The abdominal leak point pressure (ALLP) is the lowest total bladder pressure at which leakage occurs during prompted increases in abdominal pressure. The patient's bladder is filled by a catheter. The Valsalva maneuver (a forced exhale with a closed nose and mouth) then is used to increase abdominal pressure and to spur urine leakage. If the Valsalva maneuver does not, by itself, result in urine leakage, the patient is asked to perform a series of coughs. Fluoroscopy (X-ray projection on a fluorescent screen) can be used to detect the lowest total bladder pressure for leakage. An abnormal ALLP indicates that something is wrong with the internal sphincter muscle. Therefore, the ALLP test can accurately determine the presence or absence of stress incontinence.
Transurethral vaporization of the prostate (TUVP), also known as vaportrode, is a new technique that involves direct application of high heat (less than 100 degrees) to the prostate tissue by means of a grooved roller-bar that vaporizes tissue instead of burning it with a laser. The immediate tissue loss leads to quick improvement in BPH symptoms and urinary flow, comparable to TURP. The procedure takes from 20 to 65 minutes. Most patients can have their catheters removed within 24 hours and can go home on the second day after treatment.
Varicocele - varicose veins of the scrotal venous system that drains the testicles - is a common abnormality found in roughly one-third of all men who are being evaluated for infertility. And, although not all men with varicoceles are infertile, a significant number of infertile men will have a varicocele. Varicocele is caused by a back-flow and pooling of blood due to malfunctioning or missing valves in the spermatic veins. Because of the long, top-to-bottom route of the internal spermatic vein (ISV) on the left side of each testis, over 90% of varicoceles occur on the left; therefore, a right-sided varicocele may indicate the presence of another disorder, such as a venous blood clot or tumor.
Varicocele embolization is an alternative to surgery for men with varicocele. Embolization is an outpatient procedure in which the varicocele is closed off (occluded) by means of a balloon catheter (flexible tube with a tiny detachable balloon), steel coil, and/or sclerosing (vessel-hardening) solution. First, the patient is catheterized (a flexible tube is inserted into a blood vessel) at a few venous sites (e.g., right femoral vein, left renal vein, left internal spermatic vein). The patient then performs a Valsalva maneuver (a forced "exhale" with a closed nose and mouth) and undergoes venography (X-ray of a vein filled with contrast medium) to identify the location of the varicocele. Next, the balloon catheter is drawn through the vessel and usually is inflated at the level of the pubic ramus (e.g., pubic branch of the internal spermatic vein), below the insertion of most collateral (parallel) veins. Careful attention is paid to the level of occlusion to avoid varicocele recurrence. If follow-up venography shows that residual collateral veins remain, further occlusion may be performed by using a steel coil or another balloon with or without a sclerosing agent such as glucose. After the catheter materials are withdrawn and no venous bleeding is observed, the patient is sent home to resume normal activities the next day. Since venography is used to visualize and "target" the veins during embolization, varicocele theoretically should not recur in most men, but there is still a high rate of technical failure and/or recurrence. On very rare occasions, balloons have moved from the scrotal venous system into the general circulation and caused embolism (clots) in the lung and other sites.
Varicocelectomy - the cutting away of a varicocele - is usually performed with regional or general anesthesia. The surgeon makes an incision into the groin, and the problematic venous system then is repaired. The venous channels are divided to prevent varicocele recurrence, and the external cremasteric vessels (the veins associated with the testis-elevating muscle) also are tied off and divided. Varicocele repair often dramatically increases semen quality and pregnancy rates in infertile couples. The major complications of varicocelectomy are varicocele recurrence and formation of hydrocele (collection of fluid in a contained area). However, newer microsurgical techniques have substantially limited these complications.
The cutting away of a varicocele.
| Vasectomy | ||
| Vasectomy is the clinical term given to the process of dividing the tubes that deliver sperm from testes. The procedure typically takes about half an hour and involves minimal surgery. Generally, the patient heals quickly with relatively few complications or failures, and no discernible negative impact on sexual performance. | ||
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Vasectomy | |
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No Scalpel Vasectomy | |
Over 500,000 vasectomy procedures are done each year in The United States. Vasectomy is a simple, safe surgical procedure for permanent male fertility control. The tube (called a vas) which leads from the testicle is cut and sealed in order to stop sperm from leaving. The procedure usually takes about 15 to 20 minutes. Since the procedure simply interrupts the delivery of sperm it does not change hormonal function --leaving sexual drive and potency unaffected.
Vasoepididymostomoy is a microsurgical procedure that uses a microscopic camera and very small operative tools to correct obstructions in the genital tract (see also Vasography). The procedure requires removal of the blockage in the epididymis (the coiled tube that extends the length of each testis and connects with a larger duct - the vas deferens) and re-attachment of the epididymis to the vas deferens. Vasoepididymostomy may improve pregnancy rates by up to one-third of all patients; however, the success of vasoepididymostomy is dependent upon the experience and technical expertise of the microsurgeon. Classic signs of epididymal "blockage" are a swollen top of the epididymis, the presence of sperm in semen drawn from the obstructed segment, and otherwise normal testes. Blockages frequently arise in the epididymis because of inflammation due to sexually transmitted diseases (STDs). Gonorrhea is an STD that, if left untreated, is likely to damage the epididymis and produce obstruction. Other, rarer causes of obstruction include cysts, inherited atresia (tubal closure), and genital tuberculosis. Vasectomy (a contraceptive procedure involving surgical removal of a portion of the vas deferens) currently is the leading cause of infertility secondary to genital tract obstruction (see also Vasovasostomy). There is an increased likelihood of epididymal blockage among men who have had vasectomies of more than 10 years' duration.
Vasovasostomy - Vasovasostomy, otherwise known as vasectomy reversal, is the re-connection of the severed ends of the vas deferens. This procedure, like vasoepididymostomy, commonly is conducted using microsurgical methods. However, nonmicroscopic, "macrosurgical" techniques also are successfully employed. Most vasectomy reversal procedures are conducted on an outpatient basis. During microsurgical vasovasostomy, most surgeons use a "two-layer" technique in which both the inside and outside layers of the severed tubules is reconnected with tiny sutures. Close attention is paid to the character of the fluid that is obtained from the testicular end of the vas: if the fluid is clear and colorless and if sperm are present, the results of vasovasostomy usually are favorable. By contrast, if the fluid is thick or creamy and if sperm are absent, a vasoepididymostomy usually is performed rather than a vasovasostomy . The complications experienced after vasovasostomy are infrequent and minor. After vasovasostomy some men are found to produce antisperm antibodies - immune system molecules that lessen the fertilizing potential of sperm. The antibody production is a result of the vasectomy. Some physicians recommend the collection and freezing of sperm from the site of vasectomy reversal in the event that sperm are abnormal or sperm output is inadequate after successful reconnection of the vas. The new forms of fertility treatment - collectively known as Assisted Reproductive Technologies (ART) - incorporate many methods of sperm retrieval and preparation. Once the sperm have been processed to ensure optimal fertilizing potential, they are used in a variety of procedures that aid the process of conception. These procedures include artificial insemination (AI), in vitro fertilization (IVF), and sperm microinjection techniques.
