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Questions that vasectomy patients have asked and a doctor has answered.

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From Vasectomy.com’s page “Ask a Doctor.”

Do you have a question for our doctors? Fill in the form below and we’ll try to help.

March Madness and Vasectomy…fact or fiction?

March Madness and the Long Running Myth in Urology

By: Urology Care Foundation | Posted on: 23 Mar 2016

March Madness and the Long Running Myth in Urology

It’s no secret that this country loves March Madness, but is it true vasectomy appointments spike during this time of year? Do so many men opt for the procedure during March that urologists are flooded with requests? Do men want a reason to stay at home and watch these games that bad?

“Difficult to completely say if it’s a myth or not, but vasectomy appointments don’t go up during March Madness at my practice,” said Dr. Ajay Nangia. “I’ve been doing vasectomies for 16 years and it’s not like I’m suddenly getting inundated for requests on the Friday of March Madness.”

Dr. Nangia, who volunteers for the Urology Care Foundation, is an Associate Professor of Urology at the University of Kansas Medical Center. For the record, Kansas is home to some of the most loyal college basketball fans in America. The Kansas Jayhawks were a No. 1 seed in the 2016 tournament and they won it all in 2008.

Other popular sporting events rumored to cause a rise in vasectomy requests include the Olympics, World Cup and Masters (golf tournament). None of this has ever been proven in a study, according to Dr. Nangia.

“I don’t think anyone’s ever published a study on it,” Dr. Nangia said. “If there were to be a study, it shouldn’t be based on one practice.”

The American Urological Association (AUA) has never reported any data linking March Madness, or other sporting event, to an increased number of vasectomies performed. However, a report from CNN in 2014 quoted Dr. Ed Sabanegh, chairman of the Department of Urology at the Cleveland Clinic, as saying his practice performs about 50% more vasectomies in March.

Dr. Nangia thinks the idea that “vasectomy appointments skyrocket in March” might be an illusion. He explained that since many practices promote getting vasectomies in March (i.e., giving away free pizza coupons with appointments) it may simply just feel as though more men are undergoing the procedure in March. Until a study is done to find out if U.S. men line up in droves for a vasectomy during March Madness, we may never know for sure.

Learn more about vasectomy

However…if you do want to have your vasectomy during March Madness…we’ll happily we’ll make it happen! Contact us 24/7 and leave your number and we’ll call for an appointment.

New drug for getting up at night (nocturia)…well is it really new?

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Image by Amanda Camp

DDVAP or desmopressin has been used for many years for bed wetting in children. Several years ago studies were released showing its effectiveness in adults. There is a small risk of hyponatremia and this something to be monitored and made aware to the patient. I have used desmopressin many times in adults with exceptional results. Noctiva is specifically for adults. The use of a drug with good results but not for what it was approved for is referred to as “off label” and physicians use many drugs this way. Hytrin for instance was initially for blood pressure but urologists have used for years for the management of prostate enlargement. As getting up at night is a complaint we hear very frequently in men and women, Noctiva-you gotta like the name- is another arrow in the quiver of the urologist to treat nocturia.

From the FDA

The U.S. Food and Drug Administration today approved Noctiva (desmopressin acetate) nasal spray for adults who awaken at least two times per night to urinate due to a condition known as nocturnal polyuria (overproduction of urine during the night). Noctiva is the first FDA-approved treatment for this condition.

“Today’s approval provides adults who overproduce urine at night with the first FDA-approved therapeutic option to help reduce the number of times a night they wake up to urinate,” said Hylton V. Joffe, M.D., M.M.Sc., director of the Division of Bone, Reproductive, and Urologic Products in the FDA’s Center for Drug Evaluation and Research. “It is important to know that Noctiva is not approved for all causes of night-time urination, so patients should discuss their symptoms with their health care provider who can determine the underlying cause of the night-time urination and whether Noctiva is right for them.”

Nocturia (wakening at night to urinate) is a symptom that can be caused by a wide variety of conditions, such as congestive heart failure, poorly controlled diabetes mellitus, medications, or diseases of the bladder or prostate. Before considering Noctiva, health care providers should evaluate each patient for possible causes for the nocturia, and optimize the treatment of underlying conditions that may be contributing to the night-time urination. Because Noctiva is approved only for adults with nocturia caused by nocturnal polyuria, health care providers should confirm overproduction of urine at night with a 24-hour urine collection, if one has not been obtained previously. Health care providers should also be mindful of underlying conditions that can cause nocturia, but that make treatment with Noctiva unsafe, such as excessive drinking of fluids or symptomatic congestive heart failure.

Noctiva is taken daily, approximately 30 minutes before going to bed. It works by increasing the absorption of water through the kidneys, which leads to less urine production.

Noctiva’s efficacy was established in two 12-week, randomized, placebo-controlled trials in 1,045 patients 50 years of age and older with nocturia due to nocturnal polyuria. Although these trials showed a small reduction in the average number of night-time urinations with Noctiva compared to placebo, more patients treated with Noctiva were able to at least halve their number of night-time urinations, and patients treated with Noctiva had more nights with one or fewer night-time urinations.

Noctiva is being approved with a boxed warning and a Medication Guide because it can cause low sodium levels in the blood (hyponatremia). Severe hyponatremia can be life-threatening if it is not promptly diagnosed and treated, leading to seizures, coma, respiratory arrest or death. Health care providers should make sure the patient’s sodium level is normal before starting Noctiva, and should check sodium levels within one week and approximately one month after starting treatment and periodically thereafter. The lower Noctiva dose is recommended as the starting dose for those who may be at risk for hyponatremia, such as the elderly. Noctiva should not be used in patients at increased risk of severe hyponatremia, such as those with excessive fluid intake, those who have illnesses that can cause fluid or electrolyte imbalances, certain patients with kidney damage, and in those using certain medicines, known as loop diuretics or glucocorticoids.

Noctiva should also not be used in patients with symptomatic congestive heart failure or uncontrolled hypertension because fluid retention can worsen these underlying conditions. Use of Noctiva should be discontinued temporarily in patients with certain nasal conditions such as colds or allergies until those conditions have resolved.

Noctiva is also not recommended for the treatment of nocturia in pregnant women. Nocturia is usually related to normal changes in pregnancy that do not require treatment with Noctiva. Noctiva should not be used in children.

The most common side effects of Noctiva in clinical trials included nasal discomfort, cold symptoms (nasopharyngitis), nasal congestion, sneezing, high or increased blood pressure, back pain, nose bleeds, bronchitis and dizziness.

Although there are other FDA-approved medications that also contain desmopressin, none of those medications are approved to treat nocturia.

Noctiva is marketed by Milford, Pennsylvania-based Renaissance Lakewood, LLC for Serenity Pharmaceuticals, LLC.

Tribute to Vernon Farmer-U.S. Army 82nd Airborne Paratrooper.

Vernon Farmer passed away last week. He was the grandfather of Northeast Georgia Urological Surgery Center’s Scrub Tech Kathryn Loggins. Our thoughts are with her.

Several months ago he was in our office and was relating funny stories about being a paratrooper. He agreed to let us video him. Truly one of America’s greatest generation.

US Blood Upon The Risers

Although this song was originally song by American Paratroopers during WWII,
some do consider it a war protest song as well.

It tells the story of a paratrooper’s last jump because his parachute fails.
It is said that in Ft. Benning, Georgia, students of the Army Airborne School are required to memorize the lyrics of this song.

“Blood Upon the Risers” is an American paratrooper song from World War II. It is associated with all airborne units, including the 82nd Airborne Division, the 101st Airborne Division, the 173rd Airborne Brigade and 4th Brigade Combat Team (Airborne) of the 25th Infantry Division, and the 120th CTS (United States) as well as British airborne units, also being known as “Mancha Roja” (Spanish for “Red Stain”) in many airborne units from multiple Latin American countries. In Spain it is called “Sangre en las cuerdas” (Blood upon the risers in English).

The song is and was sung by troopers training to jump qualify as an act of comic camaraderie – by singing a somber sounding but comic song depicting their worst possible training outcome, members of the unit were able to not only hide their own fears, but use the fact that every one was equally working to hide theirs as a moment of bonding and genuine help in holding their courage, the song ending with the group assuring itself that if this did happen at least “You ain’t gonna (as implied – have to, or gotta) jump no more.”

This song has been featured on the television miniseries Band of Brothers and the video game Brothers in Arms: Road to Hill 30, and also mentioned in Donald Burgett’s book Currahee!: A Screaming Eagle at Normandy. Sung to the tune of “The Battle Hymn of the Republic”, the song tells of the final fatal jump of a rookie paratrooper whose parachute fails to deploy. This results in him falling to his death.

The song is also a cautionary tale on the dangers of improper preparation of a parachute jump. The protagonist does everything right except forgets to hook on his static line which would automatically deploy his main parachute, and he in panic deploys his reserve chute in bad falling position with disastrous results. As the reserve chute is stored in a belly bag on the World War II era rig, deploying it in bad falling position could easily lead in an accident not unlike the one described in the song. “Risers” are the four straps which connect the suspension lines of the parachute canopy to the parachute harness.

Gory! Gory! What a helluva way to die!
Gory! Gory! What a helluva way to die!
Gory! Gory! What a helluva way to die!
And, he ain’t gonna jump no more!
“Is everybody happy?” cried the Sergeant looking up.
Our Hero meekly answered “Yes,” and then they stood him up.
He leaped right out into the blast, his static line unhooked.
And, he ain’t gonna jump no more.
(CHORUS)
He counted loud. He counted long. He waited for the shock.
He felt the wind. He felt the cold.  He felt the awful drop.
The silk from his reserve spilled out and wrapped around his legs.
And he ain’t gonna jump no more.
The risers wrapped around his neck, connectors cracked his dome.
Suspension lines were tied in knots around his skinny bones.
His canopy became a shroud as he hurtled to the ground.
And he ain’t gonna jump no more.
(CHORUS)
The days he’d lived and loved and laughed kept running through his mind.
He thought about the girl back home, the one he left behind.
He thought about the medics and wondered what they’d find.
And he ain’t gonna jump no more.
The ambulance was on the spot. The jeeps were running wild.
The medics jumped and screamed with glee, rolled up their sleeves and smiled.
For it had been a week or so since last a ‘chute had failed.
And he ain’t gonna jump no more.
He hit the ground. The sound was “Splat!” The blood went spurting high.
His comrades then were heard to say: “A helluva way to die!”
He lay there rolling around in  all the welter of his gore.
And he ain’t gonna jump no more.
(CHORUS)
(Slowly and Solemnly)
There was blood upon the risers. There was brains upon his chute.
Intestines were a’dangling from his Paratrooper suit.
They picked him up and they poured him from his boots.
And he ain’t gonna jump no more.
Gory! Gory! What a helluva way to die!
Gory! Gory! What a helluva way to die!
Gory! Gory! What a helluva way to die!
And, he ain’t gonna jump no more!

(Change  tune to Beautiful Dreamer)

Beautiful streamer, please open for me.
Blue skies above me, but no canopy.
I counted to 10,000, but waited too long.
Reached for my ripcord … the handle was gone.

Gory! Gory! What a helluva way to die!
Gory! Gory! What a helluva way to die!
Gory! Gory! What a helluva way to die!
And, he ain’t gonna jump no more!

The “skinny” on a Vasectomy

Vasectomy Quick Facts

Here is a helpful collection of interesting facts and points of information about vasectomy:

  • Each year, between 500,000 and 600,000 men select vasectomy as the permanent birth control method of choice in their family.
  • Vasectomy is considered nearly 100 percent effective, safe, and does not interfere with sexual pleasure.
  • The No-Scalpel Vasectomy (NSV) procedure was developed in the early 1970s in China by Dr. Li Shunqiang.
  • During the past few decades, over 15 million vasectomies have been performed around the world using the NSV technique.
  • No-scalpel vasectomy can be completed in about 15 – 20 minutes.
  • A vasectomy does not reduce a manís sexual drive, virility or his ability to have or enjoy sex.
  • About 85 percent of health care insurance programs include coverage for the vasectomy procedure, so there may be little or no cost to you.
  • Most vasectomy procedures are performed by urologists; medical doctors who are specialists in the male and female urinary tract and the male reproductive organs.
  • Sterilization for a man (vasectomy) is significantly less expensive than for a woman (tubal ligation), which may be as much as five times more costly. Learn more about vasectomy costs.
  • Many vasectomy procedures are performed on Thursdays or Fridays to allow for a weekend vasectomy recovery time – before returning to work the following week.

Leave your number and we’ll call you to set up a consultation!

Steam therapy for BPH-Does it cause ED?

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Conclusions: Convective water vapor thermal therapy provides durable improvement to LUTS for 12 months and urinary flow while preserving erectile and ejaculatory functions.

Note: Most all of the treatments for enlarged prostate cause retrograde ejaculation. Because the prostate channel is opened with procedures to allow a better stream, in doing this the semen is not propelled forward and stays in the urethra. It is then voided out at the next urination. Medically this not an issue but some men do not like the fact that it happens. Retrograde ejaculation has not been noted in Rezum therapy. In addition Rezum in some cases improved sexual function which at this time is unexplained.

Convective Water Vapor Energy Tx (Rezum) of LUTS Preserves Sexual Function

Urology – October 30, 2016 – Vol. 34 – No. 9

Convective water vapor therapy provides durable improvement to lower urinary tract symptoms and urinary flow while preserving erectile and ejaculatory functions.

Article Reviewed: Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. McVary KT, Gange SN, et al: J Sex Med; 2016;13 (June): 924-933.

Background: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is a common condition concurrent with erectile dysfunction (ED). In recent years, the association between LUTS and ED has been escalating in level of concern by patients and health care providers, as treatment may impact sexual function (SF). The effectiveness of various treatments for LUTS-BPH has been defined, and most patients have some sexual side effects, although differing in type, severity, and frequency. An alternate,minimally invasive therapy utilizing convective water vapor (Rezum) has been shown to provide rapid relief in LUTS.

Objective: To determine whether therapy utilizing convective water vapor energy had any effect on erectile and ejaculatory function.

Design: Randomized controlled trial.

Methods: In the blinded group (active 136, control 61) comparison occurred at 3 months; the active arm was followed up for up to 12 months for International Prostate Symptom Score (IPSS), Qmax, and for sexual function using International Index of Erectile Function (IIEF) and the Male Sexual Health Questionnaire for Ejaculatory Function (MSHQ-EjD). The minimal clinically important difference (MCID) in EF for which subjects perceive as beneficial was determined for each EF severity category.

Results: No treatment- or device-related de novo ED occurred after therapy. The IIEF and MSHQ-EjD function scores were not different from controls at 3 months or from baseline at 1 year. The ejaculatory bother score improved to 31% over baseline (P =0.0011). Also, 32% of subjects achieved MCIDs in EF scores at 3 months and 27% at 1 year, including those with moderate to severe ED.

Conclusions: Convective water vapor thermal therapy provides durable improvement to LUTS for 12 months and urinary flow while preserving erectile and ejaculatory functions.

Reviewer’s Comments: The primary end point was the treatment of LUTS, and therefore, the endeavor to evaluate SF in this context presents an inherent limitation. The MCID suggests an improvement in ED in men with baseline ED is unexplored and a novel finding.(Reviewer–Kevin T. McVary, MD, FACS).

Northeast Georgia Urological Associates is now performing Rezum Therapy  as an out patient procedure in both the office setting and our accredited ambulatory surgery center. You can contact us 24/7 with your number below and we’ll call you to arrange your consultation.

Vasectomy follow up? Nearly one half of men never submit a post vasectomy semen specimen.

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Patient Non-Compliance With Vasectomy Follow-Up

Urology – September 30, 2013 – Vol. 30 – No. 10

Nearly 50% of patients do not perform post-vasectomy requested semen analysis.

Article Reviewed: Compliance With Semen Analysis. Duplisea J, Whelan T: J Urol; 2013;189 (June): 2248-2251.

Background: Nearly half a million men undergo vasectomy in the United States each year. While this is generally a straightforward procedure, it is not 100% successful. Post-vasectomy semen analysis helps the physician confidently determine if the procedure was successful, but no consensus exists to guide post-vasectomy semen analysis routine; the 2012 AUA guidelines suggest a single negative sample performed 8 to 16 weeks post-procedure, and <100,000 sperm/mL (non-motile) is considered a success. Patient compliance with post-vasectomy semen analysis is low and few studies review the reasons for poor compliance.

Objective: To determine which men are more or less likely to comply with requested post-vasectomy semen analysis based on demographic data.

Design/Methods: The authors performed a retrospective review of 946 men undergoing vasectomy at a single institution/single surgeon performed between January 2002 and December 2009. For this particular surgeon, post-vasectomy semen analysis was requested for 2 samples 16 weeks after vasectomy. The information was reiterated during vasectomy and written instructions were provided. The surgeon removed a piece of vas for pathologic analysis.

Results: The mean age of vasectomy patients was 33.6 years and they had a mean of 2.15 children before vasectomy. Over 80% of men were married and the complication rate was 3.4%. Complications were mostly hematoma and sperm granuloma. Vasectomy was repeated in 4 men, 3 of whom requested the repeat due to persistent non-motile sperm. Nearly 50% of men submitted no samples (48%) and 16% only submitted 1 sample. Men who were noncompliant tended to be aged <34 years, had ≥3 children, and did not have complications. Based on further logistic regression analysis, only an increased number of children was predictive of noncompliance.

Conclusions: Men with more children, of younger age, and without complications tend to be less likely to submit a post-vasectomy semen analysis. While the best protocol for post-procedure evaluation remains to be determined, increasing compliance is in the best interest of the physician.

Reviewer’s Comments: The most recent AUA guidelines do not suggest that pathologic analysis is necessary during a vasectomy, making post-vasectomy semen analysis the determinant of success. Unfortunately, as nearly all urologists experience, the majority of patients are not compliant with post-vasectomy semen analysis. The authors requested 2 post-vasectomy semen analysis samples and this was only completed by 36% of patients. Based on the guidelines, only 1 patient truly required a repeat procedure. Even with low failure rates, vasectomy remains a frequently litigated urologic procedure and physicians want to ensure success. As much as can be reiterated to the patient, obtaining a single semen analysis at least 8 weeks post-procedure should be the goal of all physicians performing vasectomy.(Reviewer–Gregory Lowe, MD).

 

Minimally invasive prostate enlargement treatment vs. more minimally invasive treatment. GreenLight Laser vs. Rezum.

Georgia GreenLight Laser

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The GreenLight uses laser energy to vaporize prostate tissue. The obstructing prostate tissue is destroyed or removed at the time of the procedure.

Rezum uses radio frequency generated steam injected into the prostate tissue to bring about changes that will over time shrink the prostate tissue away from the channel men urinate through.

The effect of the GreenLight procedure is for the most part immediate. The effect of the Rezum occurs over time.

The Rezum is “more” minimally invasive because it takes less time to perform, nothing is cut or destroyed and essentially very little risk of bleeding. There is usually 2-4 nine second treatments with Rezum and the steam is injected through a small catheter by way of puncturing the prostate.

So…who should choose which?

You can do the GreenLight with good results on most any obstructive prostate. However is a patient has been in retention (can not urinate…

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