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Q&A: Ask the Experts 

The Urology Care Foundation recently welcomed three new urologists to its Board of Directors. As the world’s leading nonprofit urological health foundation, our mission is to support and improve the prevention, detection and treatment of urological disease through research and education. The Foundation would like to welcome Dr.’s Harris Nagler, Sanford Siegel and Raju Thomas. As new board members, they’ve participated in our Ask the Experts Q & A:

1. What Causes Male Infertility?

Infertility can be a difficult and emotionally draining issue for couples. About half of all infertility cases can be linked to the male. In most cases, patients are not aware of issues that may be causing infertility. Most do not have problems with intercourse, erections or ejaculation. That is why men with fertility concerns should talk to their doctor. Male infertility is most often the result of problems making or delivering sperm. Injury, illness, exposures or other health problems can also cause fertility problems. 

An example of a treatable cause of male infertility is a blockage of the tube system that delivers sperm. A man can be born with a blockage or it could be the result of surgery, infections or something else. A blockage will often stop the flow of sperm or cause problems in the delivery of sperm. 

“Microsurgery” is a procedure done under the aid of a microscope. It can fix blockages or gather sperm for in vitro fertilization (In vitro fertilization is when an egg is fertilized by sperm outside the body). A varicocele (an enlargement of veins in the scrotum) is another example of a health issue that may cause infertility. It can impact the testicles’ job and the way sperm is made. Varicoceles are found in 16 out of 100 men, and are more often seen in infertile men. There are no drugs to treat or prevent it. When needed, surgery may be a good choice for patients. 

Many men, who have fertility problems, go on to become fathers. Talk to your doctor if you have concerns or questions about infertility. 

Harris M. Nagler, MD, FACS is a Professor of Urology at the Icahn School of Medicine at Mount Sinai in New York City.

2. Can a Vasectomy be Reversed?

Yes, a vasectomy can be successfully reversed. Vasectomy is a minor surgery in which the vas deferens (the two tubes that carry sperm from the testicles into the semen) are cut and sealed off. This blocks sperm from reaching the semen and prevents pregnancy.

Most often, a vasectomy reversal is a procedure to reconnect the tube (vas deferens) cut at the time of the vasectomy. This will allow sperm to once again flow into the semen. The cut ends of the vas deferens are reconnected using very thin micro-stitches. The procedure is called “microsurgery” because it’s performed under the aid of a microscope. 

In addition to the block in the vas deferens, sometimes another block in the epididymal gland can occur. This happens most often when the vasectomy was performed more than 10 years ago. The epididymis is a coiled tube where sperm are stored. At the time of the reversal, the surgeon will check to make sure there is not a second blockage. 

Vasectomy reversals are often done in an outpatient surgical center and men go home the same day. Your doctor will talk with you about your choices, the success rates and results.

Sperm counts are tested often after a vasectomy reversal. It can take six to eight months for sperm counts to reach normal levels. Some women get pregnant in the first few months, while it may take years after the vasectomy reversal for other couples. In general, sperm return to the semen faster, and pregnancy rates are highest, when the reversal is done sooner after the vasectomy.

Sanford Siegel, MD, FACS is President and CEO of Chesapeake Urology Associates in Baltimore.

3. What are the Benefits of Robotic Surgery to Treat Prostate Cancer? 

Robotic surgery, also called robot-assisted surgery, is a way to perform surgery using tools that are attached to a robotic arm. The surgeon controls these tools with a computer interface. It’s widely used around the world. 

Based on how the patient is doing, prostate cancer is often treated with surgery to take out the prostate, seminal vesicles, nearest parts of the vas deferens, nearby tissue and some nearby pelvic lymph nodes. This is called radical prostatectomy and makes sure cancer cells are not left behind. Robotic Assisted Radical Prostatectomy (RARP) uses a robotic system to hold the tools during this task. A Retropubic Open Radical Prostatectomy is done directly by the surgeon using an open surgical cut.

In expert hands, there are no major outcome differences between RARP and open retropubic prostatectomy. The success of the surgery depends on the surgeon’s skills. For either method, the more surgeries the doctor has done, the better he/she will be at doing it. However, RARP results in quicker healing, less blood loss and less need for narcotics. 

Raju Thomas, MD, FACS, MHA is Professor and Chair of the Department of Urology at Tulane University School of Medicine in New Orleans.  |  FALL 2016  |  UROLOGYHEALTH extra