7 Causes of Scrotal Pain

Scrotal pain is very common. Here are some causes of this condition:

1. Infection, ie of the testicle, the epididymis or both
2. Kidney and ureter stones, via referred pain.
3. Herniated disks in the nack, again via referred pain.
   
4. Hernias
5. Trauma, even mild trauma can produce inflammation and somewhat prolonged pain.
6. Torsion. The testicle can twist upon itself and disrupt its blood supply. This is a true urologic emergency.
7. Tumors. Most tumors are palpable--can be felt. Sometimes, the only symptom from a testis tumor is pain.

Scrotal pain is easy to evaluate in the office with a history, physical exam, and a doppler scrotal sonogram. In addition, almost every condition above is relatively easy to treat.

Thanks,

Dr S

Can my husband's secret vasectomy be reversed?

I read this on a vasectomy reversal online community.

"I’m so overwhelmed.

My husband had a vasectomy done this past May behind my back (yep, consultation and all). After talking he realized his mistake and has agreed to a reversal.

DH said the doctor who did the vasectomy told him he could do a reversal if he ever needed one. So, I called the office to set up a consultation and was informed that this doctor is not a urologist, but a family physician, and so cannot do a reversal. So, now I’m afraid that the vasectomy was done so well (or bad) that a reversal isn’t possible.

I have called and made a consultation appointment with an actual urologist, but it isn’t until January.

I guess I need just a little reassurance that a successful reversal is still possible."

I'd like to comment here.

1. In this case, the vasectomy was done within the last year. A vas reversal could be done successfully on this type of patient 95 times out of 100, or even better.
2. A standard vasectomy requires the surgeon to remove only a short segment of the vas. Most vasectomists only remove a segment 2-5mm in length. The length of segment removed is not a factor that influences the success rate of a future vas reversal.
   
3. Success rates for vas reversals vary for a variety of reasons. Among these reasons are: surgeon skill, time interval since the vasectomy was done, presence of sperm in the vasal fluid at the time of surgery.
4. A "well done" vasectomy is a vasectomy that renders a man sterile. A vas deferens or associated "tubing" does not need to be totally destroyed to accomplish this goal.
5. A urologist that does 1-2 vas reversals per year does not possess the same micro-surgical skills as does a vas reversal surgeon that does several vas reversals per month, or even more.

I hope this unfortunate woman finds this post and gets some relief from the stress she is experiencing.

If you would like more information on vas reversals emailed to you, subscribe here. It is free, you won't get spammed, and you can unsubscribe at anytime.



Dr S.

Tips for an "erect" Thanksgiving

Thanksgiving is a great holiday. A huge feast, booze, family: what could be better?

Well, maybe being able to perform after your feast would really make for a Thanksgiving for which to be thankful. Unfortunately, your feast, family, and fears may intervene and ruin your amorous post-feast festivities. Here are some strategies that you may employ to ensure that your thanksgiving is a "hard one."

1: Stick to lower fat foods. While PDE-5 inhibitors like Viagra and Cialis are not made less affective by ingestion after a fatty meal, their absorption is slowed so it may take a longer time for you to feel their effects. Couple that with the soporific affects of the turkey and the wine and good luck staying awake until the Viagra takes hold.

2: Start the Cialis on Thursday morning. With the 36 hour half-life of Cialis, you'll be at peak erection form by 10PM.

3: Stay off the booze: Alcohol can decrease a man's ability to achieve and maintain an erection.

4: Keep you partner happy. Ample scientific evidence exists that supports that a person's sexual satisfaction is enhanced by their partner's satisfaction.

5: Don't worry. Stress induces a "fight or flight" response which is incompatible with achieving and maintaining an erection. If worse comes to worst and you can't perform, you can always blame it on the meal.

Good luck and let me know how it goes.

As always, if you have any suggestions for topics, let me know by completing the form below or to the side bar.




The IU.

Why we fix varicoceles.

While it is true that I can be frustrated when varicocele repair does not work, I continue to believe that varicoceles cause infertility in some men and that fixing a varicocele can enable an otherwise infertile couple to have a baby naturally.

This baby, just 12 gestational weeks old, is the result of a successful bilateral varicocelectomy.

The patient initially came to me 1 year ago. He had a very low sperm count, in the 1-2 million range. He was told by another urologist that his only option was IVF. He came to me for a second opinion.

I think that varicoceles cause infertility in men through a variety of mechanisms related to heat, heavy metal, and free radical metabolism. Correcting varicoceles reverses these abnormalities.

Statistics collected over 90 years have continued to show that 50% of couples will get pregnant naturally within 12 months after the man has his varicocele corrected. Research perfomed over the last 10 years have demonstrated that surgical correction of varicoceles improves pregnancy rates for couples who need to resort to IUI (artificial insemination).

In other words, even if you may still need to undergo assisted reproductive techniques, such as IUI or IVF, correcting your husband's varicocele may improve your chances of taking home a baby.

In any case, good luck with your fertility problem if you have one.

Any questions, please feel free to contact me.

Dr S

Vasovasostomy video

This video show a 2 layer anastomosis--connecting the 2 ends--during a vasectomy reversal. The first layer uses very fine suture known as 10-0 bicurve nylon. The second layer is with 9-0 nylon. Both sutures are so small that they can only be seen with the aid of an operating microscope. Operating with such small suture requires a great deal of manual dexterity. Success rates for vasectomy reversals have dramatically improved since urologic microsurgeons began using this technique.

Any questions, please feel free to contact me.


Thanks,
Dr S

The Holiday Season = Kidney Stone Season

The image below shows a ureter stone inside a stone basket as I was removing the stone.

It is that time of year again. With the holidays come parties,
family, time off from work, and food.

Plenty of food!

Kidney stones come from, among other things, over-eating. Most
of us eat diets that are rich in animal protein, such as chicken,
fish, or red meat. During our holiday feasting, we eat more than
our fair share of it.

Animal protein causes kidney stones because the protein gets
converted to acid that is then filtered by the kidneys. The
acidic environment of the kidneys becomes the ideal condition
for kidney stones to develop and grow.

You can minimize your risk of forming kidney stones during the
holiday period by doing some of the following:

1: Substitute vegetables and legumes for meats
2: Drink more water
3: Eat less salt (calcium follows salt in the kidney)
4: Eat citrus
5: Eat home cooked rather than prepared meals (less salt)

Of course, if you do feel pain, don't suffer needlessly.

Dr S

Is CT Scanning over-utilized?

Is CT scannning used too much? This patient of mine was still having vague pelvic pain 1 month after a lithotripsy for a ureter stone. She had 50 RBCs in the urine. Rather than send her for a CT scan and some unnecessary x-ray exposure, I performed a bladder sonogram in the office and found the stone, seen above, in the distal ureter. Both the patient and I had our answer by the time she left the office. The cost to the patient and her insurance was significantly less than had I ordered a CT scan and the patient avoided the radiation exposure of the CT scan. 3 days later she passed the stone spontaneously.

In this case, the sonogram answered the question with efficiency.