Monthly Archives: March 2017

Vasectomy and prostate cancer- Is there a link? | Minneapolis & St Paul

Vasectomy is one of the most common methods of male contraception in Minnesota, and is popular due to its efficacy and permanence. It was estimated that 15%, or about 50 million men had vasectomy procedures done in the United States. The first mention of an association between vasectomy and prostate cancer were in the late 1980s, where a study showed a positive link between vasectomy and risk in developing prostate cancer. Further studies throughout the years since then have been contradictory or inconclusive as to whether or not vasectomies actually increase the risk of prostate cancer.

For the most part, prostate cancer is nothing to fear for men considering a vasectomy. A recent 2015 meta-analysis of 9 different cohort studies was statistically analyzed in order to determine if a possible correlation between vasectomies and prostate cancer. The study concluded that there was no evidence that vasectomy increased the risk of prostate cancer. While there was slight positive correlation, it was deemed not statistically significant. Furthermore, correlation does not equate causation- there is no reason why vasectomy would actually cause prostate cancer. There is no proven biological mechanism that relates these two together.

There are many reasons why early studies may have shown a correlation between the two; for an example, men who have had a vasectomy were more likely to have tests for prostate cancer under a urologist. Also, prostate cancer diagnoses in general have risen in recent decades in part due to an aging population and better testing methods. Most authorities, like the National Cancer institute and the American Urological Association, agree that vasectomy does not increase the risk of developing prostate cancer.

Regardless, the decision to get a vasectomy is not one to be made lightly. It is an important family planning decision and permanent as well- vasectomy reversals are becoming more and more easily attainable but they are still expensive compared to a vasectomy and are not guaranteed to work, especially if the vasectomy was done a long time ago. Please take the time to decide whether a vasectomy something that you really want.

Post Vasectomy Pain Syndrome (PVPS) | Minneapolis & St Paul

Some men in Minnesota experience chronic pain after a vasectomy, known as post-vasectomy pain syndrome (PVPS). While pain is normal for a few days post-vasectomy, those with PVPS will continue to have pain months after the procedure. The pain can be severe enough to interfere with daily life. It can be a dull, general pain, or be sharp and localized, and many report that the pain gets worse during intercourse. In the past, the incidence of PVPS was thought to be very low (<1%), but recent surveys have shown that up to 15% of men who get a vasectomy experience PVPS, while 2% experience chronic pain that significant effects quality of life. Dr.Shu performed about 1000 vasectomies, only one patient came to have a follow up due to ongoing post vasectomy pain after three months of vasectomy.

Treatment and cause of PVPS may be different patient-to-patient, as everyone responds differently to the procedure.There are multiple potential causes of post-vasectomy pain syndrome, including sperm granulomas (small clusters of sperm cells), neuroma (pinched nerve) due to inflammation, vasectomy being too close to the epididymis and epididymal congestion.

Generally, PVPS is treated initially treated conservatively, via heat/cold therapy, scrotal support, NSAIDs, etc. If this isn’t enough, other drug therapies are sued. If pain is debilitating and continues despite treatment, it may require the excision of a granuloma, epididymectomy (removal of epididymis), or vasectomy reversal. These methods, while more invasive, have a fairly high rate of resolution.

While PVPS is certainly something to take into account when deciding on whether or not to get a vasectomy, it is not common and in most cases very mild. For most, the freedom granted by a vasectomy far outweighs the (very low) potential of complications.

Fertility After a Successful Vasectomy Reversal | Minnesota

Many couples are concerned about the attainability of pregnancy after a successful vasectomy reversal- after a year of negative pregnancy tests, any couple may naturally feel discouraged. It is important to stay positive during this time, as pregnancy will not happen immediately. Here are some things couples should know:

First, it takes time for the sperm count to return to normal. For the first couple months, the absence of sperm is not unusual. After a vasovasostomy, sperm should be present in the ejaculate after three months, otherwise the vasovasostomy probably was unsuccessful, although we usually call it failure if no sperm is seen after six months. For an epididymovasostomy, this could take even longer. Keep in mind however, the mere presence of sperm does not guarantee conception. Sperm count must reach an adequate level in order for conception to be possible.

Second, a man renews his sperm reserve every 3-4 months, and it can take a couple turnovers, or about 6-8 months, for sperm count to reach optimal levels. Even after that, it could be up to six months to reach the proper conditions for conception. For some couples, conception could take just a few months, while others may take longer. Everyone’s body is unique- it is important not to lose hope.

The best way to ensure conception is to monitor sperm content and mobility over time. The first lab test is done six weeks after the procedure, and is repeated as required. Once it has been determined that sperm count has reached adequate levels and that the sperm is mobile, conception should occur within six months assuming the couple is having intercourse often and regulaarly and at the most fertile points of the woman’s cycle (a few days before and after ovulation). If there are still issues, and the sperm is fine, the issue may lie with the female partner’s fertility.

Conception can be a long and trying process for many couples. Again, it is important to stay positive and not be discouraged, as it can take quite a long time to meet the conditions required for conception, and there are many factors that affect pregnancy. Patience is often rewarded.

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