Benign prostatic hyperplasia, or BPH, is quite common and involves the enlargement of a man’s prostate gland as he ages. He can have trouble urinating, causing a number of lower urinary tract symptoms (LUTS).  Symptoms may include:

• Urgency – having the pressing need to urinate
• Frequency – feeling that you need to urinate more often than usual
• Incomplete emptying of bladder
• Awaking many times during the night to urinate

Advanced Urology Centers of New York has helped thousands of men with this problem, and if you think you are suffering from BPH, we can help you, too. Below are some of the tests that an AUCNY urologist may order to diagnose conditions and determine the best treatment.

• Blood tests – including Prostate-specific antigen (PSA) and other tests to determine the cause of BPH symptoms
• Digital Rectal Exam (DRE) – checks to see if the prostate is enlarged, whether there is cancer or other health issues exist.
• Transrectal Ultrasound – provides images and measurements of the size and shape of the prostate. It can find abnormal growths in the prostate.
• Urine test – used to rule out infection as the reason for existing symptoms
• 24-hour Voiding Dairy – provides the AUCNY caregivers with urine output information with the amounts and time of day of bathroom trips
• Postvoid Residual Volume Test – Shows whether you can completely empty your bladder
• Urinalysis – checks for infections, blood, proteins, and other issues that can give information about your symptoms
• Urinary Flow Study – Checks the strength and volume of your urine flow
• Cystoscopy – a procedure that allows your doctor to inspect your urinary tract including the bladder and urethra
• MRI’s and CT’s – if surgery is needed, these tests may be ordered to see the prostate and surrounding areas around it.
• Prostate Biopsy – a procedure that uses a needle to remove a small sample from the prostate gland to check for prostate cancer. This is done if there is a high PSA blood test result or abnormal digital rectal exam.

Treatment options for BPH with LUTS/ Enlarged Prostate

Medications prescribed:
Men who are experiencing moderate to severe BPH with LUTS (enlarged prostate) symptoms may be treated with medications such as alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax) or terazosin (Hytrin), which are part of a class of medications known as alpha-blockers. These treatments work by relaxing the muscles around the bladder allowing an easier flow of urine.

Minimally invasive surgery performed:

Greenlight Laser:
A laser is used to quickly heat and evaporates the prostate tissue that is blocking the bladder opening. The procedure is usually performed under general anesthesia and typically provides patients with symptom relief after the procedure.

Rezum™ Water Vapor Therapy:
Water vapor energy ablation shrinks the enlarged prostate using steam to remove the extra tissue that is pushing on the urethra. This non-surgical treatment is done in the office. Most patients see improvement of their symptoms within two weeks.

Transurethral Microwave Therapy (TUMT):
This procedure uses a small antenna that applies microwave energy to heat and destroy the extra enlarged prostate tissue which is blocking the urine flow.

Transurethral needle ablation (TUNA):
Radiofrequency waves are used to heat and destroy the enlarged prostate tissue. This procedure improves urine flow to provide symptom relief.

Transurethral Resection of the Prostate (TURP):
With the use of an electric current or laser light, TURP cuts away the extra enlarged prostate tissue. This procedure is usually a treatment for men with moderate to severe urinary problems who did not improve from medication therapy.

Urolift® System:
Serial suture implants are used to constrict the enlarged prostate tissue so that the urethra is no longer blocked. These serial sutures are placed facing each other from the lateral to the medial side of the prostate along the course of the urethra, narrowing the thick tissue bilaterally and widening the passageway. This minimally invasive procedure can usually be performed in our offices in under one hour and patients are able to go home the same day.

Surgical options:

Prostatectomy:
For very severe cases of enlarged prostate, AUCNY physicians perform a partial or complete removal of the obstructing prostate gland through a surgical incision.

Elevated PSA levels in a man’s blood could be indicative of prostatitis, benign prostatic hyperplasia (or BPH), or prostate cancer.

A PSA test measures the level of a protein in the blood called prostate-specific antigen. This normally occurring protein is produced by the prostate, a gland that is found below the bladder in males and is primarily found in semen. Small amounts are also detected in the blood which, when elevated, may indicate prostate disease. There may or may not be symptoms associated with an elevated PSA.

Elevated PSA levels can be indicative of several possible prostate diagnoses:

• Prostate cancer
• BPH (benign prostatic hypertrophy) is a non-cancerous enlarged prostate.
• Prostatitis is an inflammation or infection of the prostate.
• The measurement of PSA may also be elevated from causes other than disease such as doing strenuous exercise, sexual activity, having a strong bowel movement, or digital rectal exam within 48 hours before the drawing of the blood.

AUCNY urologists are experienced in determining the specific cause of the PSA elevation using:

Detailed history and physical examination – requesting details on symptoms, personal and family medical history, social history including smoking habits, performing a physical examination with special emphasis on the bladder area including rectal/pelvic exam. Follow up blood test for PSA, Urine test, Imaging testing (x-ray, CT, MRI and/or PET scan Surgical biopsy providing tissue sample which is examined under the microscope for cancer cells

Erectile dysfunction (ED) or impotence is defined as the inability to get or maintain an erection firm enough for sexual intercourse. There are countless television commercials showing popular prescription drugs that can help in the treatment process. However, finding the source of the problem and attempting to deal with it, rather than just treating the symptoms, is where we provide a valuable service for our patients.

While occasional difficulties are common and usually benign, a persistent problem may be the sign or symptom of an underlying medical condition which may be evaluated, diagnosed, and treated as any other medical condition.

The root causes and risk factors can be attributed to any or a combination of concerns:

• Cardiovascular – Heart, blood vessel, high blood pressure
• Hormonal – High cholesterol, diabetes, low testosterone, metabolic syndrome (a condition of high blood pressure, high insulin level, high cholesterol, and excessive fat around the waistline), spinal cord injury
• Neurologic – Parkinson’s disease, multiple sclerosis, sleep disorders
• Substances – certain prescription medications, alcoholism, substance abuse, tobacco use
• Peyronie’s disease – scar tissue formation within the penis
• Some prostate cancer or enlarged prostate treatments or surgery
• Psychological – depression, stress

Diagnostic testing by your AUCNY urologist can help determine the specific cause for the erectile dysfunction/impotence:

• Detailed history and physical examination – requesting details on symptoms, personal and family medical history, social history including smoking habits, physical examination with special emphasis on the bladder area including rectal/pelvic exam
• Blood test
• Urine test
• Ultrasound – an imaging method to check for structural or blood flow abnormalities

Treatment is tailored to the root cause of the problem by your AUCNY urologist after diagnostic testing and determination of the specific problem and may include any or a combination of:

• Prescription medications in pill form, testosterone replacement
• Self-administered injections into the base of the penis or suppositories self-administered within the penis
• Mechanical penile pumps
• Surgical penile implants
• Psychological counseling services
• Lifestyle alteration — exercise, over-the-counter supplements as recommended by your AUCNY urologist, smoking and alcohol cessation, obesity treatment

If you find you have the urge to go to the bathroom all the time, to the point where you may lose control of your bladder before reaching a toilet, you may have an overactive bladder. This condition, also known as OAB, involves the contraction of muscle fibers in the bladder that squeeze (or contracts) at inappropriate times. Our urologists will assist by diagnosing and treating OAB so you can resume your daily activities.

Symptoms can sometimes be reduced with simple lifestyle changes like modification of  the foods you eat and beverages you drink.  Training your bladder through spacing out your bathroom trips and using bladder-holding Kegel exercises to strengthen your pelvic floor muscles are also strategies to try. Carrying too much body weight may worsen symptoms; getting closer to ideal weight may help improve urinary control.

Treatments

If behavior and lifestyle changes do not help, medications relaxing the bladder may reduce symptoms. The most common drugs used for frequency / OAB are:

• Darifenacin (Enablex)
• Fesoterodine (Toviaz)
• Mirabegron (Myrbetriq)
• Oxybutynin (Oxytrol)
• Solifenacin (Vesicare)
• Tolterodine (Detrol)
• Trospium (Sanctura)

Advanced Urinary Incontinence

When initial therapies don’t work, there’s still hope!

It’s been a long road. You are probably frustrated and ready to give up on the hope of regaining the lifestyle you once enjoyed. If you are tired of the inconvenience and the embarrassment associated with bladder issues, and you’ve tried behavioral training, Kegel exercises or failed to tolerate or respond adequately to oral medications, it may be time to consider seeing a urinary incontinence specialist.

We have good news. Your AUCNY urologist works closely with Toby Handler, MD, FACS, Alfred Kohan, MD, FACS and Thomas Rechtschaffen, MD, FACS, urinary incontinence specialists who are experts in third line therapies. They can offer specialized treatment options to alleviate your urinary symptoms, which did not respond to the first- and second- line treatments.

At our surgery center, conveniently located in Farmingdale, we offer more than a state-of-the-art facility where we perform ambulatory procedures. We provide therapy for patients who have overactive bladder symptoms such as frequency, urgency or incontinence which can no longer be managed with initial treatments. Third line therapy includes Botox® injections, percutaneous tibial neuromodulation, and sacral nerve modulation. For stress incontinence, we perform pubovaginal sling surgery, a successful ambulatory procedure solution.

Botox®

Botox® is a medicine that is administered into the bladder to treat overactive bladder symptoms such as urge-incontinence and urgency-frequency syndrome. It is an office procedure which usually produces noticeable results within two weeks of treatment. In clinical trials, Botox® consistently reduced daily leakage episodes by half or more in most of our patients. The results generally last for 6 months. The most common side effect is a slight increased risk of urinary tract infection. Most of our patients do not have issues after treatment. However, a small portion of patients (5-6%) develop a temporary inability to empty their bladders. Until their bladder is fully recovered, they may require the use of a small catheter to relieve the excess urine a few times each day.

Sacral Neuromodulation (SNM)

A common cause of urge-incontinence, urgency-frequency, and non-obstructed urinary retention can be communication issues between the bladder and the brain. Sacral neuromodulation (SNM) restores bladder function by gently stimulating the sacral nerves that provide nerve impulses to the bladder. A simple nerve conduction test can be done to determine if the therapy is effective for you. During the test, you will have some patches taped to your back and wear a belt to provide the stimulation. Many patients experience effective outcomes from this therapy, which can last 5-7 years.

Percutaneous Tibial Neuromodulation (PTNM)

Percutaneous tibial neuromodulation (PTNM) is an office-based treatment that stimulates the posterior tibial nerve (located in the ankle) through an acupuncture-like needle. The tibial nerve connects to the nerves responsible for bladder function. Each weekly treatment is 30 minutes and is scheduled for 12 sessions. The sensation is not painful, although you may feel a slight tingling in your foot. In clinical trials, approximately 70% of patients reported significant improvement of their symptoms after the 12 weekly treatments. Follow-up sessions are usually performed once every 3-4 weeks to maintain the effectiveness seen during the initial treatment. You’ll be free to read, listen to music or catch up on email during these sessions.

To see a urinary incontinence specialist for third line therapies, contact Toby Handler, MD, FACS, Alfred Kohan, MD, FACS or Thomas Rechtschaffen, MD, FACS.

Kidney stones are painful, and somewhat common. Statistics point to the fact that more than 30 million Americans have suffered from urolithiasis, or stone disease, at some time in their lives. If waiting for a stone to pass fails, we can treat kidney stones by using shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy or open surgery. In any case, we have a variety of tools with which to help male and female patients with kidney stones.

Kidney stones occur when the urine becomes excessively concentrated with a substance which then crystallizes out of the urine onto the wall of the kidney instead of staying dissolved in the urine. It may pass into the ureter, the thin tube which passes the urine from the kidney into the bladder, as a very small crystal. This crystal greatly irritates the inner wall of the ureter causing severe symptoms. It may also block the ureter stopping the flow of urine and cause the kidney to back up with urine and painfully enlarge.

Symptoms of kidney or ureter stones include:

• Severe, sharp flank pain which may come in waves and radiate into the groin or lower abdomen
• Pain or burning upon urination with a persistent need to urinate
• Urine which is cloudy, has an odor, or is discolored
• Nausea, vomiting, fever, chills upon occasion

Causes and risk factors for stone formation include:

• Family or personal history of stone formation
• Dehydration from not drinking enough fluids or by loss of fluid such as diarrhea, inflammatory bowel disease, diabetic passing of excess sugar in the urine, excessive sweating
• Diet that is high in salt, sugar, or animal protein
• Obesity
• Other medical conditions such as post gastric bypass surgery, kidney disease, hormonal problems such as hyperparathyroidism which affects the calcium levels in the body
• Excessive use of antacids containing calcium, vitamin C, and use of some migraine/depression medications

To diagnose your AUCNY urologist will use some of the following:

• Detailed history and physical examination – requesting details on symptoms, personal and family medical history, social history including smoking habits, physical examination with special emphasis on the bladder area including rectal/pelvic exam
• Blood test to measure calcium, uric acid, hydration, and measures of kidney function in general
• Urine test which may include a 24-hour urine collection to analyze the substances and their concentrations in the urine
• Imaging procedures (X-ray, CT, MRI, and ultrasound)
• Analysis of passed stones that the patient strains from their urine as it is voided through astrainer (to isolate the stone as it is passed out the urethra). The stone is then analyzed by our lab to determine its composition (calcium, uric acid, oxalate, struvite) which aids your AUCNY urologist in determining the cause of the stone formation. This information guides both the treatment and subsequent prevention of future recurrences.

Treatment for small stones may consist of the following:

• Increasing water intake to help flush out the stone and dilute the causative substance
• Pain medication to make the passage of the stone through the ureter more tolerable
• Prescription medications like the alpha blockers, tamsulosin (Flomax) or dutasteride to relax your muscles to help pass the stone

For larger kidney stones that will not pass on their own, other treatments that may be offered by your AUCNY doctor are:

• Extracorporeal shock wave lithotripsy (ESWL) – sound waves are used to break the kidney stones into very small particles that will pass through your urine
• Lithotripsy – uses shock waves to break up the kidney stones so they can pass through your urinary system
• Ureteroscopy/laser surgery – a minimally invasive surgery using laser beams to destroy theureteral stones
• Percutaneous Nephrolithotomy – a procedure using small instruments and a tube to directly remove kidney stones

Infertility can affect men as well as women. For couples trying to conceive a child, the issue of infertility needs to be explored from the male side as well as the female side. Is the man not producing enough sperm? Is there an issue with the “quality” of the sperm? Are the sperm underdeveloped? Are they abnormally-shaped? Is a varicocele (dilated scrotal veins) affecting the sperm’s ability to transport to their desired location? Is sperm pushing backwards into the bladder as in retrograde ejaculation? We can investigate the issues from the male perspective and either find the source of the problem or rule out the male as having physical problems relating to conception.

Infertility is medically defined as inability to conceive after 1 year of frequent unprotected sex. Male infertility is often the cause or a significant contributing factor. The sperm of the male needs to be produced properly to be mature and healthy and must be produced in adequate numbers. It then needs to travel to the female and unite with the egg. Difficulty at any point in this process may result in infertility.

Causes of sperm malfunction include:

• Improperly made sperm that do not mature properly, may not move properly, may be in insufficient numbers, or may not be produced at all.
• Varicoceles or swollen scrotal veins may impede sperm growth and numbers by making the testicles too warm for sperm to successfully form and travel.
• Retrograde ejaculation is when the muscles of the bladder insufficiently close during orgasm causing the sperm to travel backwards into the bladder and not be ejaculated from the penis.
• Immunologic infertility is an autoimmune condition in which abnormal antibodies are produced by the male that   attack his own sperm making them nonviable.
• Obstruction is where the “road” the sperm must travel has been blocked either by a medical disorder like prior surgery, tumors, or undescended testicles (a fetal developmental abnormality) or by choice as in a vasectomy.
• Hormonal imbalances, chromosomal defects, radiation, heavy metals, and some medications may also result in infertility.
• Drug use (anabolic steroids, cocaine, marijuana), alcohol, tobacco, and obesity may significantly impair fertility.

Diagnostic testing by your AUCNY urologist can help determine the specific cause for the male infertility:

• Detailed history and physical examination – requesting details on symptoms, personal and family medical history, social history including smoking habits, physical examination with special emphasis on the bladder area including rectal/pelvic exam and blood testing
• Urine test – to check for retrograde sperm ejaculation
• Semen analysis – a semen sample is analyzed to measure the number of sperm present to determine if their numbers are adequate and to observe the sperm’s shape and movement to determine their health. Usually, multiple samples are tested as results for individual samples may vary.
• Imaging procedures – scrotal or transrectal ultrasound to check for blockages which might restrict the travel of the sperm
• Other tests such as hormone testing, genetic testing, biopsy of the testicles, or specialized sperm function tests may be ordered

Treatment is specialized depending on the specific cause of the infertility. Your AUCNY urologist will discuss all of the therapy options including:

• Prescription medications may be helpful in some forms of male infertility
• Surgical procedures may repair blockages or anatomical problems
• Assisted reproductive techniques (ART) such as intrauterine insemination where the urologist places the sperm into the female’s uterus or in vitro fertilization where the sperm and egg are joined in a lab Petri dish are available.

In rare cases, when male fertility problems cannot be resolved, other options may include using donor sperm or adoption.

Microscopic hematuria is a condition where there are blood cells leaking from the bloodstream into urine that may be unseen by the naked eye. The blood cells are only visible under a microscope. This contrasts with gross hematuria where the urine is visibly red or red-spotted. It is important that your AUCNY urologist determine the specific cause of the microscopic hematuria.

Some of the more frequent causes of microscopic hematuria are:

• Urinary tract infection which may have no apparent symptoms or may cause a persistent urge to urinate, pain or burning during urination, or a strong urinary odor
• Kidney infection (pyelonephritis) which may cause a fever or flank pain, in addition to the symptoms of a urinary tract infection
• Kidney stone or bladder stone which occurs when certain substances which are normally dissolved in the urine crystallize in the urinary tract to form small hard particles. The stones may not be associated with symptoms or may be excruciatingly painful if they are moving through the urinary tract or result in a blockage of the tract
• BPH (benign prostatic hypertrophy) which is a non-cancerous enlarged prostate
• Kidney diseases in general may result in blood cell leakage into the urine
• Cancer of the kidney, bladder, or prostate
• Vigorous exercise, especially distance runners may experience microscopic hematuria
• Other causes include certain inherited disorders, traumatic kidney injuries, and certain medications like blood thinners or arthritis pain relievers

Risk factors for microscopic hematuria may include:

• Male sex and increased age — men over 50 often have BPH (enlarged prostate)
• Recent infection of the kidney, urinary tract, or prostate
• Family history of kidney disease
• Medications like blood thinners or arthritis pain relievers
• Vigorous exercise, especially distance runners

AUCNY urologists may use a combination of methods to determine the specific cause:

• Detailed history and physical examination – requesting details about symptoms, personal and family medical history, social history including smoking habits, physical examination of the body with special emphasis on the bladder area including rectal/pelvic exam
• Blood test
• Urine test
• Imaging procedures (X-ray, CT, MRI, and ultrasound)
• Cystoscopy – a procedure in which a thin “camera” tube is inserted into the urethra for visualization

Once your AUCNY doctor reviews your tests, they will diagnose your problem. Treatment plans vary from no treatment to prescription medications depending on the specific cause of the microscopic hematuria.

While 1 in 3 men between the ages of 18 to 59 are thought to experience premature ejaculation, our urologic experts can help patients explore the psychological and physical issues that may be causing premature ejaculation or contributing to it. We may prescribe behavioral therapies or medical therapies (medications) to try to help find the source of the problem. Then, we can work with patients to address those problems and reduce the incidence of PE going forward. It all starts by making an appointment with one of our physicians at one of our many convenient locations.

Premature ejaculation is a common problem, occurs when a man ejaculates during sexual intercourse before he or his partner desires. If it happens infrequently, it may be of no concern but if it persists, it can be treated by the urologists at AUCNY.

The most common causes and risk factors include:

• Psychological factors – early sexual experiences, abuse, depression, poor body image, guilty feelings, anxiety, stress, and relationship difficulties. Worrying about premature ejaculation can be a cause of the problem itself resulting in a circular process worsening the condition.
• Biological problems — erectile dysfunction (inability to maintain an erection), abnormal hormone or brain chemical levels, inflammation or infection of the prostate or urethra, or inherited abnormalities

An AUCNY urologist has many treatment options to choose from:

• Pelvic floor (Kegel) exercises to strengthen the muscles of the pelvic floor to afford better ejaculation control
• Use of “bedroom” techniques assisted by the partner such as compression of the end of the penis for several seconds until the urge to ejaculate passes
• Condom use – will decrease sensation to the penis, especially condoms with a local anesthetic or use of thicker latex
• Medication such as topical local anesthetics or prescription antidepressants using their side effects of delaying orgasm, or erectile dysfunction medication
• Counseling and behavioral techniques – such as masturbating before intercourse

Prostatitis is an inflammation of the area around the prostate gland, or an inflammation of the prostate. It can affect a man of any age but is most common in men under 50 years old. Some men may experience pain and discomfort of prostatitis, while others may experience no pain at all.

Prostatitis may not present with symptoms but most often shows as:

• Aching abdomen, groin, pelvis, genitals, or perineum (the area between scrotum and anus) especially at night
• Urine which is cloudy or blood-tinged
• Painful ejaculation
• Possible flu-like symptoms

Prostatitis may be caused by a bacterial infection or not be associated with an infectious process. Prostatitis can be classified in four main types:

• Acute bacterial prostatitis – the least common but potentially most serious type. This bacterial infection presents with chills, fever, lower back, and groin pain, burning on urination, and body aches with white blood cells and bacteria in the urine. Antibiotics are used for an intermediate amount of time.
• Chronic bacterial prostatitis – also uncommon, is a bacterial infection of the prostate which chronically smolders with exacerbations/remissions and recurrences. Antibiotics are used for a prolonged period of time.
• Chronic non-bacterial prostatitis – the most common form of prostatitis, is not well understood as its symptoms come and go, and sometimes is associated with inflammatory changes in the urine, semen, and prostatic fluids.
• Asymptomatic inflammatory prostatitis — prostatic inflammatory fluid changes without associated symptoms is often discovered when the patient is examined for infertility or possible prostate cancer.

AUCNY urologists have many diagnostic tools at their disposal:

• Detailed history and physical examination – requesting details on symptoms, personal and family medical history, social history including smoking habits, physical examination with special emphasis on the bladder area including rectal/pelvic exam
• Blood test
• Urine test – for both chemical and bacterial analysis to see if a bacterial infection is present
• Chest x-ray, bone scan, CT, MRI, PET scan – imaging procedures to rule out other possible medical conditions

Treatment of the bacterial prostatitis is usually done with antibiotics. Sometimes medications known as alpha blockers are used to relax the bladder neck and muscles. The symptoms of non-bacterial prostatitis may be helped by diet modification or warm baths in addition to prescription medication. Oftentimes, no treatment is necessary for asymptomatic prostatitis in the absence of other co-existing medical conditions.

Did you know that millions of men and women suffer from urinary tract infections each year and that almost half of all women will experience one during their lifetime? Advanced Urology Centers of New York treats thousands of patients each year for urinary tract infections.

A urinary tract infection (UTI) occurs when urine, which is normally germ-free, becomes infected and rises from the urethra into the bladder and sometimes even into the kidney. Approximately one out of ten men and half of women will experience a urinary tract infection during their life. Children can be affected as well with infection rates of almost one in ten girls and one in fifty boys.

Symptoms include:

• Persistent urge to urinate, often with a burning sensation
• Cloudy, strong odor, or blood-tinged urine
• Pelvic pain in women
• Urethritis or infection of the urethra — burning on urination and possible discharge
• Cystitis or bladder infection — pelvic or lower abdominal ache, frequent painful urination with possible blood-tinge
• Pyelonephritis or kidney infection — back or flank pain with possible fever, chills, nausea, and vomiting

Risk factors include:

• Being female increases the risk of getting a UTI because of the relative shortness of the urethra and proximity to the anus and bladder. It is especially common in those who are sexually active, use insertional birth control methods, or are post-menopausal
• Abnormalities of the urinary tract including blockages due to kidney stones or an enlarged prostate
• Suppressed immune system including diseases like diabetes or use of certain medications (steroids) which interfere with the body’s ability to fight infection.
• Recent urinary surgery or catheter use

Diagnostic tests used by AUCNY urologists may include:

• Detailed history and physical examination – requesting details on symptoms, personal and family medical history, social history including smoking habits, physical examination with special emphasis on the bladder area including rectal/pelvic exam
• Urine sample analysis both placing a sample under the microscope and attempting to grow bacteria from the sample in a lab
• Blood test to determine if bacteria has spread into the bloodstream
• Imaging procedures (X-ray, CT, MRI, and ultrasound)
• Cystoscopy – a procedure in which a thin “camera” tube is inserted into the urethra for visualization

As urinary tract infections can result in bacterial spread throughout the bloodstream known as sepsis, prompt urologic treatment is advised. Complications may include recurrent infections, chronic or permanent kidney infection and urethral scarring in men.

Treatment is best determined by your AUCNY urologist and may involve the use of antibiotics, either oral or intravenous depending on the organism causing the infection, the degrees of spread, if bloodstream involvement is present, and the general overall medical condition of the individual patient.

This surgical procedure is an option selected by men who, for one reason or another, decide that they no longer want to be able to father children. Our urologists have performed thousands of vasectomies, and if you are considering having one yourself, we can often perform the procedure in our office, or sometimes in a surgical center or hospital setting.

Vasectomy is a male birth control procedure in which the tubes that normally carry and deliver sperm are cut and sealed. The procedure is nearly 100% effective in preventing pregnancy. It is an outpatient procedure performed under local anesthesia through a small incision and, although it might be reversable, it should be considered permanent.

The potential risks are similar to any minor procedure:

• Bleeding of the scrotum, in the semen, a local blood clot or bruising of the scrotum
• Infection of the surgical site with possible discomfort and/or swelling
• Rarely, fluid buildup within the scrotum, chronic discomfort or inflammation, development of an abnormal cyst may form.
• Very rarely, the vasectomy may fail resulting in pregnancy.

The basic steps of a vasectomy are:

• Local anesthesia and a preparation of the scrotal skin with a topical antiseptic
• A small puncture-type incision is made in each side of the scrotum
• The small tube (vas deferens) which transports the sperm is identified on each side, severed (with some surgeons removing a segment to make the ends of the tube distant from each other) and the ends of the tube sealed by cautery or stitching. The skin incisions are then closed.

A vasectomy does not provide immediate protection against pregnancy as it may take several months and up to 20 ejaculates to clear the present sperm. A semen analysis is performed six to twelve weeks after surgery to microscopically determine that no sperm is present. During this time, other methods of birth control must be used. Also, a vasectomy will not protect against any infectious disease transmission between the partners even after the six to twelve week analysis is performed.