Bananas and Vasectomies-Oh my!

Don’t “slip-up!”

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

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.

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.

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?

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?

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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Something different: A recommendation for a book to read.

gentleman in moscow

No, there are no hidden urological messages in this book…it is just delightful. All of the Russian stuff circulating around in the news has piqued my interest in Russian history. This book is historical fiction and about a Count who in 1918 or so has been banned to live out the rest of his life…in a hotel. Just as I thought “Boys in the Boat” would be too limited in scope to enjoy and was wrong, so too was my first impression of this book.

Not since “A Man Called Ove” has a book captured my imagination and has been informative as well. If you like a bit of history and want to go a little deeper into Russian history than you’ll get on the news, then let me assure you that you will cherish this book.

Don’t like to read? I listen to books while I’m in the care or when I walk or ride a bike…so there is no excuse.

Enjoy!

Popular question: Does a vasectomy cause prostate cancer?

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Vasectomy Not Associated With Prostate Cancer

Urology – February 28, 2009 – Vol. 25 – No. 04

There is no association between prostate cancer and age at vasectomy or years since vasectomy.

Article Reviewed: Vasectomy and the Risk of Prostate Cancer. Holt SK, Salinas CA, Stanford JL: J Urol; 2008;180 (December): 2565-2568.

Background: The majority of the literature now has shown no association between vasectomy and prostate cancer. The effect of vasectomy on men with a family history of prostate cancer or on those who underwent a vasectomy at a young age or had an extended period of time since the procedure has been poorly studied due to small sample sizes and short study follow-up.

Objective: To assess the risk of prostate cancer in men by age and length of time to exposure from vasectomy to disease.

Design: Population-based, prostate cancer case-controlled study.

Participants: 1327 men aged 35 to 74 years residing in King County, Washington, with a diagnosis of prostate cancer.

Methods: Cases of prostate cancer were identified from the SEER database for this population. Structured in-person interviews were conducted. Eligible controls were identified by random digit telephone dialing. Analysis based on prostate cancer Gleason score and stage was performed. Analysis was also performed based on demographics, age, prostate cancer screening history (within the last 5 years), family history of prostate cancer, and vasectomy parameters.

Results: 1327 men were eligible for study from the SEER database; 1001 completed the personal questionnaire. In total, 1340 controls were identified, of which 942 were interviewed. The control population showed that men who had undergone vasectomy were older, white, married, non-smokers with higher income and education, and had undergone PSA screening. Of men with prostate cancer and controls, 36% had undergone a vasectomy. Mean number of years since vasectomy in cases and controls was 21.1 years. No significant association was seen between prostate cancer and vasectomy status, age at vasectomy, years since vasectomy, or year of vasectomy. There was no evidence of risk estimates across vasectomy parameters. Risk did not change if men with prostate cancer within 2 years of vasectomy and controls with no PSA screening within 5 years (n=136) were excluded.

Conclusions:

No association was found between prostate cancer and vasectomy, even in men who had a vasectomy performed at a young age or had an extended period of time since vasectomy.

Reviewer’s Comments: This paper is a well-conducted, large case-control study that answers the concern about possible limitations of previous work that reported the lack of association between prostate cancer and vasectomy. This criticism often indicated inadequate follow-up since vasectomy to make this claim. In this study, average time since vasectomy in cases of prostate cancer and controls was 21 years. Multiple variables were looked at including vasectomy in the face of prostate cancer family history and screening. This large study should end the criticism on previous work that did not answer the question of prostate cancer and time from vasectomy. (Reviewer–Ajay K. Nangia, MBBS).