Choosing a vasectomy reversal doctor.

3-5% of people who have had a vasectomy in the past will want it reversed at some point in the future. If you are one of them, read the following.

Choosing a vasectomy reversal specialist is important. The one you select should have the following qualities and skills.

• Experience: This is the most important quality. It is actually quite simple: the more the urologist has done,the better.
• Training: Look for a urologist that has advanced fellowship training in microsurgery.
• Tools: Serious microsurgeons have their own, speciailized microsurgical tools and instruments, and they share them with no one. Ask your doctor to show you his instrument set.

If you wish to have your vasectomy reversed, please feel free to contact me or see me, here in Long Island.

Why do varicoceles cause male infertility?

As a urologist and male infertility specialist, I see many men with varicoceles, so I am frequently talking to patients about varicoceles. Thus, varicoceles are good subject for the blog.

Varicoceles are dilated veins that surround the testicular artery within the spermatic cord, the cord by which the testicles hang from the body. The testicles are located in the scrotum--the sack--because they need to be cooler than the rest of the body. Varicoceles make the testicles too hot, and this heat, among other things, impacts the testicles' ability to produce healthy sperm.

Varicoceles are similar to varicose veins in the legs, though they are in the scrotum. When the veins get large, blood flow within the vein can be affected in a way that allows toxic metabolities to accumulate. Some of these metabolites include molecules called reactive oxidative species--or oxidants. Other chemicals include substances such as trace metals present in certain food-stuffs, cigarette smoke, and the environment in general. In some men, a build up of these toxic metabolites can have a deleterious effect on sperm and the testicles.

The presence of a varicocele on one side affects sperm production from both testicles. Why this is, no one knows. Varicoceles are more common on the left cord. This is because of the anatomy of venous drainage from the left testicle back to the vena cava--the largest vein in the body--by way of the left renal vein. Varicoceles on the right side only are uncommon, though bilateral varicoceles exist frequently.

While 20% of all men have varicoceles, 35 % of men with fertility problems have them. Correction of the varicoceles in men who have a problem--such as a low sperm count or difficulty inpregnating their wives--can result in improvements in sperm counts, motilities, and morphologies in the majority of affected men, even in severe cases of male factor infertility. Most importantly, perhaps, is that >50% of couples can expect to become pregnant naturally within 1 year after varicocele repair. Those couples who do not achieve a natural proegnancy will ultimately require assisted reproductive help in the form of IUI, IVF, or ICSI. The presense of varicoceles negatively affects success rates with these assisted reproductive techniques and fixing the varicocele improves pregnancy rates for these couples.

Varicoceles are typically not visible to the eye, at least not unless they become very large. Instead, the urologist can feel them on physical exam. Sometimes the patient will notice the varicocele themselves and comment that they feel a swelling or "a bag of worms" in their scrotums.

Varicocele surgery is outpatient and ambulatory. Most patients with desk type jobs may return to work in 2-3 days; a bit longer for patients with more physical jobs. Men may return to sexually activity a few days later and can expect improvement in the sperm quality within 6-12 months.

Treatment options for ED.

A patient asked me yesterday about the options to treat his ED. Here is, in essence, what I told him.

1: Medical Therapies: These are the PDE5 inhibitors, viagra, cialis, and levitra. All 3 work quite well, in general, and each have their own unique qualities. Some patients will respond well to one, but not to another. Similarly, some patients will experience side-effects with one agent, yet not another agent. In general, these medications are good first line therapies.

2: Injection therapies: This is a very effective form of treatment that works >90-95% of the time. It involves the man injecting a tiny needle into the base of his penis 10-15 minutes before he wishes to engage in sex. The injection is painless and most find men have no problem learning how to perform the injections. However, the majority of men who start to use injection therapy will ultimately discontinue it for a variety of reasons.

3: Penile implants: This is the most effective form of treatment for ED and the only one that allows for the patient's return to normal functioning. It involves the urologist placing a small pump into the scrotum via a small opening in the skin. When the man desires an erection, all he does is press on the pump and sterile water transfers into the penis and he gets a normal, firm erection that will stay up as long as he desires. Men who have this procedure done report the highest satisfaction levels, though it is the most invasive form of treatment and it has side-effects.

4: Other options: Other options exist, though they really do not work well or any better than placebo, so I don't recommend them.

Thanks,

Dr Schoor

Penile Warts: 4 ways to treat

HPV, the virus that can cause cervical cancer in woman, can also cause genital warts in men. Men are often referred to the urologist when their partner learns that they have HPV related changes on a PAP smear or have genital warts themselves. It is the urologist's job to evaluate the man for any visible warts and to treat them if present. Here are 4 ways to treat warts in men.

• Medication: A high percentage of penile warts will disappear after 4-6 weeks of treatment with a chemotherapeutic gel. When used properly, there are few side effects. The gel is quite expensive for people without good prescription coverage.
• Laser surgery: This is a very effective way to treat warts but it must be done in a hospital type setting with a special laser, thus making it quite costly. For patients without adequate insurance coverage, this may not be a good approach.
• Cryotherapy: This is an excellent and inexpensive method to treat penile warts. It is painless, can be done in the office, and has a very low recurrence rate. The only downside is the typical need for 2-4 treatments to completely erradicate the warts.
• Cautery and excision: This is the least expensive way to remove the lesions but is associated with high recurrence rates and scar formation.

If you see any lesions you want more information about, please complete the form below and someone will contact you within 24 hours.

Where is the best sperm located?

This is a question I am often asked by my patients who need to undergo a sperm retrieval procedure. The answer is. . .it depends. Actually it depends on the following factors:

• Obstructive Azoospermia: Patients with blockages but otherwise normal sperm production within the testicle can expect to have healthy sperm in the epididymis and the testicle. Sperm from both areas will work fine.
• Non-obstructive Azoospermia: These patients don't produce sperm in sufficient number to reach the ejaculate or even, in most coses, the epididymis. Sperm must be retrieved in these men from the testicle.
• Embryologist Preference: Some embryologists(the person who actually performs the ICSI/IVF) have more experience with epididymal sperm as opposed to testicular sperm and thus prefer epididymal sperm. Epididymal sperm, in general, is more motile than testicular sperm, and embryologists tend to favor more motile sperm over less motile sperm.
• Urologist Preference: Some cases of severe male factor infertility require specialized techniques to locare and harvest sperm in sufficient quantities to be of use to the embryologist. In addition, in these cases, the urologist must be availabe "on-call" to perform the procedure. Not all urologists have that degree of expertise or scheduling flexibility.