Monthly Archives: May 2017

Why do Vasectomy Reversals Fail? | Minnesota

First, it’s important to distinguish patency rate and pregnancy rate. Patency rate refers to the likelihood of the vas deferens remaining open and providing unobstructed flow of sperm cells. High patency rate means that flow is unobstructed and sperm has a high likelihood returning to fluid. Pregnancy rate refers to likelihood of pregnancy. Pregnancy rates are lower than patency rates, as there are multiple factors that affect pregnancy.

One reason is abnormal sperm quality. Some men might just have low sperm quality to begin with, which a vasectomy reversal alone would not be able to fix, no matter how unobstructed the vas deferens is. Options for those wanting to have children with this condition include IVF or a trial of steroids and lycopene supplement.

Another common reason for failure is anti-sperm antibodies, which immobilize sperm. These antibodies are typically found in the blood, so it is not common to find it in seminal fluid. Studies suggest 8-21% of men that have not had a vasectomy have anti-sperm antibodies in their fluid. By contrast, studies on vasectomized men show that 50-80% of men develop concentrations of these antibodies after the first year post-vasectomy. It is unclear how much this affects fertility after a reversal, as there have not been many studies done that confirm it, and there is not a surefire method of testing for antibodies in the semen either.

Another possibility is simply scarring, which is not uncommon but possible as a result of vasectomy reversal. It can be treated with anti-inflammatory medication and/or repeat of the procedure. Even if none of these affect you, those who have had vasectomies for a very long time may experience epididymal dysfunction (e.g. the ability for sperm to move through the epididymis), which will either clear up on its own, or may require that you use IVF.

Finally, many times it is the female partner that results in low pregnancy rates. Women over 35 experience a drop in fertility, which may be one reason why there is a discrepancy between patency and pregnancy rates.

Reasons of Vasectomy Failure | Minnesota

While vasectomy has long been thought of as permanent, ending your ability to have kids, this is clearly not the case for Jets quarterback Antonio Cromartie, who had twins last year with his wife Terricka, conceived well after his vasectomy a couple years ago. The couple found out about the pregnancy completely on accident one day when his wife went to the ER with a bad stomach. However, it was clearly not an issue for the footballer and they kept the baby. He’s now welcoming their 14th child into their home.

Why do vasectomies fail?
Vasectomy failure is the occurrence of pregnancy or failure to achieve azoospermia after a reasonable period of time following vasectomy. The positive result of Post Vasectomy Semen Analysis (PVSA) can be stressful for couples looking forward to anxiety-free intercourse, without the threat of pregnancy.

The most common reason is intercourse immediately after the vasectomy without protection. Even after the vas deferens (the tube that carries sperm) is cut and sealed, sperm will still be in the tube and it takes some time in order to ensure the vas is completely cleared out. Men typically have to ejaculate 20-25 times before all the sperm is gone. Unprotected sex before this time can definitely lead to unintentional pregnancy. This is the reason that you continue to use protection for three months after your vasectomy.

The second most likely, though less common, is recanalization failure. Actually, recanalization is the most common reason for technical failure in vasectomy, and it could happen even in a experienced surgeon. In vasectomies, the vas deferens is cut and the ends are blocked. Recanalization occurs when the sperm is still allowed to pass and go into the ejaculate. Sperm try and often succeed in penetrating through the end of the blocked vas. After a couple months of this, there can be many tiny holes in end of the vas deferens where sperm may flow out through pseudo channels.

Recanalization following vasectomy should be suspected if motile sperms or rising sperm concentrations are seen after a initial or routine PVSA has shown azoospermia or Rare Non-motile Sperms (RNMS). Recanalization can be either transient or persistent based on the results of serial PVSAs. Pregnancy due to recanalization is estimated to occur after approximately 1 in 2000 vasectomies or less often. The incidence of recanalization is very likely greater than the reported rate of pregnancy after post-vasectomy azoospermia because not all recanalizations result in pregnancy.

About half of the recanalizations will close (seal by scarrring) by itself in 6 months and contraceptive success will be achieved, the patients don’t need to repeat vasectomy. Other 50% patients who have persistent recanalization need to repeat vasectomy.

The third and least common is technical failure resulting from a surgical error such as occluding one vas twice without occluding the other vas or failure to identify the very rare situation of vas duplication on one side. An extra vas is a very rare condition. Very occationally, the wrong tube (unusual large blood vessels) can be mistakenly blocked. Technical failure is characterized by persistently normal or nearly normal motile sperm counts and sperm motility after vasectomy, as if the procedure was never done! It happens more often in a inexperienced family physicians or surgeons.

It is recommended to get sperm tested three months after the vasectomy to ensure that it worked. But our patients usually don’t need to have a semen analysis periodically if the vasectomy performed in our clinic is confirmed to be successful. Dr. Shu has performed about 1500 cases of vasectomies, all of them being successful!

Vasectomy is a big life decision. It is important to know if the vasectomy was successful or not, so get your sperm tested after your vasectomy!

Dr. Shu Led the Chinese American Physicians and Established the International Volunteering Physician Organization

Medical Volunteers International (MVI) is a volunteer organization initiated and created by Chinese physicians in the United States. It is non-profit, non-religious, and non-affiliated to any political group. It is for all Chinese physicians and other physicians of other ethnicities in the world to join, collectively promote, and develop international medical volunteering.

Dr. Shu is the founder of Medical Volunteers International (MVI), and he is currently serving as MVI President.

MVI’s aim is to provide Chinese physicians and physicians of other ethnicities with useful information about international medical volunteering, and to build a platform for volunteers exchanging and sharing personal experiences. Through connection and communication with other international medical volunteer organizations, MVI will help their members find suitable volunteer projects. Meanwhile MVI will actively create and initiate its own projects in Haiti, Cambodia and Senegal beginning in 2018. These projects will focus on helping areas in urgent need of medical resources and supplies, as well as patients in need of necessary medical treatments.

In 2014, Dr.Steven Shu joined the “No-Scalpel Vasectomy International, Inc”, an international medical volunteer organization led by Dr. Doug Stein. Dr.Shu made a total of four trips to the Philippines and Haiti in the past two years.

Dr. Shu’s personal experience led him to a larger vision, driven by a sense of individual responsibility and ideology. He realized that an individual’s strength is often limited. However, if individuals come together to build an organization, this organization’s power will be unlimited. There are more than 6,000 Chinese physicians in the United States, hundreds of thousands around the world, and much more in Mainland China, Taiwan, and Hong Kong.

With the power of social media and social networking, overseas Chinese physicians should be able to set up an organization, such as MVI, to connect with people around the world to help those in need of medical aid. Through communicating with other Chinese physicians, Dr.Shu learned that many physicians share similar interests and goals, and are willing to be involved in medical volunteering, but most of them do not know how or where to start. He also learned that some physicians in North America are already at the forefront of such endeavors, the most prominent being Dr. Jun Xu. Dr. Xu has visited Senegalese, Africa for medical mission trips every year since 2013, and Dr. Junkui Zhang and Dr. Tiebo Fu have participated in medical volunteer activities in Central America. Therefore, at the end of 2016, after careful and thorough consideration, Dr.Shu decided that the time for advocating overseas Chinese physicians to establish an international medical volunteer platform has come.

After discussion with Dr. Jun Xu and other physicians who showed great enthusiasm and support, a council of nine members was formed. On January 29, 2017, MVI was established and started to recruit new members immediately. In the meantime, fund-raising efforts have begun.

MVI was incorporated on February 8, 2017. By April 30, 2017, a total of 99 people joined the MVI with 64 official physician members. IRS approved the MVI’s 501 C3 tax exempt status in the March, 2017.

Comparative Analysis of Anticipated Pain Versus Experienced Pain in Patients Undergoing Office Vasectomy.

Advances in vasectomy technique have minimized patient discomfort; however fear of pain remains a primary concern. The Urologist Dr. Furr at the University of Oklahoma just published the clinical research article on the pain related to vasectomy in Canadian J Urol. (2017 Apr;24(2):8744-8748), the research was to determine how the anticipation of pain associated with vasectomy compares with patient’s actual intraoperative experienced pain levels.

A cohort of 172 patients undergoing clinic vasectomy was analyzed, and the result indicated that the actual pain experienced by a patient is significantly lower than their anticipation of vasectomy pain. This clinic research data will aid clinicians in appropriately counseling patients and minimizing pre-procedural anxiety.

Modern no-scalpel vasectomy is a minimally invasive office procedure that performed near painlessly under local anesthesia. Fear of pain is still the number one reason for men in Minnesota to resist getting a vasectomy because they don’t want to have surgery near their genital organs. A good consultation before vasectomy the helps to relieve anxiety.

Conventional needle anesthesia in vasectomy involves the use of a 27 gauge needle for local anesthesia. Dr. Shu applies local anesthesia with a special spray applicator without the use of needles. A spray applicator (MadaJet®) delivers a stream of anesthetic so fine that it penetrates the skin and diffuses to a depth of about 3/16 of an inch, enough to surround and anesthetize each vas tube in turn as it is lifted into position beneath the skin, attaining a close to 100% efficacy rate with no need for supplemental anesthetic.

Dr. Shu uses the modern no-scalpel technique, exposing each vas in turn through a tiny opening in the front scrotal wall without using scalpel, the trauma in the scrotum is so minimal that significantly reduces the pain during the procedure and post-operative period.

The patients always states right after their vasectomy, “it is amazing”, “Wow, much better than I thought”, “I worried for nothing”, “It is truly a easy vasectomy”, “easy vasectomy which is understated”, “it is almost painless”.

MadaJet_2

MadaJetSprayApplicatorMadaJet

Microsurgical Vasovasostomy | Minnesota

Microsurgery involves the use of an operating room microscope or surgical loupes (magnifying glasses) to conduct very small scale operations on the body. Microsurgical reconstruction of tissue is often a complex and very technical procedure. In the early 1900s, Carrel and Guthrie pioneered microsurgery techniques through experimental procedures on animals, replanting and transplanting tissues and organs such as amputated limbs, and kidneys. The first use of optical magnification was recorded in 1921, where a monocular microscope was used for ear surgery by Nylen. It was during this time period microsurgical instruments, operating microscopes, and other advancements in medical technologies paved the way for microsurgery.

Advancements in vasectomy reversal closely mirror those in other procedures in well. The first successful vasovasostomy was in 1919, although its efficacy was questionably. By 1948, 18% of urologists had tried it, and the success rate was only 40%. The first microsurgical vasectomy reversal took place in 1971, by Owen. The next big advancements came in 1977, with the development of 2-layer and modified microsurgical suture techniques. The patency rate has rose to more than 90% with these advancements if vasectomies are done with nine years. Microsurgery continues to see advancements every year. Robots with hands far steadier than any human now have the capacity to perform operations as small as vasectomy reversal.

Ultimately, microsurgery is a powerful contemporary surgical technique with many different applications, not least of which is vasectomy reversal. It is because of microsurgery and its advancements that effective vasectomy reversals are possible, now with minimal pain or downtime at Procedure Clinic. It will be fascinating to see what this procedure could look like many years into the future!

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