Sunday, May 15, 2011

I have a varicocele and do not want to undergo surgery. My doctor says I should undergo embolization. Can you explain?

For those who are afraid of the knife or the surgeon, a technique called embolization can be performed. This is done in a radiology suite by a radiologist and involves passing a small tube from the groin to the varicocele. The entire procedure is visualized under x-rays and then the veins are plugged or closed off. The procedure is tedious and time consuming and is generally recommended when there is recurrence of varicoceles. Best advice-if your varicocele is not bothering you, leave it alone. Some doctors like to perform unnecessary surgery and make money.

Wednesday, March 2, 2011

I am a 33 year old man and am interested in augmenting my lips. What dermal filler should I choose?

Today, lip augmentation has become a refined technique with excellent results most of the time. In most cases, lip augmentation is done with dermal fillers. There are many types of dermal fillers on the market and selection of which one can be difficult. In most cases, it is the physician who selects the dermal filler. The dermal fillers already come as a solution or in a pre-filled syringe. Some dermal fillers are like thin plastic and sometimes even fat is used to plump-up lips. For the plastic type lip filler, one needs to make a tiny incision to insert them. The best advice is go for a temporary filler the first time and see if you like the feeling of luscious lips. If you do, next time go for the permanent filler.

I am a 33 year old male and have flat thin lips. Do men ever undergo lip augmentation?

Sure. The second most common cosmetic procedure after breast augmentation is making lips plump and sexy. While the majority of individuals who seek lip augmentation are women, men are also fast catching up. Having a nice plump set of lips is always sexy and erotic.

Tuesday, October 26, 2010

Final Advice on Varicoceles

There is a lot of conflicting advice on Varicoceles and how they may affect sterility. Surgery for Varicocele is strictly elective and no one should be rushed into. 

For best advice, talk to a reputable urologist. Ask questions and if in doubt seek a second opinion. Whilst there are some who say Varicocele affect sterility, there are is also data that show that 
Varicoceles have no bearing on sterility. 

The last thing you want is to undergo an unnecessary surgical procedure that has a real risk of damaging your sexual organ. If you have no symptoms- leave the Varicocele alone. If you have symptoms, wear scrotal support panties. Both are reasonable treatments. One should only undergo Varicocele surgery if there is documentation of abnormal sperm and that one is unable to father a child.

What are results like after surgery?

Surgery is hyped up to be the best treatment for Varicocele. It is estimated that in about 40-60 percent of men, sterility can be restored. However, real data are lacking and many men have undergone this surgery, needlessly. There are many men who have had their Varicocele fixed and still cannot conceive

            Do Varicocele recur after treatment?

Sure, recurrence of Varicocele is quite common. These recurrences may occur a few months or may even occur a few years later. In most cases, recurrence is due to poor technical surgery and leaving some small veins intact at first surgery. To obliterate a Varicocele; one has to ligate all small veins.

Who fixes a varicocele?

Urologists are physicians who specialize in the field of male genitals and most are decent surgeons.

What is embolization?

This is perhaps the best treatment for Varicocele. It is an easy procedure done by an interventional radiologist. One side of your groin is numbed with a local anesthetic and a small tube is passed into the vein. Using x rays, the Varicocele is identified in the scrotum and through the tube, glue like substances are injected into the Varicocele. Confirmation that the Varicocele is blocked is done with another x ray study and you are done. There is no general anesthesia, no incisions and the pain is minimal. You go home in the evening. Data on embolization are decent and recurrences are rare. However, the procedure is very expensive and there is still a question of whether the Varicocele should be treated in the first place.

Which individual with a Varicocele should be treated?

If one has symptoms, then a scrotal support should be worn. Varicocele is not life threatening nor is it an emergency; one should never be rushed into surgery. Varicocele surgery is purely an elective procedure and should be done after giving it a lot of thought. If the Varicocele is small and one has no symptoms or problems with fertility, just leave it alone.

Repair of a Varicocele is indicated when the couple has documented infertility and abnormal semen has been demonstrated.

Repair should be done when there is a significant discrepancy in size between the two testes.
Just having a Varicocele does not mean that you need surgery. Never go to a surgeon who recommends surgery without documenting that you have problems with semen.

What are surgical options for treatment of a varicocele?

There are three options to treat a varicocele and include:

-       Open surgical varicocele repair
-       angiographic embolization- highly recommended
-       laparoscopic method

What other problems are associated with a varicocele?

The occasional individual with a Varicocele may have small testes. However, this is not a universal finding and it is meaningless. There is not a single study, which has shown a relationship between Varicoceles and small testes- it is believed to be a coincidental finding.

Why do some individuals develop Varicoceles suddenly?

Sometimes a sudden swelling may appear in the scrotum and this is most common on the left side. Usually sudden appearance of a Varicocele happens in elderly individuals and a cancer or a mass somewhere in the abdomen may be a reason. A CT scan will immediately determine if this is the case

Are Varicocele life threatening?

No, varicoceles have no affect on health; they do not rupture nor cause severe pain.

Who should not undergo Varicocele treatment?

Despite what some physicians suggest, the majority of young males with Varicocele should be left alone if there are no symptoms.

Individuals with mild symptoms should wear a scrotal support (special panties should be worn) and this will ease the discomfort.

Married men have a Varicocele and have no problems with fertility should stay away from surgeons.

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