis protrudes from the body in a prominent way.  Anthropologists have demonstrated that penis size, like plumage on a peacock, may confer a reproductive advantage to the well endowed man, as women see this as a sign of fertility.   However, testicular size is far more important.

The majority of a testicles volume is made up of seminiferous tubules, where sperm are made.  Men with very small testis have less of this machinery.   The normal testicle should have a long axis (length) of ~4.5 cm.   One can use a $5 caliper to measure a testicle.  

So if you want kids, find a mate with large testicles.