Question: Persistent sperm after a vasectomy?

Persistent sperm after vasectomy? A relatively common issue that is frustrating to the patient and the urologist alike.

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My husband had a vasectomy 8 months ago he has had more then 40 ejaculation since his surgery, or maybe even more. The semen analysis came back with more then 20 hpf. Motile and non motile sperm were seen. Could his vasectomy have failed, or can it take a long time to become sterile? Thank you.

Dr. McHugh’s answer:

There two scenarios here. It is possible that the vasectomy has successfully divided the vas and that the sperm are, for whatever reason, slow to completely clear. If this is the thinking you would re check after another twenty or so ejaculations. On the other hand this may represent a recanalization of the vas tubes, a small channel, that has reconnected the vas tubes. In this case another vasectomy would be performed. A couple of things: You could have a formal semen analysis performed to actually get a count…

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Why do Vasectomy Reversals cost more than vasectomies?

Patients commonly ask if a microscopic vasectomy reversal is similar to having a vasectomy. The former takes two hours or so to perform and the latter fifteen minutes. This explains why a patient might experience more bruising and swelling with a reversal.

Georgia Vasectomy/Vasectomy Reversal-John McHugh M.D.


Cutting the vas deferens in two (a vasectomy) is easier than putting it back together (a vasectomy reversal) and is indeed a horse of a different color.

  • Vasectomies are covered by insurance-vas reversals are not.
  • Because the reversal is not covered by insurance the patient sees, feels, and pays the entire expense of the procedure, the surgeon, the supplies (microscopic suture) and the facility.
  • The surgeon fees are relatively high because very few urologists do reversals often or often enough to do well.
  • Few urologists are comfortable enough to feel they can do the procedure with a high likelihood of patency (presence of sperm after a vasectomy reversal) and this in turn also limits the number of urologists willing to perform the procedure.
  • The identification of the vasectomy site and preparing it for the reversal is something that is comfortable to all urologists. Reanastamosing the inner tubule of the vas…

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Saw Palmetto for prostate enlargement. Is it effective?


Saw Palmetto works to reduce the size of the prostate and is effective for some over time. It is in almost every “Men’s Health Vitamin.” Think of it as a weak non prescription form of Proscar or Avodart. As I tell patients who ask me if this an other over the counter meds are worth taking, “It won’t hurt,” I say.

Saw Palmetto article in Medical News Today

Solutions for Female Stress Urinary Incontinence

The treatment of incontinence is a multi-factorial pursuit. In addition to the treatments listed estrogen cream and attention to food triggers should be considered. J.M.

St. Louis Missouri Urologists

Metropolitan Urological Specialists of Saint Louis, Missouri, with offices in Creve Coeur, Kirkwood, Florissant, and Washington, MO is focused on providing innovative solutions for prevalent women’s health conditions. Their purpose is to give practical, easy-to-understand facts so ladies, with their medical professionals, can consider their options and work out educated decisions.

What Is Stress Urinary Incontinence?

Stress Urinary Incontinence, or SUI, is the unexpected, unintended release of urine during normal, day to day activities. SUI is a different sort of condition compared to Overactive Bladder (OAB), a problem characterized by urgency, frequency, getting up at night with or without bladder seepage. Lots of women have both of the types of incontinence. You may have SUI should you lose urine when you:

  • Metropolitan Urological Specialists Metro Urology prostate cancer sexual health robotic prostatectomyCough, sneeze, or laugh
  • Walk, work out, or lift something
  • Rise from a sitting or lying position

It’s also possible to visit bathroom frequently each day to protect…

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The prostatic urethra. The reason men have more trouble voiding after the age of 50.


“A man spends his first fifty years trying to make a living…the second fifty years trying to make water.”

As you watch the video the  camera progresses in a fashion similar to the flow of urine: That being from the bladder, over the bladder neck, through the prostatic urethra and then out the urethra. (To grandmother’s house we go!)

You’ll note how the prostate lobes close in on the channel and all you see is lobe touching lobe. This usually begins after the age of fifty in men and is responsible for a slowing of the stream and then the things that accompany this such as frequency, urgency and getting up at night.

Medicines for this condition either relax the prostate to open this blockage (Flomax) or shrink the prostate to enlarge the channel (Proscar). If this is unsuccessful, i.e. the gland is too big for the medicine, then surgical options are done to remove the tissue to open the channel. (GreenLight Page.)

What is the most common question we hear about surgery of the prostate?

“Doc, If you are going to cut out the prostate what happens to the urethra? Do you destroy that too?”

Yes the urethra does line the lobes of the prostate and yes it is destroyed and removed. But much like how your hand heals with a cut, the tissue grows back over it-reepithelialization.