Posts Tagged ‘no scalpel vasectomy’

Gainesville/Northeast Georgia Urological- Vasectomy Madness 2014!

Get a no needle no scalpel vasectomy during March Madness and get a free pizza and a frozen bag of peas!

Watch all the games while recovering with your wife’s blessing.

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The Madajet Injector spays the anesthetic into the vas and surrounding tissues under pressure.

The Madajet Injector spays the anesthetic into the vas and surrounding tissues under pressure.

There are several reasons why not all urologists use the Madajet “No Needle Vasectomy” technique.

  • They weren’t “trained to do this technique as a resident.”
  • The system is an expense
  • They feel it is all hype and adds no benefit to the procedure or the patient
  • There is a learning curve they don’t want to go through
  • The staff has to learn to prepare the system
  • They will have also buy a ultrasonic sterilizer for the system
  • They feel it will take longer than using a needle
  • They feel that patients are not “really” that afraid of needles
  • They just plain don’t want to change the way they have done for years

I know I have been there.  I started using the Madajet about three years ago. And let me tell you by the time you buy all the instruments, teach the staff, and begin to use and learn to efficiently use the device you do begin to question its efficacy. You see, having a nurse fill a syringe with Lidocane and place on the vasectomy tray and doing something the way you have done with success for years is a lot easier than “change.”

So I have been on both sides and this is my assessment. It is better.  I am now to the point that placing the 6 Madajet injections (three to each vas) is a much improved way to “deaden” the skin and vas for a vasectomy.

  • Less medicine is used so it is easier to identify the vas and to work on it when the actual procedure begins.
  • For those patients who are truly “needle phobic” not using a needle and telling them from the start that there will be no needle is indeed helpful in reducing anxiety. Reducing anxiety is important as it makes the procedure easier for both the patient and the doctor.
  • Once you learn how to use the Madajet the numbing part of the procedure takes less time.
  • The anesthesia is quite good and it is uncommon to need to use a needle for the procedure although this does happen from time to time. This occurs more frequently in patients with thick scrotal skin. (That’s right…not all men’s scrotal tissue is the same and the thicker skin makes it harder for the Madaject to penetrate all the tissue.)

There are YouTube videos of urologists demonstrating the use of the Madajet if it would be of interest to the patient considering a vasectomy.

Summary: Is using the Madajet better? I think so but in the big scheme of things it does not change the basics of the vasectomy (cutting the vas and sealing the ends) but the amount of medicine is less, the anesthesia is good, the vas are easier to work on as a result of the less volume of medicine, and the patient is more relaxed knowing there is no needle.

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I've lived these twenty years must I suffer for fifty more....Bowie

I’ve lived these twenty years must I suffer for fifty more….Bowie

I mentioned the concept in my book, I think urologists (rightfully or wrongly) use it as a reason for patients to have their prostate removed, patients often use it as a justification to have the prostate removed, it probably pisses off and frustrates the radiation therapist….and that is the concept of:

If I remove the prostate first I can always have the option of radiation if the cancer comes back, but if I do radiation first I don’t have the option of then removing safely my prostate. I have more options down the road if I have the prostate removed.

Yes it is an option…but does it matter…that is the question my prostate cancer friend.

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my friends my family my habits...they mean so much to me...

my friends my family my habits…they mean so much to me…

  • If you are choosing to have a prostatectomy because “you’ll be cured”
  • Or if you think that you’ll have the option of having radiation if cancer comes back
  • Or if you think “well if I have the prostate surgery I can have radiation but not vice versa”
  • Or if you think one or the other gives you a better chance of cure

Well…It is true that you can have radiation after surgery but it is difficult to have the surgery after radiation, however is that really an advantage of one treatment modality over the other?

  • Radiation is easier to tolerate voiding wise after the prostate is removed because the irritative nature of the radiation of the prostatic urethra is not an issue because it is gone with surgery- that’s a plus
  • Just because you can do radiation after the prostate is removed doesn’t mean you’ll have any advantage for cure
  • If you knew that you had a 20% chance of needing radiation ( i.e. the psa goes up after your surgery) would you just choose radiation from the get go and not have a prostatectomy and all that stuff (ED and incontinence) that goes with it
  • I don’t think many patients who choose prostatectomy think about the percentage chance of needing radiation and if they did would they make a different decision
  • You see the radiation therapist is very aware of the chances of capsular penetration and will amend their radiation to suit…i.e. seeds and external beam with or without hormone therapy

Is it a lot like the igloo cooler and that it keeps things that are cold cold and things that are hot hot…..the question is …..

“How do it know.”

Well the Partin Tables- The male diagnosed with prostate cancer should know of these tables and how to apply to their decision making. These tables predict the chance of capsular spread and hence the potential need for more treatment after prostatectomy-cool huh?

So even though you can have radiation after surgery is a true statement  in the big scheme of things it might not be a point that really a therapeutic difference in one’s decision making.

I have a Partin Table link  in the right side bar and the internet is replete with “googlable” sites that explain it use.

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a final four tickets

CBS Atlanta Comes to Northeast Georgia Urological Associates-The T.V. Segment 

Atlanta CBS reporter barely gets out of office alive...and without a vasectomy!

Atlanta CBS reporter barely gets out of office alive…and without a vasectomy!

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i was doing something close to nothing...but different from the day before......prince

The thunder drowned out what the lightening could see…….Prince

Wife to husband in front of bedroom chest of drawers mirror:

“Look at me. Fat, bad hair, wrinkles, bad posture, drooping body parts, and old as hell. Honey, can you say at least one thing positive about me?”

Husband to wife: ” Your eyesight is excellent.”





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Small Percentage Of Men Complain Of Shortened Penis After Prostate Cancer Treatment

The Huffington Post UK | Posted: 04/01/2013 11:42 GMT | Updated: 04/01/2013 15:00 GMT
A small percentage of men have complained of a shortened penis after prostate cancer treatment, research reveals.

In a study conducted by researchers from Dana-Farber/Brigham and Women’s Cancer Center in Boston, some men have lamented that the change in their penis has interfered with intimate relationships and caused them to regret their choice of treatment.

The study’s findings, which are being published in the January issue of the journal Urology, are based on surveys completed by physicians of 948 men treated for prostate cancer and who had suffered a recurrence of the disease.

Complaints were more common in men treated with radical prostatectomy (surgical removal of the prostate) or male hormone-blocking drugs combined with radiation therapy, according to the study.

No men reported a perceived shortening of their penis following radiation therapy alone.

Twenty-five men complained of smaller penises after treatment – 3.73% for surgery, 2.67% for radiotherapy plus androgen deprivation therapy (ADT), and 0% for radiotherapy alone. Radiotherapy included both radiation administered by an external x-ray machine, and brachytherapy – the implantation of radioactive seeds directly into the prostate.

The scientific team, led by radiation oncologist Paul Nguyen, MD, and medical student Arti Parekh, said it is the first study to link men’s perceptions of a reduction in penis size to lowered life satisfaction, problems in emotional relationships, and misgivings about the specific form of prostate cancer treatment they chose.

Nguyen said that the potential side effect of a smaller penis is well-known among physicians and surgeons.

“But it’s almost never discussed with patients, so it can be very upsetting to some men when it occurs,” he added. “Patients can deal with almost any side effect if they have some inkling ahead of time that they may happen.”

The report’s authors said physicians should discuss the possibility with their patients so that they can make more-informed treatment choices.

There were no direct measurements of penis size either before or after treatment, said the researchers. Nor did the patients’ physicians specifically ask about this side effect; the issue was brought up by patients in conversations with their doctors. For this and other reasons, the authors of the new study suggest that the problem is likely more common than reported in the survey.

“Prostate cancer is one of the few cancers where patients have a choice of therapies, and because of the range of possible side effects, it can be a tough choice,” said Nguyen. “This study says that when penile shortening does occur, it really does affect patients and their quality of life. It’s something we should be discussing up front so that it will help reduce treatment regrets.”

The likelihood and magnitude of penis shortening as a consequence of treatment have not been well studied, said the researchers.

However, Jim Hu, MD, a surgeon at the University of California, Los Angeles Medical Center and a co-author of the study, said: “Previous studies have concluded that there is shortened penis length following prostatectomy. This is most common with non-nerve sparing surgery, as this may result in fibrosis and atrophy of erectile tissue due to damage to nerve and vascular structures.” The present study did not find much difference on that score.

Experts Predict Revolution In Prostate Cancer Treatment

The study’s subjects were men enrolled in a registry called COMPARE that collects data on patients whose prostate cancer shows signs of recurring after initial treatment. Of the 948 men in the study, 22% were younger than 60 and the majority were in their 60s, 70s and 80s. Just over half – 54% – had undergone surgery to remove their cancerous prostate, while 24% received radiation therapy combined with hormone-blocking treatment, and 22% had radiation therapy alone.

In an editorial comment accompanying the report, Luc Cormier, MD, PhD, of Dijon University Hospital in France said the study “is really of interest because of the number of patients and that it included other treatment methods in addition to radical prostatectomy.”

The surveys of the men did not report on their sexual functioning. Cormier observed that “sexual activity needs to be thoroughly measured owing to the obvious relationship with the patients’ perception of penile length.”

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