Thank you! Best of Hall 2020 urology!

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best of hall

a john micro vas improved

Microscopic Vasectomy Reversal

  • One of Georgia’s most experienced urological microscopic surgeons.
  • Hundreds performed.
  • Performed in practice owned urological surgery center.
  • General anesthesia by board certified anesthesiologist.
  • All inclusive pricing.
  • Free in office or phone consultation.

No scalpel No needle Vasectomy

  • Over thirty years of experience.
  • Over a thousand performed.
  • In office or conscious sedation in surgery center.
  • Fair self-pay pricing.
  • We “Cater to Cowards”
  • Free eBook on Vasectomy at gavasectomyreversal.com/vasectomy

Website: northeastgaurology.com

Vasectomy hotline: 770-5350001 ext.112

Email vasectomy/reversal coordinator: lisa.campbell@ngurology.com

When considering a Vasectomy or a Vasectomy Reversal…”Just google: McHugh”

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Vasectomies seasonal? Think holidays and basketball!

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March and the end of the calendar year have the highest proportion of vasectomies performed in the U.S. population.

Background: Vasectomy is a common and safe urologic procedure providing permanent sterilization. Despite ubiquitous use in the United States, temporal trends and actual number of vasectomies performed are poorly understood.

Objective: To estimate the annual number of vasectomies performed in the U.S. population including changes over time, monthly variation, and demographic information.

Design: Query of claims data.

Methods: Truven Health MarketScan claims data were obtained. Estimates of number of possible men who could have obtained vasectomy were taken from census data. Claims data only included men with private insurance.

Results: Data from 2007 to 2015 was included. Authors estimated 527,000 vasectomies occur yearly in the United States. Prevalence of vasectomy decreased across all age groups and regions during the time period. Men aged 35 to 44 years were the most likely to get vasectomy (1.3% of population) followed by men aged 25 to 34 years (0.98%). The proportion by location was highest in the North Central (0.66%) followed by the West Coast (0.61%), the South (0.50%), and the Northeast (0.41%). Urologists performed the largest proportion of vasectomies (82%) followed by primary care doctors (6.4%). More than 80% of all vasectomies are performed in the office setting. A slight increase is seen in March of the calendar year with much higher proportions of vasectomies occurring at the end of the calendar year.

Conclusions: Approximately 0.5% to 0.6% of the eligible male population has a vasectomy on a yearly basis. Trends are seen based on age, geography, and month of the year.

Reviewer’s Comments:

The monthly increases at the end of the year and in March around the NCAA (National Collegiate Athletic Association) college basketball tournament are real and seen in clinical practice.

This is not the type of study that necessarily changes the practice of urologists but is still interesting although possibly you could increase the number of vasectomy spots in the higher demand months to catch on the trends. The overall trend seen during the study years is likely due to the financial recovery after the crash of 2008. Although not examined here, previous studies have found correlations between vasectomies, vasectomy reversals, and financial indicators.(Reviewer–Charles Welliver, MD).

Bananas and Vasectomies-Oh my!

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Don’t “slip-up!”

Dr. McHugh’s chocolate lab Penelope is famous on AccessWDUN!

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Everything you wanted to know about a vasectomy but your wife forgot to ask!

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

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

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Considering a vasectomy or know someone who is? Take a look at Dr. McHugh’s Ebook or share with someone it may benefit.

Vasectomy- Everything you wanted to know about a vasectomy but your wife was forgot to ask!

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Vasectomy Reversal-What a Woman Wants to Know.

Posted on by John McHugh

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

From Vasectomy.com

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The decision to reverse a vasectomy should be considered carefully by each couple. As a woman, you may have special concerns that are difficult to express.

Vasectomy reversal (and the microsurgery involved) raises questions for both men and women. Although men need to be forthcoming about any questions, concerns and fears they share with their physician, it is just as important for women to be informed and reassured about the procedure. You may be surprised to know that many women share the apprehensions about reversal surgery that you may have.

Candid questions, correct information, and the assurance of an experienced urologist are the keys to feeling more comfortable and sure about the decision you and your spouse have made to have a vasectomy reversal. Make a list of the questions that concern you most before meeting with your doctor.

Here are some of the questions women commonly ask:

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Water Water Water Everywhere…now drink it! Prevents bladder infections.

Posted on by John McHugh

Patients with cystitis should be objectively educated on pros and cons of increasing water intake.

 

Background: Increased water intake is commonly recommended to prevent recurrent cystitis in premenopausal women, but the overall conclusive evidence and research is weak.

Objective: To determine the impact of increasing daily water intake on recurrent cystitis frequency.

Design: Randomized, open-labeled, controlled, 12-month clinical conducted at 1 research center in Sofia, Bulgaria, but also overseen by U.S. researchers and supported by Danone Research.

Methods: 140 healthy women with ≥3 episodes of recurrent cystitis in the past year consuming <1.5 L (approximately 51 ounces) fluid daily were included. Baseline, 6-month, and 12-month visits occurred along with monthly phone calls. Participants were assigned to drink their normal fluid intake in addition to 1.5 L of water or no extra fluids (control group) for 12 months. Mean age was 35 years.

Results: Mean number of episodes was 1.7 for water and 3.2 for control (P <0.001). Mean number of antibiotic treatments used to treat cystitis was 1.9 and 3.6 (P <0.001). Mean time between episodes was 142.8 and 84.4 days (P <0.001). Participants in the water group versus control had increased mean urine volume (P <0.04) and voids and reduced urine osmolality (both P <0.001).

Conclusions: Increased water consumption is an effective antibiotic-reducing method to prevent recurrent cystitis in high-risk premenopausal women who usually drink low levels of fluids daily.

Reviewer’s Comments: The occasional Internet advice to consume 8 glasses of water per day to improve your health has minimal to no evidence, but preliminary research is beginning to support something similar to this practice in urology to prevent kidney stones and now perhaps recurrent cystitis in premenopausal women who usually consume low levels of fluids (average of 0.5 L or 17 ounces/day). This is an unusually low amount (basically 2 cups of water per day) that was being consumed at baseline. What was missed is that 20% to 25% on average of fluid or water intake in humans actually comes from food sources, and this was not taken into account or addressed, which is surprising. In addition, the study occurred in Bulgaria at a clinical research center and not in the United States despite the slight indirect implication, and a commercial water source funded the study. Side effects were similar between the groups. Regardless, discussing fluid intake with patients is a logical, practical, and cost-effective option for patients that fit the criteria of this study.(Reviewer–Mark Moyad, MD, MPH).

Article Reviewed: Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. Hooton TM, Vecchio M, et al: JAMA Intern Med; 2018;178 (November 1): 1509-1515.

Urine cytology-why do urologists order this?

Posted on by John McHugh

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.

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

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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.

Posted on by John McHugh

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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