Vasectomy message boards…are they helpful? Well…yes and no.

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Online themes focus on relaying personal experience or to obtain information on expectations after vasectomy.

I was told by a lawn management consultant that the soccer field I was trying to improve was of the “Heinz 57” variety. In other words a mixture of many types of grass and weeds. Decision making in medicine, and having a vasectomy and who will do it,  is often the result of the accumulation of a hodgepodge of information.

I have told my prostate caner patients for years to learn from the internet, friends, family, books and yes…wait for it…your doctor to arrive at a decision about your medical care that is best for you. Getting a vasectomy is no different. So…take what you get from others, all others, with a proverbial grain of salt!  J.M.

Background: Patients are increasingly utilizing the internet to gain knowledge and information about disease states and treatments.

Objective: To identify common themes and usages of online message boards focused on vasectomy.

Design: Review of online content from patients.

Methods: Using the search term “vasectomy,” internet discussion boards were identified. The 3 discussion boards with the most posts were selected for investigation. An iterative and structured analysis process was undertaken to determine common themes.

Results: 129 posts from the 3 message boards were examined. The 2 most common topics were changes in sexual function after vasectomy and pain after vasectomy. Changes in sexual function included a variety of concerns including unexpected genital or sexual issues arising after vasectomy. Declines in sexual drive, erection quality, and orgasmic or ejaculatory changes were described. Posts relating to pain around vasectomy discussed concerns related to a “normal” amount of postprocedural pain or how to manage pain after vasectomy. Other topics included planning for postvasectomy care, potential issues after vasectomy, and feelings about a vasectomy. Overall, online content roughly divided into 2 uses – sharing personal experiences regarding vasectomy and to get information about what to expect, and how to manage issues that may arise after vasectomy. Medical provider input was not seen, and while some factual content was identified, personal opinion was more common.

Conclusions: Internet message boards on vasectomy focus on information exchange and personal experience. Factual content is limited, and medical provider input is uncommon.

Reviewer’s Comments: This is an interesting study that analyzes how men use the internet to discuss vasectomy. I am generally positive on patients using the internet to gain a functional knowledge of medical conditions if they are open to additional education during our visit. The use here of patients being able to relate to other men either before or after their vasectomy is a benefit as this personal type of interaction is not part of the usual patient-physician interaction. Online message board content is of course subject to the patients who decide to post and may be skewed by patients with poor outcomes. The aforesaid findings can potentially help providers counsel patients on expectations after vasectomy.(Reviewer–Charles Welliver, MD).

Article Reviewed: A Thematic Analysis of Online Discussion Boards for Vasectomy. Samplaski MK: Urology; 2018;111 (January): 32-38.

Vasectomy vs. tubal ligation-Which is more common?

The prevalence of vasectomy was 6.6% (compared with a tubal ligation prevalence of 16.35%).

Many factors, including social, medical, and unknown reasons, contribute to the decision of a couple to proceed with one form or another of surgical sterilization.

Objective: To describe the demographics and family planning attitudes of vasectomized men.

Design: Retrospective cohort analysis of National Survey for Family Growth data collected through the National Center for Health Statistics between June 2006 and June 2010.

Methods: The survey sampled 10,403 men from various urban and rural communities, aged 15 to 45 years, regarding family planning attitudes. These sampled statistics could be extrapolated to provide a reasonably accurate national survey portrait.

Results: The prevalence of vasectomy was 6.6% (compared with a tubal ligation prevalence of 16.35%). The odds ratios (OR) for having a vasectomy in this sample were: currently married 7.8; previously married 5.8; and increased age 1.1. The odds increased with increased number of biologic children. Examples of factors decreasing the odds of having a vasectomy were: immigrant status (OR 0.18); African American (OR 0.22); Hispanic (OR 0.054); or Catholic (OR 0.55). Also, this survey determined that 19.6% of vasectomized men expressed a desire for future children suggesting a higher than previously recognized prevalence of sterilization regret; yet only 1.9% of vasectomized men in the sample reported having a reversal.

Conclusions: Many factors, some social, some medical, some unknown, contribute to the decision of a couple to proceed with one form or another of surgical sterilization.

Reviewer’s Comments: As pointed out in this article, there are many factors that contribute to the decision to cease further childbearing. A permanent sterilization procedure is a popular choice, particularly among married couples. The demographic factors that tilt a couple towards tubal ligation or vasectomy are explored in this article, and the data promote lively speculation.(Reviewer–Berel Held, MD).

Article Reviewed: Vasectomy Demographics and Postvasectomy Desire for Future Children: Results From a Contemporary National Survey. Sharma V, Le BV, et al: Fertil Steril; 2013;99 (June): 1880-1885.

Did you know? Dr. McHugh is in Top 5% of urologists performing vasectomies in the U.S.

From Amino, Inc.

How does Amino determine Dr. McHugh’s vasectomy experience?

To give you an overview of Dr. McHugh’s practice experience, we show you how his practice compares to other doctors nationwide.

To determine Dr. McHugh’s experience treating vasectomy patients, we use our database of over 9 billion doctor-patient interactions. In our database, we look at every doctor who is a family practitioner, urologist, or surgeon, because these are the specialties that our data shows are most likely to treat vasectomy patients.

From this group of doctors, we rank doctors nationwide by the number of vasectomy patients they treated from 2014–2018. We give Dr. McHugh a badge if we have enough data to determine that he is among the top-ranked doctors for vasectomy, meaning he sees a lot of vasectomy patients compared to other doctors.

For vasectomy, Dr. McHugh has a top 5% badge, because he treated more vasectomy patients than 95% of similar doctors nationwide for 2014–2018.

We determine which of Dr. McHugh’s patients receive vasectomy by looking at the medical billing codes that appear on the electronic health insurance claims from their interactions with Dr. McHugh. Because there are tens of thousands of unique medical billing codes used to describe different types of health care interactions, Amino groups billing codes that describe similar health conditions or services into a single category that we display on our website with a user-friendly name (e.g. “diabetes”, “asthma”, “knee replacement”).

We count each distinct patient only once for any given reason for visit, but the same patient may be counted toward multiple reasons for visit if Dr. McHugh treated that patient for multiple reasons.

Know someone considering a vasectomy? A 101 Vasectomy primer of “A vasectomy through pictures!”

The pictures are graphic and show actual pictures of a vasectomy.

Scheduling a vasectomy is easy. We make a point to make your experience comfortable and hopefully pleasant. Using the contact form a consultation can be made 24-7 or one can call 770-535-0001 ext 113 and Kathy Burton will streamline the process. Do you have a burning question about having a vasectomy? You also can ask us questions by utilizing the contact form below or visiting Vasectomy.com. Dr. McHugh answers vasectomy questions from all over the U.S.

 

 

 

 

 

 

 

 

Urine cytology-why do urologists order this?

Urine cytology is useful in the diagnosis of bladder cancer for several reasons. The discussion below is one application. Another way I use cytology is in the patient with blood in their urine but they don’t want to commit to cystoscopy. If the cytology is wnl, it is unlikely that the patient has a bladder cancer. One caveat: Low grade TCC of the bladder may be missed with cytology alone, but some make the case that this “non aggressive” form of bladder cancer will do little harm anyway. This is where the “art of medicine” comes in!

Most unnecessary biopsies of erythematous bladder lesions can be avoided by guidance of urine cytology.

Background: Bacillus Calmette-Guérin (BCG) is recommended for non–muscle-invasive bladder cancer (NMIBC). However, treatment often causes bladder irritation and may result in erythematous lesions on cystoscopy. Distinguishing benign from malignant lesions is challenging. Urine cytology may provide a way to differentiate lesions that should be biopsied compared to those that can be observed.

Objective: To evaluate the benefit of urine cytology in patients with erythematous bladder lesions after BCG therapy.

Participants: NMIBC patients treated with ≥1 BCG instillations between 2009 and 2015 from 2 Finnish hospitals.

Methods: The biopsy histology was evaluated according to the cystoscopic appearance of tumor growth or erythematous lesions. Urine cytology results were also evaluated. Based on biopsy pathology, cytology was evaluated to determine sensitivity, specificity, and positive predictive values (PPVs) and negative predictive values (NPVs).

Results: BCG treatment was provided to 206 patients, of whom 159 (76%) underwent a biopsy or resection. A total of 367 lesions were evaluated, of which 209 were erythematous lesions. Benign pathology was found in 187 (89.5%) erythematous lesions. As compared to papillary or flat lesions, cytology was most accurate for erythematous lesions with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 59%, 76%, 94%, and 23%, respectively.

Conclusions: In patients undergoing BCG therapy, a negative cytology might provide reassurance when considering biopsy of an erythematous lesion.

Reviewer’s Comments: BCG therapy is a proven treatment for patients with intermediate- and high-risk NMIBC. However, treatment often results in bladder irritation and discomfort. On follow-up evaluation, erythematous lesions are often present. Many are benign, but some represent residual malignancy. Understanding the benefit of urine cytology may prevent biopsy in patients who are otherwise responding to therapy. This study was a 2-center Finnish study of patients undergoing biopsy following treatment with BCG. Urine cytology results were compared to biopsy pathology depending on biopsy of either tumors (papillary or flat) or erythematous lesions. Accuracy of cytology was evaluated using sensitivity, specificity, NPV, and PPV. The study comprised 206 patients undergoing BCG treatment; 159 had a biopsy of 367 total lesions. Erythematous lesions represented the majority of biopsies; 10% proved to be malignant on pathologic examination. As compared to biopsies of papillary or flat tumors, urine cytology was most consistent with biopsy result for erythematous lesions. For patients undergoing BCG for NMIBC, biopsy or resection is warranted for all patients with papillary or flat tumors. For those with erythematous lesions, cytology may be used to determine the benefit of biopsy. Patients with a negative urine cytology might be eligible for monitoring without biopsy.(Reviewer–Kelly Stratton, MD).

Article Reviewed: Urine Cytology Is a Feasible Tool in Assessing Erythematous Bladder Lesions After BCG Treatment. Pertti N, Otto E, et al: BJU Int; 2018; (June 29): epub ahead of print.

Only a few urologists in Georgia perform microscopic vasectomy reversals. Why is that?

It is very difficult to sew microscopic suture the size of a strand of hair to connect an opening the size of the “O” in God on a penny looking through a magnifying operating microscope. 12-15 sutures are placed on each side to complete the procedure.

It takes experience, patience, and having a “knack for it” to perform this procedure it in a time efficient and successful fashion.

The video shows the completion of one of 12-15 sutures necessary to complete one side.

Note the fluidity of completing the knot and the lack of  wasted motion. This takes years of experience.

At Northeast Georgia Urological Associates we perform on a regular basis (50 a year) reversals in our accredited surgery center. You can call, email or text to arrange a free in office or by phone consultation. We will respond promptly and look forward to speaking with you.

Prostate cancer detection-To MRI or Not to MRI…that is the question?

The MRI of the prostate conundrum…helpful or a hoax?

Prostate Diaries

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If you had clinically insignificant prostate cancer…would you want to know it?

If you knew it do you know exactly what that means?

Or do you think the doctor or radiologist telling you that can promise you that it won’t actually become, or already is, clinically significant?

Would you want a biopsy to “prove with tissue” the exact Gleason’s grade of this insignificant cancer?

Have you ever compared the cost of a standard prostate biopsy to the cost of a prostate MRI and a fusion biopsy together?

If the fusion biopsy and the pre biopsy MRI has a higher rate of finding clinically significant prostate cancer but is not good at finding the so called “insignificant prostate cancer” does this actually give you peace of mind?

Who started all of this anyway? Could it have been the same group that said the Psa was worthless and cost too much to…

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What is Gleason’s score? If you have been told you have prostate cancer and you don’t know…get a second opinion.

Know thy Gleason’s Score!

Prostate Diaries

453What is Gleason’s score?-Click Here

Here’s the thing…if you want to have your prostate removed because you’ve been told you’d be “done with it” that might not necessarily be true. If your cancer is Gleason’s 8 and you elect to remove the prostate there is still a significant chance you’ll still need radiation. Knowing this and that you may not be “done with it” would you consider having radiation from the get go? It would make a difference to me.

Here’s your homework…go to the Johns Hopkins website for prostate cancer and plug your numbers into the Partin table app. This will tell you the chance you’ll need radiation if you choose to have the prostate removed first.

Will this help in the decision making process? You bet your bottom dollar!

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