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).

 

What is hematuria?

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The evaluation of microscopic hematuria is one of the most common reasons a patient is sent to see a urologist. The big three things we look for are kidney tumors, bladder tumors or stones. The most common evaluation is a non contrasted Ct scan and cystoscopy (looking into the bladder with a scope). Benign reasons for blood in the urine include irritation of the urethra in a female and the vascular lining of the prostate through which urine passes. Even the evaluation is usually negative, because blood in the urine can represent an early sign of malignancy, it is usually evaluated to assure there is no asymptomatic underlying cause. 

In the picture above even though the urine appears clear there can still be significant microscopic blood in the specimen that the patient cannot see and also causing no symptoms.

Hematuria-should you be concerned?

Considering a Vasectomy?

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Is testosterone replacement safe after you’ve been treated for prostate cancer?

Prostate-Cancer-Symptoms

TRT Requires Close Long-Term Follow-Up

Urology – May 1, 2007 – Vol. 22 – No. 11

Patients with low serum testosterone levels and symptomatic hypogonadism who have undergone treatment for early, localized prostate cancer may be treated with testosterone replacement therapy as long as they are followed closely and remain in remission.

Article Reviewed: Testosterone Replacement for Hypogonadism After Treatment of Early Prostate Cancer With Brachytherapy. Sarosdy MF: Cancer; 2007; 109 (February 1): 536-541.

Testosterone Replacement for Hypogonadism After Treatment of Early Prostate Cancer With Brachytherapy.

Sarosdy MF:
Cancer; 2007; 109 (February 1): 536-541

Read More…

A stone in your kidney but no pain…what to do?

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In general “if it ain’t broke don’t fix it” however…read on…

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 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).

 

Sex helps pass kidney stones?

Want to improve your sex life? Get a kidney stone!

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Urology – January 30, 2016 – Vol. 33 – No. 9

Sexual intercourse 3 to 4 times per week may increase the probability of spontaneous stone passage for distal ureteral stones <6 mm in size.

Article Reviewed: Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study. Doluoglu OG, Demirbas A, et al: Urology; 2015;86 (July): 19-24.

Objective: To investigate the role of sexual intercourse on passage of distal ureteral stones.

Design: Prospective, randomized controlled study.

Participants: 90 male patients with distal ureteral stones <6 mm in size undergoing a trial of spontaneous passage.

Methods: Group 1 was randomized to sexual intercourse 3 to 4 times a week, group 2 received tamsulosin 0.4 mg/day for medical expulsive therapy, and group 3 served as a control. Expulsion rate was compared at 2 and 4 weeks.

Results: Mean stone size was similar between all groups at just under 5 mm (group 1, 4.7 mm; group 2, 5.0 mm; group 3, 4.9 mm). At 2 weeks, 83.9% (26/31) patients in the sexual intercourse group had passed stones. In comparison, 47.6% (10/21) in the tamsulosin group and 34.8% (8/23) in the control group had passed stones (P =0.001). At 4 weeks, the differences lost significance, but still showed benefit for the sexual intercourse group with 93.5% passage compared to 81.0% passage in the tamsulosin group and 78.3% passage in the control. The mean expulsion time was 10.0 days in the sexual intercourse group, 16.6 days in the tamsulosin group, and 18.0 days in the control group.

Conclusions: Sexual intercourse 3 to 4 times per week may increase the probability of spontaneous stone passage for distal ureteral stones <6 mm in size.

Reviewer’s Comments: This study led to lots of conversation given the unique and unusual approach proposed to improve spontaneous ureteral stone passage. The authors hypothesized that sexual intercourse may improve spontaneous stone passage by nitric oxide release leading to relaxation of ureteral muscles. They found that the sexual intercourse group passed their stones much faster than either the tamsulosin or control group. While intriguing, several problems exist with the study, which makes me somewhat surprised that it was published. The study is extremely underpowered based on overestimations in initial statistical planning. No compliance measures with sexual activity and/or lack of sexual activity or with taking tamsulosin as prescribed were performed. Only 6% of patients were lost to follow-up in the sexual activity group compared to 23% in the tamsulosin and control arms. If those patients were lost to follow-up because they passed their stones, then the study would have no significance. Last, sexual activity would be a very brief exposure of nitric oxide to the ureter (if the theory is correct). Younger patients should still get nocturnal erections, which would also release nitric oxide for brief periods. It seems that a more consistent delivery of nitric oxide such as with PDE5 inhibitors may be more successful, and PDE5 inhibitors have shown some promise in early studies. Overall, the study makes a good headline and interesting discussion, but much better studies are needed to find a relevant method to facilitate stone passage.(Reviewer–David A. Duchene, MD).

Northeast Georgia Urological Associates-Active Surveillance for Prostate Cancer

If you have been recently diagnosed with prostate cancer you owe it to yourself and your family to watch the following video. Active surveillance should be considered by you to be one of the treatment options for your prostate cancer.

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Contact us 24/7 for an appointment-Leave your number in the form below and we’ll call you the next business day. Our urologists have over thirty years of experience in management and treatment of prostate cancer.

Fall is in the air…bladder healthy soup?

Soup

Take advantage of the extra time you spend inside this winter to make some tasty meals. Here is a recipe for Chicken and White Bean Soup. It’s made with ‘good for you’ ingredients – and won’t bother a sensitive bladder.

Makes 6 servings, 1 ½ cups each
Calories per serving: 172

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Myths about premature ejaculation…and other information/treatment.

Premature Ejaculation – Common Myths Debunked

Premature ejaculation – and ejaculation in general – is complex and not well understood. As a result, there are numerous beliefs about PE that are either not true nor backed up by scientific evidence.  Below are the most common myths about PE along with the best facts available along with numerous resources for learning more about PE from medical institutions. Read More…

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The Urologists at Northeast Georgia Urological Associates treat all forms of sexual dysfunction. Premature ejaculation often times requires a multi-functional approach combining treatment options for optimal results. Feel free to contact us for an appointment.

Make an appointment 24/7-Give us your number and we’ll call with an appointment the next business day.