Men’s Health

Crouse Hospital urologists are trained in the latest techniques and treatment options for benign prostate disease.
The typical symptoms of benign prostatic enlargement can include:

• Weakened urinary stream
• Voiding more frequently
• Getting up several times during bed time to evacuate the bladder
• Urgent urination
• Incontinence
• Overall bothersome urinary symptoms
• Urinary retention or inability to empty the bladder

Workup of BPH can include non-invasive studies performed in the office including uroflows; ultrasound evaluation of the bladder to assess for completion of emptying; more advanced testing with urodynamics to better assess bladder function as well as possible obstruction; cystoscopic examination with lighted telescopes to assess for other causes of obstructed urination, such as strictures; and to better assess response to possible treatment options. Treatment options can include medical therapy using five-alpha-reductase inhibitors as well as alpha-blockers; minimally invasive in-office procedures, such as microwave therapy (TUMT) and transurethral needle ablation (TUNA); in-office laser procedures; and operative procedures, including traditional transurethral resection of the prostate, laser vaporization of the prostate, laser enucleation of the prostate and electro vaporization of the prostate.

Testicular Disease

Testicular disease can present in many forms that need careful evaluation by a physician. such as either enlargement of the scrotum on one or both sides of the genitals versus areas of firm masses or tenderness that can slowly develop or maybe relatively acute in onset. It is important to see a physician for any significant pain or changes in the testicles, which should be examined routinely every month (similar to women performing monthly self-breast exams). This subject can be embarrassing for many men to discuss with their doctor, although delaying evaluation may pose significant risks to your health.

Evaluation of testicular masses are very important, since testicular cancer is the most common cancer in men between the ages of 18 and 35 (although it can be found outside of that age group as well). The majority of these cases are curable, although they need to be diagnosed in the early stages.

A number of other benign testicular diseases exist that our physicians can diagnose and treat:

• Epididymitis – an inflammation within the tubule system next to the testicle which can cause significant redness, tenderness and even fever. It can progress relatively quickly and it needs to be evaluated and treated appropriately otherwise it can lead to damage to the testicle possibly requiring even removal of the testicle.

• Testicular Torsion – Torsion presents itself very acutely typically with severe pain in the affected testicle where the testicle has twisted its blood supply resulting in the blood supply being compromised. This is usually a significant emergency and needs to be evaluated immediately in order to keep the testicle viable and it should be evaluated in the Emergency Room upon the first signs of acute testicular pain.

• Hydrocele – A hydrocele is a fluid collection that develops around the testicle and this typically occurs relatively slowly, although it can be the result of an acute process as well and needs to be evaluated carefully to be sure that it is not the result of a testicular mass or tumor. This can be uncomfortable due to increasing size and requires a complete physical examination to be sure that there is no underlying pathology and it typically can be treated with surgical procedures.

• Varicoceles – Varicoceles are dilated veins which return blood from the testicle back to the body. Typically varicoceles are seen just above the left testicle. If it is noted above the right testicle it certainly requires further evaluation by a Physician and possible imaging studies to be sure that there is no obstruction of the blood flow returning from that testicle. This can lead to issues with fertility and possible discomfort and need to be evaluated appropriately.

It is difficult to tell with many testicular abnormalities whether they represent significant disease such as testicular cancer versus other more benign findings. Any abnormality should be evaluated carefully by a physician with physical examination and possible x-ray imaging.

Impotence & Erectile Dysfunction Evaluation & Treatment

There are many new treatment options for impotence as well as more traditional options. The best treatment for a particular patient depends on careful evaluation of the patient. Impotence can be a sign of other significant medical issues including vascular disease, neurologic issues, injuries, prostate cancer as well as other significant problems. Patients require careful evaluation by their Physician. Physicians at Associated Medical Professionals of NY are trained in the evaluation and treatment options for patients with both mild and complicated disease states. Evaluation requires a careful history of both, medical issues as well as sexual health issues and a complete urologic and neurologic physical examination with review of medications, previous procedures, and also evaluation of any medical conditions and assessment of the efficacy treatment. Further evaluation of erectile dysfunction and impotence may include laboratory studies such as blood work, Doppler Ultrasound studies to assess the penile blood flow. Treatment options can include oral PDE-5 inhibitors such as Viagra, Levitra, Cialis, and Staxyn, intraurethral treatment options such as Muse, intercavernosal injections, vacuum assist device, penile prostheses including inflatable penile prosthesis for surgical options.

Vasectomy & Reversals

A vasectomy is one treatment option for possible permanent sterilization for patients and their spouse who are absolutely sure that they no longer desire any further children. It is a relatively simple in office procedure that is typically performed under local anesthetic and well tolerated. The option of sedation is available for patients who are very apprehensive about the possibility of local anesthetic. This is performed in a discreet and comfortable in office procedure with overall low risks and allows patients the ability to have the confidence of permanent sterilization for those patients who no longer desire any further children.

Second Chances: Vasectomy Reversal

Many men successfully undergo vasectomy for permanent birth control. While a routine, safe procedure, it has traditionally been considered irreversible. Newer surgical techniques and improved surgical equipment have turned the tables on this assumption. Our sophisticated microscope capable of binocular, three-dimensional magnification of the tiny vas deferens physicians to re-connect the sperm-carrying channel and restore natural fertility. The procedure is done with a mild IV anesthetic and takes approximately two to three hours. Recovery is similar to a vasectomy and men are encouraged to take one week off from work and avoid exercise and strenuous activity for four weeks. Drs. Block, El-Hassan, Kaye, Kronhaus, Pavlov-Shapiro and Sauer are available to counsel couples on the vasectomy reversal procedure. Most insurances do not pay for this service and the actual charge for the procedure may vary.

Male Infertility

Infertility is diagnosed as couples that have been unable to become pregnant after at least one year of unprotected sex although we do oftentimes evaluate patients prior to this. It can include those patients who have secondary infertility which refers to couples that have been pregnant at least once although cannot conceive again. Physicians at Associated Medical Professionals of NY have been trained in the full evaluation of male infertility which may be secondary to low sperm counts or sperm that do not perform properly and are unable to fertilize the egg.

Multiple issues can lead to male infertility including birth defects, heavy use of alcohol or illicit drugs, hormonal imbalances, impotence, chronic or acute infections, advanced age, previous treatment with either chemotherapy or radiation for cancers, history of STD’s leading to scarring or injury, retrograde ejaculation, smoking, and certain medications. This can be very distressing to couples and should be evaluated within 6-12 months of inability to conceive without the use of contraceptives.

Evaluation for male infertility typically includes multiple semen analysis to assess for sperm counts as well as dysfunction. It may occasionally also require blood work and rarely testicular biopsy.

Treatment options include:
• Education
• Invitro Fertilization
• Medications to improve possibility of fertilization and setting up appropriate follow up and evaluation of the female partner as well.