Vasectomy is one of the most common surgical procedures performed in the United States each year.  In total, about 600,000 are done annually.  Most of these are done by Urologists nowadays although traditionally the workload was shared with general surgeons and primary care physicians.  

Before having this procedure, all men must be sure that they are done having or do not ever want to have children.  The reason for this is simply that a vasectomy is meant to be a permanent means of male sterilization.  While we can do vasectomy reversals, these can be costly procedures which result in successful pregnancies in only about one half of cases.  The bottom line - make sure you and your partner (if you have one) do not want any more children... ever!

Potential vasectomy patients should know that there is a failure rate of around 1 in 1,000 to 1 in 2,000.  All men should have a negative post vasectomy semen analysis prior to commencing with unprotected intercourse.  Men also have the option of having a secondary sample checked as well, which can be done at any point after the first collection, even years later for those that just want to be sure.  Current AUA guidelines recommend that only a single negative sample (defined as fewer than 100,000 non moving sperm) needs to be collected, but it is very very important to obtain this sample.  Samples are usually collected two to three months after the procedure to allow time to "clean out the pipes" and eliminate residual sperm.  

There are many different variations of the technique used to perform these procedures.  Current guidelines state that cautery (burning, welding closed) of the vas deferens (tube that carries the sperm) comes with the lowest risk of failure.  These are usually done as brief in office procedures with a local anesthetic and minimal discomfort.  Rest and ice after the procedure are critical to aid the healing process.  Men should avoid strenuous activity and sexual intercourse for about one week after the procedure.  All men should also be aware that this procedure does not protect against sexually transmitted diseases.  

As with any surgical procedure, talk to your doctor and make sure that you feel comfortable with him or her before proceeding.

Erectile Dysfunction (ED, or "impotence") is a common problem, affecting about one half of men by the time we reach age 65. Treatments for ED were largely popularized and in the mainstream after Bob Dole (former presidential nominee) openly discussed his erectile difficulties in a TV ad in 1999.  There are many possible causes for ED - and many treatment options.

Over recent years a greater understanding has evolved about ED and its possible association with other underlying disease processes, such as diabetes and vascular disease.  Once a thorough evaluation has been completed, the next step in deciding on a treatment plan that best suits you.

I view the treatment of ED as having 3 layers.  The first and simplest is attempting oral medications.  We have a number now available, such as Viagra, Levitra, Cialis, Staxyn, and Stendra.  It is important to understand that these medications can help facilitate but do not cause erections.  

The second layer of treatment options can directly cause erections.  

• One is the vacuum erection device (VED).  This is a cylindrical tube that is placed onto the penis.  A pump (handheld or electronic) is activated to create a vacuum which engorges the penis and results in an erection.  Constricting bands (thick rubber bands) are placed at the base of the penis to prevent an outflow of blood.  Side effects can include bruising of the penis, pain, and a sense of numbness.
  
• Medicated urethral system for erections (MUSE) requires implantation of a pellet of alprostadil into the urethra (pee channel).  Intracavernosal injections (ICI) are direct penile injections of medications that cause dilation of blood vessels resulting in an erection.  Among the side effects is priapism, a prolonged and painful erection that requires immediate medical attention.  Pain, bruising, and scar tissue formation can also occur.
  

Lastly, we have the option of an inflatable penile prosthesis (IPP).  This option is typically met with a healthy degree of skepticism when first discussed.  However, most men who have an IPP placed are very happy that they did so.  In fact, patient and partner satisfaction surveys exceed 85 to 90%.  It is important to understand that this is a surgical procedure and once placed natural erections will no longer occur.  Instead, a pump, which is placed in the scrotum, is used to inflate the penis whenever sexual activity is desired.  Sensation, orgasm, and ejaculation all occur in an un-altered fashion.  When the device is no longer needed, the pump is used to deflate the device until the next time.  The implantation is done as a same day surgery but it is not activated until after 4 to 6 weeks of recovery.  Key risks include bleeding and infection.  Your Urologist can review the procedure in more detail so you can decide if such a surgery is right for you.

The take home message should be that there are many treatment options available to men who suffer from ED.  The first step is to discuss this problem with your healthcare provider so he or she knows about it and can get you started on your road to recovery.