ARIZONA UROLOGY UPDATE|
Charles S. Tomaszewski, M.D.
Erectile Dysfunction |
Male Infertility |
Arizona Urology Update is a publication of Associated Urologists, Ltd., Phoenix, AZ, and is produced for physicians, our patient friends and others who seek to know the latest in urological developments for the treatment of prostate cancer, incontinence, male infertility, and impotence. To be on our mailing list please contact Associated Urologists, 1255 Route 70, Suite 33-S, Lakewood, NJ 08701, Tel: 732.364.1664, Fax: 732.364.1667.
On the Forefront of Erectile Dysfunction
At Associated Urologists we treat patients with erectile dysfunction with the greatest expertise and utmost discretion. This has been a specialty of ours for many years. We pride ourselves in not only the best in treating erectile dysfunction but also in being on the forefront of diagnosing the problems relating to erectile dysfunction. In our office we have the technology to determine what the reason is behind the erection problem and direct therapy specifically for each individual patient. We have used the Rigiscan machine for many years which has been an excellent tool to distinguish between psychogenic erectile dysfunction (meaning a psychological basis for the erection problem) and more physical problems relating to erection difficulty. Today, using more modern techniques we are now better able to distinguish between the different types of physical inabilities to have erections.
This new technique is called ultrasound blood flow test of the penis, or Doppler blood flow study. This study enables us to decide if the problem is related to poor blood inflow to the penis or due to leakiness of the penile veins. About 15 minutes is required for the study which is done in our office. A small amount of medication which causes the blood vessels in the penis to dilate is given and after a few minutes an ultrasound probe is placed over the surface of the penis and the blood flow is measured easily and painlessly. This test in combination with specific blood tests is extremely helpful in determining exactly why the patient is experiencing problems with erections and allows us to direct the patient to the best mode of therapy for him. In this way, more patients experience better and quicker solutions to enhance their sexual relationships.
back to index
Focus on Infertility
Many patients today visit their urologist or gynecologist because of difficulty in having children. In today's society, where in many cases both the husband and wife are professional and delay starting their family, difficulties arise in being able to achieve a pregnancy. The incidence of infertility certainly increases with age and more and more people are seeking medical help in order to have a baby. In about 40 percent of the cases the problem lies with the male alone, and in 20 percent the problem is a combination of the husband and wife. For the male, the crux of the evaluation is the semen analysis. In many cases the sperm counts may be low or the sperm themselves may be sluggish. However in many patients there are no sperm all to be found. The reason for this phenomenon is either the testicles are not able to make any sperm or because of because of a blockage in the ducts that lead the sperm, from the testicle to the semen. If the problem is because the ducts are blocked, then either surgery or a very simple office procedure a can remove the sperm in order to perform in vitro fertilization.
At Associated Urologists we have developed a painless technique to remove the sperm of the blocked testicles as an outpatient procedure. The patient is brought into the office after having prepared himself with an antibiotic. The local anesthetic is given around both testicles and a small gauge needle is passed through the skin and into the epididymis where the sperm are stored. The epididymis is the area where the sperm achieve maturation and are best suited for the in vitro fertilization procedure. The samples are taken from both epididimydes and, in conjunction with the Arizona Reproductive Medicine Specialists who work with us, the specimens are analyzed to see if there are live and usable sperm available. The andrologist will immediately give us a report and let us know if more specimens are needed or if enough sperm have been extracted and the patient can go home.
Our results have been extremely encouraging. In those patients who are able to produce sperm we are 100 percent successful in removing enough for use in vitro. Once the sperm have been taken to the Arizona Reproductive Medicine Specialists laboratory their success rate for fertilization and pregnancies runs about 40 to 50 percent. Working together we have found that so many people are now able to start their families and experience the ultimate in happiness - watching their children being born and grow up before their very eyes.
back to index
What's New in Prostate Cancer?
In the year 2000 the American Cancer Society estimates that in the United States 180,400 men will be
found to have prostate cancer. The expected number of deaths for prostate cancer in the United States
is estimated to be 31,900.This surpasses the number of cases of lung cancer and all other
cancers for men. Fortunately, there is a heightened awareness of prostate cancer and many men are
found with the disease before it becomes incurable. This is mainly due to the blood test called PSA
which stands for prostate specific antigen. More and more men are going to doctors to have their
prostate checked annually and to have this blood test done on a regular basis. The treatments for
prostate cancer are a choice of either watchful waiting, radiation, or surgery. In patients with
aggressive cancers either radiation or surgery are chosen to cure the disease.
When patients choose surgery to remove their cancer they do have a choice. The most common surgery performed is called a radical prostatectomy. This involves removing the entire prostate and removing the lymph nodes which drain the prostate as well. This operation is done through a large abdominal incision and can entail a large amount of pain and blood loss. In most patients who undergo a radical prostatectomy the lymph nodes are found not to contain cancer and the patients go on to have their prostate removed for cure. There is another way to remove the prostate for cure which is a much easier surgery to undergo and entails very little blood loss. This type of surgery is called a radical perineal prostatectomy and is done through a 3 inch incision between the scrotum and the rectum. Most patients are discharged one or two days after the surgery and experience very little pain. The technique is very simple and allows the surgeon to perform the operation quickly and with little chance to be incontinent afterwards. There are few urologists who are experts in performing this technique. We at Associated Urologists have been performing this technique for many years and have had great success in curing patients of their prostate cancer with minimal complications. If you feel that you or someone you know would be a good candidate for this procedure please call our offices for a consultation.
back to top