da Vinci® Robotic Prostatectomy
A da Vinci®Robotic Prostatectomy is a minimally invasive surgery that is used to remove a male patient’s prostate cancer. During this procedure, the prostate gland, and usually some surrounding tissue,are surgically removed. Using da Vinci® technology, your surgeon will complete the surgery with the assistance of a robotic platform that has wristed instruments and a 3-D camera.
During a regular, open-surgery prostatectomy, the surgeonmakes a long incision, either in the lower abdomen (a retropubic prostatectomy) or in the perineum (a perineal prostatectomy).To access the prostate during a perineal prostatectomy, the incision is made between the anus and scrotum.
During a da Vinci®Robotic Prostatectomy, your surgeon will perform the surgery laparoscopically. A few small incisions will be made, rather than a long incision. The high-tech da Vinci® “robot” will access the prostate through these small incisions. (Please note that the da Vinci® robot does not operate on its own; it is constantly being maneuvered by your surgeon.) The da Vinci® system allows your surgeon to use the 3-D camera for more precise detection and the miniature wristed instruments for more defined removal of the cancer.
With a prostatectomy, many men’s top goal is to eliminate the cancer while maintaining urinary continence and erectile function. Studies have shown that men who have a da Vinci®Robotic Prostatectomy, rather than an open-surgery radical prostatectomy, regain their urinary continence within 6 months and regain their ability to have an erection faster, too.
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A vasectomy is a permanent form of male birth control. During the procedure, the supply of sperm to semen is prevented by cutting and sealing the tubes (vas deferens) that transport sperm. The surgery typically takes about 20 to 30 minutes, and is performed using a local anesthetic.
A vasectomy is a great birth control solution for men who are certain they do not want to father any children. It is nearly 100% effective at preventing pregnancy, and is less expense than tubal ligation.
A vasectomy does not decrease sex drive or masculinity in any way, and there’s very little risk that sexual organs will be injured during surgery. There’s also no proof that a vasectomy could cause prostate or testicular cancer or heart problems.
Serious complications are rare. Possible side effects following surgery include swelling, pain and bruising, which should get better within a few days. Severe pain at the surgery site during and after the procedure is rare. Your urologist will discuss other possible side effects with you prior to treatment.
Following surgery, you must wear tight fitting underwear, which along with a bandage will help support your scrotum. The scrotum is the bag of skin behind the penis that contains the testicles, and other structures that create, store and carry sperm and male sex hormones.
You’ll need to rest for 24 hours. Light physical activities are okay after two to three days, but avoid heavy work, lifting and sports for at least a week. Apply an ice pack to the scrotum periodically, one to three days after surgery. This will reduce pain and swelling. Avoid taking blood-thinning medicines for three to seven days after surgery, and do not bath or swim for a few days.
Most importantly, do not have sexual intercourse until your doctor tells you it is okay, unless you utilize another form of birth control. It typically takes several weeks before sperm are no longer present in semen. If you notice signs of infection, such as fever, severe pain or swelling, contact your doctor immediately.
During a vasectomy reversal, the tubes that transport sperm from the testicles into semen is re-connected. If the surgery is successful, you’ll be able to father children. While this procedure works for most men, for some it is not successful. The surgery can be performed several years after the original vasectomy, however; in this case, it is less likely to be successful.
Vasectomy reversals are typically performed using general anesthesia or a local or spinal anesthetic. An epidural may be administered instead.
Prior to the surgery, your urologist will perform a physical exam and speak with you about any health concerns. He or she will confirm that you can produce healthy sperm by doing a testicular biopsy. If you’ve fathered a child in the past, the biopsy will not be necessary. Lastly, your doctor will want to assess whether your partner can have children, especially if they are over 35 or have never conceived.
Vasectomy reversals are more complex than vasectomies, and can be expensive.
Complications are rare and include:
- Infection at the surgery site
- Bleeding within the scrotum
- Chronic scrotum pain
Following surgery, If you experience fever, find it hard to urinate, notice a marble-sized lump developing in the scrotum, swelling that does not get better, or bleeding at the surgery site, contact your urologist immediately.
After surgery, you’ll have to wear a jock strap for several weeks to decrease movement and swelling. Placing an ice pack on the scrotum occasionally will also help reduce swelling. You may experience soreness for several days, and any bruising will go away within two weeks.
Avoid bathing or swimming for the first two days after surgery. Do not play sports or lift heavy objects for at least three weeks. You should be able to go back to work within a few days if you have a desk job. If your job is more strenuous physically, consult your doctor about when you should return to work. Do not have sexual intercourse for at least two to four weeks after surgery.
After about six weeks, your urologist will examine your semen under a microscope to see if the vasectomy reversal was successful.
If the vasectomy reversal was not successful the first time, some men have the surgery again.
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Prostatitis is a disease of the prostate gland. The prostate is the male reproductive gland that surrounds the urethra and produces the fluid that carries sperm. There are various forms of prostatitis that cause pain in the groin and difficultly urinating. Prostatitis is divided into four categories.
Types of Prostatitis
- Acute BacterialProstatitis
- Chronic Bacterial Prostatitis
- Chronic Prostatitis
- Asymptomatic Inflammatory Prostatitis
Symptoms of prostatitis will vary based on the type of prostatitis you are diagnosed with. However, several of the following symptoms are generally present. In the instance of Asymptomatic Inflammatory Prostatitis, however, no symptoms are present and inflammation of the prostate is discovered by chance during other testing.
Symptoms of Prostatitis
- Pain while urinating
- Frequent urination
- Difficulty emptying the bladder
- Ongoing urge to urinate
- Pain in the abdomen
- Pain in the lower back
- Pain between the rectum and penis
- Discomfort in the testicles
- Painful ejaculations
- Pelvic pain
- Frequent urinary tract infections (seen in Chronic Bacterial Prostatitis)
- High Fever (generally associated with Bacterial Prostatitis)
Diagnosing prostatitis involves your doctor ruling out other possible conditions and determining exactly what kind of prostatitis you are experiencing. Diagnosis prostatitis includes a general exam and may include urine and semen testing, a rectal exam, a urodynamic test of the bladder or a cystoscopy.
Treatments recommended for prostatitis will depend on the type of disease you are determined to have.
Treatments of Prostatitis
- Antibiotics (used for Acute and Chronic Bacterial Prostatitis)
- Alpha blockers
- Pain relievers
- Soaking in a warm bath
- Sitting on a pillow
- Instructions to avoid alcohol and caffeine
- Instructions to avoid spicy food
Extreme cases that don’t respond to medication or preventive measures can require surgery. You doctor will review your individual case history before making this determination.
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Men with Peyronie'sDisease experience curved, painful erections due to the development of fibrous scar tissue within the penis. Generally, a curved erection is common and not a cause for worry. But in some cases Peyronie's Disease can cause a considerable bend or pain, which can keep a man from having intercourse, and make it hard to get or sustain an erection. Peyronie's Disease can also cause anxiety and stress.
Symptoms of Peyronie's Disease can occur suddenly or develop gradually. Common symptoms include:
- Pain during an erection, orgasm or when the penis is touched.
- The penis may become shorter.
- Erectile dysfunction
- Scar tissue under the skin of the penis, which typically feels like a band of hard tissue or flat lumps.
- The penis bends (curves) significantly, either up, down or to one side.
No one knows what exactly causes Peyronie's Disease. It is generally thought that the disease occurs when small blood vessels inside the penis rupture as a result of an injury. As the injury heals, blood cells and other cells can get trapped at the location of the injury, causing scar tissue to build-up. But all men that injure their penis do not develop Peyronie's Disease.
Heredity may also be a factor in determining who is more susceptible to the disease. The occurrence of Peyronie's Disease increases with age.
It is possible for the bending of the penis to get progressively worse, and at some point stop. For most men, the pain during an erection gets better in one to two years, however, the bending and scar tissue remains. The pain and bend associated with the disease hardly ever gets better without treatment.
If the pain associated with erections is mild, the curving of the penis is not severe and is not getting worse, and if intercourse if still possible without pain, doctors usually wait to see if the symptoms will get worse, and then initiate treatment.
If symptoms are severe and get worse over time, doctors recommend medication or surgery.
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Male infertility is the inability to impregnate a fertile female. Of the approximate 15 percent of couples who are infertile, about half of these cases are caused by male infertility.
Male infertility can be caused by a number of factors, such as:
- Low sperm count in the semen
- Deformed/misshapen sperm
- Slow-moving or immobile sperm
- Blockages in the vas deferens that prevent the delivery of sperm
- Certain illnesses
- Certain medications
- Traumatic injuries
- Rigorous activities, such as bicycling or horseback riding
- Unhealthy substance use, such as smoking, alcohol consumption and the use of drugs
- Unhealthy body weight
- Severe emotional stress
- Vitamin deficiency
- Age – men over age 35 have a decline in fertility
There are a number of treatment options available for male infertility. While some options require invasive surgery, others include simply taking medication. Your treatment plan does depend on the reason for your infertility.
We will perform a blood test, and if you have a high white blood cell count, you could have an infection in your reproductive tract. Taking an antibiotic will cure the infection, which may or may not restore your fertility.
If you suffer from erectile dysfunction, this could be causing your infertility. Taking a medication can also help this problem.
Your infertility can also be caused by abnormal hormone levels. This can be regulated by hormone replacement therapy or hormone medications.
If you have a blockage in your vas deferens or a varicocele, where the veins of the spermatic cord are enlarged and prevent the flow of sperm, either of these problems can be corrected with surgery. A varicocele ligation procedure can correct this problem.
If you’ve had a vasectomy and would like it reversed in order to conceive, we can perform a vasovasotomy procedure or a vasoepididymostomy.
- Assisted Reproductive Technology
If you have an ailment which causes problems with sperm delivery, a fertility doctor can always extract sperm directly from your testicle or bladder. This sperm can then me injected into an egg. The most common type of assisted reproductive technology, this is known as in vitro fertilization. The woman’s egg is removed from the ovary while the man’s sperm is extracted. The egg is then fertilized with the sperm in a laboratory and placed back into the woman’s (or surrogate’s) uterus.
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Males experiencing erectile dysfunction, or impotence, are incapable of getting and keeping an erection firm enough for sexual intercourse. Occasional erection problems are not a cause for concern. However, if the problem is ongoing, it may cause stress, insecurity and relationship problems.
Symptoms of erectile dysfunction include trouble getting or keeping an erection and decreased sexual desire.
Male sexual arousal is a multifaceted process involving the brain, hormones, nerves, muscles, emotions and blood vessels. A problem with any of these elements can cause erectile dysfunction. Mental health issues and stress can cause or make erectile dysfunction worse.
Many cases of erectile dysfunction occur because of a physical condition, such as heart disease, diabetes, high blood pressure, obesity, low testosterone, tobacco use, and alcohol and substance abuse. Erectile dysfunction may also occur as a result of treatment for an enlarged prostate or prostate cancer, or due to surgeries or injuries affecting the spinal cord or pelvic area.
As men get older, it may take longer to get an erection; moreover the erection may not be as firm. This is not necessarily because of old age, but because of health problems or medications, which are more common as men age.
Several treatment options for erectile dysfunction are available, and include medications, testosterone replacement, penile implants, surgery, and psychological counseling or lifestyle changes.
The first step is to visit your general practitioner. He or she can recommend the best treatment option for you following a physical exam and a review of your medical history. If you have a chronic medical condition, or your doctor believes an underlying problem is causing erectile dysfunction, you will be referred to urologist for further testing.
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Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) or prostate gland enlargement, commonly affects men as they get older. BPH symptoms include a frequent, urgent need to urinate and straining when urinating. Doctors are not sure what exactly causes BPH. If not treated, BPH can cause bladder, kidney or urinary tract problems. Several treatment options are available, and include medications, surgery, and lifestyle changes.
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