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

2005_12_14_15_52_33_706

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…

View original post 205 more words

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!

View original post

When it comes to a vasectomy…”We cater to cowards.”

Our office made T-shirts a few years back with “We cater to cowards” on the front. They were a big hit, however it happened on more than one occasion that someone asked, “Aren’t you making fun of men? Aren’t you going to make them mad at you?” Well…here’s the dirty little secret…it is no secret that men don’t make good patients in general and they don’t make good vasectomy patient’s in particular. They are unabashedly honest about not liking the idea of “being cut on down there.” So… no it doesn’t embarrass them “a tall” and the more things we can do to make the process pleasant and yes, less painful, the better.

For our vasectomy patients we offer a wide array of options to neutralize this “pain concern issue.”

  • A pre-med prescription of a sedative and a pain pill one hour before the procedure
  • If done in the office we use the No-needle No-scalpel technique (This means one small incision the size of a piece of rice that does not require a suture).
  • We have a fan in the room moving air around and this helps any anxiety.  We play music in the room louder than normal as a distraction. These are small things but part of a bigger plan to decrease any nervousness the patient might be experiencing…without voicing it. That’s right, not every anxious male patient is going to tell you he is anxious or worried. He may not tell us…but we know.
  • For the patient who “doesn’t want to know nothing” and just fall asleep and then wake up and it’s done…we have an accredited surgery center where the vasectomy can be done under I.V. general anesthesia.  Easily 65% of our patients prefer this if they are not significantly affected by cost.
  • We have special pricing that is fair and matches up with what the expense would have been if they had insurance for patients who are self pay or have high deductibles.
  • We mention “fair” because often times non insurance self pay patients, at some practices, are asked to pay more than what an insurance would allow.  We don’t do that.
  • It doesn’t hurt, no pun intended, that we have done thousands of vasectomies over our thirty years in practice and  continue to perform 12-15 a month at both our office and our surgery center.

A recent testimonial from a vasectomy patient:

I was very pleased with the entire process. Dr. McHugh fully educated me on the vasectomy and then performed the procedure perfectly. He made the entire experience easy and painless.

W.W. Gainesville, GA – Oct 06, 2018
The above testimony demonstrates what we at Northeast Georgia Urological Associates hope to achieve with each vasectomy we perform!
Call or email to schedule your vasectomy consultation 24/7 using the form below.

Considering a vasectomy?

Concerned about a high deductible or being self-pay? How about concern about pain? Click here for video.

Call or email 24/7 to schedule consultation-we’ll make every effort to address your biggest concerns and …”get er done.”

Gettin neutered vs. gettin fixed-there’s a difference.

vasec neutered cropped

Did you know?

  • When a male dog is neutered he is having his testicles removed.
  • Testosterone and sperm are produced in the testicles, however only sperm goes out through the vas deferns.
  • Although produced in the testicles, testosterone goes out into the body through the blood system.
  • So…a vasectomy, which severs and occludes the vas tubes, prevents sperm from being in the ejaculate and does not affect the testosterone level.
  • Tell that to your friends at work who, upon hearing that you are having a vasectomy, that no, you won’t be having a voice like a girl. Now you know why.
  • After a vasectomy you are infertile, not impotent.
  • Because the testosterone remains the same you have no change in your libido.
  • It takes about 30 ejaculations to clear the vas tube of sperm beyond the vasectomy site so you will be advised to use protection until the urologist confirms the absence of sperm by microscopic evaluation or a home kit called spermcheck.com which can be ordered online.

In case you have other questions…below is an informative and slightly humorous podcast by Dr. McHugh entitled Vasectomy 101 (Everything you wanted to know but were afraid to ask.)

Considering a vasectomy?  Contact us for a consultation. We have special pricing for patients with a high deductible as well as those who are self-pay.