Urology Blog

Don’t Discount the Value of Vasectomy Reversal

Vasectomy Reversal Chattanooga, TNCompleting your family can be incredibly gratifying. Many people think long and hard about how many children they want to have and when they will stop having children. Often, this decision is made on the spot, with a sense of knowing that “this is it for us.” In most cases, once that door to having more children is closed, it never reopens. However, the unpredictability of life can disrupt such a decision. For the man who has undergone a vasectomy, the idea of future children may seem far-fetched. It doesn’t have to be. Vasectomy reversal offers hope to the vast majority of men who are interested in reinstating their fertility.

Pregnancy Success after Vasectomy Reversal

Historically, vasectomy has been perceived as a permanent form of birth control. However, in recent years, vasectomy reversal has become increasingly common. While it is impossible to guarantee complete success in every case, men are often surprised that their chances are far better than they imagine. According to statistics, approximately 76 percent of men who undergo vasectomy reversal within three years of their initial procedure are able to father children. Though success rates are lower (30%), men whose vasectomy reversal is performed more than a decade before their initial procedure may also be able to father more children.

Factors that Relate to Vasectomy Reversal Success

There are two ways in which vasectomy reversal success is measured. One is the presence of sperm in the patient’s ejaculate. The other is pregnancy. Generally, when sperm is identified in vasal fluid at the time of surgery, the procedure is considered a success. Conception after vasectomy reversal is affected by other contributing factors, though, including the age of the parents and the condition of the epididymis, the duct through which sperm travels.

Is IVF a Better Option?

Both IVF and vasectomy reversal are worth consideration for couples who wish to become pregnant after a man has had a vasectomy. When IVF is performed in such an instance, sperm is surgically extracted from the male partner. Eggs are extracted from the female partner, and the two meet in a laboratory setting. The entire IVF process is quite involved and requires multiple procedures for many couples. This increases the cost of care but does not significantly increase the likelihood of conceiving. Studies suggest that approximately 40% of IVF couples complete a successful pregnancy, while 43% of vasectomy reversal couples achieve the same.

We are here to help you navigate your option for vasectomy reversal in Chattanooga, TN. For more information, call (423) 778-8765.

Robotics Are the Surgical Revolution We’ve Been Waiting For

Robotic Urologic Surgery Chattanooga TNRobotic surgery, a technique in which surgeons perform minimally invasive surgery using a robotic device, has become the new norm across many medical subspecialties. Systems such as the da Vinci robotic surgery platform are commonly perceived as an optimal course of treatment for patients compared to open surgical techniques and even minimally invasive laparoscopic procedures. The reason why robotic surgery stands out is that studies demonstrate a high rate of accuracy and safety, resulting in less bleeding during surgery and shorter hospital stays after surgery.

Since the emergence of robot-assisted surgery more than 15 years ago, an increasing number of surgical procedures have been handled using this innovative technique. Nearly every surgical specialty now utilizes robotics. To keep up with the demand for optimal patient outcomes, device manufacturers have continued to refine robotic systems for optimal maneuvering. For example, the robotic arm that “performs” surgery (led by a skilled surgeon) can be moved in a variety of ways to reach any part of the body. Today’s robots have more dexterity than the surgeon’s hands alone, and also better eyes.

According to surgeons who have used robot-assisted surgical systems since they first became available liken the upgrades on system lenses to those we are accustomed to seeing with cell phone cameras. In addition to improved optics, robotics has also evolved to have smaller operating arms and more instruments to assist with surgical procedures, such as vessel sealers.

What This Means for You

It isn’t the technology itself that is the most impressive aspect of robotic surgery, though it is pretty extraordinary even to imagine we can perform surgery using robotic hands these days. What stands out to surgeons is the way that robotic surgery helps them achieve the best outcome for their patients. Since the development of robotic surgery, the number of blood transfusions needed during or after surgery has declined dramatically. Patients who undergo robotic surgery have less scarring and report a much more comfortable recovery than those treated with conventional open surgery techniques.

At UT Urology, we have a strong commitment to medical advancement. Our team is abreast of improvements in surgical techniques and technologies like robotic surgery and is proud to offer the highest standard of care to our patients.

Do you need treatment for a urologic condition? Contact our Chattanooga office at (423) 778-8765.

Five Specific Urologic Conditions Affected by Smoking

Men's Health Chattanooga, TNUrologic conditions such as erectile dysfunction, infertility, and overactive bladder may develop as a result of a number of different factors. Some of the factors related to conditions like these relate to how a person lives from day to day. This is good news, because it affords us the opportunity to reduce the risk of urologic problems by looking at lifestyle modifications. One lifestyle change that is recommended often is that smoking comes to an end.

Before discussing the particular urologic conditions that can be adversely affected by smoking, we want to point out that research points to a number of forms of tobacco use and smoking that are detrimental. Habits such as smokeless tobacco, hooka-smoking, and the use of e-cigarettes are as harmful as cigarettes, according to studies. Furthermore, second-hand smoke also poses a risk.

According to the Centers for Disease Control and Prevention, smoking-related disease currently affects more than 16 million people in our country. As this relates to urologic conditions, we see a link between smoking and . . .

Erectile dysfunction

The range of physical and psychological factors related to erectile dysfunction includes smoking. Scientists suggest that the connection between the two may be the damage that smoking causes to the blood vessels throughout the body, including the small vessels responsible for supplying the penis. In many cases, erectile dysfunction is diagnosed as a man ages. However, cases that are diagnosed in men of all ages reveal a strong link to smoking.

Infertility

Smokers are twice as likely to struggle with infertility than non-smokers. For many years now, doctors have discouraged smoking during pregnancy. However, studies have also indicated that smoking may impede a couple’s effort to conceive by harming the genetic value of sperm and eggs. Additionally, smoking may disrupt hormone production, and create an unfriendly uterine environment that increases the risk of miscarriage and birth defects.

On the bright side of research, we see that fertility begins to improve within 2 months after a couple stops smoking and may be completely reversed within 12 months.

Overactive Bladder

Overactive bladder is a type of urinary incontinence that affects more than 30 million Americans. This condition disrupts sleep, sometimes several times a night, and diminishes quality of life due to a need to remain close to a bathroom. Studies have revealed that women who smoke cigarettes are three-times more likely to develop symptoms of overactive bladder than non-smokers. It is believed that this is caused by the toxic chemicals from cigarettes collecting in urine.

Bladder Cancer

Here again, we see that the chemicals in cigarettes collect in urine and irritate the lining of the bladder. In 50- to 60 percent of bladder cancer diagnoses in men, smoking is a related cause. In women, smoking is thought to contribute to approximately 20- to 30 percent of bladder cancer diagnoses.

There is widespread evidence that confirms the extensive dangers of smoking. As a collective, the medical community supports patients in developing lifestyle habits that promote health and longevity. As a practice, we are focused on helping men of all ages sustain vital wellness. For more information on our urology services, call (423) 778-4636.

Dr. Amar Singh Featured in an Article

kidney stone article chattanooga, tn

Dr. Amar Singh featured in the article, “After rough ride, Jim Trubey is back in his Santa suit.” Read the full article here or watch a video about Santa Jim to learn more about Dr. Singh’s kidney stone treatment.

Making Strides in Testicular Cancer Treatment

Testicular Pain Treatment Chattanooga, TNTesticular cancer may not be an incredibly common form of the disease. However, it is the most common type of cancer to affect men in the 15-year-old to 34-year-old age category. Every year, nearly 10,000 new cases – and 350 deaths – occur from testicular cancer. This is sufficient evidence that we need to continue striving for improved diagnostics and treatment options. Where it all begins, though, is with awareness.

Awareness of Risks

The list of risk factors for testicular cancer is small and includes a family history of the disease, abnormal development of the testicles, and an undescended testicle. Aside from these risk factors, researchers have not yet been able to determine why some men develop abnormal cellular regeneration in a testicle.

Awareness of Symptoms

Not many men make a habit of familiarizing themselves with their testicles in a formal manner. Many cases of testicular cancer have been identified purely by accident. Some are recognized during a physical examination at the doctor’s office. It isn’t very often that symptoms are obvious enough to present themselves randomly, such as a sensation of swelling or heaviness. Men in the high-risk age group may want to set aside a few minutes now and then to perform a self-examination.

The process of observing and feeling the testicles for signs of anomaly is relatively simple. Just spending some time looking at the testicles (with the penis moved out of the way) allows a man to more quickly notice if swelling is present. Lumps are not usually obvious to the naked eye. They may be felt by gently moving the testicle between the thumb and fingers. The observation and gentle palpation of each testicle can accelerate the early detection of testicular cancer, so is valuable to the outcome of care.

Evidence of potential testicular cancer should be formally evaluated by a urologist as soon as possible. Prompt treatment may not be the only key to the success of testicular cancer treatment. Where the primary benefit lies is the method of care needed to achieve an optimal outcome from surgery, chemotherapy, or other modalities. If testicular cancer is not diagnosed and treated in an appropriate time frame, cancer can spread to the lymph nodes, creating urgency for more aggressive treatment.

UT Urology serves patients from Chattanooga and surrounding areas. For more information on the diagnosis and treatment of testicular cancer, call (423) 778-8765.

When Libido Takes a Hit

Low Testosterone Chattanooga, TNLibido, or sex drive, is an important aspect of health and wellness for both men and women. It is also one of the personal characteristics that we may question the most. Do we want sex often enough? Is our level of sexual desire normal? The problem with sex, in general, is that it can be a touchy subject. That being said, we’re going to dive right in.

Libido’s Natural Decline

One of the reasons that we may find ourselves questioning our personal preferences for frequency of sex is that our biology is constantly changing. These changes dictate how often we may feel “in the mood.” For women, biological shifts occur more frequently than for men. Each menstrual cycle, every pregnancy, and the years of perimenopause all bring with them a roller-coaster of hormones. As a result, a woman may experience numerous ups and downs throughout her life. This is not indicative of a sexual issue; it is the natural biological process.

Hormones also affect a man’s sex drive as he ages, though perhaps not in the same manner as the average woman. As a man’s testosterone levels fall, issues such as erectile dysfunction may arise. Along with it, this particular problem often generates its unique form of stress. The question of whether or not sexual intercourse will be “successful” may lead a man to avoid sex, further exacerbating the natural diminishment of libido.

What to do: Both men and women have the ability to better understand and manage sexual health at every age by consulting with their physician. Today, the availability of bioidentical hormones has increased interest in such treatment for ailing libido. Because conditions such as erectile dysfunction may also coincide with other health concerns, men are encouraged to obtain a full checkup that includes a prostate exam and hormone testing as they age.

There are several reasons why libido may rise and fall as we age. Our priority in providing patient care is to help patients assess the potential causes of low libidos, such as hormone imbalance, so appropriate treatment, if necessary, may be developed.

For more information on the services available in our Chattanooga urology practice, call (423) 778-8765.

That Dad Bod Could be a Threat to Longevity

MEN'S HEALTH Chattanooga, TNIn recent years, we have seen a push toward acceptance of a wider range of body types. There is no place in life for body-shaming, we can all agree on that. No man or woman should be held to an unattainable standard of fitness for the sole purpose of physical attractiveness. We have come so far in our desire to accept that we have witnessed the emergence of terms like “dad bod.” The softer tone of the male body was, for a time, almost revered. It seems this trend is on its way out, though, and this could be a really good thing.

New research findings suggest that a dad bod may not only be slightly unsexy, but that pleasantly plump could also mean surprisingly at risk for health conditions later in life. Data from a Harvard study indicates that weight gain in early and mid-adulthood has a direct effect on longevity. To put it bluntly, weight gain in our twenties, thirties, and forties means a shorter life. Not only a shorter life but one that is more likely to involve chronic health problems, too.

The Harvard study involved data collection from two previous studies, the Nurse’s Health Study (1976-2012) and the Health Professionals Follow-up Study (1986-2012). Reported weight for each of the 92,837 participants was collected and analyzed over a period of decades. The first weight measurement was taken at age 18 or 21, females and males, respectively. The final measurement was collected at age 55.

Researchers found that weight gain correlated with an increased risk for particularly concerning health conditions, including:

  • Type II diabetes (30%)
  • Hypertension (14%)
  • Cardiovascular disease (8%)
  • Premature death, non-smokers (5%)

In addition to an increased risk for health conditions, every 11 pounds that were gained decreased the odds of healthy aging by 17%.

Men who have been diagnosed with enlarged prostate, prostatitis, or prostate cancer, or who struggle with erectile dysfunction, are also encouraged to spend more time focused on eating well and exercising. Healthy weight facilitates a healthy life now, as well as years down the road.

Do you need more information on men’s health, erectile dysfunction, or prostate conditions? We’re here to serve you. Call UT Urology in Chattanooga at (423) 778-8765.

How to Train Your Bladder

When we think about overactive bladder (OAB) treatments, many of us inevitably focus on the many medications that we can use to treat the symptoms of urinary urgency, frequency or urgency incontinence. Or perhaps we might even think of more advanced therapies such as botulinum toxin, sacral neuromodulation or percutaneous tibial neuromodulation. However, patients and health providers should be careful not to dismiss everyday changes that can be made without ever going to the pharmacy or visiting the doctor’s office. In fact, because behavioral changes can be so important, the current American Urological Association guidelines on OAB urge providers to offer these as first-line therapies. Even better, behavioral treatments are as effective as medications with few if any side effects. For those people who may eventually require medications or more advanced therapy, multiple studies confirm that these treatments are made more effective if combined with behavioral treatments.

bladder health | Chattanooga TNBehavioral treatments for OAB include fluid reduction, diet changes, weight loss, and pelvic floor exercises. Bladder training (BT) is another means of behavior therapy for OAB that can be effective in a properly motivated or dedicated person. BT begins with education about overactive bladder often accomplished with brochures, websites or videos. Completing a record for several days of how often one voids (and whether there is an urgency to void) helps to identify a time interval of typical urination. The goal becomes to gradually increase that interval, usually by 30 minutes every 1-2 weeks. There are numerous distraction techniques (pelvic contractions, relaxation techniques) that can be used to ignore any urinary urgency that comes in between the interval.

How effective is bladder training? Trials comparing BT to the most common medications used to treat OAB show that it is as effective as medications with fewer side effects. Perhaps more encouraging, other therapies including medications, are more effective if you add bladder training. So, not only can behavioral therapies be used to treat OAB on their own, but they should be continued even if you move on to other therapies.

It should be remembered that bladder training can be difficult. It requires time and attention that some people are not able to devote. The number of patients remaining adherent to bladder training tends to be low in many of these studies. We certainly could use better tools to make this therapy more successful. Yet, for the determined patient who wants a successful therapy without the cost or side effects of medication, BT can be a wonderful therapy.

Colin M. Goudelocke, M.D.

Normal Bacteria in the Bladder?

I suspect that if you ask most people (including most health providers) whether it is normal to have bacteria in the bladder, you would hear an emphatic “NO!”. The conventional wisdom has long been that the bladder is a sterile environment. But for many years there has been mounting evidence that this simply is not true. A recent review article written by Thomas-White et al provides an excellent history and summary of our developing understanding of normal and beneficial bacteria found in the bladder. These authors also detail their own research which is helping to lead to a radical new understanding of what constitutes a healthy bladder.

bacteria in the bladder | Chattanooga TNThis enlightening paper begins by pointing out that our misunderstanding of urine as sterile dates back to the 19th century when we were just beginning to grasp the nature of bacteria. This idea of a sterile bladder delayed one of the most important advancements in our treatment of patients with neurologic injuries of the bladder: self-catheterization. Prior to the 1960’s, patients with urinary retention were not told to self-catheterize out of fear that it would lead to infections. Unfortunately, the opposite is true and infections are actually prevented by catheterization in these patients.

Most importantly, the authors detail their ground-breaking new work that is advancing our understanding that not only are healthy bladders full of bacteria but that some of these bacteria may be very beneficial for bladder health. Their research identifying bacteria that are clearly alive and present in the bladder suggests that patients with overactive bladder (OAB) may lack an abundance of certain Lactobacillus species. These are the same types of bacteria thought to be protective of infection in the intestine and vagina. It may be that these types of bacteria are also protective against developing urinary tract infections.

For decades we have been guided by an overly simple understanding of the bladder and urine that today seems just plain wrong. This may even influence our current over-use of antibiotics, particularly as it relates to bladder bacteria.  Perhaps our abundant use of antibiotics may predispose some patients to recurrent urinary tract infections by killing beneficial and protective bacteria in the vagina and bladder. It is wonderful to see such cutting-edge scientific study that may one day revolutionize the way we approach our bladder health.

Colin M. Goudelocke, M.D.

Sleep Apnea and Frequent Night Urination

Many people blame their frequent visits to the bathroom every night on an overactive bladder (OAB) or, for men, an enlarged prostate. While these may be frequent causes of nocturia (waking up to urinate more than one time per night), an often overlooked cause is obstructive sleep apnea. If you wonder how sleep apnea could cause you get up multiple times at night to urinate, a recent study by Miyauchi et al  confirms both the relationship between nocturia and sleep apnea as well as the improvement seen with treatment.
Sleep Apnea and Frequent Night Urination | Chattanooga TNWe begin by noting that many patients who get up frequently at night do so because they make too much urine at night. The bladder is simply filling up more quickly than it should. Normally for young people, no more than 20% of your daily urine production should come while you are asleep. In older patients, less than 33% is more normal. Patients who exceed this are said to have nocturnal polyuria, meaning they make too much urine at night. This is easily diagnosed by having patients keep a diary for several nights to measure how much urine they make during the night compared to the day.

While there are several causes of nocturnal polyuria, an often overlooked one is obstructive sleep apnea. Blockage of your airway in sleep apnea results in a lot of negative pressure in the chest as you try to breathe (try closing your throat and taking a breath).  This causes more blood to return to the heart. When this part of the heart expands from the extra blood, it releases a hormone (atrial natriuretic peptide) that makes you make more urine. It’s as if the body thinks there is too much blood volume (maybe you drank a lot of fluid) and tries to get rid of the excess fluid. So, patients with obstructive sleep apnea make too much urine at night.

The encouraging news is that treatment of the sleep apnea such as with a mask providing continuous airway pressure (CPAP) not only treats the sleep apnea but also will reduce the urine production and the nocturia. So next time you find yourself getting up that 3rd or 4th time at night, consider having an evaluation of whether you are making too much urine at night. If so, a test for sleep apnea may be in order.

Colin M. Goudelocke, M.D.

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