Effectiveness of Antibiotics Given to Asymptomatic Men for an Increased Prostate Specific Antigen .

I'd like to comment on this article, Effectiveness of Antibiotics Given to Asymptomatic Men for an Increased Prostate Specific Antigen
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PSA is a screening tool for prostate cancer but can become elevated by a variety of conditions, such as prostate enlargement, inflammation, or infection.

The prostate biopsy, or TRUS, is one tool in the evaluation of an elevated PSA.  Prostate biopsies are safe but can cause patients to develop infections with fevers after the procedure.  This complication occurs often if the biopsy is performed on a man with an undiagnosed prostate infection.

Prostate infections can be difficult to diagnose.  Sometimes, the only sign that one may exist is an elevated PSA. 

Urologists do biopsies in selected patients with elevated PSAs in order to detect prostate cancer.  Since infection can cause an elevated PSA in a man and such an infection would make performing a prostate biopsy more dangerous, it is not unreasonable to give a man a trial of antibiotics for several weeks and repeating the PSA.  If the PSA does not come down, then biopsy.  If it does, then patient and doctor can have another discussion and decide if a biopsy is still warranted.

Antibiotics do not treat prostate cancer.
PSA does not harm any body.

Good urologists use more than just numbers to determine whether or not to do a biopsy.

I hope this helps.

Dr S

An andrology only blog from Dr Schoor.

I just started a new blog at WordPress on andrology. I want to see how long it takes me to get it noticed by the organic search engines.

Check it out: The Andrology Blog.

Oh yeh, I do plan to continue to write here, but not about andrology related topics.

The Catholic Stance on Testicular Sperm Extractions/Asiprations

Hot off the press in the NYTimes today.

I do the sperm aspiration procedures in my Smithtown Long Island private office. Though I go to a Catholic Health Service Hospital, I am unable to do them there due to the above ruling.

Dr S

A nice technique for Testicular Sperm Extraction.

I like this technique for testicular sperm extraction. I do it in my Smithtown Long Island office.

Dr S

A Varicocele

This person had a palpable (I could feel it) varicocele on exam that was confirmed by in-office doppler scrotal ultrasound.

Varicoceles are essentially varicose veins of the scrotum. Varicoceles contribute to infertility by making the testicle too hot, among other things. Varicoceles can cause abnormal sperm counts, motility, and morphology. In addition, some me have vague testicular or scrotal discomfort from the varicoceles. Most varicoceles occur on the left side only. Isolated right sided varicoceles are very rare and may be caused by the presence of a large kidney tumor. If a man has a varicocle only on the right side, the urologist needs to obtain kidney imaging. Bilateral varicoceles are common and when present do not indicate that a kidney mass may be present.

Varicoceles can be fixed easily and with little risk or discomfort. The procedure to fix the varicocele is outpatient and can even be done under local anesthetic. When the urologist uses a high power operative microscope during the varicocelectomy, success rates improve and very few men will experience any side-effects after the surgery.

When abnormalities exist on the semen analysis, 65% or so of men will experience improvement in the abnormality. 50% of couples will get pregnant naturally within a year after the man's varicocele is fixed. Success rates for IUI (artificial insemination) improve dramtically in couples after the man has had his varicocele corrected.

Varicoceles are abnormal findings in men, though they are quite common in the general population. Since they are abnormal, most insurance plans, including Medicare, cover the varicocelectomy surgery.

Varicoceles are diagnoses intially on a physical examination. I confirm the physical exam finding with a scrotal doppler ultrasound that I perform right in my office. Other urologists with similar training and expertise can do this as well.

If you have any questions, please fill out the form on the side-bar.

Dr S

Sperm Aspiration Techniques

Ten percent of men have no sperm in their ejaculates, yet with modern fertility procedures they can still have their own, biological children. A urologist that is skillful in the sperm retrieval procedure can locate pockets of healthy sperm in the majority of azoospermic (no sperm) men. There are a number of different approaches that the urologist can take. These include:

• mTESE--or the microTESE. In this technique, the urologist uses the aid of a high power operative microscope to locate normal looking sperm ducts within the testicle. Success rates are high, but this approach requires special equipment that many IVF centers do not possess, is very invasive, and can result in significant post-op swelling and soreness.
  
• TESE Mapping. In this method, the urologist samples geographic regions of the testicle with multiple needle biopsies looking for sperm. When sperm is found, a larger specimen is taken from that area. Success rates are good with this approach as well, but it is time consuming, invasive, and requires that the man have multiple operations.
  
• The fresh TESE. This is the most common approach and involves coordinating the TESE with the woman's fresh egg retrieval and IVF-ICSI cycle. With a fresh TESE, sperm does not need to be frozen, the man needs only one procedure, and success rates are very high. The downside is that couples only learn whether or not the TESE was successful in finding healthy sperm until after they have already committed large sums of money, energy, and emotion to the IVF process.
• The needle TESE. In this approach, the urologist simply places a needle into tubules within the testicle, aspirates backwards, removes tubules, and hopefully finds sperm. The advantage of this approach is that it is very non-invasive, truly painless, and it allows for very quick recovery. The disadvantage is that success rates are poor for men with disorders of sperm production, as opposed to obstruction or blockages, like after a vasectomy. For men who have had vasectomies but wish to have another baby with IVF, the needle TESE is a great option.
  
• The Doppler-Sono TESE. This is a relatively new modification to the TESE procedure. It involves using high resolution color Doppler ultrasound to image the testicle itself and identify regions within it that may contain sperm. Such regions will have increased vascularity and enlarged tubules that can be seen on the sonographic image. A skinny needle is then placed under ultrasound guidance into these areas, tubules containing sperm are removed, and the sperm is the used for IVF-ICSI. In essence, the Doppler-Sono TESE combines the success rates of the microTESE with the non-invasive, painless, and recovery characteristics of the needle TESE.

Which TESE procedure is right for you and your partner will depend on a number of factors.
These factors will be discussed in a future post.

If you would like to learn more, submit the form to the side of this page.

Thanks,

DrS

Voiding Problems

These men all have voiding problems caused by benign prostate hypertrophy, or BPH. Their prostates have grown into the bladder and cause a bladder outlet obstruction.

Most men respond to treatment with medications, though some men will need surgical treatments, such as microwave therapy, laser treatment, or the Gyrus-TURP.

BPH is a non-cancerous condition, but can cause serious and even life threatening medical problems.