Male Urology

Vasectomy

What is a vasectomy?

A vasectomy is a form of birth control. It prevents the transportation of sperm when a man ejaculates.

How do you perform a vasectomy?

We provide vasectomies in our office as an outpatient procedure. Dr. Price uses a no-needle, no-scalpel technique for the vasectomy procedure. Through a small opening, the ends of the vas deferens are cut. Then the ends are tied, stitched or sealed. The vas deferens are then replaced inside the scrotum and the skin is closed with stitches that dissolve. They do not have to be removed.

No-scalpel vasectomy:

During a no-scalpel vasectomy, the physician feels for the vas under the skin of the scrotum and holds it in place with a small clamp. Then a tiny puncture is made with a special instrument and the opening is stretched so the vas can be gently lifted out, cut, then tied or cauterized and put back in place.

What can I expect before the procedure?

The first appointment with Dr. Price is for discussion of the procedure and confirmation of the desire for sterilization. You will be given a prescription for a sedative to be taken before your procedure. The surgical consent form must be signed prior to taking the sedative. The nurses will assist you in completing these tasks. You must have someone drive you to and from your procedure.

How long does the procedure last?

The procedure takes about 30 minutes. A local anesthesia will be used to numb the area and eliminate pain, but you will be aware of touch, tension and movement during the procedure.

What can I expect after the procedure?

The scrotum will be numb for one to two hours following the procedure. We recommend rest for the remainder of the day and wearing snug underwear. The office staff will provide instructions about care and rest. You will be able to return to work in a day or two.

Because it usually takes several months after the procedure for all remaining sperm to be ejaculated or absorbed, you must use another method of birth control until you have your semen samples tested with a zero sperm count. We provide that test in our office at 8 weeks and 12 weeks after the procedure which is included in the vasectomy fee.

You can resume sexual intercourse when you are comfortable, but we recommend waiting about a week. Until you receive the results of your semen analysis, you must use another form of birth control to prevent pregnancy.

How long does it take for all sperm to be gone?

We recommend the follow up test on your semen at 8 and 12 weeks after the vasectomy.

Prostate Health

  • Elevated PSA
  • Prostatitis
  • Benign Prostatic Hyperplasia (BPH)
  • Prostate Cancer

What is the Prostate?

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.

The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen.

More than 50 percent of men in their 60s and as many as 90 percent in their 70s have symptoms of an enlarged prostate or BPH. Each year more than 230,000 men are diagnosed with prostate cancer and about 30,000 will die of it.

We recommend men start PSA testing at age 50. However, if there is a family history of prostate cancer, we recommend starting the screenings at age 40.

What is a PSA screening?

PSA screening is done by drawing blood. The screening checks for levels of the prostate-specific antigen. Elevated levels of the antigen may indicate prostate cancer, a noncancerous condition such as prostatitis or an enlarged prostate.

What causes an elevated PSA?

An elevated PSA can mean several conditions, including prostate cancer. There are other conditions that can cause the elevated PSA, including BPH (benign prostate hyperplasia), prostatitis (prostate infection), urinary retention (inability to urinate completely), as well as perineal trauma (trauma to the region where the prostate is located).

How do you treat an elevated PSA?

If your screening returns with an elevated PSA, Dr. Price will request you come in for an office visit. He will perform a physical exam as a first step because there are several conditions that can cause the elevated PSA.

Should Dr. Price suspect prostate cancer, then he will recommend a prostate biopsy. The biopsy is provided in our office under local anesthetic. Dr. Price will discuss with you the results of the biopsy and any further treatment necessary.

Prostatitis

What is Prostatitis?

Prostatitis is an infection of the prostate and its surrounding structures. Prostatitis can also be an inflammation with no sign of infection. It can affect men of all ages.

What are the symptoms of Prostatitis?

While the symptoms vary a great deal, if it is acute bacterial prostatitis, symptoms include chills, fever, severe burning during urination and the inability to empty the bladder. The onset of these symptoms is quick and severe. A patient with chronic bacterial prostatitis, the symptoms are similar but not as severe. It includes burning during urination, testicular, bladder and low back pain and urinary frequency (especially at night).

The primary symptoms of chronic prostatitis are repeated bladder infections. Prostatitis is considered chronic if it lasts more than three months. Symptoms include pelvic pain, difficult and sometimes painful urination, discomfort or pain in the bladder, testicles and penis as well as painful and difficult ejaculation.

How is Prostatitis diagnosed and treated?

It is important to be sure these symptoms are not caused by another condition. Dr. Price will examine the prostate gland to determine if it is enlarged or tender and to assess the degree of pain and discomfort. A digital rectal exam may be performed.

Treatment for prostatitis can include anti-inflammatory drugs for chronic prostatitis and antibiotics for infectious prostatitis.

Dr. Price will discuss all of the potential treatments based on each patient’s individual diagnosis.

Benign Prostatic Hyperplasia (BPH)

What is BPH?

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating.

It occurs in most men as they age. It is not cancer and not usually serious.

What are the symptoms of BPH?

  • Trouble getting a urine stream started and completely stopped.
  • Feeling like you need to urinate often. It may wake you up at night.
  • A weak urine stream
  • A sense that your bladder is not completely empty after you urinate.

How is BPH diagnosed and treated?

Dr. Price can diagnose BPH by asking questions about your symptoms, knowing your past health history and doing a physical exam. Tests can include a urine test (urinalysis) and a digital rectal exam. In some cases, a PSA screen is done.

Once diagnosed and the severity determined, Dr. Price will discuss treatments that can include medication and minimally invasive treatments.

Prostate Cancer

What is Prostate Cancer?

Usually a slow-growing cancer, prostate cancer affects about 16 out of 100 men. Prostate cancer is different from most cancers in that a large percentage of men may have a silent form of the cancer. It often does not produce symptoms.

What are the symptoms of Prostate Cancer?

In its early stages, often there are no symptoms. In advanced stages, bone pain may be present due to spread of the disease.

How do you diagnose and treat Prostate Cancer?

When the prostate cancer grows large enough, it begins to fill the prostate and often can be felt by the urologist during a digital rectal exam. A PSA screen, which is done through a blood test, also can indicate prostate cancer.

If cancer is diagnosed, Dr. Price will work with you to determine the best course of treatment. There are options to consider:

  • External radiation
  • Brachytherapy
  • Open radical prostatectomy
  • Laparoscopic Robotic Prostatectomy
  • If surgery is an option discussed by both Dr. Price and the patient, there are considerations:
  • Precise removal of the cancer
  • Preservation of urinary control
  • Return of potency
  • Minimization of post-surgery pain
  • Minimize blood loss
  • Quick return to your normal activities

With the daVinci Surgical System, Dr. Price performs a Laparoscopic Robotic Prostatectomy, which is the latest, most advanced method of technology for this type surgery.

Benefits of da Vinci Robotic Surgery for prostate cancer patients includes:

  • Faster recovery
  • Shorter hospital stay
  • Less pain
  • Less blood loss
  • Small incisions

See more about Dr. Price’s experience and expertise with the da Vinci Robot.

Dr. Price will work with each patient to ensure the treatment is specialized to the patient’s needs.

Testicular Health

Hydrocele

What is a Hydrocele?

Hydrocele is a build-up of watery fluid around one or both testicles that causes the scrotum or groin to swell. This is usually painless but may be unsightly and uncomfortable. The cause is unknown.

What are the symptoms of Hydrocele?

Often, there are no symptoms. Patients may notice enlargement of the scrotum. Symptoms, when present, include pain, swelling or redness of the area and a feeling of pressure at the base of the penis.

How do you diagnose and treat Hydrocele?

It is diagnosed by a physician by examining the scrotum. Dr. Price will shine a light on each testicle to check for solid masses to be sure no cancer is present. An ultrasound can also be used to confirm the Hydrocele diagnosis.

Since Hydroceles is not usually dangerous, it is treated only when it causes pain or when it decreases the blood supply to the penis, which is rare.

Hydroceles in men under than 65 may go away on their own but in men over 65; they usually do not go away spontaneously.

Surgery or removing the fluid with a needle would be considered if it gets larger or causes discomfort.

Epididymal Cysts

What is an Epididymal Cyst?

An Epididymal Cyst (spermatocele) is a painless, fluid-filled cyst in the long, tightly coiled tube that lies above and behind each testicle. The fluid in the cyst may contain sperm that are no longer alive.

What are the symptoms of Epididymal Cyst?

Often it does not cause symptoms. You may notice what looks or feels like an extra lump or mass above the testicle on one side of your scrotum. Or you may notice a general enlargement of your scrotum. Symptoms, when present, can include pain, swelling, or redness of the scrotum or a feeling of pressure at the base of the penis.

How do you diagnose and treat Epididymal Cyst?

The Epididymal Cyst can be found during a physical exam.

These are treated only when they cause pain or in the rare instance they decrease the blood supply to the penis. If it causes discomfort, surgery can be considered. It is an outpatient procedure to remove the cyst through a small scrotal incision.

Testicular Cancer

What is Testicular Cancer?

While it is rare, this is the most common cancer affecting men between the ages of 15 and 35. If you find a mass or nodule within the testicle, please make an appointment with Dr. Price as soon as possible. Testicular cancer has a good chance of cure if caught early.

What are the symptoms of Testicular Cancer?

Testicular Cancer is often a painless lump or swelling in a testicle. There might be a feeling of heaviness in the scrotum. Some experience a dull pain or feeling of pressure in the lower belly or groin.

How do you diagnose and treat Testicular Cancer?

A history of “undescended testicle” or a testicle that was not within the scrotum at the time of birth is the most significant risk factor for testicular cancer.

Through a physical exam and blood tests, Dr. Price can make the diagnosis. The blood work looks for a release of proteins that can be measured to determine the type and extent of cancer present.

If a mass is discovered, a CT scan of the abdomen/pelvis and a chest X-ray and biopsy are considered to help direct the proper treatment.

Treatment usually is removal of the testicle and can include radiation or chemotherapy depending on the type of cancer.

Penile Health/Erectile Dysfunction

What is Erectile Dysfunction?

If you cannot keep an erection that is firm enough for intercourse.

What causes Erectile Dysfunction?

Erectile Dysfunction can be caused by any number of physical and psychological factors. In general, ED is divided into organic (having to do with a bodily organ or organ system) and psychogenic (mental) impotence, but most men with organic causes have a mental or psychological component as well.

Vascular diseases account for nearly half of all cases of ED in men older than 50 years. Vascular disease includes atherosclerosis (fatty deposits on the walls of arteries, also called hardening of the arteries), a history of heart attacks, peripheral vascular disease (problems with blood circulation), and high blood pressure. Prolonged tobacco use (smoking) is considered an important risk factor for ED because it is associated with poor circulation and reduced blood flow in the penis.

Trauma to the pelvic blood vessels and nerves is another potential factor in the development of ED. Bicycle riding for long periods has been implicated, so some of the newer bicycle seats have been designed to soften pressure on the perineum (the soft area between the anus and the scrotum).

Dr. Price will discuss with you the issues that cause erectile dysfunction to determine your specific causes and develop a treatment plan.

Penile Implants

Why do you use penile implants?

Penile Implants are used to treat erection problems (erectile dysfunction) and are either noninflatable or inflatable cylinders that replace the spongy tissue inside the penis that fills with blood during an erection. The implants come in a variety of diameters and lengths.

Dr. Price will discuss the types of implants and determine with you the best course of treatment for your specific condition.

Peyronie’s Disease

What is Peyronie’s Disease?

Peyronie's disease is caused by scar tissue, or plaque, which forms along the length of the penis in the corpora cavernosa. This plaque is not visible, and depending on the severity of the condition, the plaque can cause the penis to bend, making sexual intercourse difficult and occasionally painful.

What Causes Peyronie's Disease?

The cause of Peyronie's disease is unclear. Many researchers believe the plaque of Peyronie's disease can develop following trauma (hitting or bending) that causes localized bleeding inside the penis.

What Are the Symptoms of Peyronie's Disease?

Symptoms may develop slowly or appear overnight. When the penis is soft, no problem can be seen. But, in severe cases, the hardened plaque (which is noncancerous) reduces flexibility, causing pain and forcing the penis to bend during erection. In most cases, the pain decreases over time, but the bend in the penis can remain a problem. Overall, Peyronie's disease will resolve on its own between 5%-19% of the time.

How do you diagnose Peyronie's Disease?

Dr. Price will talk to you about any circumstances, such as injury, that may have occurred prior to symptoms appearing. The hardened tissue can be felt during an exam, although sometimes it is necessary to do the exam with the penis erect. In some cases where the doctor's exam does not confirm Peyronie's disease, or in cases where the condition develops rapidly, your doctor may perform a biopsy.

How do you treat Peyronie’s Disease?

Since some people's condition improves without treatment, often the suggestion to wait one to two years or longer may be made before attempting to correct it. Mild cases of the condition rarely require treatment. Also, the pain associated with Peyronie's disease occurs only with an erection and is usually mild. If intercourse is satisfactory then no treatment may be needed.