ya, osam-bin-riding nos what its all about. Lets get in depth about the penis.
lets start off at the top
CIRCUMCISION
Alternative names
foreskin removal; excision of penile foreskin; removal of foreskin
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Definition
Surgical removal of the foreskin of the penis.
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Description
Circumcision of a newborn boy is usually done before he leaves the hospital. A numbing medication (local anesthesia such as Xylocaine) is injected into the penis to reduce pain. Ring-type clamps are placed around the foreskin, tightened like a tourniquet to reduce bleeding, and the foreskin is removed below the clamp. The clamp may be metal or plastic (Plastibell). The Plastibell will fall off in 5 to 8 days, after the surgical site has healed.
Circumcision of older and adolescent boys is usually done while the child is completely asleep and pain-free (using general anesthesia). The foreskin is removed and stitched onto the remaining skin of the penis. Stitches that will dissolve (absorbable sutures) are used and will be absorbed within 7 to 10 days.
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Indications
The common indication for circumcision is cultural or religious desire for circumcision.
Other indications (rare):
treatment for inability to pull back the foreskin completely (phimosis)
infection of the penis (balanitis).
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Expectations after surgery
For both newborns and older children, circumcision is considered a very safe procedure with complete healing expected.
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Convalescence
Healing time for newborns usually takes about 1 week. Apply petroleum jelly after diaper changes to protect the healing incision. Some initial swelling and yellow crust formation around the incision is normal.
Healing time for older children and adolescents may take up to 3 weeks. In most instances, the child will be discharged from the hospital on the day of the surgery. Suggestions for home care for older children include:
Avoid vigorous exercise during the healing time.
If the wound bleeds during the first 24 hours after surgery, apply pressure with a clean cloth for 10 minutes.
Use ice packs (20 minutes on, 20 minutes off) for the first 24 hours after surgery to reduce swelling and pain.
Bathing and showering are usually permitted. The incision may be gently washed with mild, unscented soap.
Change the dressing at least once a day and apply an antibiotic ointment. If the dressing gets wet, change it promptly.
Use prescribed pain medicine as directed. Pain medication should not be needed longer than 4 to 7 days.
Call your pediatrician or surgeon if:
fresh bleeding occurs
the entire penis looks red and swollen
pus drains from around the incision
pain becomes severe or lasts for more than expected.
FORESKIN RESTORATION
The term foreskin restoration does not refer to the restoration of the original foreskin. It is not possible to recreate the tissue that was removed at circumcision. What is possible, however, is to expand and develop the remaining shaft skin forward, so as to restore to the penis a retractable hood of skin over the glans that will resemble a natural foreskin (albeit not 100%), will cover and protect the glans, and will provide the mechanical gliding action of a foreskin. This skin is referred to as the restored foreskin.
Non-surgical foreskin restoration is based on TWO fundamental and well-documented dermatological principles, to which the skin of the penis is no exception:
Skin is an adaptable tissue, capable of expansion and development over time, if moderate tension is applied to it regularly, over several hours at a time;
In the course of this gradual and progressive expansion process, the total number of skin cells increases, resulting in a net gain in skin, and not merely a thinning-out.
The most common example of these two basic principles at work is that of a person who gains weight: their skin increases in surface area, without becoming thinner.
It is interesting to note that foreskin restoration has a history dating back millenia, and is even mentioned in the Old Testament. However, the non-surgical methods using gradual stretching techniques have been greatly improved in approximately the last decade.
WHAT IS IMPOTENCE?
Impotence or erectile dysfunction is a very common problem that affects 20 million (approximately 1 out of 5) American Men. Erectile dysfunction is the result of a single, or more commonly a combination of multiple factors. At one time impotence was thought to be the result of psychological problems but we now know that 90% of the cases are organic in nature. Some of the many causes of impotence include, diabetes, high blood pressure, heart and vascular disease, stress, hormone problems, pelvic surgery, trauma, venous leak, and side effects of frequently prescribed medications.
No matter what the cause, most men have a secondary psychological reaction that can worsen the situation. Feelings of performance anxiety, guilt, and low self-esteem are common. For many years impotence was a problem that was not talked about because of its personal nature. Men suffering from this condition often do not know about the various treatment options availible to them and do not seek help.
TREATMENT
Treatment options for erectile dysfunction can be divided into four broad categories, pharmacological, mechanical, surgical, and psychological.
Pharmacological treatment involves delivering medication which can help restore erections. There are several different types of medication and ways of administering them.In general, medical therapy is the most appealing form of treatment and can be highly successful.
The Prostate Gland
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.
Scientists do not know all the prostate's functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.
One of the gland's main roles is to squeeze fluid into the urethra as sperm move through during sexual climax.
What is Prostate Cancer?
Prostate cancer develops from cells of the prostate gland. Eventually the cancer cells may spread outside the gland to other parts of the body. Most prostate cancers grow very slowly. Autopsy studies show that many elderly men who died of other diseases also had a prostate cancer that neither they nor their doctor were aware of. But some prostate cancers can grow and spread quickly.
The prostate gland is about the size of a walnut and is located in front of the rectum, behind the base of the penis, and under the bladder. It is found only in men, and contains gland cells that produce some of the seminal fluid, which protects and nourishes sperm cells.
The prostate surrounds the upper part of the urethra, the tube that carries urine and semen out of the penis. Nerves located next to the prostate take part in causing an erection of the penis, and treatments that remove or damage these nerves can cause erectile dysfunction, also known as impotence. Lymph is a clear fluid that contains tissue waste products and immune system cells. Lymphatic vessels carry this fluid to lymph nodes (small, bean-shaped collections of immune system cells important in fighting infections). Most lymphatic vessels of the prostate lead to pelvic lymph nodes. Cancer cells can enter lymph vessels and spread out along these vessels to reach lymph nodes, where they can continue to grow. If prostate cancer cells have multiplied in the pelvic lymph nodes, they are more likely to have spread to other organs of the body as well.
Although several other cell types are found in the prostate, over 99% of prostate cancers develop from glandular cells. The medical term for a cancer that starts in glandular cells is adenocarcinoma. Because other types of prostate cancer are so rare, when someone speaks of prostate cancer it is assumed they are referring to a prostatic adenocarcinoma, unless they specifically mention some other cell type.
Prostatic intraepithelial neoplasia (PIN) is a condition in which there are changes in the microscopic appearance (the size, shape, or the rate at which they multiply) of prostate epithelial cells. Older men are more likely to have this condition. PIN is classified as either low grade or high grade. If a person has high grade PIN, repeat biopsies and PSA tests should be done regularly. PIN may lead to the development of prostate cancer. At this time there is no standard treatment for PIN. Studies are being done to determine if treatments used for BPH (benign prostatic hyperplasia) are also effective in treating PIN.
WHAT ARE THE KEY STATISTICS ABOUT PROSTATE CANCER?
Prostate cancer is the most common cancer, excluding nonmelanoma skin cancers, in American men. The American Cancer Society estimates during 2000 approximately 180,400 new cases of prostate cancer will be diagnosed in the United States.
Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. The American Cancer Society estimates that 31,900 men in the United States will die of this disease during 2000. Prostate cancer accounts for about 11% of male cancer-related deaths.
The 5-year survival rates discussed in this section refer to the percent of men who live at least 5 years after their cancer is diagnosed. It is important to remember that many of these men live much longer than 5 years after diagnosis. Of course, 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. Improvements in treatment often result in a more favorable outlook for recently diagnosed men. And the survival statistics in this section include all men diagnosed with prostate cancer, regardless of their treatment. The prognosis for a man depends on the extent of his cancer but is also affected by factors such as the treatment he chooses and other individual aspects of his medical situation.
Eighty-nine percent of men diagnosed with prostate cancer survive at least 5 years, and 63% survive at least 10 years. Fifty-eight percent of all prostate cancers are found while they are still localized (that is, confined to the prostate), and the 5-year relative survival rate for men with localized prostate cancer is 100%. Thirty-one percent of prostate cancers have already spread locally (to tissues near the prostate) at the time of diagnosis. The 5-year survival rate for these men is 94%. Among the 11% of men whose prostate cancers have already spread to distant parts of the body at the time of diagnosis, about 31% are expected to survive at least five years.
Testosterone is the main male hormone, produced mostly in the testes. Testosterone stimulates the development of the male secondary sex characteristics at puberty, causing growth of the beard and pubic hair, development of the penis, and change of voice. The hormone also aids in the growth and muscular development of the adult male. If little or no testosterone production occurs before puberty, secondary sexual characteristics fail to develop.
Andropause
(a.k.a. Male Menopause, Midlife Crisis)
Between the ages of 40 and 55, men can experience a phenomenon which is similar to the female menopause that is referred to as male andropause.
When a woman reaches her late forties or early fifties, she undergoes bodily changes associated with reduction of female sex hormones and the ending of her periods. These changes are often associated with symptoms such as hot flashes, mood swings and/or depression, vaginal dryness, atrophic changes in the vagina and skin, reduced sexual desire, and an accelerated bone loss leading to osteoporosis. These changes in a woman are called the female menopause. The symptoms and signs associated with this condition can generally be corrected with the judicious use of natural hormonal replacement therapy. Unfortunately, most gynecologists today do not use natural female hormones for replacement, but rather synthetic hormones or hormones that do not entirely match the female hormones that are being replaced.
The concept of a male andropause has been more controversial than that of the female menopause, with many arguing that it doesn’t exist. Part of the reason for the controversy is that, in contrast to women, men do not have a clear-cut external signpost, namely the cessation of menstruation. Nevertheless, even though women do have this clear-cut demarcation, the changes that take place in their bodies associated with the stopping of menstruation, occur gradually over months or even years. This period, during which a woman may experience irregular menstrual periods, hot flashes, mood swings and other bodily changes, is often called the peri-menopausal period.
A man often begins to experience changes in his body somewhere between ages 40 and 55. These bodily changes may be accompanied by changes in attitudes and moods. During this time a man frequently begins to question his values, accomplishments and the direction of his life. The entire gestalt of these changes has led to the notion of the mid-life crisis. In this series, I’ll not focus on all aspects of these changes, but rather on the physical bodily changes that has been termed the male menopause or andropause. We’ll look at what occurs and what can be done to slow down these inevitable changes of aging.
The physical changes that occur with andropause may be divided into: (1) urinary and sexual changes and (2) more generalized changes. The urinary-sexual changes, which may occur in any combination and in varying degrees, include: (1) reduced sexual desire or libido, (2) reduced sexual potency or difficulty developing or maintaining erections, (3) ejaculatory problems, (4) reduced fertility, and (5) urinary problems, such as increased urinary frequency-especially at night, a weak urinary stream, hesitancy during urination, difficulty starting urination, and urinary incontinence. All of these changes, as I shall show, may be due, at least in part, to a gradual failure of the testes’ production of testosterone, the male sex hormone. This would be analogous to the changes seen in a woman, who at the time of menopause, has a reduction in the female sex hormones, estrogen and progesterone.
How To Enhance Your Fertility
(and help to ensure a healthier baby, too)
Sperm from a man's body unites with a woman's egg to create a totally unique and genetically irreplaceable human life. It's an amazing process. Yet most men know very little about what contributes to reproductive health - or conversely, what undermines it. We seldom think about our fertility or the health of our sperm... except perhaps during sexual activity. Yet science tells us we should consider our fertility and be protective of it.
Indeed, there are things we can do to safeguard our reproductive health...and the well-being of our future children. It all starts with being more knowledgeable about our health in general, and about behavioral choices and environmental hazards that can adversely affect our reproductive well-being.
Infertility Isn't Just The 'Woman's Problem' Anymore.
It used to be, and not so long ago, that if a couple was unable to conceive, the woman was the 'infertile one.'
Now it is generally recognized within medical circles that the problem lies with the man in 35% of cases (some say a couple's inability to conceive is due to male conditions 40% - 50% of the time).
This is an incredible statistic, when you consider that the average, healthy male releases somewhere between 120 million and 600 million sperm each time he ejaculates, and manufactures an estimated 400,000,000,000 sperm in his lifetime. It would appear that men have it made in the reproductive department, but this is not always the case, and sometimes things go haywire.
The most common reason for infertility in the male is the inability to produce adequate numbers of healthy sperm. Infertility in men may also be caused by problems delivering sperm into the vagina, as occurs in impotence or in disorders affecting ejaculation, including inhibited ejaculation and retrograde ejaculation (when ejaculate is forced backward into the bladder). It may also be caused by failure of the testes to descend into the scrotum, by diseases or severe physical injuries which damage the sperm-producing structures, or by antibodies to the sperm found in either the male or the female.
Obstacles To Fertilization.
A number of problems can prevent fertilization from taking place, and many of these can indeed originate with the male. The major cause of male infertility is an inability to produce enough healthy sperm.
All of the unwanted pregnancies occurring each year in the U.S. might lead you to believe otherwise, but for fertilization to occur, all systems have to be A- OK, on-line, and fully functional.
For example, your sperm must be present in sufficient volume, it must be active, it must not be clumping together, it must be relatively normal in shape and size, and it must not be adversely affected by sperm antibodies either in the man or in the woman. Further, it must be able to penetrate the barrier of the woman's cervical mucus and overcome staggering odds to ever even reach the fallopian tubes and go on to meet the egg.
When the couple can't conceive despite repeated attempts, your doctor may recommend a semen analysis to assess male factors which might be preventing fertilization. Your sperm will be put under the microscope, literally and figuratively.
Delivering The Specimen.
You will be asked to provide a semen sample by masturbating into a clean, large-mouth, glass jar or plastic specimen cup, or by ejaculating into a special condom without spermicide during intercourse with your partner. The important thing is to keep the sample warm (men are often asked to carry the container under their armpits), and get the sample to the laboratory for analysis quickly. Most fertility experts want your semen within an hour, preferably sooner.
What Is Semen Made Of?
As mentioned previously, the average, healthy man will have anywhere from 120 million to 600 million sperm in a single ejaculation. Besides sperm, semen contains water; simple sugars (to provide fuel for sperm); alkalies (to protect sperm against the acidity of the male urethra and the vagina); prostaglandins (substances that cause contractions of the uterus and fallopian tubes, and are thought to aid in the sperm's passage to the womb); vitamin C; zinc; cholesterol; and a few other things.
While semen can transmit a variety of diseases, including the AIDS virus, healthy semen doesn't contain anything that's harmful or bad for the health.
What Does A Semen Analysis Analyze?
The complete semen analysis includes:
Volume of the semen
Sperm count (the amount of sperm in a certain volume of semen, also known as the sperm concentration or sperm density)
Sperm size and shape (morphology)
Sperm motility (percentage of actively moving sperm)
New, computer-assisted sperm analysis may help assess sperm motility more accurately. Using a computer in combination with the microscope, a technician can assess how rapidly sperm move and how straight they swim.
Other factors that infertility specialists look at include the quality of the seminal fluid in which sperm swim, and the sperm's ability to survive in and move through cervical mucus, as well as its ability to penetrate and fertilize an egg.
What's The 'Norm' In Semen?
Volume: 3 milliliters (2 to 6 mL range considered normal)
Concentration: 20 million sperm or more per milliliter
Motility: 50% of sperm still active after two hours
Normal forms/appearance: 60% of the sperm
Viscosity - ejaculate normally liquefies within an hour
pH: 7 to 8
How To Enhance Your Reproductive Health
Stop smoking. Smoking is linked to low sperm counts and sluggish motility, and recent findings suggest a 64 percent increase in miscarriage when both partners smoke or when just the man smokes.
Give up marijuana. Long-term use of marijuana in men results in a low sperm count and sperm that exhibit abnormal patterns of development.
Stay off the sauce. Chronic alcohol abuse damages the intricate plumbing of the male reproductive system, reducing a man's ability to produce normally formed sperm cells.
Ease up on intense exercise. Men who exercise excessively may be reducing their sperm count due to the heat that builds up around the testicles during strenuous exercise.
Up your C. Low vitamin C levels may cause sperm to clump together, rendering as many as 16 percent of all men infertile.
Check into your antibiotics. Some groups of antibiotics have been shown to affect sperm quality temporarily by decreasing count and motility. These groups are nitrofurans (nitrofurazone or nitrofurantoin) and macrolides (erythromycin).
Stay clear of environmental poisons and hazards. These include pesticides/insecticides, organic solvents, lead, ionizing radiation, heavy metals, and toxic chemicals.
Check your nutrition. If you're malnourished or not getting enough of the right foods and nutrients, your sperm count could suffer.
Keep your scrotum cool. Watch out for excessive heat in the scrotal area. Wear loose-fitting underwear (not tight jockey shorts), and avoid tight-fitting jogging pants. Avoid hot tubs, hot baths, saunas, or hot work environments.
Abstain, but not too long. Brief periods of sexual restraint (three to six days) seem to increase both the volume and potency of semen. Prolonged abstinence, on the other hand, will result in a higher volume of older sperm, which exhibit decreased motility.
What Can Hurt Your Fertility And Your Chances Of Fathering A Healthy Child?
Your fertility is often a reflection of your general health. If you are healthy and abide by principles of good healthy living, chances are your sperm will also be healthy, provided you haven't sustained permanent damage to your sperm-making equipment in the past (through trauma or infection, for instance), or weren't born with a disorder or structural problem that could prevent you from producing viable sperm. The following list of 'threats' to male fertility, while certainly not all-inclusive, will help you to avoid injurious substances, situations, and behaviors:
Smoking (smoking significantly decreases both sperm count and the liveliness of sperm cells)
Prolonged use of marijuana
Use of other 'recreational' drugs (e.g., cocaine)
Chronic alcohol abuse
Use of anabolic steroids (which can cause testicular shrinkage and infertility)
Overly intense exercise (excessive exercise may lower your sperm count by producing higher levels of adrenal steroid hormones, which lower the amount of testosterone in the body. This testosterone deficiency, in turn, decreases sperm production)
Inadequate vitamin C and zinc in the diet
Some groups of antibiotics (e.g., nitrofurans and macrolides) - The antidiarrheal drug sulfasalazine - The anti-fungal medication ketoconazole. Azulfidine, a drug used to treat ulcerative colitis - Varicocele (a varicose vein in the testicle that produces too much heat, which harms and kills sperm)
Infections of reproductive system structures, such as prostatitis, epididymitis, and orchitis
Infectious diseases that affect the testes, such as mumps in adulthood
Trauma or injury to the testes
Exposure to DES (diethylstilbestrol) during your mother's pregnancy, which can cause testicular and epididymal abnormalities and decreased sperm production
Fevers
Tight underwear or jogging pants
Hot tubs, saunas..anything that raises the temperature of your scrotum, including overheated vehicles and hot work environments
A testosterone deficiency
Exposure to environmental hazards such as pesticides, lead, paint, radiation (x- ray), radioactive substances, mercury, benzene, boron, and heavy metals
Chemotherapeutic (cancer-treating) agents
A blockage or structural abnormality in the vas deferens
Damage to the spermatic ducts, usually due to a sexually transmitted disease such as gonorrhea or chlamydia. Also, passing a sexually transmitted infection onto your partner may render her infertile
Malnutrition and anemia
Tuberculosis
Excessive stress
Can Damaged Sperm Result In Birth Defects?
Researchers now suspect that reproduction and fetal development may be affected if the biological father has been exposed to lifestyle or occupation hazards, such as smoking cigarettes, drinking alcohol, taking non-prescribed drugs, and being exposed to toxic chemicals.
VASECTOMY REVERSAL
Approximately 500,000 men request vasectomies each year and it is recognized that 5% of them will change their minds, usually due to remarriage, death of a child or improved circumstances allowing for more children. Over the past 20 years, the surgical technique of vasovasostomy provided excellent results, permitting a man to re-establish his fertility. The surgery is performed as an outpatient, with well over 95% success for those men who have sperm at the time of surgery.
Within the aspect of medicine or life, good judgement is based on experience and experience is based on poor judgement. Therefore, you, as the patient, look to find the physician with the greatest experience and most skill in performing these operations (over 50 per year).
For those couples experiencing infertility due to a man's vasectomy, there are the alternatives of T.D.I. (therapeutic donor insemination) or IVF/ICSI (in-vitro fertilization with intracytoplasmic sperm injection), but restoration of a man's fertility by reconnecting the tubes at the site of the previous vasectomy appears to provide couples with the most optimal and least expensive option for a family.
HOW IS VASECTOMY REVERSAL PERFORMED?
A small incision is made in the scrotal skin over the old vasectomy site. The two ends of the vas deferens are found and freed from the surrounding scar tissue. A drop of fluid from the testicular end of the vas is placed on a glass slide and examined using a light microscope (picture below). This is a crucial part of the operation because the information obtained is used to decide what type of microsurgical reconstruction needs to be performed. Since the testicle continues to produce sperm after a vasectomy, the fluid in the vas should contain sperm. There are 3 possible scenarios which may be encountered when examining the vasal fluid. The first and best scenario is that the vasal fluid contains whole sperm. The second possible finding is that the fluid is thin and copious and contains only sperm parts or no sperm. The third is that the fluid is thick, pasty and contains no sperm. This means that a 'blow out' or rupture has occurred in the epididymis. This causes a secondary blockage which needs to be bypassed to allow the sperm to get out into the vas. If this second blockage is present and is not recognized then the operation is doomed to failure.If the vasal fluid contains sperm then the two ends of the vas deferens can be sewn together. This procedure is known as a vasovasostomy (pictures below). The lumen or channel inside the vas deferens through which the sperm swim is only 0.2 to0.3 millimeters in diameter ( roughly the size of a pen dot). An operating microscope is employed to magnify the operating field 16 times. The vas can then be better visualized and the sutures can be precisely placed. The technique we prefer is a two layered closure using 10-0 and 9-0 suture (half the thickness of a human hair). We place 6-8 interrupted sutures in the mucosa or inner layer of the vas to insure that the repair is water tight. This is very important because one reason that vasectomy reversals fail is that sperm leak out from the vas at the surgical site and cause inflammation and a new blockage. The muscular layer of the vas is then reapproximated adding strength to the repair. The surrounding connective tissue is also brought together to take any tension off of the repair site. The skin incision is then closed.
VASECTOMY REVERSAL
Approximately 500,000 men request vasectomies each year and it is recognized that 5% of them will change their minds, usually due to remarriage, death of a child or improved circumstances allowing for more children. Over the past 20 years, the surgical technique of vasovasostomy provided excellent results, permitting a man to re-establish his fertility. The surgery is performed as an outpatient, with well over 95% success for those men who have sperm at the time of surgery.
Within the aspect of medicine or life, good judgement is based on experience and experience is based on poor judgement. Therefore, you, as the patient, look to find the physician with the greatest experience and most skill in performing these operations (over 50 per year).
For those couples experiencing infertility due to a man's vasectomy, there are the alternatives of T.D.I. (therapeutic donor insemination) or IVF/ICSI (in-vitro fertilization with intracytoplasmic sperm injection), but restoration of a man's fertility by reconnecting the tubes at the site of the previous vasectomy appears to provide couples with the most optimal and least expensive option for a family.
HOW IS VASECTOMY REVERSAL PERFORMED?
A small incision is made in the scrotal skin over the old vasectomy site. The two ends of the vas deferens are found and freed from the surrounding scar tissue. A drop of fluid from the testicular end of the vas is placed on a glass slide and examined using a light microscope (picture below). This is a crucial part of the operation because the information obtained is used to decide what type of microsurgical reconstruction needs to be performed. Since the testicle continues to produce sperm after a vasectomy, the fluid in the vas should contain sperm. There are 3 possible scenarios which may be encountered when examining the vasal fluid. The first and best scenario is that the vasal fluid contains whole sperm. The second possible finding is that the fluid is thin and copious and contains only sperm parts or no sperm. The third is that the fluid is thick, pasty and contains no sperm. This means that a 'blow out' or rupture has occurred in the epididymis. This causes a secondary blockage which needs to be bypassed to allow the sperm to get out into the vas. If this second blockage is present and is not recognized then the operation is doomed to failure.
If the vasal fluid contains sperm then the two ends of the vas deferens can be sewn together. This procedure is known as a vasovasostomy (pictures below). The lumen or channel inside the vas deferens through which the sperm swim is only 0.2 to0.3 millimeters in diameter ( roughly the size of a pen dot). An operating microscope is employed to magnify the operating field 16 times. The vas can then be better visualized and the sutures can be precisely placed. The technique we prefer is a two layered closure using 10-0 and 9-0 suture (half the thickness of a human hair). We place 6-8 interrupted sutures in the mucosa or inner layer of the vas to insure that the repair is water tight. This is very important because one reason that vasectomy reversals fail is that sperm leak out from the vas at the surgical site and cause inflammation and a new blockage. The muscular layer of the vas is then reapproximated adding strength to the repair. The surrounding connective tissue is also brought together to take any tension off of the repair site. The skin incision is then closed.
If an epididymal blowout has occurred then the blockage must be bypassed. The epididymis is closely examined and a tubule is opened and the fluid checked for the presence of sperm. If motile sperm are found then the vas can be sewn to the open epididymal tubule (picture below). This is called a vasoepididymostomy. A vasoepididymostomy is a technically more difficult procedure to perform than a vasovasostomy because the epididymal tubules are very thin and delicate. The results of vasoepididymostomy are not as good as with vasovaostomy. It is for this reason that if the vasal fluid looks good or has sperm parts, then a vasovasostomy is performed. Motile sperm can also be collected from the epididymis and frozen for later use if the vasoepididymostomy fails. RESULTS
The results of vasectomy reversal are reported as two percentages. The first is patency rate which means the percentage of men who have the return of sperm in the ejaculate after reversal. This means that the operation was technically successful. The second statistic which is the most important is the pregnancy rate. The pregnancy rate is always lower than the patency rate because many more factors play a role in getting pregnant other that the presence of sperm.
The results of microsurgical vasovasostomy from the Vasovasostomy Study Group data are >90% patency if sperm were present in the vasal fluid at the time of surgery and pregnancy rates up to 76%. The results of Dr. Werthman's personal series to date is 100% patency rate if sperm were present at surgery. For microsurgical vasoepididymostomy the patency rate is about 60% and the pregnancy rate is 40%. It is for this reason that we recommend sperm harvesting and freezing at the time of vasoepididymostomy. This way no further procedures need be done to get sperm should the vasoepididymostomy fail. We perform this service at no extra charge.
Data collected by the Vasovasostomy Study Group (the largest multicenter study of vasectomy reversals, published in 1991) showed a distinct increase in success rates when the surgery was performed using an operating microscope by a skilled microsurgeon. The American Urological Association offers several fellowships (1-2 years of specialized intensive training) in male infertility and microsurgery. While many doctors will attempt this surgery, most have no formal training as microsurgeons. It is incumbent upon the prospective patient to make sure that the surgeon he chooses is a fellowship trained microsurgeon and infertility expert who practices microsurgery on a consistent basis. Even though a failed vasectomy reversal can be successfully repaired, the first attempt is the best chance.
What Is Testicular Cancer?
Cancer is a group of diseases in which malignant (harmful) cells grow out of control and spread to other parts of the body.
Testicular cancer occurs when a tumor (abnormal overgrowth of cells) forms within one of the testicles.
Testicular cancer is very rare and is seen in less than 1% of the population. Usually it is seen in young men.
Signs and Symptoms
A lump or swelling in one of the testicles.
Possible local pain, tenderness, or lower back pain.
Sometimes a feeling of heaviness in a testicle.
Causes
Doctors still do not know what causes testicular cancer.
It occurs most frequently in young men between the ages of 15 and 35.
Men whose testicles have not descended or dropped have a greater risk of getting testicular cancer.
Treatment And Self-helps
The best way to identify testicular cancer is self examination done monthly after showering
If, during the self examination, you feel a hard lump on the testicle, see your doctor.
When Do I Call The Doctor?
If treated in its early stages, nearly 100% of testicular cancer cases are cured.
Only your doctor can positively identify testicular cancer, so see him if you find any hard lumps on your testicles.
The most common form of treatment for testicular cancer is surgery to remove the testicle with the tumor. Since usually only one testicle is removed, there is no loss of sexual function.
Chemotherapy or drug therapy is the usual choice of treatment after surgery if cancer is found outside the testicle.
Radiation therapy (x-rays to kill cancer cells) may be used if the cancer has spread beyond the testicles.
What is a hypospadias?
Hypospadias is a birth defect found in boys in which the urinary tract opening is not located properly at the tip of the penis, this occurs in about 1 in 100 male births. When a boy is born with hypospadias, there is a 20% chance of finding hypospadias in another family member, such as a father or a brother.
There are varying degrees of severity of hypospadias and several different surgical procedures to correct it, depending upon the type. 'Chordee', a bending of the penis on erection, sometimes occurs with hypospadias. In this case, hypospadias repair and chordee repairs are performed at the same time. Hypospadias surgery will be performed to extend the urinary tube (urethra) to the end of the penis, while the chordee repair will straighten out the penis.
Why should hypospadias be treated?
The ability to stand and urinate is important for boys. When the urethra opens before it reaches the tip of the penis, a boy may be unable to stand and urinate with a direct stream. The youngster who has to sit to urinate is at an extreme social disadvantage. Additionally, as an adult male, a straight penis is necessary for satisfactory sexual function and reproduction.
How is hypospadias treated?
Hypospadias is treated through surgery and early childhood is generally the best time for surgical correction of hypospadias because younger children tend to tolerate the discomfort of surgery better than older children. Additionally, psychological studies indicate that the best time to perform surgery on the male genitalia is between the ages of 8 months to 18 months.
The surgical procedure for hypospadias correction and the surgical recovery time will vary depending upon the severity of the problem. Mild cases of hypospadias, with minimal chordee, are often corrected by simple outpatient procedures. Moderate to severe cases with chordee may require more extensive surgery with a stay in a hospital.
What are the possible complications of hypospadias repair?
There are a number of possible risks associated with any surgical procedure. Some of the more common complications associated with hypospadias surgeries are as follow:
Bleeding is controlled post-operatively by the use of pressure dressings. However, a small amount of bleeding for the first several days post-operatively is normal. A few drops of blood or a spot no larger than a quarter on the diaper is acceptable.
Bladder Spasms usually due to the presence of the in-dwelling catheters are common post-operatively and are controlled by medications that relax the bladder.
Infections are a risk after any surgical procedure, is uncommon after hypospadias repair. To prevent infection the child may be prescribed an oral antibiotic for several days post-operatively. The child may develop a fever or other signs of infection including any increase in redness, swelling, or the presence of pus at the incision site.
Fistula is a urine leak from the newly formed urethra, usually requires outpatient surgical repair.
Stenosis is a narrowing of the urethra and is a serious but a rare complication following hypospadias repair.
Recurrent Chordee is an uncommon complication, but does require surgical correction to repair
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