Recent Healthgrades Review!

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J.W. Atlanta | Nov 09, 2017
What an excellent day, Dr. McHugh was on his game and did an outstanding job on me with my vasectomy. It’s day 3 an I’m not even sore, he’s great with all his patients an willing to answer any questions. Thanks Doc…
Thank you. We are glad you are doing well. J.M.

Ival O. Salyer: Maybe the most interesting person alive…and a patient of ours!

Note the events, experiences and names alluded to in a mere impromptu 1:26 off the cuff interview at an office visit. Amazing. He did not have time to mention his over 100 patents and doing research work on a mechanical heart with a famous Johns Hopkins’ cardiovascular surgeon! And it is 100 and 1/2…not just 100… and don’t you forget that. Can you imagine being able to say you’ve met Winston Churchill?

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Indira Priyadarshini Gandhi (Hindustani: [ˈɪnːdɪrə ˈɡaːnd̪ʱi]née Nehru; 19 November 1917 – 31 October 1984) was an Indian politician and central figure of the Indian National Congress party. She was the first and to date the only female Prime Minister of India. Indira Gandhi was the daughter of India‘s first Prime Minister, Jawaharlal Nehru. Despite her surname Gandhi, she is not related to the family of Mahatma Gandhi. She served as Prime Minister from 1966 to 1977 and then again from 1980 until her assassination in 1984, making her the second-longest-serving Prime Minister of India after her father.

Gandhi served as her father’s personal assistant and hostess during his tenure as prime minister between 1947 and 1964. She was elected Congress President in 1959. Upon her father’s death in 1964 she was appointed as a member of the Rajya Sabha (upper house) and became a member of Lal Bahadur Shastri‘s cabinet as Minister of Information and Broadcasting. In the Congress Party’s parliamentary leadership election held in early 1966, upon the death of Shastri, she defeated her rival, Morarji Desai, to become leader, and thus succeeded Shastri as Prime Minister of India.

As the Prime Minister of India, Gandhi was known for her political ruthlessness and unprecedented centralisation of power. She went to war with Pakistan in support of the independence movement and war of independence in East Pakistan, which resulted in an Indian victory and the creation of Bangladesh, as well as increasing India’s influence to the point where it became the regional hegemon of South Asia. Gandhi also presided over a controversial state of emergency from 1975 to 1977 during which she ruled by decree. Akin to Mahatma Gandhi’s fate, she was assassinated by Sikh nationalists in 1984. In her case, her elimination by her bodyguards was claimed to be a retaliation for the storming of the Harmandir Sahib (Golden Temple) in Amritsar that she ordered to counter the Punjab insurgency, less than a month before her 67th birthday. The assassins, Beant Singh and Satwant Singh, were both shot by other security guards. Satwant Singh recovered from his injuries and was executed after being found guilty of murder.

Got stones? What to do with them in the kidney but they aren’t blocking- a very common question.

Your Best Management for Asymptomatic Nonobstructing Kidney Stones

Urology – August 30, 2015 – Vol. 33 – No. 2

Lower-pole kidney stones are less likely to become symptomatic during observation.

Article Reviewed: The Natural History of Nonobstructing Asymptomatic Renal Stones Managed With Active Surveillance. Dropkin BM, Moses RA, et al: J Urol; 2015;193 (April): 1265-1269.

Objective: To determine the natural history of observed nonobstructing asymptomatic kidney stones and factors associated with eventual stone-related events.

Design: Retrospective chart review of the records of 160 kidney stones in 110 patients on active surveillance.

Methods: Stone characteristics, patient characteristics, and stone-related parameters were evaluated to determine factors for stone-related symptoms, spontaneous passage, requirement for surgical intervention, and stone growth.

Results: 160 stones with an average size of 7.0 mm ± 4.2 mm in 110 patients were followed up 41 ± 19 months. A total of 28% (45 of 160) of stones caused symptoms and 2% (3 of 160) caused silent obstruction on average of 37 ± 17 months. Upper-pole/mid-pole stones were more likely than lower-pole stones to become symptomatic (40%) or pass spontaneously (15%). No other factors demonstrated statistical significance in predicting symptoms.

Conclusions: Over a 3-year period, most asymptomatic nonobstructing renal calculi remained asymptomatic. Approximately 30% caused symptoms, 20% required surgical intervention, 20% grew >50% initial size, and 7% passed spontaneously. Lower-pole stones caused fewer issues than upper- or mid-pole stones. Silent obstruction may occur and necessitates regular imaging and follow-up of even asymptomatic stones.

Reviewer’s Comments: This is a very nice article following the natural history of asymptomatic nonobstructing kidney stones, which are often picked up on imaging for other indications. It shows almost identical results to previous studies, which is that over a specified period (average of 3 years in this study), approximately 30% of stones will become symptomatic or need intervention. In this study, however, if you account for patients (instead of stones), nearly 40% became symptomatic over the study period. One must also consider that 20% of stones in this study grew >50% their original size. A small percentage developed silent obstruction, which is the most concerning aspect in regard to possible renal function loss. The authors conclude that most stones remain asymptomatic over time and hint that active surveillance may be the best option. The authors make a very valid point. However, the debate becomes whether you and your patient consider 30% to 40% as an acceptable number. Are we really saving 70% of individuals from needed intervention or having symptoms, or are we just delaying the inevitable? With the exception of uric acid stones, which may dissolve, stones do not disappear. I think with longer follow-up, more will eventually become symptomatic.

Whether you treat prophylactically or only treat when indications arise becomes a decision between you and your patient. It also is influenced by the patient’s age, health, anxiety, history of kidney stones, and lifestyle. Overall, this is a nice article to provide numbers to patients in regard to nonobstructing asymptomatic kidney stones.

(Reviewer–David A. Duchene, MD).

 

Author: Dropkin BM, Moses RA, et al
Author Email: Benjamin.m.dropkin.med@dartmouth.edu

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.

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Top Tweets for Urology Care Foundation

Urology Care Foundation is funded by the American Urological Association. It is a very useful site both for urologists as well as urological patients. On this site a patient can download infographic posters and subscribe for free for the monthly magazine. Click on the image below to get a taste of the top 5 tweets by UCF for the year and then checkout this informative website-urologyhealth.org.

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